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Odai-Afotey A, Haakenstad E, Zhang S, Neville BA, Lipsitz S, McCleary NJ. Abstract 5939: Feasibility of systemic SDOH collection and associated resource utilization at a large academic cancer center. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-5939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: The WHO defines social determinants of health (SDoH) as “the conditions in which people are born, grow, live and age” which includes factors such as housing and food insecurity, employment, and social support and can account for 30-55% of health outcomes. Addressing unmet SDoH needs may reduce interruptions to cancer care caused by ED visits and hospitalizations (EDH). We aimed to determine feasibility of systematic patient-reported SDoH collection at a large academic cancer center and association of unmet SDoH needs with EDH.METHODS: We conducted a cross-sectional analysis of SDoH needs among new oncology patient (pt) consults from 5/15-9/21at Dana Farber Cancer Institute (DCFI). Pts completed an intake questionnaire including demographic, disease, as well as SDOH needs on a dichotomous or 5-point Likert scale, specifically health literacy (“how confident are you in filling out medical forms?”), health numeracy (“how confident are you in understanding medical statistics?”), financial distress (“how difficult is it for you, or your family, to meet monthly payments on your/your family’s bills?”) and social isolation (“do you currently live alone?”). We ran bivariate and multivariable models on the association between demographics, SDoH and EDH within 30 days of initial oncology visit using robust generalized estimating equations controlling for clustering by consult provider. RESULTS: 125,997new consults were seen from 05/15-09//21, of which 20,913 completed the intake questionnaire and were alive at 30 days of consult. Of those pts, most were female (60%), aged 40-64 (50%), White (90%), non-Hispanic (84%), primarily English-speaking (9%) and 7% had an EDH within 30 days of their 1st outpatient visit. The most reported SDOH need was limited health numeracy (26%). In bivariate analysis, factors associated with ED visits included: limited English proficiency lung or GU/GYN cancer, living > 25 mi.from DFCI, and limited health literacy and numeracy (all p<0.05). Demographics associated with hospitalizations included: White race and English as primary language (EPL) (both p<0.05). Multivariable analysis showed female gender (OR 1.53, p < 0.01), lung (OR 3.22*) and GU/GYN (OR 2.21*) (p < 0.05 for both) cancer, and living > 25 mi from DFCI (OR 2.50, p < 0.0001) were associated with increased likelihood of ED visit while EPL (OR 1.80, p<0.05) and GU/GYN (OR 1.65, p<0.01*) cancer were associated with increased likelihood of hospitalization.CONCLUSIONS: It is feasible to systematically screen for unmet SDoH which are associated with increased frequency of ED visits. Differences in characteristics associated with ED vs. hospitalization could indicate possible bias or suggest SDoH needs as a reason for avoidance of costly medical care. Further study will expand both the content and site of SDoH data collection, non-English languages used for data collection, and measure impact of resource matching to reduce disruptions to cancer care.
*Compared to breast cancer
Citation Format: Ashley Odai-Afotey, Ellana Haakenstad, Sunyi Zhang, Bridget A. Neville, Stuart Lipsitz, Nadine J. McCleary. Feasibility of systemic SDOH collection and associated resource utilization at a large academic cancer center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5939.
