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Kats DJ, Donelan K, Banerjee S, de Graaf G, Skladzien E, Hooper BT, Mordi R, Mykhailenko T, Buckley F, Santoro SL, Patsiogiannis V, Krell K, Haugen K, Skotko BG. Results of inaugural international Down Syndrome Societal Services and Supports survey. Genet Med 2024:101114. [PMID: 38512346 DOI: 10.1016/j.gim.2024.101114] [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: 12/14/2023] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE We previously designed the Down Syndrome Societal Services and Supports Survey (DS-4S) to measure country-specific supports for people with Down syndrome (DS) across multiple life domains (healthcare, education, policy, independence, and community inclusion). We now report and analyze the results. METHODS We partnered with international DS consortia, who distributed the DS-4S to 154 cumulative members representing over 100 countries. Organizations were included if they had a holistic focus on the lives of people with DS and if at least 50% of their members either have DS or are family members of people with DS. Factor analysis was used to analyze the results. RESULTS We received survey responses from 55 different organizations in 50 countries who met inclusion criteria. Each country had complete data for at least 4 of the 5 domains. The lowest 5 scores were from countries in Africa and Asia; the highest 5 scores were in Europe and North America. CONCLUSION The responses to the DS-4S stratified countries within each surveyed domain. The DS-4S can now be used to track countries' progress over time and to determine which countries have best practices that might be replicated. We will publish the results and update them biennially at www.DownSyndromeQualityOfLife.com.
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Affiliation(s)
- Daniel J Kats
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Karen Donelan
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA; Health Policy Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Harvard University, Boston, MA
| | - Souvik Banerjee
- Department of Economics, Indian Institute of Technology Bombay, Powai, Mumbai, India
| | - Gert de Graaf
- Dutch Down Syndrome Foundation, Meppel, The Netherlands
| | | | | | - Rose Mordi
- Down Syndrome Foundation Nigeria, Lagos, Nigeria
| | | | - Frank Buckley
- Down Syndrome Education International, Kirkby Lonsdale, Cumbria, United Kingdom
| | - Stephanie L Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Vasiliki Patsiogiannis
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
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Park ER, Kirchhoff AC, Donelan K, Perez GK, McDonald A, Bliss CC, Foor A, van Thiel Berghuijs KM, Waters AR, Durieux N, Leisenring W, Armstrong GT, Ponzani C, Lopez A, Vaca Lopez PL, Battaglia T, Galbraith AA, Kuhlthau KA. Health Insurance Navigation Tools Intervention: A Pilot Trial Within the Childhood Cancer Survivor Study. JCO Oncol Pract 2024:OP2300680. [PMID: 38471048 DOI: 10.1200/op.23.00680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/01/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE Childhood cancer survivors are at increased risk for underinsurance and health insurance-related financial burden. Interventions targeting health insurance literacy (HIL) to improve the ability to understand and use health insurance are needed. METHODS We codeveloped a four-session health insurance navigation tools (HINT) intervention, delivered synchronously by a patient navigator, and a corresponding booklet. We conducted a randomized pilot trial with survivors from the Childhood Cancer Survivor Study comparing HINT with enhanced usual care (EUC; booklet). We assessed feasibility, acceptability, and preliminary efficacy (HIL, primary outcome; knowledge and confidence with health insurance terms and activity) on a 5-month survey and exit interviews. RESULTS Among 231 invited, 82 (32.5%) survivors enrolled (53.7% female; median age 39 years, 75.6% had employer-sponsored insurance). Baseline HIL scores were low (mean = 28.5; 16-64; lower scores better); many lacked knowledge of Affordable Care Act (ACA) provisions. 80.5% completed four HINT sessions, and 93.9% completed the follow-up survey. Participants rated HINT's helpfulness a mean of 8.9 (0-10). Exit interviews confirmed HINT's acceptability, specifically its virtual and personalized delivery and helpfulness in building confidence in understanding one's coverage. Compared with EUC, HINT significantly improved HIL (effect size = 0.94. P < .001), ACA provisions knowledge (effect size = 0.73, P = .003), psychological financial hardship (effect size = 0.64, P < .006), and health insurance satisfaction (effect size = 0.55, P = .03). CONCLUSION Results support the feasibility and acceptability of a virtual health insurance navigation program targeted for childhood survivors to improve HIL. Randomized trials to assess the efficacy and sustainability of health insurance navigation on HIL and financial burden are needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Lopez
- Massachusetts General Hospital, Boston, MA
| | | | - Tracy Battaglia
- Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Alison A Galbraith
- Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CFJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg 2024; 279:429-436. [PMID: 37991182 DOI: 10.1097/sla.0000000000006159] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To characterize the current state of mental health within the surgical workforce in the United States. BACKGROUND Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown. METHODS Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed. RESULTS Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4%-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. In all, 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P <0.001), anxiety (31.6% vs. 16.2%, P =0.001), PTSD (12.8% vs. 5.6%, P =0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P =0.022). Overall, 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past 2 weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P =0.033) and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P <0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P =0.002) were associated with increased odds of suicidal ideation over the past 12 months. CONCLUSIONS Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the United States.
