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Royse LA, Strother S, Trachsel M, Mehr DR, Hoffman K, Cook JL. Engaging Patients and Caregivers to Develop a Patient-Centered Agenda for Comparative Effectiveness Research Focused on the Treatment of Complex Knee Problems. J Knee Surg 2023; 36:1422-1437. [PMID: 37604174 DOI: 10.1055/s-0043-1772608] [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] [Indexed: 08/23/2023]
Abstract
Complex articular cartilage loss in the knee is being diagnosed more frequently and earlier in life, and patients are faced with major decisions regarding invasive surgical interventions at increasingly younger ages. There is a critical unmet need to provide patient-centered comparative effectiveness research for the hundreds of thousands of patients faced with these treatment decisions each year. Toward filling the need, we developed the Patient AdvisoR Team iN Orthopaedic ReSearch (PARTNORS) program. We recruited a diverse group of patients and caregivers with lived experiences in dealing with complex knee problems to define patient-centered research priorities for comparative biological and artificial knee surgery research for middle-aged adults. Adapting the Stakeholder Engagement in Question Development and Prioritization Method, PARTNORS defined a 20-question list of patient-centered research questions of factors influencing a patients' choice between biological and artificial knee surgeries. The highest prioritized research question related to functional level postsurgery as it relates to daily activities and recreational activities. The second highest prioritized research questions related to insurance coverage and financial costs. Other prioritized research areas included caregiving needs, implant longevity, recovery and rehabilitation time, patient satisfaction and success rates, individual characteristics, and risks. By engaging a group of patients and caregivers and including them as members of a multidisciplinary research team, comparative effectiveness research that includes patient-centered factors that go beyond typical clinical success indicators for knee surgery can be designed to allow physicians and patients to work together toward evidence-based shared decisions. This shared decision-making process helps to align patients' and health care team's goals and expectations to improve outcomes.
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Affiliation(s)
- Lisa A Royse
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Sandi Strother
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Matt Trachsel
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Kimberly Hoffman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
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Smaling HJ, Jingyuan X, Nakanishi M, Shinan-Altman S, Mehr DR, Radbruch L, Gaertner J, Werner P, Achterberg WP, van der Steen JT. Interventions that may increase control at the end of life in persons with dementia: the cross-cultural CONT-END acceptability study protocol and pilot-testing. BMC Palliat Care 2023; 22:142. [PMID: 37752467 PMCID: PMC10523619 DOI: 10.1186/s12904-023-01249-7] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Interventions such as advance care planning (ACP), technology, or access to euthanasia may increase the sense of control over the end of life. In people with advanced dementia, the loss of cognitive and physical function limits the ability to control care. To date, little is known about the acceptability of these interventions from the perspective of persons with dementia and others involved. This study will examine the cross-cultural acceptability, and factors associated with acceptability, of four end-of-life interventions in dementia which contain an element of striving for control. Also, we report on the development and pilot testing of animation video vignettes that explain the interventions in a standardized manner. METHODS Cross-sectional mixed-methods vignette study. We assess acceptability of two ACP approaches, technology use at the end of life and euthanasia in persons with dementia, their family caregivers and physicians in six countries (Netherlands, Japan, Israel, USA, Germany, Switzerland). We aim to include 80 participants per country, 50 physicians, 15 persons with dementia, and 15 family caregivers. After viewing each animation video, participants are interviewed about acceptability of the intervention. We will examine differences in acceptability between group and country and explore other potentially associated factors including variables indicating life view, personality, view on dementia and demographics. In the pilot study, participants commented on the understandability and clarity of the vignettes and instruments. Based on their feedback, the scripts of the animation videos were clarified, simplified and adapted to being less slanted in a specific direction. DISCUSSION In the pilot study, the persons with dementia, their family caregivers and other older adults found the adapted animation videos and instruments understandable, acceptable, feasible, and not burdensome. The CONT-END acceptability study will provide insight into cross-cultural acceptability of interventions in dementia care from the perspective of important stakeholders. This can help to better align interventions with preferences. The study will also result in a more fundamental understanding as to how and when having control at the end of life in dementia is perceived as beneficial or perhaps harmful. TRIAL REGISTRATION The CONT-END acceptability study was originally registered at the Netherlands Trial Register (NL7985) at 31 August, 2019, and can be found on the International Clinical Trials Registry Platform.
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Affiliation(s)
- Hanneke J.A. Smaling
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
| | - Xu Jingyuan
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
| | - Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - David R. Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO USA
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
- Centre for Palliative Medicine, Helios Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Jan Gaertner
- Palliative Care Center Hildegard, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Wilco P. Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands
- Center for Old Age Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, Postal zone V0-P, P.O. Box 9600, Leiden, 2300 RC The Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Nijmegen, The Netherlands
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Powell KR, Popescu M, Lee S, Mehr DR, Alexander GL. Examining the Use of Text Messages Among Multidisciplinary Care Teams to Reduce Avoidable Hospitalization of Nursing Home Residents with Dementia: Protocol for a Secondary Analysis. JMIR Res Protoc 2023; 12:e50231. [PMID: 37556199 PMCID: PMC10448283 DOI: 10.2196/50231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Reducing avoidable nursing home (NH)-to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes. OBJECTIVE Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization. METHODS This project is a secondary analysis of data collected from a Centers for Medicare & Medicaid Services (CMS)-funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD. RESULTS After accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025. CONCLUSIONS To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50231.
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Affiliation(s)
- Kimberly R Powell
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Mihail Popescu
- School of Medicine, University of Missouri, Columbia, MO, United States
| | - Suhwon Lee
- College of Arts and Sciences, University of Missouri, Columbia, MO, United States
| | - David R Mehr
- School of Medicine, University of Missouri, Columbia, MO, United States
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Hartnett KB, Ferguson BJ, Hecht PM, Schuster LE, Shenker JI, Mehr DR, Fritsche KL, Belury MA, Scharre DW, Horwitz AJ, Kille BM, Sutton BE, Tatum PE, Greenlief CM, Beversdorf DQ. Potential Neuroprotective Effects of Dietary Omega-3 Fatty Acids on Stress in Alzheimer's Disease. Biomolecules 2023; 13:1096. [PMID: 37509132 PMCID: PMC10377362 DOI: 10.3390/biom13071096] [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: 05/26/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND A large number of individual potentially modifiable factors are associated with risk for Alzheimer's disease (AD). However, less is known about the interactions between the individual factors. METHODS In order to begin to examine the relationship between a pair of factors, we performed a pilot study, surveying patients with AD and controls for stress exposure and dietary omega-3 fatty acid intake to explore their relationship for risk of AD. RESULTS For individuals with the greatest stress exposure, omega-3 fatty acid intake was significantly greater in healthy controls than in AD patients. There was no difference among those with low stress exposure. CONCLUSIONS These initial results begin to suggest that omega-3 fatty acids may mitigate AD risk in the setting of greater stress exposure. This will need to be examined with larger populations and other pairs of risk factors to better understand these important relationships. Examining how individual risk factors interact will ultimately be important for learning how to optimally decrease the risk of AD.
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Affiliation(s)
- Kaitlyn B Hartnett
- School of Medicine, University of Missouri-Columbia, Columbia, MO 65212, USA
| | - Bradley J Ferguson
- Interdisciplinary Neuroscience Program, University of Missouri-Columbia, Columbia, MO 65212, USA
- Department of Health Psychology, University of Missouri-Columbia, Columbia, MO 65212, USA
- Department of Neurology, University of Missouri-Columbia, Columbia, MO 65212, USA
| | - Patrick M Hecht
- Interdisciplinary Neuroscience Program, University of Missouri-Columbia, Columbia, MO 65212, USA
| | - Luke E Schuster
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Joel I Shenker
- Department of Neurology, University of Missouri-Columbia, Columbia, MO 65212, USA
| | - David R Mehr
- Family & Community Medicine, University of Missouri-Columbia, Columbia, MO 65212, USA
| | - Kevin L Fritsche
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
| | - Martha A Belury
- Department of Human Sciences, Ohio State University, Columbus, OH 43210, USA
| | - Douglas W Scharre
- Department of Neurology, Ohio State University, Columbus, OH 43210, USA
| | | | | | - Briann E Sutton
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
| | - Paul E Tatum
- Division of Palliative Medicine; Washington University. St. Louis, MO 63110, USA
| | | | - David Q Beversdorf
- Interdisciplinary Neuroscience Program, University of Missouri-Columbia, Columbia, MO 65212, USA
- Department of Neurology, University of Missouri-Columbia, Columbia, MO 65212, USA
- Department of Radiology, University of Missouri, Columbia, MO 65212, USA
- Psychological Sciences, University of Missouri, Columbia, MO 65212, USA
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Golzy M, Rosen GH, Kruse RL, Hooshmand K, Mehr DR, Murray KS. AUTHOR REPLY. Urology 2023; 174:148-149. [PMID: 37030909 DOI: 10.1016/j.urology.2022.12.038] [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] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- Mojgan Golzy
- Department of Family and Community Medicine - Biostatistics Unit, School of Medicine, University of Missouri, Columbia, MO
| | - Geoffrey H Rosen
- Department of Surgery - Urology Division, School of Medicine, University of Missouri, Columbia, MO
| | - Robin L Kruse
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO
| | | | - David R Mehr
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO
| | - Katie S Murray
- Department of Surgery - Urology Division, School of Medicine, University of Missouri, Columbia, MO
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Rolbiecki AJ, Craig K, Megan Polniak, Smith J, Ghosh P, Mehr DR. Virtual Reality and Neurofeedback for Management of Cancer Symptoms: A Feasibility Pilot. Am J Hosp Palliat Care 2023; 40:291-298. [PMID: 35723043 DOI: 10.1177/10499091221109900] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Evidence suggests the usefulness of complementary and alternative medicine approaches, like neurofeedback and virtual reality, for the management of cancer-related pain and mood. It is not well-understood whether neurofeedback delivered through virtual reality is feasible and acceptable to patients actively undergoing cancer treatment. Objective: The purpose of this study was to explore the feasibility and acceptability of a nature-based virtual reality combined with neurofeedback as a non-pharmacologic strategy for managing cancer-related pain and anxiety. Methods: This study utilized a mixed-methods approach. Participants included 15 cancer patients undergoing treatment. Patients engaged in a 22-minute nature-based virtual reality experience, wearing a virtual reality headset with a Brainlink headband measuring EEG activity. Participants were asked to complete the Edmonton Symptom Assessment System revised version (ESAS-r) before (T1) and after (T3) the experience to measure pain and anxiety. They were asked their level of pain midway through the experience (T2) and completed a follow-up interview afterward. Results: This study revealed feasible delivery of a virtual reality intervention combined with neurofeedback for patients seeking cancer treatment. All participants (100%) completed the intervention experience. Patients report this is an acceptable approach to managing cancer-related pain and anxiety. Comparisons between patients' pain scores at T1, T2, and T3 reveal statistically significant reductions in pain (p .001). Patients also report decreased depression and anxiety. Conclusion: This is the first study examining virtual reality combined with neurofeedback as a non-pharmacologic intervention for managing cancer symptoms during treatment. The study reveals it is a promising for managing cancer-symptoms.