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Odai-Afotey A, Haakenstad E, Neville BA, Lipsitz SR, Zhang S, McCleary NJ. Feasibility of systematic screening for unmet social determinants of health (SDoH) needs and associated resource utilization in ambulatory oncology. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6535 Background: Addressing unmet SDoH needs may reduce interruptions to cancer care caused by ED visits and hospitalizations (EDH). We aimed to determine feasibility of systematic screening for unmet patient-reported SDoH needs within a large tertiary academic comprehensive cancer center and association of unmet needs with EDH. Methods: We conducted a cross-sectional analysis of SDoH needs among new oncology patient (pts) consults from 5/15-9/21 at Dana-Farber Cancer Institute (DCFI). Pts completed an intake questionnaire including demographics, disease, and SDoH needs of financial distress, health literacy/numeracy, social isolation on a dichotomous or 5-point Likert scale. We ran bivariate and multivariable models on the association between demographics, SDoH and EDH within 30 days of consult using robust generalized estimating equations controlling for clustering by consult provider. Results: 125,997 unique new consults were seen from 5/15 – 9/21 of which 20,913 completed the intake questionnaire and were alive at 30 days after consult. Respondents were age 40-64 (50%), female (60%), non-Hispanic (84%), White (90%) and English speaking (97%), and 7% had an EDH within 30 days of consult. The most reported SDoH need was limited health numeracy (26%). In bivariate analysis, factors associated with ED visits were: non-English language, lung or GU/GYN cancer, living > 25 mi from DFCI and limited health literacy and numeracy (all p < 0.05). Demographics associated with hospitalizations included: White race and English as a primary language (EPL) (both p < 0.05). Multivariable analysis showed female gender (OR 1.53, p < 0.01), lung (OR 3.22*) and GU/GYN (OR 2.21*) (p < 0.05 for both) cancer, and living > 25 mi from DFCI (OR 2.50, p < 0.0001) were associated with increased likelihood of ED visit while EPL (OR 1.80, p < 0.05) and GU/GYN (OR 1.65, p < 0.01*) cancer were associated with increased likelihood of hospitalization. Conclusions: It is feasible to systematically screen for unmet SDoH which are associated with increased frequency of ED visits. Differences in characteristics associated with ED vs. hospitalization could indicate possible bias or suggest SDoH needs as a reason for avoidance of costly medical care. Further study will expand SDoH screening and measure impact of resource matching to reduce disruptions to cancer care. [Table: see text]
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Affiliation(s)
| | | | | | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
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Doolin JW, Haakenstad E, Neville BA, Lipsitz SR, Zhang S, Cleveland J, Hiruy S, Hassett MJ, Revette AC, Schrag D, Basch E, McCleary NJ. A phase II feasibility study of electronic patient reported outcomes (ePROs) for oral cancer directed therapies (OCDT). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e13509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13509 Background: Patients receiving oral cancer directed therapy (OCDT) may be at greater risk of toxicity and non-adherence than those on intravenous treatments. Electronic patient reported outcomes (ePROs) have the potential to mitigate those risks by alerting clinicians to patient status between visits, prompting earlier intervention. Best practices for ePROs implementation are not yet defined. We sought to demonstrate the feasibility of ePROs between visits for patients receiving OCDT both without and with asynchronous nursing triage calls for severe symptoms. Methods: In this Phase II feasibility study, patients were prospectively enrolled into two arms. In the first arm, “passive management” (Arm 1) patients were sent weekly ePROs with 15 symptoms, graded 0 (none) to 3 (severe), through the electronic patient portal (ePP). Responses were available for review by clinicians via the electronic medical record (EMR). In the second arm, “active management” (Arm 2) patients received the same weekly ePROs. If a patient responded with a severe symptom, a nurse would call within one business day to triage the concern. The primary outcome was 30-day feasibility, defined as a patient responding to 50% or more of ePROs sent during this period. Secondary outcomes included feasibility at 60- and 90-days, unplanned healthcare utilization (urgent care, ED visit or hospitalization), and nursing calls. At the time the Arm 2 was enrolling, a language-concordant interface for the EMR and ePP became available. The study was amended to include primarily Spanish speaking patients with a language concordant ePROs survey. Results: 100 patients were enrolled, 50 per arm. 10 patients who primarily spoke Spanish were included in Arm 2; the remaining 90 patients were fluent in English. 