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Affiliation(s)
- Reagan A Collins
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Tianna Herman
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Rebecca A Snyder
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anne Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tania K Arora
- Department of Surgery, Augusta University at the Medical College of Georgia, Augusta, GA
| | | | | | - Diego Vicente
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cornelia L Griggs
- Department of Pediatric Surgery, Massachusetts General Hospital, Boston, MA
| | - Imani E McElroy
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Anji E Wall
- Department of Surgery, Baylor University Medical Center, Dallas, TX
| | - Tasha M Hughes
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Jaber Valinejad
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Andres Alban
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - J Shannon Swan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Nathaniel Mercaldo
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Mohammad S Jalali
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jagpreet Chhatwal
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - G Scott Gazelle
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Erika Rangel
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Karen Donelan
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Jessica A Gold
- Department of Psychiatry, Washington University in St Louis, St Louis, MO
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, MN
| | - Carrie Cunningham
- Department of Surgery, Massachusetts General Hospital, Boston, MA
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA
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Carter J, Swack N, Isselbacher E, Donelan K, Thorndike A. Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55687. [PMID: 38216543 PMCID: PMC10879973 DOI: 10.2196/55687] [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: 12/20/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Interventions focused on remote monitoring and social needs care have shown promise in improving clinical outcomes for patients with heart failure (HF). However, patient willingness to use technology as well as concerns about access in underresourced settings have limited digital platform implementation and adoption. There is little research in HF populations examining the effect of a combined digital and social needs care intervention that could enhance patient engagement in digital platform use while closing gaps in care related to social determinants of health. Here, we describe the protocol for a clinical trial of a digitally enabled community health worker intervention designed for patients with HF. OBJECTIVE This study aims to describe the protocol for a randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of an intervention that combines remote monitoring with a digital platform and community health worker (CHW) social needs care for patients with HF who are transitioning from hospital to home. Given the elevated morbidity and mortality, identifying comprehensive and patient-centered interventions at the time of hospital care transitions that can improve clinical outcomes, impact cost, and augment the quality of care for this cohort is a priority. METHODS This trial randomized adult inpatient participants (n=50) with a diagnosis of HF receiving care at a single academic health care institution to the 30-day intervention (digital platform+CHW pairing+usual care) or the 30-day control (CHW pairing+usual care) arms. All study participants completed baseline questionnaires and 30-day exit interviews and questionnaires. The primary outcomes will be acceptability, feasibility, and preliminary effectiveness. RESULTS This clinical trial opened for enrollment in September 2022 and was completed in June 2023. Initial results are expected to be published in the spring of 2024, and analysis is currently underway. Feasibility outcome measures will include the use rates of the biometric sensor (average hours per day), the digital blood pressure monitor (average times per day), the weight scale (average times per day), and the completion of the symptoms questionnaire (average times per day). The acceptability outcome will be measured by the patients' response to the truthfulness of the statement that they would be willing to use the digital platform in the future (response options: very true, somewhat true, or not true). Preliminary effectiveness will be measured by tracking 30-day clinical outcomes (hospital readmissions, emergency room visits, and missed primary care and cardiology appointments). CONCLUSIONS The results of this investigation are expected to contribute to our understanding of the use of digital interventions and the implementation of supportive home-based social needs care to enhance engagement and the potential effectiveness of clinically focused digital platforms. These results may inform the construction of a future multi-institutional trial designed to test the true effectiveness of this intervention in HF. TRIAL REGISTRATION ClinicalTrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55687.