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Affiliation(s)
- Abigail J Rolbiecki
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Kevin Craig
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Megan Polniak
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Jamie Smith
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - Parijat Ghosh
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
| | - David R Mehr
- Department of Family and Community Medicine, 14716University of Missouri, Columbia, MO, USA
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Golzy M, Rosen GH, Kruse RL, Hooshmand K, Mehr DR, Murray KS. Holistic Assessment of Quality of Life Predicts Survival in Older Patients with Bladder Cancer. Urology 2023; 174:141-149. [PMID: 36669573 DOI: 10.1016/j.urology.2022.12.036] [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: 10/07/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine if clustering methods can use a holistic assessment of health-related quality-of-life after bladder cancer diagnosis to predict survival outcomes independent of clinical characteristics. In the United States, an estimated 81,180 cases of bladder cancer will be diagnosed in 2022. We aim to help address the knowledge gap concerning the impact of patient functional status on outcomes. MATERIALS AND METHODS This is a cross-sectional, retrospective cohort study of patients in the End Results-Medicare Health Outcomes Survey Registry. Age and 36-Item Short Form Survey (SF-36) responses were used as K-means inputs to identify homogenous clusters of older patients with bladder cancer. We analyzed the association between the identified clusters, patient and disease characteristics, and outcomes. We used Cox proportional hazard regression to compare overall survival. RESULTS We identified 5 homogenous clusters that exhibited differences in patient characteristics and survival. There was no significant difference in cancer stage or surgery type among the clusters. The Cox proportional hazard regression demonstrated significant associations of cluster with gender, age, education, marital status, smoking status, type of surgery, and cancer stage on overall survival. Cluster independently predicted overall survival. CONCLUSION Using unsupervised machine learning, we identified clusters of patients with bladder cancer who had similar mental and physical function scores. Cluster grouping suggests that patients' mental and physical function may not be based on disease or treatment. There are significant survival differences between all clusters, demonstrating that a holistic assessment of patient-reported health-related quality-of-life has the potential to predict survival and possible modifiable risk factors in older patients with bladder cancer.
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Affiliation(s)
- Mojgan Golzy
- Department of Family and Community Medicine - Biostatistics Unit, School of Medicine, University of Missouri, Columbia, MO
| | - Geoffrey H Rosen
- Department of Surgery - Urology Division, School of Medicine, University of Missouri, Columbia, MO
| | - Robin L Kruse
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO
| | | | - David R Mehr
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO
| | - Katie S Murray
- Department of Surgery - Urology Division, School of Medicine, University of Missouri, Columbia, MO.
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Patil SJ, Golzy M, Johnson A, Wang Y, Parker JC, Saper RB, Haire-Joshu D, Mehr DR, Foraker RE, Kruse RL. Individual-Level and Neighborhood-Level Factors Associated with Longitudinal Changes in Cardiometabolic Measures in Participants of a Clinic-Based Care Coordination Program: A Secondary Data Analysis. J Clin Med 2022; 11:2897. [PMID: 35629024 PMCID: PMC9145991 DOI: 10.3390/jcm11102897] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Identifying individual and neighborhood-level factors associated with worsening cardiometabolic risks despite clinic-based care coordination may help identify candidates for supplementary team-based care. Methods: Secondary data analysis of data from a two-year nurse-led care coordination program cohort of Medicare, Medicaid, dual-eligible adults, Leveraging Information Technology to Guide High Tech, High Touch Care (LIGHT2), from ten Midwestern primary care clinics in the U.S. Outcome Measures: Hemoglobin A1C, low-density-lipoprotein (LDL) cholesterol, and blood pressure. Multivariable generalized linear regression models assessed individual and neighborhood-level factors associated with changes in outcome measures from before to after completion of the LIGHT2 program. Results: 6378 participants had pre-and post-intervention levels reported for at least one outcome measure. In adjusted models, higher pre-intervention cardiometabolic measures were associated with worsening of all cardiometabolic measures. Women had worsening LDL-cholesterol compared with men. Women with pre-intervention HbA1c > 6.8% and systolic blood pressure > 131 mm of Hg had worse post-intervention HbA1c and systolic blood pressure compared with men. Adding individual’s neighborhood-level risks did not change effect sizes significantly. Conclusions: Increased cardiometabolic risks and gender were associated with worsening cardiometabolic outcomes. Understanding unresolved gender-specific needs and preferences of patients with increased cardiometabolic risks may aid in tailoring clinic-community-linked care planning.
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Affiliation(s)
- Sonal J Patil
- Department of Wellness and Preventive Medicine, Cleveland Clinic Community Care Institute, Cleveland, OH 44104, USA
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Mojgan Golzy
- Biostatistics and Research Design Unit, School of Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Angela Johnson
- Center for Applied Research and Engagement Systems (CARES), University of Missouri, Columbia, MO 65211, USA
| | - Yan Wang
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Jerry C Parker
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, MO 65211, USA
| | - Robert B Saper
- Department of Wellness and Preventive Medicine, Cleveland Clinic Community Care Institute, Cleveland, OH 44104, USA
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Randi E Foraker
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA
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Dannecker EA, Royse LA, Vilceanu D, Warne-Griggs MD, Adib Keleh S, Stucky R, Bloom TL, Mehr DR. Perspectives of patients with chronic pain about a pain science education video. Physiother Theory Pract 2021; 38:2745-2756. [PMID: 34098844 DOI: 10.1080/09593985.2021.1934920] [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: 10/21/2022]
Abstract
Purpose: Patients have responded in variable ways to pain science education about the psychosocial correlates of pain. To improve the effectiveness of pain education approaches, this study qualitatively explored participants' perceptions of and responses to pain science education.Methods: We conducted a qualitative content analysis of interviews with fifteen, adult patients (73.3% female) who had recently attended a first visit to a chronic pain clinic and watched a pain science educational video.Results: Participants thought it was important to improve their and healthcare providers' understanding of their pain. They viewed the video favorably, learned information from it, and thought it could feasibly facilitate communication with their healthcare providers, but, for many participants, the video either did not answer their questions and/or raised more questions. Participants' responses to the video included negative and positive emotions and were influenced by their need for confirmation that their pain was real and personal relevance of the pain science content.Conclusion: Study results support the feasibility and value of delivering pain science education via video and increase our understanding of patients' perceptions of and responses to pain science education. The video's triggering of emotional responses warrants additional research.
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Affiliation(s)
- Erin A Dannecker
- Department of Physical Therapy, University of Missouri, Columbia, MO
| | - Lisa A Royse
- Missouri Orthopaedic Institute, University of Missouri, Columbia, MO
| | | | | | - Shady Adib Keleh
- Department of Anesthesiology and Perioperative Medicine, One Hospital Drive, University of Missouri, Columbia, United States
| | - Renee Stucky
- Physical Medicine and Rehabilitation, University of Missouri, One Hospital Drive, University of Missouri, Columbia, MO
| | - Tina L Bloom
- School of Nursing, Notre Dame of Maryland University, Baltimore, MD
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences, Columbia, MO
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Rolbiecki AJ, Oliver DP, Teti M, Washington KT, Benson JJ, Kruse RL, Smith J, Demiris G, Ersek M, Mehr DR. Caregiver Speaks Study Protocol: A Technologically-Mediated Storytelling Intervention for Hospice Family Caregivers of Persons Living With Dementia. Am J Hosp Palliat Care 2021; 38:376-382. [PMID: 32985230 PMCID: PMC7946764 DOI: 10.1177/1049909120960449] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We present the protocol of a study aiming to examine the efficacy of a technologically-mediated storytelling intervention called Caregiver Speaks in reducing distress and grief intensity experienced by active and bereaved hospice family caregivers of persons living with dementia (PLWD). DESIGN The study is a mixed-method, 2-group, randomized controlled trial. SETTING This study takes place in 5 hospice agencies in the Midwest and Northeastern United States. PARTICIPANTS Participants include hospice family caregivers of PLWD. INTERVENTION Participants are randomized to usual hospice care or the intervention group. In the Caregiver Speaks intervention, caregivers engage in photo-elicitation storytelling (sharing photos that capture their thoughts, feelings, and reactions to caregiving and bereavement) via a privately facilitated Facebook group. This intervention will longitudinally follow caregivers from active caregiving into bereavement. The usual care group continues to receive hospice care but does not participate in the online group. OUTCOMES MEASURED We anticipate enrolling 468 participants. Our primary outcomes of interest are participant depression and anxiety, which are measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder screening (GAD-7). Our secondary outcomes of interest are participants' perceived social support, measured by the Perceived Social Support for Caregiving (PSSC) scale, and grief intensity, which is measured by the Texas Revised Inventory of Grief Present Subscale (TRIG-Present).