96 patients were eligible for evaluation of 30-day feasibility, 92 for 60-day, and 86 for 90-day. The 30-day feasibility by arm was 57% in Arm 1 and 45% in Arm 2 (p = 0.26). The 30-day feasibility in the Spanish language subgroup of the Arm 2 was 56%. Nursing calls in the first 30-days were 101 in Arm 1 and 109 in Arm 2. Multivariable regression for predictors of responding to 50% or more of ePROs in days 0-30 did not identify statistically significant correlates of feasibility. Conclusions: ePROs administered via an ePP were feasible the first 30 days on oral cancer directed treatment. Adding nurse triage calls between visits and a language concordant process for primarily Spanish speaking patients were feasible. Larger studies are needed to determine which factors truly impact use of the program and, most importantly, adherence and quality of life.[Table: see text]
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Affiliation(s)
- Jim W Doolin
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | - Stuart R. Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | | | | | | | | | - Anna C. Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, MA
| | | | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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McCleary NJ, Harmsen WS, Haakenstad E, Cleary JM, Meyerhardt JA, Zalcberg J, Adams R, Grothey A, Sobrero AF, Van Cutsem E, Goldberg RM, Peeters M, Tabernero J, Seymour M, Saltz LB, Giantonio BJ, Arnold D, Rothenberg ML, Koopman M, Schmoll HJ, Pitot HC, Hoff PM, Tebbutt N, Masi G, Souglakos J, Bokemeyer C, Heinemann V, Yoshino T, Chibaudel B, deGramont A, Shi Q, Lichtman SM. Metastatic Colorectal Cancer Outcomes by Age Among ARCAD First- and Second-Line Clinical Trials. JNCI Cancer Spectr 2022; 6:pkac014. [PMID: 35603849 PMCID: PMC8935011 DOI: 10.1093/jncics/pkac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/09/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We evaluated the time to progression (TTP) and survival outcomes of second-line therapy for metastatic colorectal cancer among adults aged 70 years and older compared with younger adults following progression on first-line clinical trials. METHODS Associations between clinical and disease characteristics, time to initial progression, and rate of receipt of second-line therapy were evaluated. TTP and overall survival (OS) were compared between older and younger adults in first- and second-line trials by Cox regression, adjusting for age, sex, Eastern Cooperative Oncology Group Performance Status, number of metastatic sites and presence of metastasis in the lung, liver, or peritoneum. All statistical tests were 2-sided. RESULTS Older adults comprised 16.4% of patients on first-line trials (870 total older adults aged >70 years; 4419 total younger adults aged ≤70 years, on first-line trials). Older adults and those with Eastern Cooperative Oncology Group Performance Status >0 were less likely to receive second-line therapy than younger adults. Odds of receiving second-line therapy decreased by 11% for each additional decade of life in multivariable analysis (odds ratio = 1.11, 95% confidence interval = 1.02 to 1.21, P = .01). Older and younger adults enrolled in second-line trials experienced similar median TTP and median OS (median TTP = 5.1 vs 5.2 months, respectively; median OS = 11.6 vs 12.4 months, respectively). CONCLUSIONS Older adults were less likely to receive second-line therapy for metastatic colorectal cancer, though we did not observe a statistical difference in survival outcomes vs younger adults following second-line therapy. Further study should examine factors affecting decisions to treat older adults with second-line therapy. Inclusion of geriatric assessment may provide better criteria regarding the risks and benefits of second-line therapy.