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Affiliation(s)
- Jocelyn Carter
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Natalia Swack
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Eric Isselbacher
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, United States
| | - Karen Donelan
- Heller School for Policy and Management, Brandeis University, Waltham, MA, United States
| | - Anne Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
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Auerbach DI, Buerhaus PI, Donelan K, Staiger DO. Projecting the Future Registered Nurse Workforce After the COVID-19 Pandemic. JAMA Health Forum 2024; 5:e235389. [PMID: 38363560 PMCID: PMC10873770 DOI: 10.1001/jamahealthforum.2023.5389] [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] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/16/2023] [Indexed: 02/17/2024] Open
Abstract
Importance Health care delivery systems rely on a well-prepared and adequately sized registered nurse (RN) workforce. The US RN workforce decreased by more than 100 000 in 2021 during the COVID-19 pandemic-a far greater single-year drop than observed over the past 4 decades. The implication for the longer-term growth of the RN workforce is unknown. Objective To describe recent trends in RN employment through 2023 and forecast the growth of the RN workforce through 2035. Design, Setting, and Participants Descriptive analysis of recent trends since the start of the COVID-19 pandemic in RN employment using data from the US Bureau of the Census Current Population Survey and including employed RNs aged 23 to 69 years from 1982 through 2023, and retrospective cohort analysis of employment trends by birth year and age to project the age distribution and employment of RNs through 2035. Main Outcome and Measures Annual full-time equivalent (FTE) employment of RNs by age, demographics, and sector of employment; forecast of RN workforce by age through 2035. Results The final sample included 455 085 RN respondents aged 23 to 69 years. After a sharp decline in 2021, RN employment recovered, and the total number of FTE RNs in 2022 and 2023 was 6% higher than in 2019 (3.35 million vs 3.16 million, respectively). Using data on employment, education, and population through 2022, the size of the RN workforce was projected to increase by roughly 1.2 million FTEs to 4.56 million by 2035, close to prepandemic forecasts. Growth will be driven primarily by RNs aged 35 to 49 years, who are projected to compose nearly half (47%) of the RN workforce in 2035, up from 38% in 2022. Conclusions and Relevance In this study, the rebound in the total size of the US RN workforce during 2022 and 2023 indicates that the earlier drop in RN employment during the first 2 years of the COVID-19 pandemic was likely transitory. Updated forecasts of the future RN workforce are very close to those made before the pandemic.
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Affiliation(s)
| | | | - Karen Donelan
- Institute on Healthcare Systems, Brandeis University, Waltham, Massachusetts
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Fung V, Levison JH, Wilson A, Cheng D, Chau C, Krane D, Trieu HD, Irwin K, Cella E, Bird B, Shellenberger K, Silverman P, Batson J, Fathi A, Gamse S, Wolfe J, Holland S, Donelan K, Samuels R, Becker JE, Freedberg KA, Reichman JL, Keller T, Tsai AC, Hsu J, Skotko BG, Bartels S. COVID-19-Related Outcomes Among Group Home Residents with Serious Mental Illness in Massachusetts in the First Year of the Pandemic. Adm Policy Ment Health 2024; 51:60-68. [PMID: 37938475 PMCID: PMC10872570 DOI: 10.1007/s10488-023-01311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023]
Abstract
This study examined COVID-19 infection and hospitalizations among people with serious mental illness who resided in residential care group homes in Massachusetts during the first year of the COVID-19 pandemic. The authors analyzed data on 2261 group home residents and COVID-19 data from the Massachusetts Department of Public Health. Outcomes included positive COVID-19 tests and COVID-19 hospitalizations March 1, 2020-June 30, 2020 (wave 1) and July 1, 2020-March 31, 2021 (wave 2). Associations between hazard of outcomes and resident and group home characteristics were estimated using multi-level Cox frailty models including home- and city-level frailties. Between March 2020 and March 2021, 182 (8%) residents tested positive for COVID-19, and 51 (2%) had a COVID-19 hospitalization. Compared with the Massachusetts population, group home residents had age-adjusted rate ratios of 3.0 (4.86 vs. 1.60 per 100) for COVID infection and 13.5 (1.99 vs. 0.15 per 100) for COVID hospitalizations during wave 1; during wave 2, the rate ratios were 0.5 (4.55 vs. 8.48 per 100) and 1.7 (0.69 vs. 0.40 per 100). In Cox models, residents in homes with more beds, higher staff-to-resident ratios, recent infections among staff and other residents, and in cities with high community transmission risk had greater hazard of COVID-19 infection. Policies and interventions that target group home-specific risks are needed to mitigate adverse communicable disease outcomes in this population.Clinical Trial Registration Number This study provides baseline (i.e., pre-randomization) data from a clinical trial study NCT04726371.