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Affiliation(s)
- Abigail J. Rolbiecki
- University of Missouri, Department of Family and Community Medicine, Columbia, Missouri, USA
| | - Debra Parker Oliver
- University of Missouri, Department of Family and Community Medicine, Columbia, Missouri, USA
| | - Michelle Teti
- University of Missouri, Department of Public Health, Columbia, Missouri, USA
| | - Karla T. Washington
- University of Missouri, Department of Family and Community Medicine, Columbia, Missouri, USA
| | - Jacquelyn J. Benson
- University of Missouri, Department of Human Development and Family Science, Columbia, Missouri, USA
| | - Robin L. Kruse
- University of Missouri, Department of Family and Community Medicine, Columbia, Missouri, USA
| | - Jamie Smith
- University of Missouri, Department of Family and Community Medicine, Columbia, Missouri, USA
| | - George Demiris
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
| | - Mary Ersek
- University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
- Department of Veterans Affairs, Philadelphia, PA, USA
| | - David R. Mehr
- University of Missouri, Department of Family and Community Medicine, Columbia, Missouri, USA
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Popejoy LL, Vogelsmeier AA, Wang Y, Wakefield BJ, Galambos CM, Mehr DR. Testing Re-Engineered Discharge Program Implementation Strategies in SNFs. Clin Nurs Res 2020; 30:644-653. [PMID: 33349042 DOI: 10.1177/1054773820982612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Re-Engineered Discharge (RED) program, designed for hospitals, is being trialed in skilled nursing facilities (SNFs) with promising results. This paper reports on the quantitative results of a multimethod study testing two different RED program implementation strategies in SNFs. A pretest-posttest design was used to compare utilization outcomes of two different RED implementation strategies (Enhanced and Standard) and overall group differences in four Midwestern SNFs. In the Standard group there were higher odds of being readmitted in the pre-intervention versus post-intervention period. After adjusting coefficients using Poisson regression, in the pre-intervention period the adjusted number of rehospitalizations for the Standard group was 45% higher at 30 days, 50% higher at 60 days (p = .01), and 39% higher at 180 days (p = .001). SNF RED may be a useful program to reduce rehospitalizations after discharge. Benefit of SNF RED is dependent on degree of adoption of the intervention.
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Affiliation(s)
| | | | - Yan Wang
- University of Missouri, Columbia, USA
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12
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van der Steen JT, Azizi B, Nakanishi M, Shinan‐Altman S, Mehr DR, Radbruch L, Gaertner J, Werner P, Achterberg WP, Tilburgs B, Smaling HJA. Cross‐cultural acceptability of interventions at the end of life in dementia: Video vignette study design and pilot evaluation (ERC CONT‐END WP1). Alzheimers Dement 2020. [DOI: 10.1002/alz.041542] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jenny T van der Steen
- Radboud University Medical Center Nijmegen Netherlands
- Leiden University Medical Center Leiden Netherlands
| | - Bahar Azizi
- Leiden University Medical Center Leiden Netherlands
| | - Miharu Nakanishi
- Tokyo Metropolitan Institute of Medical Science Setagaya‐ku Japan
| | | | - David R Mehr
- University of Missouri, Columbia Columbia MO USA
| | | | - Jan Gaertner
- Palliative Care Center Hildegard Basel Switzerland
| | | | | | - Bram Tilburgs
- Radboud University Medical Center Nijmegen Netherlands
- Leiden University Medical Center Leiden Netherlands
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Abstract
The purpose of this study was to evaluate differences in the types of nursing activities and communication processes reported in a primary care clinic between patients who used a home-based monitoring system to electronically communicate self-monitored blood glucose and blood pressure values and those who assumed usual care. Data were extracted from electronic medical records from individuals who participated in a randomized controlled trial comparing in-home monitoring and usual care in patients with Type 2 diabetes and hypertension being treated in a primary care clinic. Data about nursing activities initiated by primary care clinic nurses were compared between groups using descriptive statistics and independent t-tests. Significant differences between groups were identified for the direct care nursing activities of providing lifestyle and health education, medication adjustments, and patient follow-up. This study provides evidence of greater nursing activity reported in a primary care clinic in patients who utilized a home-based monitoring system.
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Affiliation(s)
- Chelsea Howland
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Laurel Despins
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Jeri Sindt
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Bonnie Wakefield
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - David R Mehr
- Curtis W. and Ann H. Long Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
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14
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Washington KT, Kukulka K, Govindarjan R, Mehr DR. Engaging Specialist Palliative Care in the Management of Amyotrophic Lateral Sclerosis: A Patient-, Family-, and Provider-Based Approach. J Palliat Care 2020; 37:170-176. [PMID: 32066316 DOI: 10.1177/0825859719895827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe key stakeholders' perspectives on specialist palliative care and its integration into the management of amyotrophic lateral sclerosis (ALS). METHODS The study conducted was a qualitative, noninterventional, descriptive study. Data were collected via individual interviews of 42 stakeholders (n = 14 patients, n = 16 family caregivers, and n = 12 health-care providers). Transcribed interviews were analyzed using inductive thematic analysis techniques. RESULTS Stakeholders' general impressions of specialist palliative care were highly variable. Many expressed limited or inaccurate understandings of palliative care's definition and purpose. Perceptions of palliative care as hospice were common. Stakeholders generally supported the integration of specialist palliative care into ALS management, and many recognized the value of early integration of palliative services in both the community and the clinical setting. CONCLUSION Key stakeholders readily identified a meaningful role for specialist palliative care in ALS management. Integration of specialist palliative care into existing systems of support would be facilitated by a more comprehensive understanding of the service among patients, family caregivers, and health-care providers.
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Affiliation(s)
- Karla T Washington
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Klaudia Kukulka
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Raghav Govindarjan
- Department of Neurology, School of Medicine, University of Missouri, Columbia, MO, USA
| | - David R Mehr
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
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15
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Rauh SP, Heymans MW, van der Maaden T, Mehr DR, Kruse RL, de Vet HCW, van der Steen JT. Predicting Mortality in Nursing Home Residents With Dementia and Pneumonia Treated With Antibiotics: Validation of a Prediction Model in a More Recent Population. J Gerontol A Biol Sci Med Sci 2019; 74:1922-1928. [PMID: 30418501 DOI: 10.1093/gerona/gly260] [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] [Received: 07/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to find the best predictive model for 14-day mortality in antibiotic-treated nursing home residents with dementia and pneumonia by first applying an existing model to the recent PneuMonitor study. Second, we evaluated whether model performance improved by revising variables or adding variables related to recent changes in the care for older people. METHODS The original prognostic model included gender, respiratory rate, respiratory difficulty, pulse rate, decreased alertness, fluid intake, eating dependency, and pressure sores. This model was applied to 380 recent pneumonia episodes in nursing home residents with dementia, updated by considering revising and/or adding variables, internally validated using bootstrapping, and transformed into a simplified risk score that can be used in clinical practice. Model performance was evaluated by Hosmer-Lemeshow statistics and calibration graphs to assess calibration; and area under the receiver operating characteristic curve (AUC) to assess discrimination. RESULTS The newer cohort had lower 14-day mortality and was less often dehydrated or malnourished. Median AUC of the original model over the imputed datasets was 0.76 (interquartile range: 0.76-0.77), compared to 0.80 in the old cohort. Extending the model with dehydration, bowel incontinence, increase in eating dependency and cardiovascular history, while removing pressure sores, improved AUC: 0.80 (interquartile range: 0.80-0.81) after internal validation. Calibration remained adequate (Hosmer-Lemeshow statistic: p = .67). CONCLUSIONS In the newer cohort with less severe illness, model performance of the existing model was adequate, but a new extended model distinguished better between residents at low and high mortality risk.
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Affiliation(s)
- Simone P Rauh
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Tessa van der Maaden
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - David R Mehr
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia
| | - Robin L Kruse
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands.,Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
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Rathbun JR, Ge B, Mehr DR, Kruse RL, Murray KS. Readmission after Radical Cystectomy Based on Discharge Destination. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.704] [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: 10/25/2022]
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17
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Chase JAD, Russell D, Rice M, Abbott C, Bowles KH, Mehr DR. Caregivers' Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting. J Patient Exp 2019; 7:561-569. [PMID: 33062879 PMCID: PMC7534114 DOI: 10.1177/2374373519869156] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.
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Affiliation(s)
- Jo-Ana D Chase
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Meridith Rice
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Carmen Abbott
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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18
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Patil SJ, Lewis M, Tallon EM, Wareg NK, Murray KS, Elliott SG, Stevermer JJ, Kruse RL, Mehr DR. Lay Advisor Interventions in Rural Populations: A Systematic Review and Meta-analysis. Am J Prev Med 2019; 57:117-126. [PMID: 31130461 DOI: 10.1016/j.amepre.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 01/22/2023]
Abstract
CONTEXT Age-adjusted death rates for heart disease are higher in rural areas than in urban areas. Lay advisors could potentially facilitate improvement in cardiovascular health outcomes. The aim of this systematic review and meta-analysis is to estimate lay advisor intervention effects on cardiovascular health metrics in rural populations. EVIDENCE ACQUISITION Searches of databases including MEDLINE, CINAHL, and Scopus from 1975 through October 2017 retrieved 323 citations, of which 272 abstracts were reviewed. Two authors independently abstracted data from eligible studies. Analysis was conducted in March 2018. EVIDENCE SYNTHESIS Of 21 articles included in the systematic review, eight were RCTs and 13 were pre- and post-intervention studies. Of the RCTs, three took place in the U.S. Only two studies had low risk of bias. Using a random effects model, meta-analysis of six RCTs (1,641 participants) showed that lay advisor interventions in rural residents were associated with improvement in HbA1c of 0.4% (95% CI=0.13, 0.66, p=0.004, I2=60.65%). From four RCTs (873 participants), lay advisor interventions significantly improved BMI with pooled effect of 2.18 (95% CI=1.13, 3.24, p<0.001, I2=0.00%). Most studies had normal baseline blood pressure and cholesterol levels before intervention, and no significant effects were noted for these outcomes. Diverse types of measures used for diet, physical activity, and smoking precluded statistical synthesis. CONCLUSIONS Lay advisor interventions had significant positive effects on glycemic control and BMI for rural residents; however, further rigorous studies are needed in U.S. rural populations, and elements of effective lay advisor interventions require further investigation.