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Affiliation(s)
- Nadine J McCleary
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - William S Harmsen
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Ellana Haakenstad
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - James M Cleary
- Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - Axel Grothey
- West Cancer Center and Research Institute, OneOncology, Germantown, TN, USA
| | | | | | - Richard M Goldberg
- West Virginia University Cancer Institute and the Mary Babb Randolph Cancer Center, Morgantown, WV, USA
| | - Marc Peeters
- Department of Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Josep Tabernero
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Institute of Oncology Barcelona-Quiron, UVic-UCC, Barcelona, Spain
| | - Matt Seymour
- NIHR Clinical Research Network, Leeds, UK
- St. James’s Hospital and University of Leeds, Leeds, UK
| | | | - Bruce J Giantonio
- Perelman School of Medicine Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Dirk Arnold
- Instituto CUF de Oncologia, Lisbon, Portugal
- Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, University of Urtrecht, Utrecht, Netherlands
| | - Hans-Joachim Schmoll
- Klinik fur Innere Med IV, University Clinic Halle (Saale), Halle, Germany
- Martin Luther University, Halle, Germany
| | - Henry C Pitot
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Paulo M Hoff
- Centro de Oncologia de Brasilia do Sirio Libanes-Unidade Lago Sul, Siro Libanes, Brazil
- Universidade de São Paulo Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil
| | - Niall Tebbutt
- University of Sydney Medical School, Sydney, Australia
- Austin Health, Heidelberg, Victoria, Australia
| | - Gianluca Masi
- Department of Oncology, University of Pisa, Pisa, Italy
| | - John Souglakos
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece
| | | | - Volker Heinemann
- Department of Hematology/Oncology, Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Germany
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Institut Franco-Britannique, Levallois-Perret, France
| | - Aimery deGramont
- Department of Medical Oncology, Institut Franco-Britannique, Levallois-Perret, France
| | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
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McCleary NJ, Haakenstad E, Cleveland J, Zhang S, Hassett MJ, Schrag D. Frequency and distribution of gastrointestinal oncology patient-reported symptomatic adverse events (SAEs) at a comprehensive cancer center. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
463 Background: In clinical trials, the systematic collection of patient (pt) reported outcomes has been shown to improve quality of life & overall survival. To develop predictive care models for symptom management, we explored the frequency & distribution of SAEs reported by pts who reported electronic patient reported outcomes (ePRO) prior to outpatient visits to the Gastrointestinal Cancer Center (GCC) at Dana Farber Cancer Institute (DFCI). Methods: ePRO is a modified NCI Patient Reported Outcomes – Common Terminology Criteria for Adverse Events instrument distributed weekly to GCC pts with a medical/surgical/radiation oncology encounter. Responses are available to the care team in the electronic health record. ePRO consists of presence/frequency/severity/interference of 15 core SAEs (fatigue, insomnia, general pain, decreased appetite, nausea, vomiting, constipation, diarrhea, shortness of breath, numbness and tingling, rash, concentration, fever, anxiety, sadness). Responses are scored 0 to 3 (with 2 and 3 indicating moderate and severe SAEs, respectively). We examined the frequency & distribution of grade 2 and 3 SAEs in ePRO responders by age, gender, race/ethnicity. All pts had gastrointestinal cancer and an outpatient visit for treatment, symptom management, follow-up care. Results: From 9/1/2018 to 8/31/2020, 1912 unique pts responded (response rate 23%). Most respondents were age 50-69 years (58% compared to 15% age <50, 27% age ≥70; range 18-95), male (53%), white (75%). Grade 3 SAE frequencies were pain (12%), fatigue (11%), anxiety/constipation/insomnia/decreased appetite (5%), sadness/numbness and tingling/diarrhea (3%), concentration/shortness of breath (2%), nausea/rash (1%), fever/vomiting (0%). Across pts, fatigue, general pain, insomnia, anxiety were the most common grade 2 and 3 SAEs. Shortness of breath, vomiting, rash, fever were least common (Table). Conclusions: In GCC pts responding to ePRO, the most frequent SAEs were pain, fatigue, insomnia, anxiety. Shortness of breath, nausea, vomiting, diarrhea were less often severe. Pts <50 were more likely to report severe anxiety but there were no other major differences based on age, sex, race/ethnicity. Ongoing efforts will increase pt/provider engagement and develop predictive models & symptom management interventions from ePRO responses. [Table: see text]