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Affiliation(s)
- Vicki Fung
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA.
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Julie H Levison
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Anna Wilson
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - David Cheng
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Cindy Chau
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - David Krane
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Hao D Trieu
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Kelly Irwin
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | - Karen Donelan
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronita Samuels
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
| | - Jessica E Becker
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth A Freedberg
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Alexander C Tsai
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - John Hsu
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Stephen Bartels
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA, 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Vetter M, Donelan K, Guzikowski S, Michael C, Ritchie CS, Vogeli C, Forester BP. The needs of family caregivers of persons living with dementia cared for in primary care practices. J Eval Clin Pract 2023; 29:1243-1246. [PMID: 37593781 PMCID: PMC10841202 DOI: 10.1111/jep.13919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/19/2023]
Abstract
RATIONALE The informal caregivers who provide unpaid support for persons living with dementia (PLWD) are often unprepared to appropriately manage symptoms and navigate health services to support themselves or the PLWD. AIM To understand informal caregivers' perceived capabilities of handling dementia symptomology and perceived support from providers. METHODS We identified and surveyed caregivers of primary care patients in the Mass General Brigham health system. We included a self-efficacy questionnaire to assess caregivers' ability and confidence in access to dementia care, symptom management, and provider support. RESULTS Respondents indicated that although their provider had knowledge of dementia and memory care, they were least likely to agree (39.2%) that their provider helped them with these challenging symptoms. Those who live with the care recipient were least likely to receive advice about common symptoms (43.6%) and to access community services (63.8%), and in general felt moderately knowledgeable about the progression of the disease (47.9%). CONCLUSIONS The findings imply that caregivers are aware of disease progression, dementia symptoms, and do not feel supported by their providers in managing care or accessing support services. There is opportunity to support informal caregivers in a primary care setting by appropriately uptraining providers in dementia care.
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Affiliation(s)
- Michael Vetter
- Institute on Healthcare Systems, Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Karen Donelan
- Institute on Healthcare Systems, Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
- The Mongan Institute, Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sophia Guzikowski
- The Mongan Institute, Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Carie Michael
- Institute on Healthcare Systems, Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Christine S Ritchie
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- The Mongan Institute, Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christine Vogeli
- The Mongan Institute, Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mass General Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Brent P Forester
- Department of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts, USA
- Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, USA
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8
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Wallace ZS, McMahon GA, Hang B, Fu X, Harkness T, Donelan K, Fernandes A, Cook C, Katz G, Perugino C, Stone JH. Assessment of patient-reported symptoms and distress in IgG4-related disease (IgG4-RD): Development, clinical validation, and content validation of the IgG4-RD Symptom Severity Index. Semin Arthritis Rheum 2023; 63:152253. [PMID: 37619485 PMCID: PMC11004491 DOI: 10.1016/j.semarthrit.2023.152253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE IgG4-related disease (IgG4-RD), a multi-organ autoimmune disease, causes diverse manifestations that can lead to symptoms and distress. We developed and validated the Symptom Severity Index (SSI) to assess symptom burden. METHODS A pilot SSI was tested in n = 5; several gaps were identified. Twenty semi-structured qualitative interviews were performed to expand the item set and identify missing symptoms. Subsequent changes resulted in the current SSI; it was administered with quality of life (QOL) measures to n = 136. We assessed symptom burden and the construct validity of the SSI. A distress score for each symptom is calculated by multiplying symptom frequency ("Never" [0 points] to "Every Day" [3 points]) by associated distress ("None" [0 points] to "Very Much" [4 points]). Each distress score is summed to calculate a total SSI score. RESULTS The SSI assesses the frequency and distress of 24 symptoms. Among n = 136 with ≥ 1 SSI, 90% experienced ≥ 1 symptom and 88% had distress. The median SSI score was 6.5 (IQR 3.0, 18.0). Fear of more severe disease was observed in 49%. The SSI inversely correlated with the SF-36 (r= - 0.51, p<0.001), the feeling thermometer (r= - 0.28, p<0.001), and the EQ-5D (r= - 0.28, p<0.001). The median SSI score was higher during active vs non-active disease among n = 52 who completed >1 SSI (15 [6, 26] vs. 3 [2, 14], p = 0.008). CONCLUSIONS Symptoms and distress are common in IgG4-RD and associated with worse health-related QOL. The SSI has face, content, and construct validity; it corresponds with QOL measures.