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Affiliation(s)
- Sonal J Patil
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri.
| | - Melissa Lewis
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Erin M Tallon
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Nuha K Wareg
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Katie S Murray
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Susan G Elliott
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - James J Stevermer
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
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19
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Chase JAD, Russell D, Rice M, Abbott C, Bowles KH, Mehr DR. Caregivers' Perceptions Managing Functional Needs Among Older Adults Receiving Post-Acute Home Health Care. Res Gerontol Nurs 2019; 12:174-183. [PMID: 30901481 DOI: 10.3928/19404921-20190319-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/15/2019] [Indexed: 11/20/2022]
Abstract
Caregivers play important roles in managing the physical functioning (PF) needs of older adults transitioning home after a hospitalization. Training and support of caregivers in the post-acute home health care (HHC) setting should incorporate caregivers' perspectives. To explore caregivers' experiences managing PF needs in the post-acute HHC setting, semi-structured telephone interviews of 20 caregivers were conducted. Conventional content analysis revealed patient-, caregiving task-, caregiver-, and home environment-related themes consistent with the Theory of Dependent Care. Caregivers highlighted the dynamics and contributors of PF needs for older patients in the post-acute HHC setting and depicted the enormity of caregiving tasks needed to manage older patients' PF needs. Caregivers also described their perceived roles and challenges in managing PF deficits, including a sense of isolation when they were the sole caregiver. Findings from this research can guide nursing efforts to target caregiver training and support during this critical care transition. [Res Gerontol Nurs. 2019; 12(4):174-183.].
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20
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Kukulka K, Washington KT, Govindarajan R, Mehr DR. Stakeholder Perspectives on the Biopsychosocial and Spiritual Realities of Living With ALS: Implications for Palliative Care Teams. Am J Hosp Palliat Care 2019; 36:851-857. [PMID: 30827121 DOI: 10.1177/1049909119834493] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
CONTEXT Amyotrophic lateral sclerosis (ALS) is an all-encompassing, life-limiting disease, resulting in the eventual paralysis of all voluntary muscles and concurrent loss of independence. As the disease advances, both patients and their family caregivers develop complex biological, psychological, and social needs, leading to increasing calls for the involvement of palliative care teams in the management of ALS. OBJECTIVE The purpose of this study was to generate a rich description of the realities of living with ALS, equipping palliative care teams with an in-depth understanding of the experiences and needs of patients with ALS and their family caregivers. METHODS This study employed a mixed-methods design, with quantitative data supplementing a larger body of qualitative data. Semi-structured interviews with 42 key stakeholders, including patients, family caregivers, and health-care providers, were analyzed for themes essential for effective understanding of ALS. RESULTS Identified themes were organized into 2 broad categories: (1) biopsychosocial needs of patients with ALS and family caregivers and (2) the impact of ALS on spiritual and emotional well-being. Quantitative data supported the recognized themes, particularly with regard to challenges associated with preserving independence, securing sufficient social support, and managing the emotional complexities of the disease. CONCLUSION Study findings illustrate the intricacies of living with ALS and the importance of eliciting individualized values when caring for patients with ALS and their families. The complex biopsychosocial needs experienced by patients and family caregivers suggest numerous opportunities for meaningful palliative care involvement.
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Affiliation(s)
- Klaudia Kukulka
- 1 Deparment of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri
| | - Karla T Washington
- 1 Deparment of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri
| | - Raghav Govindarajan
- 2 Department of Neurology, School of Medicine, University of Missouri, Columbia, Missouri
| | - David R Mehr
- 1 Deparment of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri
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Abstract
This article describes our recommendation for adapting hospital-based RED (Reengineered Discharge) processes to skilled nursing facilities (SNFs). Using focus groups, the SNFs' discharge processes were assessed twice additionally, research staff then recorded field notes documenting discussions about facility discharge processes as they related to RED processes. Data were systematically analyzed using thematic analysis to identify recommendations for adapting RED to the SNF setting including (a) rapidly identifying, involving, and preparing family/caregivers to implement a patient focused SNF discharge plan; (b) reconnecting patients quickly to primary care providers; and (c) educating patients at discharge about their target health condition, medications, and impact of changes on other chronic health needs. Limited SNF staff capacity and corporate-level policies limited adoption of some key RED components. Transitional care processes such as RED, developed to avoid discharge problems, can be adapted for SNFs to improve their discharges.
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22
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Rolbiecki AJ, Teti M, Crenshaw B, LeMaster JW, Ordway J, Mehr DR. Exploring Lived Experiences of Chronic Pain Through Photo-Elicitation and Social Networking. Pain Medicine 2018; 20:1202-1211. [DOI: 10.1093/pm/pny175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Michelle Teti
- Health Sciences, University of Missouri, Columbia, Missouri
| | | | - Joseph W LeMaster
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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23
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Murray KS, Prunty M, Henderson A, Haden T, Pokala N, Ge B, Wakefield M, Petroski GF, Mehr DR, Kruse RL. Functional Status in Patients Requiring Nursing Home Stay After Radical Cystectomy. Urology 2018; 121:39-43. [PMID: 30076943 DOI: 10.1016/j.urology.2018.07.030] [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] [Received: 05/22/2018] [Revised: 06/25/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the ability to perform activities of daily living (ADLs) in patients who required nursing home (NH) care after radical cystectomy (RC), as this surgery can impair patients' ability to perform ADLs in the postoperative period. METHODS Patients undergoing RC were identified in a novel database of patients with at least two NH assessments linked with Medicare inpatient claims. The NH assessment included the Minimum Data Set (MDS)-ADL Long Form (0-28; a higher score equals greater impairment), which quantifies ADLs. Paired t-tests and chi-squared analysis were used for comparisons. RESULTS We identified 471 patients that underwent RC and had at least one MDS-ADL assessment. In total, 245 patients lived elsewhere prior to RC and went to an NH after RC, while 122 patients lived in an NH before and after RC. Mean age of the population was 80.7 years (standard deviation 5.7). Of the 245 patients who did not live in a facility before RC, 68% of patients were discharged directly to an NH and 31% were discharged to another location before NH. There was no difference in MDS-ADL score between these groups (16.4 vs 15.0, P = .09). Among the patients who lived in an NH before and after RC, the mean pre- and post-operative MDS-ADL scores were significantly different (12.1 vs 16.6, P<.0001). CONCLUSION ADLs, as measured by the MDS-ADL Long Form score, worsen after RC. This should be an important part of the risks and benefits conversation with patients, their families, and caregivers.
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Affiliation(s)
- Katie S Murray
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Megan Prunty
- University of Missouri School of Medicine, Columbia, MO
| | - Alex Henderson
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Tyler Haden
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Naveen Pokala
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | - Bin Ge
- Office of Medical Research, University of Missouri, Columbia, MO
| | - Mark Wakefield
- Department of Surgery, Division of Urology, University of Missouri, Columbia, MO
| | | | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
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24
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Affiliation(s)
- David R Mehr
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia
| | - Paul E Tatum
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia
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25
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Patil SJ, Ruppar T, Koopman RJ, Lindbloom EJ, Elliott SG, Mehr DR, Conn VS. Effect of peer support interventions on cardiovascular disease risk factors in adults with diabetes: a systematic review and meta-analysis. BMC Public Health 2018; 18:398. [PMID: 29566684 PMCID: PMC5865386 DOI: 10.1186/s12889-018-5326-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 03/15/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Peer support by persons affected with diabetes improves peer supporter's diabetes self-management skills. Peer support interventions by individuals who have diabetes or are affected by diabetes have been shown to improve glycemic control; however, its effects on other cardiovascular disease risk factors in adults with diabetes are unknown. We aimed to estimate the effect of peer support interventions on cardiovascular disease risk factors other than glycemic control in adults with diabetes. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials comparing peer support interventions to a control condition in adults affected by diabetes that measured any cardiovascular disease risk factors [Body Mass Index, smoking, diet, physical activity, cholesterol level, glucose control and blood pressure]. Quality was assessed by Cochrane's risk of bias tool. We calculated standardized mean difference effect sizes using random effects models. RESULTS We retrieved 438 citations from multiple databases including OVID MEDLINE, Cochrane database and Scopus, and author searches. Of 233 abstracts reviewed, 16 articles met inclusion criteria. A random effects model in a total of 3243 participants showed a positive effect of peer support interventions on systolic BP with a pooled effect size of 2.07 mmHg (CI 0.35 mmHg to 3.79 mmHg, p = 0.02); baseline pooled systolic blood pressure was 137 mmHg. There was a non-significant effect of peer support interventions on diastolic blood pressure, cholesterol, body mass index, diet and physical activity. Cardiovascular disease risk factors other than glycemic control outcomes were secondary outcomes in most studies and baseline values were normal or mildly elevated. Only one study reported smoking outcomes. CONCLUSIONS We found a small (2 mmHg) positive effect of peer support interventions on systolic blood pressure in adults with diabetes whose baseline blood pressure was on average minimally elevated. Additional studies need to be conducted to further understand the effect of peer support interventions on high-risk cardiovascular disease risk factors in adults with diabetes.