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McCleary NJ, Haakenstad E, Rowell J, Cleveland J, Zhang S, Lee S, Hassett MJ, Schrag D. Resource utilization rates among English versus limited English proficient patients (pts) by patient-report of low health literacy (LHL). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
107 Background: About 30 million people in the US report Limited-English Proficiency (LEP). LEP cancer pts are less likely to understand their medical condition(s) and are at increased risk of LHL, emergency department (ED) visits or hospitalizations. We examined the relationship between LEP, LHL, and ED visits/hospitalization in oncology. Methods: Dana-Farber Cancer Institute’s New Pt Intake Questionnaire (NPIQ) documents clinical and social determinants of health, including LHL. Pts reported LHL if they responded “a little bit”, “somewhat” or “not at all” to 1 of 2 questions: 1) “How confident are you in filling out medical forms?” and 2) “How confident are you in understanding medical statistics?”. Pts reported LEP if they noted a primary language other than English at registration. ED visits/hospitalizations were determined from Partners Healthcare System records. Statistically significant relationships between LEP, LHL and ED visits/hospitalizations and pt demographics (age, sex, race/ethnicity, zip code) and clinical (disease center, treatment intent) characteristics were determined with χ2 tests. Results: From 5/30/15 – 4/30/20, 21570 of 98200 eligible pts responded to NPIQ (response rate 22.0%). LHL differed by age (p-value < 0.001), gender (p-value < 0.001) and race/ethnicity (p-value = 0.007). Among LEP pts reporting LHL, financial distress (p-value = 0.004), emotional distress (PROMIS score; p-value = 0.014), and prior cancer (p-value = 0.006) were more prevalent; however, there was no significant statistical increase in ED visits (p-value = 0.237) or hospitalizations (p-value = 0.965) compared to LEP not reporting LHL. Conclusions: The results indicate that sociodemographic and other pt characteristics contribute to ED and hospital utilization in LEP cancer pts. Future studies will employ prospective data to examine the covariates’ predictive ability for resource utilization with LHL among LEP pts. [Table: see text]
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Affiliation(s)
| | | | - Jessi Rowell
- University of Virginia Charlottesville, Charlottesville, VA
| | | | | | - Sherry Lee
- Dana-Farber Cancer Institute, Boston, MA
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Grimm B, Watanabe-Galloway S, Palm D, Pounds L, Deras M, Dawson S, Wittmuss L, Smith B, Haakenstad E. An Academic and Practice Partnership to Assess the Behavioral Health Needs of Nebraska. Community Ment Health J 2019; 55:561-568. [PMID: 30094737 PMCID: PMC7467552 DOI: 10.1007/s10597-018-0303-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
Schools of Public Health have a commitment to engage in practice-based research and be involved in collaborative partnerships. In 2016 the faculty, staff, and students from the University of Nebraska Medical Center College of Public Health and the Nebraska Department of Health and Human Services, Division of Behavioral Health collaborated to develop and administer a comprehensive assessment of the mental health and substance use disorder services provided by the Division of Behavioral Health. The purpose of this paper is to describe the process used to develop the trusting and mutually beneficial partnership and the data tools that were created and used to assess and determine the behavioral health needs. It is unrealistic to think that practitioners could undertake a project of this magnitude on their own. It is essential to have identified processes and systems in place for others to follow.
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Affiliation(s)
- Brandon Grimm
- Department of Health Promotion, University of Nebraska Medical Center College of Public Health, 984335 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Dave Palm
- Department of Health Services Research and Administration, University of Nebraska Medical Center College of Public Health, 984350 Nebraska Medical Center, Omaha, NE, 68198-4350, USA
| | - Lea Pounds
- Department of Health Promotion, University of Nebraska Medical Center College of Public Health, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Marlene Deras
- Health Professions Tracking Center, University of Nebraska Medical Center College of Public Health, 984335 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Sheri Dawson
- Division of Behavioral Health, Nebraska Department of Health and Human Services, 301 Centennial Mall South, Lincoln, NE, 68509, USA
| | - Linda Wittmuss
- Division of Behavioral Health, Nebraska Department of Health and Human Services, 301 Centennial Mall South, Lincoln, NE, 68509, USA
| | - Brittney Smith
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Ellana Haakenstad
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
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