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Affiliation(s)
- Zachary S Wallace
- Clinical Epidemiology Program, Mongan Institute, Massachusetts General Hospital, USA; Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, USA; Harvard Medical School, USA.
| | - Grace A McMahon
- Clinical Epidemiology Program, Mongan Institute, Massachusetts General Hospital, USA; Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, USA
| | - Buuthien Hang
- Clinical Epidemiology Program, Mongan Institute, Massachusetts General Hospital, USA
| | - Xiaoqing Fu
- Clinical Epidemiology Program, Mongan Institute, Massachusetts General Hospital, USA; Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, USA
| | - Tyler Harkness
- Clinical Epidemiology Program, Mongan Institute, Massachusetts General Hospital, USA; Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, USA
| | - Karen Donelan
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, USA; Harvard Medical School, USA
| | - Ana Fernandes
- Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, USA
| | - Claire Cook
- Clinical Epidemiology Program, Mongan Institute, Massachusetts General Hospital, USA; Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, USA
| | - Guy Katz
- Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, USA
| | - Cory Perugino
- Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, USA; Harvard Medical School, USA
| | - John H Stone
- Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, USA; Harvard Medical School, USA
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Carter J, Swack N, Isselbacher E, Donelan K, Thorndike AN. Feasibility and Acceptability of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Single-Arm Pilot Study. JMIR Cardio 2023; 7:e47818. [PMID: 37698975 PMCID: PMC10580132 DOI: 10.2196/47818] [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: 04/05/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Heart failure (HF) is one of the leading causes of hospital admissions. Clinical (eg, complex comorbidities and low ejection fraction) and social needs factors (eg, access to transportation, food security, and housing security) have both contributed to hospitalizations, emphasizing the importance of increased clinical and social needs support at home. Digital platforms designed for remote monitoring of HF can improve clinical outcomes, but their effectiveness has been limited by patient barriers such as lack of familiarity with technology and unmet social care needs. To address these barriers, this study explored combining a digital platform with community health worker (CHW) social needs care for patients with HF. OBJECTIVE We aim to determine the feasibility and acceptability of an intervention combining digital platform use and CHW social needs care for patients with HF. METHODS Adults (aged ≥18 years) with HF receiving care at a single health care institution and with a history of hospital admission in the previous 12 months were enrolled in a single-arm pilot study from July to November 2021 (N=14). The 30-day intervention used a digital platform within a mobile app that included symptom questionnaire and educational videos connected to a biometric sensor (tracking heart rate, oxygenation, and steps taken), a digital weight scale, and a digital blood pressure monitor. All patients were paired with a CHW who had access to the digital platform data. A CHW provided routine phone calls to patients throughout the study period to discuss their biometric data and to address barriers to any social needs. Feasibility outcomes were patient use of the platform and engagement with the CHW. The acceptability outcome was patient willingness to use the intervention again. RESULTS Participants (N=14) were 67.7 (SD 11.7) years old; 8 (57.1%) were women, and 7 (50%) were insured by Medicare. Participants wore the sensor for 82.2% (n=24.66) of study days with an average of 13.5 (SD 2.1) hours per day. Participants used the digital blood pressure monitor and digital weight scale for an average of 1.2 (SD 0.17) times per day and 1.1 (SD 0.12) times per day, respectively. All participants completed the symptom questionnaire on at least 71% (n=21.3) of study days; 11 (78.6%) participants had ≥3 CHW interactions, and 11 (78.6%) indicated that if given the opportunity, they would use the platform again in the future. Exit interviews found that despite some platform "glitches," participants generally found the remote monitoring platform to be "helpful" and "motivating." CONCLUSIONS A novel intervention combining a digital platform with CHW social needs care for patients with HF was feasible and acceptable. The majority of participants were engaged throughout the study and indicated their willingness to use the intervention again. A future clinical trial is needed to determine the effectiveness of this intervention.