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Affiliation(s)
- Sonal J. Patil
- Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences Building, DC032.00, Columbia, MO 65212 USA
| | - Todd Ruppar
- College of Nursing, Rush University Medical Center, Chicago, IL USA
| | - Richelle J. Koopman
- Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences Building, DC032.00, Columbia, MO 65212 USA
| | - Erik J. Lindbloom
- Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences Building, DC032.00, Columbia, MO 65212 USA
| | - Susan G. Elliott
- Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences Building, DC032.00, Columbia, MO 65212 USA
| | - David R. Mehr
- Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences Building, DC032.00, Columbia, MO 65212 USA
| | - Vicki S. Conn
- Sinclair School of Nursing, University of Missouri, Columbia, MO USA
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Nace DA, Archbald-Pannone LR, Ashraf MS, Drinka PJ, Frentzel E, Gaur S, Mahajan D, Mehr DR, Mercer WC, Sloane PD, Jump RLP. Pneumococcal Vaccination Guidance for Post-Acute and Long-Term Care Settings: Recommendations From AMDA's Infection Advisory Committee. J Am Med Dir Assoc 2017; 18:99-104. [PMID: 28126142 DOI: 10.1016/j.jamda.2016.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/09/2016] [Indexed: 11/15/2022]
Abstract
Efforts at preventing pneumococcal disease are a national health priority, particularly in older adults and especially in post-acute and long-term care settings The Advisory Committee on Immunization Practices recommends that all adults ≥65 years of age, as well as adults 18-64 years of age with specific risk factors, receive both the recently introduced polysaccharide-protein conjugate vaccine against 13 pneumococcal serotypes as well as the polysaccharide vaccine against 23 pneumococcal serotypes. Nursing facility licensure regulations require facilities to assess the pneumococcal vaccination status of each resident, provide education regarding pneumococcal vaccination, and administer the appropriate pneumococcal vaccine when indicated. Sorting out the indications and timing for 13 pneumococcal serotypes and 23 pneumococcal serotypes administration is complex and presents a significant challenge to healthcare providers. Here, we discuss the importance of pneumococcal vaccination for older adults, detail AMDA-The Society for Post-Acute and Long-Term Care Medicine (The Society)'s recommendations for pneumococcal vaccination practice and procedures, and offer guidance to postacute and long-term care providers supporting the development and effective implementation of pneumococcal vaccine policies.
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Affiliation(s)
- David A Nace
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
| | - Laurie R Archbald-Pannone
- Divisions of General, Geriatric, Palliative, and Hospital Medicine and Infectious Diseases and International Health, Department of Internal Medicine, University of Virginia, Charlottesville, VA
| | - Muhammad S Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Paul J Drinka
- Divisions of Internal Medicine and Geriatric Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Swati Gaur
- Northeast Georgia Health System, Gainesville, GA; Senior Care Advances, Gainesville, GA
| | - Dheeraj Mahajan
- Chicago Internal Medicine Practice and Research (CIMPAR), Chicago, IL; University of Illinois, Chicago, IL
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri-Columbia School of Medicine, Columbia, MO
| | - William C Mercer
- Peterson Rehabilitation Hospital and Geriatric Center, Wheeling, WV; Wheeling Ohio County Health Department, Wheeling, WV
| | - Philip D Sloane
- Program on Aging, Disability and Long-Term Care, Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC
| | - Robin L P Jump
- Geriatric Research Education and Clinical Center, Division of Infectious Diseases, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH
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Patil SJ, Ruppar T, Koopman RJ, Lindbloom EJ, Elliott SG, Mehr DR, Conn VS. Peer Support Interventions for Adults With Diabetes: A Meta-Analysis of Hemoglobin A 1c Outcomes. Ann Fam Med 2016; 14:540-551. [PMID: 28376441 PMCID: PMC5389404 DOI: 10.1370/afm.1982] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 02/02/2016] [Revised: 05/26/2016] [Accepted: 06/02/2016] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Peer support intervention trials have shown varying effects on glycemic control. We aimed to estimate the effect of peer support interventions delivered by people affected by diabetes (those with the disease or a caregiver) on hemoglobin A1c (HbA1c) levels in adults. METHODS We searched multiple databases from 1960 to November 2015, including Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, and Scopus. We included randomized controlled trials (RCTs) of adults with diabetes receiving peer support interventions compared with otherwise similar care. Seventeen of 205 retrieved studies were eligible for inclusion. Quality was assessed with the Cochrane risk of bias tool. We calculated the standardized mean difference (SMD) of change in HbA1c level from baseline between groups using a random effects model. Subgroup analyses were predefined. RESULTS Seventeen studies (3 cluster RCTs, 14 RCTs) with 4,715 participants showed an improvement in pooled HbA1c level with an SMD of 0.121 (95% CI, 0.026-0.217; P = .01; I2 = 60.66%) in the peer support intervention group compared with the control group; this difference translated to an improvement in HbA1c level of 0.24% (95% CI, 0.05%-0.43%). Peer support interventions showed an HbA1c improvement of 0.48% (95% CI, 0.25%-0.70%; P <.001; I2 = 17.12%) in the subset of studies with predominantly Hispanic participants and 0.53% (95% CI, 0.32%-0.73%; P <.001; I2 = 9.24%) in the subset of studies with predominantly minority participants; both were clinically relevant. In sensitivity analysis excluding cluster RCTs, the overall effect size changed little. CONCLUSIONS Peer support interventions for diabetes overall achieved a statistically significant but minor improvement in HbA1c levels. These interventions may, however, be particularly effective in improving glycemic control for people from minority groups, especially those of Hispanic ethnicity.
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Affiliation(s)
- Sonal J Patil
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Todd Ruppar
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Erik J Lindbloom
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Susan G Elliott
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Vicki S Conn
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
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Rauh SP, Heymans MW, Mehr DR, Kruse RL, Lane P, Kowall NW, Volicer L, van der Steen JT. Predicting mortality in patients treated differently: updating and external validation of a prediction model for nursing home residents with dementia and lower respiratory infections. BMJ Open 2016; 6:e011380. [PMID: 27577584 PMCID: PMC5013486 DOI: 10.1136/bmjopen-2016-011380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate whether a model that was previously developed to predict 14-day mortality for nursing home residents with dementia and lower respiratory tract infection who received antibiotics could be applied to residents who were not treated with antibiotics. Specifically, in this same data set, to update the model using recalibration methods; and subsequently examine the historical, geographical, methodological and spectrum transportability through external validation of the updated model. DESIGN 1 cohort study was used to develop the prediction model, and 4 cohort studies from 2 countries were used for the external validation of the model. SETTING Nursing homes in the Netherlands and the USA. PARTICIPANTS 157 untreated residents were included in the development of the model; 239 untreated residents were included in the external validation cohorts. OUTCOME Model performance was evaluated by assessing discrimination: area under the receiver operating characteristic curves; and calibration: Hosmer and Lemeshow goodness-of-fit statistics and calibration graphs. Further, reclassification tables allowed for a comparison of patient classifications between models. RESULTS The original prediction model applied to the untreated residents, who were sicker, showed excellent discrimination but poor calibration, underestimating mortality. Adjusting the intercept improved calibration. Recalibrating the slope did not substantially improve the performance of the model. Applying the updated model to the other 4 data sets resulted in acceptable discrimination. Calibration was inadequate only in one data set that differed substantially from the other data sets in case-mix. Adjusting the intercept for this population again improved calibration. CONCLUSIONS The discriminative performance of the model seems robust for differences between settings. To improve calibration, we recommend adjusting the intercept when applying the model in settings where different mortality rates are expected. An impact study may evaluate the usefulness of the two prediction models for treated and untreated residents and whether it supports decision-making in clinical practice.
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Affiliation(s)
- Simone P Rauh
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - David R Mehr
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Patricia Lane
- E.N. Rogers Memorial Veterans Hospital, Geriatric Research Education Clinical Center, Bedford, Massachusetts, USA
| | - Neil W Kowall
- VA Boston Healthcare System, Department of Veterans Affairs and Boston University Alzheimer Disease Center at BU School of Medicine, Boston, Massachusetts, USA
| | - Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Jenny T van der Steen
- Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
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van der Maaden T, de Vet HCW, Achterberg WP, Boersma F, Schols JMGA, Mehr DR, Galindo-Garre F, Hertogh CMPM, Koopmans RTCM, van der Steen JT. Improving comfort in people with dementia and pneumonia: a cluster randomized trial. BMC Med 2016; 14:116. [PMID: 27515720 PMCID: PMC4981997 DOI: 10.1186/s12916-016-0663-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 04/20/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pneumonia in people with dementia has been associated with severe discomfort. We sought to assess the effectiveness of a practice guideline for optimal symptom relief for nursing home residents with dementia and pneumonia. METHODS A single-blind, multicenter, cluster randomized controlled trial was conducted in 32 Dutch nursing homes. Outcomes were assessed on the patient level. The main outcome measures were discomfort and symptoms: discomfort (DS-DAT: Discomfort Scale-Dementia of Alzheimer Type), (lack of) comfort (EOLD-CAD: End Of Life in Dementia-Comfort Assessment in Dying), pain (PAINAD: Pain Assessment in Advanced Dementia), and respiratory distress (RDOS: Respiratory Distress Observation Scale). Outcomes were scheduled daily from diagnosis until 10 days later and a final time between 13-15 days from diagnosis by trained observers who were blinded to the intervention and the residents' condition and treatment. In a pre-intervention phase, usual care was provided to all homes. In the intervention phase, matched clusters of homes were randomized to either the control (n = 16) or intervention condition (n = 16). RESULTS Between 1 January 2012 and 1 May 2015, 464 episodes of pneumonia were included. Outcomes were obtained for 399 episodes in 367 residents. Longitudinal multilevel linear regression analyses were performed on log-transformed outcomes, so coefficients should be interpreted as a ratio, and a coefficient of 1 means no difference. The practice guideline in the intervention phase did not reduce the level of discomfort and symptoms: DS-DAT: 1.11 (95 % CI 0.93-1.31), EOLD-CAD: 1.01 (95 % CI 0.98-1.05), PAINAD: 1.04 (95 % CI 0.93-1.15), RDOS: 1.11 (95 % CI 0.90-1.24). However, in both the intervention and control groups, lack of comfort and respiratory distress gradually decreased during the entire 3.5 years of data collection, and were lower in the intervention phase compared to the pre-intervention phase: DS-DAT: 0.93 (95 % CI 0.85-1.01), EOLD-CAD: 0.98 (95 % CI 0.97-1.00), PAINAD: 0.96 (95 % CI 0.91-1.01), RDOS: 0.92 (95 % CI 0.87-0.98). CONCLUSIONS When compared to usual care, the practice guideline for optimal symptom relief did not relieve discomfort and symptoms in nursing home residents with dementia and pneumonia. However, discomfort and symptoms decreased gradually throughout the data collection in both the intervention homes and the control homes. An intervention that focuses on creating awareness may be more effective than a physician practice guideline. TRIAL REGISTRATION The Netherlands National Trial Register (ID number NTR5071 . Registered 10 March 2015).