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Affiliation(s)
- Jocelyn Carter
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Natalia Swack
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Eric Isselbacher
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Karen Donelan
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Anne N Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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10
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Oreskovic NM, Donelan K, Bartels SJ, Chau C, Irwin KE, Krane D, Levison JH, Michael C, Trieu H, Skotko BG. The house is a machine for everything: the role of the built environment in group homes during the COVID-19 pandemic. Public Health 2023; 224:20-25. [PMID: 37696198 DOI: 10.1016/j.puhe.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/11/2023] [Accepted: 08/06/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Individuals living in group homes during the COVID-19 pandemic faced unique challenges and health risks related to living in shared spaces. This study aimed to assess the experiences of living and working in a group home during the pandemic and to explore the role of the built environment. STUDY DESIGN AND METHODS We conducted longitudinal working groups with group home residents with intellectual and developmental disabilities and serious mental illness, group home staff, and families/caregivers of residents from December 2020 through December 2022. Common themes highlighting ways in which group home residents, staff, and caregivers perceived the built environment to impact living in a group home during the COVID-19 pandemic were identified. RESULTS Resonant themes centered around increased risk of COVID-19 infection, ad hoc spatial adaptations for infection control, space-related challenges due to isolation and quarantine requirements, and limited access to public spaces. CONCLUSION Group home residents and staff experienced multiple health and wellness challenges during the COVID-19 pandemic related to their surrounding built environment. Mechanisms to engage group home residents in modifications of their built environment may improve the effectiveness of infection control policies while acknowledging individual autonomy.
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Affiliation(s)
- N M Oreskovic
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
| | - K Donelan
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - S J Bartels
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - C Chau
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - K E Irwin
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - D Krane
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - J H Levison
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - C Michael
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - H Trieu
- The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - B G Skotko
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
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11
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Applewhite D, Regan S, Donelan K, Macias-Konstantopoulos WL, Kehoe LG, Williamson D, Wakeman SE. Attitudes Toward Injection Practices Among People Who Inject Drugs Utilizing Medical Services: Opportunities for Harm Reduction Counseling in Health Care Settings. Health Promot Pract 2023:15248399231192996. [PMID: 37589192 DOI: 10.1177/15248399231192996] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Hospitals are an important setting to provide harm reduction services to people who inject drugs (PWID). This study aimed to characterize PWID's injection practices, the perceived risk and benefits of those practices, and the immediate IDU risk environment among individuals seeking medical care. Surveys were administered to 120 PWID seeking medical services at an urban hospital. Poisson regression was used to examine the effect of perceived risk or importance of injection practices on the rate of engaging in those practices. The mean participant reported "often" reusing syringes and "occasionally" cleaning their hands or skin prior to injection. 78% of participants reported that syringes were extremely risky to share, which was associated with lower likelihood of sharing them (ARR: 0.59; 95% CI: 0.36-0.95). 38% of participants reported it was extremely important to use a new syringe for each injection, and these participants were more likely to report never reusing syringes >5 times (ARR: 1.62, 95% CI: 1.11-2.35). Other factors that may influence injection practices-including fear of arrest, withdrawal, lack of access to supplies, and injecting outdoors-were common among participants. In conclusion, practices that place PWID at risk of injury and infection are common, and risk-benefit perception is associated with some, but not all, injection practices. Injecting in challenging environments and conditions is common. Therefore, harm reduction counseling in medical settings must be accompanied by other strategies to reduce risk, including facilitating access to supplies. Ultimately, structural interventions, such as affordable housing, are needed to address the risk environment.