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Affiliation(s)
- Tessa van der Maaden
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. .,Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Henrica C W de Vet
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Froukje Boersma
- Department of General Practice, Elderly Care Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Jos M G A Schols
- Department of Family Medicine and Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - David R Mehr
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Francisca Galindo-Garre
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.,Joachim en Anna, center for specialized geriatric care, Nijmegen, The Netherlands.,Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands. .,Radboudumc Alzheimer Center, Nijmegen, The Netherlands.
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Ruppar TM, Cooper PS, Mehr DR, Delgado JM, Dunbar-Jacob JM. Medication Adherence Interventions Improve Heart Failure Mortality and Readmission Rates: Systematic Review and Meta-Analysis of Controlled Trials. J Am Heart Assoc 2016; 5:e002606. [PMID: 27317347 PMCID: PMC4937243 DOI: 10.1161/jaha.115.002606] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 03/28/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Poor adherence to medications is a common problem among heart failure (HF) patients. Inadequate adherence leads to increased HF exacerbations, reduced physical function, and higher risk for hospital admission and death. Many interventions have been tested to improve adherence to HF medications, but the overall impact of such interventions on readmissions and mortality is unknown. METHODS AND RESULTS We conducted a comprehensive search and systematic review of intervention studies testing interventions to improve adherence to HF medications. Mortality and readmission outcome effect sizes (ESs) were calculated from the reported data. ESs were combined using random-effects model meta-analysis methods, because differences in true between-study effects were expected from variation in study populations and interventions. ES differences attributed to study design, sample, and intervention characteristics were assessed using moderator analyses when sufficient data were available. We assessed publication bias using funnel plots. Comprehensive searches yielded 6665 individual citations, which ultimately yielded 57 eligible studies. Overall, medication adherence interventions were found to significantly reduce mortality risk among HF patients (relative risk, 0.89; 95% CI, 0.81, 0.99), and decrease the odds for hospital readmission (odds ratio, 0.79; 95% CI, 0.71, 0.89). Heterogeneity was low. Moderator analyses did not detect differences in ES from common sources of potential study bias. CONCLUSIONS Interventions to improve medication adherence among HF patients have significant effects on reducing readmissions and decreasing mortality. Medication adherence should be addressed in regular follow-up visits with HF patients, and interventions to improve adherence should be a key part of HF self-care programs.
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Affiliation(s)
- Todd M Ruppar
- Sinclair School of Nursing, University of Missouri, Columbia, MO
| | - Pamela S Cooper
- Sinclair School of Nursing, University of Missouri, Columbia, MO
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, MO
| | - Janet M Delgado
- Sinclair School of Nursing, University of Missouri, Columbia, MO
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van der Maaden T, van der Steen JT, de Vet HCW, Achterberg WP, Boersma F, Schols JMGA, van Berkel JFJM, Mehr DR, Arcand M, Hoepelman AIM, Koopmans RTCM, Hertogh CMPM. Development of a practice guideline for optimal symptom relief for patients with pneumonia and dementia in nursing homes using a Delphi study. Int J Geriatr Psychiatry 2015; 30:487-96. [PMID: 25043614 DOI: 10.1002/gps.4167] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/26/2013] [Revised: 05/24/2014] [Accepted: 05/29/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aimed to develop a practice guideline for a structured and consensus-based approach to relieve symptoms of pneumonia in patients with dementia in nursing homes. METHODS A five-round Delphi study involving a panel consisting of 24 experts was conducted. An initial version of the practice guideline was developed with leading representatives of Dutch University Medical Centers with a department for elderly care medicine, based on existing guidelines for palliative care. The experts evaluated the initial version, after which we identified topics that reflected the main divergences. The experts rated their agreement with statements that addressed the main divergences on a 5-point Likert scale. Consensus was determined according to pre-defined criteria. The practice guideline was then revised according to the final decisions made by the project group and the representatives. RESULTS The response rate for the expert panel was 67%. Main divergences included the applicability of guidelines for palliative care to patients with dementia and pneumonia in long-term care and the appropriateness of specific pharmacological treatment of dyspnea and coughing. Moderate consensus was reached for 80% of the statements. Major revisions included adding pharmacological treatment for coughing and recommending opioid rotation in the case of opioid-induced delirium. Two areas of divergent opinion remained: the usefulness of oxygen administration and treatment of rattling breath. The project group made the final decision in these areas. CONCLUSIONS We developed a mostly consensus-based practice guideline for patients with dementia and pneumonia and mapped controversial issues for future investigation.
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Affiliation(s)
- Tessa van der Maaden
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
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Koopman RJ, Petroski GF, Canfield SM, Stuppy JA, Mehr DR. Development of the PRE-HIT instrument: patient readiness to engage in health information technology. BMC Fam Pract 2014; 15:18. [PMID: 24472182 PMCID: PMC3916695 DOI: 10.1186/1471-2296-15-18] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/21/2014] [Indexed: 11/24/2022]
Abstract
Background Technology-based aids for lifestyle change are becoming more prevalent for chronic conditions. Important “digital divides” remain, as well as concerns about privacy, data security, and lack of motivation. Researchers need a way to characterize participants’ readiness to use health technologies. To address this need, we created an instrument to measure patient readiness to engage with health technologies among adult patients with chronic conditions. Methods Initial focus groups to determine domains, followed by item development and refinement, and exploratory factor analysis to determine final items and factor structure. The development sample included 200 patients with chronic conditions from 6 family medicine clinics. From 98 potential items, 53 best candidate items were examined using exploratory factor analysis. Pearson’s Correlation for Test/Retest reliability at 3 months. Results The final instrument had 28 items that sorted into 8 factors with associated Cronbach’s alpha: 1) Health Information Need (0.84), 2) Computer/Internet Experience (0.87), 3) Computer Anxiety (0.82), 4) Preferred Mode of Interaction (0.73), 5) Relationship with Doctor (0.65), 6) Cell Phone Expertise (0.75), 7) Internet Privacy (0.71), and 8) No News is Good News (0.57). Test-retest reliability for the 8 subscales ranged from (0.60 to 0.85). Conclusion The Patient Readiness to Engage in Health Internet Technology (PRE-HIT) instrument has good psychometric properties and will be an aid to researchers investigating technology-based health interventions. Future work will examine predictive validity.
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Affiliation(s)
- Richelle J Koopman
- Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences Building, DC032,00, Columbia, Missouri 65212, USA.
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Conn VS, Koopman RJ, Ruppar TM, Phillips LJ, Mehr DR, Hafdahl AR. Insulin Sensitivity Following Exercise Interventions: Systematic Review and Meta-Analysis of Outcomes Among Healthy Adults. J Prim Care Community Health 2014; 5:211-22. [PMID: 24474665 DOI: 10.1177/2150131913520328] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [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: 12/16/2022] Open
Abstract
OBJECTIVE Although exercise can improve insulin sensitivity, no adequate synthesis exists of exercise intervention studies with regard to their effect on insulin sensitivity. This comprehensive meta-analysis synthesized the insulin sensitivity outcomes of supervised exercise interventions. METHOD Extensive literature searching located published and unpublished intervention studies that measured insulin sensitivity outcomes. Eligible studies tested supervised exercise interventions among healthy adults. Primary study characteristics and results were coded. Random-effects meta-analyses of standardized mean differences included moderator analyses. RESULTS Data were synthesized across 2509 subjects (115 samples, 78 reports). The overall mean effect size for 2-group postintervention comparisons was 0.38 (95% confidence interval [CI] = 0.25-0.51, I (2) = 0%) and for 2-group pre-post comparisons was 0.43 (95% CI = 0.30-0.56, I (2) = 52%; higher mean insulin sensitivity for treatment than control subjects). The postintervention mean of 0.38 is consistent with treatment subjects ending studies with a mean fasting insulin of 6.8 mU/L if control participants' mean fasting insulin were 7.9 mU/L. Exploratory moderator analyses did not document different insulin sensitivity effect sizes across intervention characteristics or sample attributes. CONCLUSION This study documented that exercise is a valuable primary care and community health strategy for healthy adults to improve insulin sensitivity and lower the risk for diabetes conferred by insulin resistance.
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Wakefield BJ, Koopman RJ, Keplinger LE, Bomar M, Bernt B, Johanning JL, Kruse RL, Davis JW, Wakefield DS, Mehr DR. Effect of home telemonitoring on glycemic and blood pressure control in primary care clinic patients with diabetes. Telemed J E Health 2014; 20:199-205. [PMID: 24404819 DOI: 10.1089/tmj.2013.0151] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Patient self-management support may be augmented by using home-based technologies that generate data points that providers can potentially use to make more timely changes in the patients' care. The purpose of this study was to evaluate the effectiveness of short-term targeted use of remote data transmission on treatment outcomes in patients with diabetes who had either out-of-range hemoglobin A1c (A1c) and/or blood pressure (BP) measurements. MATERIALS AND METHODS A single-center randomized controlled clinical trial design compared in-home monitoring (n=55) and usual care (n=53) in patients with type 2 diabetes and hypertension being treated in primary care clinics. Primary outcomes were A1c and systolic BP after a 12-week intervention. RESULTS There were no significant differences between the intervention and control groups on either A1c or systolic BP following the intervention. CONCLUSIONS The addition of technology alone is unlikely to lead to improvements in outcomes. Practices need to be selective in their use of telemonitoring with patients, limiting it to patients who have motivation or a significant change in care, such as starting insulin. Attention to the need for effective and responsive clinic processes to optimize the use of the additional data is also important when implementing these types of technology.
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Koopman RJ, Wakefield BJ, Johanning JL, Keplinger LE, Kruse RL, Bomar M, Bernt B, Wakefield DS, Mehr DR. Implementing home blood glucose and blood pressure telemonitoring in primary care practices for patients with diabetes: lessons learned. Telemed J E Health 2013; 20:253-60. [PMID: 24350806 DOI: 10.1089/tmj.2013.0188] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prior telemonitoring trials of blood pressure and blood glucose have shown improvements in blood pressure and glycemic targets. However, implementation of telemonitoring in primary care practices may not yield the same results as research trials with extra resources and rigid protocols. In this study we examined the process of implementing home telemonitoring of blood glucose and blood pressure for patients with diabetes in six primary care practices. MATERIALS AND METHODS Grounded theory qualitative analysis was conducted in parallel with a randomized controlled effectiveness trial of home telemonitoring. Data included semistructured interviews with 6 nurse care coordinators and 12 physicians in six participating practices and field notes from exit interviews with 93 of 108 randomized patients. RESULTS The three stakeholder groups (patients, nurse care coordinators, and physicians) exhibited some shared themes and some unique to the particular stakeholder group. Major themes were that practices should (1) understand the capabilities and limitations of the technology and the willingness of patient and physician stakeholders to use it, (2) understand the workflow, flow of information, and human factors needed to optimize use of the technology, (3) engage and prepare the physicians, and (4) involve the patient in the process. Although there was enthusiasm for a patient-centered medical home model that included between-visit telemonitoring, there was concern about the support and resources needed to provide this service to patients. CONCLUSIONS As with many technology interventions, careful consideration of workflow and information flow will help enable effective implementations.
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Affiliation(s)
- Richelle J Koopman
- 1 Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri School of Medicine , Columbia, Missouri
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Kruse RL, Petroski GF, Mehr DR, Banaszak-Holl J, Intrator O. Activity of daily living trajectories surrounding acute hospitalization of long-stay nursing home residents. J Am Geriatr Soc 2013; 61:1909-18. [PMID: 24219192 DOI: 10.1111/jgs.12511] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 11/28/2022]
Abstract
OBJECTIVES To explore patterns of change in nursing home (NH) residents' activities of daily living (ADLs), particularly surrounding acute hospital stays. DESIGN Longitudinal study using Medicare and Minimum Data Set (MDS) assessments. SETTING National sample of long-stay NH residents. PARTICIPANTS NH residents who were hospitalized for the seven most-common inpatient diagnoses (N = 40,128). Each hospital admission was at least 90 days after any prior hospitalization and had at least two preceding MDS assessments. MEASUREMENTS The MDS ADL long-form score, a simple sum of seven self-care variables coded from 0 (independent) to 4 (totally dependent) was used to indicate resident ADL function. Scores ranged from 0 to 28, with higher scores indicating greater impairment. A linear mixed model describing ADL trajectories was jointly estimated with time-to-event models for mortality and hospital readmission. RESULTS Before hospitalization, the most common trajectory was stable (53.7%), with 27.5% of residents worsening and 18.8% improving. ADL function after hospital discharge was most often characterized as stable (43.1%) or worsening (39.2%). Mortality (20.3%) was higher for those with worsening prehospital ADL function (28.9%) than for those with stable (19.1%) or improving (11.3%) trajectories. Hospital diagnosis was associated with amount of ADL worsening and rate of subsequent ADL change. Most residents with the best initial function continued to worsen after hospital discharge. Cognitive impairment was associated with poorer ADL function and accelerated worsening of ADLs. CONCLUSION For many long-stay NH residents, substantial and sustained ADL worsening accompanies acute hospitalization, so acute hospitalization presents an opportunity to revisit care goals; the results of the current study can help inform decision-making.
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Affiliation(s)
- Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
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Della Rocca GJ, Moylan KC, Crist BD, Volgas DA, Stannard JP, Mehr DR. Comanagement of geriatric patients with hip fractures: a retrospective, controlled, cohort study. Geriatr Orthop Surg Rehabil 2013; 4:10-5. [PMID: 23936734 DOI: 10.1177/2151458513495238] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this 3-year retrospective, controlled, cohort study is to characterize an interdisciplinary method of managing geriatric patients with hip fracture. All patients aged 65 years or older admitted to a single academic level I trauma center during a 3-year period with an isolated hip fracture were included as participants for this study. Thirty-one geriatric patients with hip fracture were treated with historical methods of care (cohort 1). The comparison group of 115 similar patients was treated under a newly developed, institutional comanagement hip fracture protocol (cohort 2). There were no differences in age, sex distribution, or comorbidity distribution between the 2 cohorts. Patients requiring intensive care unit (ICU) admission decreased significantly from 48% in cohort 1 to 23% in cohort 2 (P = .0091). Length of ICU stay for patients requiring ICU admission also decreased significantly, from a mean of 8.1 days in cohort 1 to 1.8 days in cohort 2 (P = .024). Total hospital stay decreased significantly, from a mean of 9.9 days in cohort 1 to 7.1 days in cohort 2 (P = .021). Although no decrease in in-hospital mortality rates was noted from cohort 1 to cohort 2, a trend toward decreased 1-year mortality rates was seen after implementation of the hip fracture protocol. Hospital charges decreased significantly, from US$52 323 per patient in cohort 1 to US$38 586 in cohort 2 (P = .0183). Implementation of a comanagement protocol for care of geriatric patients with hip fracture, consisting of admission to a geriatric primary care service, standardized perioperative assessment regimens, expeditious surgical treatment, and continued primary geriatric care postoperatively, resulted in reductions in lengths of stay, ICU admissions, and hospital costs per patient. On an annualized basis, this represented a savings of over US$700 000 for our institution.
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Keplinger LE, Koopman RJ, Mehr DR, Kruse RL, Wakefield DS, Wakefield BJ, Canfield SM. Patient portal implementation: resident and attending physician attitudes. Fam Med 2013; 45:335-340. [PMID: 23681685 PMCID: PMC6980343] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Electronic patient portals are increasingly common, but there is little information regarding attitudes of faculty and residents at academic medical centers toward them. METHODS The primary objective was to investigate attitudes toward electronic patient portals among primary care residents and faculty and changes in faculty attitudes after implementation. The study design included a pre-implementation survey of 39 general internal medicine and family medicine residents and 43 generalist faculty addressing attitudes and expectations of a planned patient portal and also a pre- and post-implementation survey of general internal medicine and family medicine faculty physicians. The survey also addressed email communication with patients. RESULTS Prior to portal implementation, residents reported receiving much less e-mail from patients than faculty physicians; 68% and 9% of residents and faculty, respectively, reported no email exchange in a typical month. Residents were less likely to agree with allowing patients to view selected parts of their medical record on-line than faculty physicians (57% and 81%, respectively). Physicians who participated in the portal's pilot implementation had expected workload to increase (64% agreed), but after implementation, 87% of those responding were neutral or disagreed that workload had increased. After implementation, only 33% believed quality of care had improved compared to 55% who had expected it to improve prior to implementation. CONCLUSIONS Residents and faculty physicians need to be prepared for a changing environment of electronic communication with patients. Some positive and negative expectations of physicians toward enhanced electronic access by patients were not borne out by experience.
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Affiliation(s)
- Lynn E. Keplinger
- Department of Internal Medicine, Division of General Internal Medicine, University of Missouri School of Medicine
| | - Richelle J. Koopman
- Curtis W. and Ann H. Long Department of Family & Community Medicine, University of Missouri School of Medicine
| | - David R. Mehr
- Curtis W. and Ann H. Long Department of Family & Community Medicine, University of Missouri School of Medicine
| | - Robin L. Kruse
- Curtis W. and Ann H. Long Department of Family & Community Medicine, University of Missouri School of Medicine
| | - Douglas S. Wakefield
- Center for Healthcare Quality, Department of Health Management & Informatics, University of Missouri School of Medicine
| | | | - Shannon M. Canfield
- Curtis W. and Ann H. Long Department of Family & Community Medicine, University of Missouri School of Medicine
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Rigler SK, Shireman TI, Cook-Wiens GJ, Ellerbeck EF, Whittle JC, Mehr DR, Mahnken JD. Fracture risk in nursing home residents initiating antipsychotic medications. J Am Geriatr Soc 2013; 61:715-22. [PMID: 23590366 DOI: 10.1111/jgs.12216] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine whether antipsychotic medication initiation is associated with subsequent fracture in nursing home residents, whether fracture rates differ between users of first- and second-generation antipsychotics, and whether fracture rates differ between users of haloperidol, risperidone, olanzapine, and quetiapine. DESIGN Time-to-event analyses were conducted in a retrospective cohort using linked Medicaid; Medicare; Minimum Data Set; and Online Survey, Certification, and Reporting data sets. SETTING Nursing homes in California, Florida, Missouri, New Jersey, and Pennsylvania. PARTICIPANTS Nursing home residents aged ≥ 65. MEASUREMENTS Fracture outcomes (any fracture; hip fracture) in users of first- and second-generation anti-psychotic and specifically users of haloperidol, risperidone, olanzapine, and quetiapine. Comparisons incorporated propensity scores that included individual- (demographic characteristics, comorbidity, diagnoses, weight, fall history, concomitant medications, cognitive performance, physical function, aggressive behavior) and facility- (nursing home size, ownership factors, staffing levels) level variables. RESULTS Of 8,262 subjects (in 4,131 pairs), 4.3% suffered any fracture during observation, with 1% having a hip fracture during an average follow-up period of 93 ± 71 days (range 1-293 days). Antipsychotic initiation was associated with any fracture (hazard ratio (HR) = 1.39, P = .004) and hip fracture (HR = 1.76, P = .02). The highest risk was found for hip fracture when antipsychotic use was adjusted for dose (HR = 2.96, P = .008), but no differences in time to fracture were found between first- and second-generation agents or between individual drugs. CONCLUSION Antipsychotic initiation is associated with fracture in nursing home residents, but risk does not differ between commonly used antipsychotics.
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Affiliation(s)
- Sally K Rigler
- Department of Medicine and, School of Medicine, University of Kansas, Kansas City, Kansas 66160, USA.
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Kruse RL, Koopman RJ, Wakefield BJ, Wakefield DS, Keplinger LE, Canfield SM, Mehr DR. Internet use by primary care patients: where is the digital divide? Fam Med 2012; 44:342-347. [PMID: 23027117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Internet-based technologies such as personal health records and patient portals are increasingly viewed as essential for enhancing patient-provider communication and patient-centered care. We examined how primary care patients use the Internet, particularly patient characteristics associated with Internet use. METHODS We surveyed patients in five primary care clinic waiting rooms. Patients who had used email or the Internet in the past month (Internet users) were asked how often they used a computer for a variety of tasks. Participants who reported not using the Internet were asked about several potential barriers to Internet use. RESULTS We approached 713 patients, and 638 (89.6%) completed questionnaires; 499 (78%) were Internet users and 139 (22%) were non-users. Lack of computer access and not knowing how to use email or the Internet were the most common barriers to Internet use. Younger age, higher education and income, better health, and absence of a chronic illness were associated with Internet use. After controlling for age and other variables, chronic illness was no longer associated with Internet use. CONCLUSIONS Internet use was high among our primary care patients. The major factor associated with Internet use among patients with chronic conditions was their age. If older adults with chronic illness are to reap the benefits of health information technology, their Internet access will need to be improved. Institutions that are planning to offer consumer health information technology should be aware of groups with lower Internet access.
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Affiliation(s)
- Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia 65212, USA.
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Wakefield DS, Kruse RL, Wakefield BJ, Koopman RJ, Keplinger LE, Canfield SM, Mehr DR. Consistency of patient preferences about a secure Internet-based patient communications portal: contemplating, enrolling, and using. Am J Med Qual 2012; 27:494-502. [PMID: 22517909 DOI: 10.1177/1062860611436246] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Internet-based secure communication portals (portal) have the potential to enhance patient care via improved patient-provider communications. This study examines differences among primary care patients' perceptions when contemplating using, enrolling to use, and using a portal for health care purposes. A total of 3 groups of patients from 1 Midwestern academic medical center were surveyed at different points in time: (1) Waiting Room survey asking about hypothetical interest in using a portal to communicate with their physicians; (2) patient portal Enrollment survey; and (3) Follow-up postenrollment experience survey. Those who enroll and use a patient portal have different demographic characteristics and interest levels in selected portal functions (eg, e-mailing providers, viewing medical records online, making appointments) and initially perceive only limited improvements in care because of the portal. These differences have potential market implications and provide insight into selecting and maintaining portal functions of greater interest to patients who use the portal.
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Ghandour A, Saab R, Mehr DR. Detecting and treating delirium--key interventions you may be missing. J Fam Pract 2011; 60:726-734. [PMID: 22163355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Koopman RJ, Kochendorfer KM, Moore JL, Mehr DR, Wakefield DS, Yadamsuren B, Coberly JS, Kruse RL, Wakefield BJ, Belden JL. A diabetes dashboard and physician efficiency and accuracy in accessing data needed for high-quality diabetes care. Ann Fam Med 2011; 9:398-405. [PMID: 21911758 PMCID: PMC3185474 DOI: 10.1370/afm.1286] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We compared use of a new diabetes dashboard screen with use of a conventional approach of viewing multiple electronic health record (EHR) screens to find data needed for ambulatory diabetes care. METHODS We performed a usability study, including a quantitative time study and qualitative analysis of information-seeking behaviors. While being recorded with Morae Recorder software and "think-aloud" interview methods, 10 primary care physicians first searched their EHR for 10 diabetes data elements using a conventional approach for a simulated patient, and then using a new diabetes dashboard for another. We measured time, number of mouse clicks, and accuracy. Two coders analyzed think-aloud and interview data using grounded theory methodology. RESULTS The mean time needed to find all data elements was 5.5 minutes using the conventional approach vs 1.3 minutes using the diabetes dashboard (P <.001). Physicians correctly identified 94% of the data requested using the conventional method, vs 100% with the dashboard (P <.01). The mean number of mouse clicks was 60 for conventional searching vs 3 clicks with the diabetes dashboard (P <.001). A common theme was that in everyday practice, if physicians had to spend too much time searching for data, they would either continue without it or order a test again. CONCLUSIONS Using a patient-specific diabetes dashboard improves both the efficiency and accuracy of acquiring data needed for high-quality diabetes care. Usability analysis tools can provide important insights into the value of optimizing physician use of health information technologies.
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Affiliation(s)
- Richelle J Koopman
- Curtis W. and Ann H. Long Department of Family and Community Medicine, University of Missouri, School of Medicine, Columbia, Missouri 65212, USA.
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Abstract
OBJECTIVES We conducted a meta-analysis summarizing the effects of interventions designed to increase physical activity among healthy adults. METHODS Our comprehensive searches located 358 reports eligible for inclusion. We used random-effects analyses to synthesize data, and we used meta-analytic analogues of regression and analysis of variance to examine potential moderator variables. We also explored moderator variable robustness and publication bias. RESULTS We computed meta-analytic results from studies comprising 99 011 participants. The overall mean effect size for comparisons of treatment groups versus control groups was 0.19 (higher mean for treatment participants than for control participants). This effect size is consistent with a mean difference of 496 ambulatory steps per day between treatment and control participants. Exploratory moderator analyses suggested that the characteristics of the most effective interventions were behavioral interventions instead of cognitive interventions, face-to-face delivery versus mediated interventions (e.g., via telephone or mail), and targeting individuals instead of communities. Participant characteristics were unrelated to physical activity effect sizes. Substantial between-studies heterogeneity remained beyond individual moderators. CONCLUSIONS Interventions designed to increase physical activity were modestly effective. Interventions to increase activity should emphasize behavioral strategies over cognitive strategies.
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Affiliation(s)
- Vicki S Conn
- University of Missouri School of Nursing, Columbia, MO, USA.
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Kochendorfer KM, Morris LE, Kruse RL, Ge BG, Mehr DR. Attending and resident physician perceptions of an EMR-generated rounding report for adult inpatient services. Fam Med 2010; 42:343-349. [PMID: 20461566] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND With limited work hours, efficient rounding and effective hand-offs have become essential. We created a completely electronic medical record (EMR)-generated rounding report for use during pre-rounding, team rounds, and sign-out/hand-offs. We hypothesized that this would reduce workloads. METHODS We used a pre- and post-implementation survey of the residents and faculty members of the Departments of Family and Community Medicine and Internal Medicine. RESULTS After 5 months of use, residents and attending physicians reported a daily time savings of 44 minutes. Seventy-six percent of users also agreed that the rounding report improved patient safety. Rounding report users were more satisfied with the rounding process, spent less time updating other lists or documents, and less time pre-rounding. In addition, there were trends toward spending more time with patients, adherence to work-hour rules, increased accuracy of information during sign-out, improved satisfaction, confidence while cross-covering, and decreased clinically relevant errors. CONCLUSIONS Utilization of well-designed, EMR-generated reports for the use of patient transfer, sign-out, and rounding should become more commonplace considering the improved efficiency, satisfaction, and potential for improved patient care.
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Affiliation(s)
- Karl M Kochendorfer
- Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA.
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Conn VS, Hafdahl AR, Cooper PS, Ruppar TM, Mehr DR, Russell CL. Interventions to Improve Medication Adherence Among Older Adults: Meta-Analysis of Adherence Outcomes Among Randomized Controlled Trials. The Gerontologist 2009; 49:447-62. [PMID: 19460887 DOI: 10.1093/geront/gnp037] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Vicki S Conn
- RN, S317 Sinclair School of Nursing, University of Missouri, Columbia, MO 65211, USA.
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48
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High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, Yoshikawa TT. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. J Am Geriatr Soc 2009; 57:375-94. [PMID: 19278394 PMCID: PMC7166905 DOI: 10.1111/j.1532-5415.2009.02175.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Residents of long‐term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one‐half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on‐site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided.
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Affiliation(s)
- Kevin P High
- Section on Infectious Diseases, Wake Forest University Health Sciences, Winston Salem, North Carolina 27157-1042, USA.
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49
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High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, Yoshikawa TT. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. J Am Geriatr Soc 2009. [PMID: 19278394 DOI: 10.1111/j.1532‐5415.2009.02175.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one-half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on-site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided.
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Affiliation(s)
- Kevin P High
- Section on Infectious Diseases, Wake Forest University Health Sciences, Winston Salem, North Carolina 27157-1042, USA.
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50
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High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, Yoshikawa TT. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:149-71. [PMID: 19072244 DOI: 10.1086/595683] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Residents of long-term care facilities (LTCFs) are at great risk for infection. Most residents are older and have multiple comorbidities that complicate recognition of infection; for example, typically defined fever is absent in more than one-half of LTCF residents with serious infection. Furthermore, LTCFs often do not have the on-site equipment or personnel to evaluate suspected infection in the fashion typically performed in acute care hospitals. In recognition of the differences between LTCFs and hospitals with regard to hosts and resources present, the Infectious Diseases Society of America first provided guidelines for evaluation of fever and infection in LTCF residents in 2000. The guideline presented here represents the second edition, updated by data generated over the intervening 8 years. It focuses on the typical elderly person institutionalized with multiple chronic comorbidities and functional disabilities (e.g., a nursing home resident). Specific topic reviews and recommendations are provided with regard to what resources are typically available to evaluate suspected infection, what symptoms and signs suggest infection in a resident of an LTCF, who should initially evaluate the resident with suspected infection, what clinical evaluation should be performed, how LTCF staff can effectively communicate about possible infection with clinicians, and what laboratory tests should be ordered. Finally, a general outline of how a suspected outbreak of a specific infectious disease should be investigated in an LTCF is provided.
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Affiliation(s)
- Kevin P High
- Section on Infectious Diseases, Wake Forest University Health Sciences, Winston Salem, 100 Medical Center Blvd., Winston Salem, NC 27157-1042, USA.
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