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Affiliation(s)
- Dinah Applewhite
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Susan Regan
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Karen Donelan
- Massachusetts General Hospital, Boston, MA, USA
- The Heller School for Social Policy and Management, Brandis University, Waltham, MA, USA
| | | | - Laura G Kehoe
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Sarah E Wakeman
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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12
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Santoro SL, Haugen K, Donelan K, Skotko BG. Global health measures from a National Down Syndrome Registry. Am J Med Genet A 2023; 191:2092-2099. [PMID: 37183579 PMCID: PMC10526626 DOI: 10.1002/ajmg.a.63243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/14/2022] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
People with Down syndrome (DS) have a unique medical profile which may impact views of health. We aimed to study the use of global health measures for DS in a national cohort. We prospectively surveyed parents of individuals with DS from the DS-Connect® registry with validated Patient Reported Outcomes Measurement Information System (PROMIS)® instruments of global health. Analyses included use of scoring manuals and the PROMIS® scoring service, descriptive statistics, and t-tests. We received completed surveys from 223 parents of individuals with DS; previously published limitations of the instrument in this population were shown again. T-scores differed from the available comparative standardized scores to these measures from PROMIS® reference population on Fatigue (p < 0.001) and Global Health (p < 0.001), but not on Pain Interference (p = 0.41).
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Affiliation(s)
- Stephanie L. Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Donelan
- Health Policy Research Center, The Mongan Institute, Survey Research Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Institute of Healthcare Systems, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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13
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Merrill AL, Stein SL, Chu JT, Sarode AL, McKinley SK, Parangi S, Donelan K, Palamara K. Do Resident Coaching Programs Benefit their Coaches? Impact of a Professional Development Coaching Program on The Coaches. World J Surg 2023; 47:1609-1616. [PMID: 36847851 PMCID: PMC9969939 DOI: 10.1007/s00268-023-06957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Coaching has been shown to decrease physician burnout; however, coachee outcomes have been the focus. We report the impact of coaching on women-identifying surgeons who participated as coaches in a 9-month virtual program. METHODS A coaching program was implemented in the Association of Women Surgeons (AWS) to determine the effects of coaching on well-being and burnout from 2018 to 2020. AWS members volunteered and completed training in professional development coaching. Pre- and post-study measures were assessed, and bivariate analysis performed based on burnout and professional fulfillment score. RESULTS Seventy-five coaches participated; 57 completed both pre- and post-study surveys. There were no significant changes in burnout or professional fulfillment including the Positive Emotion, Engagement, Relationship, Meaning, and Accomplishment scale, hardiness, self-valuation, coping, gratitude, or intolerance of uncertainty scores from baseline to post-survey. On bivariate analysis, hardiness was associated with lower burnout throughout the duration of the program. Coaches with lower burnout at the end of the program met with their coachee more frequently than coaches with higher burnout [mean (SD) 3.95(2.16) versus 2.35(2.13) p = 0.0099]. DISCUSSION Burnout and professional fulfillment demonstrated no change in women surgeons who participated as professional development coaches. Those with lower burnout and higher professional fulfillment at the end of the program were found to have higher hardiness, which may be worth future investigation. CONCLUSIONS Acquisition of coaching skills did not directly improve well-being in faculty who participated in a resident coaching program. Future studies would benefit from control groups and exploration of qualitative benefits of coaching.
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Affiliation(s)
- Andrea L Merrill
- Department of Surgery, Boston Medical Center, 820 Harrison Avenue, FGH Building- Suite 5005, Boston, MA, 02118, US.
| | - Sharon L Stein
- Department of Surgery, University Hospitals Cleveland, Cleveland, OH, US
- Association of Women Surgeons, Chicago, IL, US
| | - Jacqueline T Chu
- Department of Medicine, Massachusetts General Hospital, Boston, MA, US
| | - Anuja L Sarode
- Department of Surgery, University Hospitals Cleveland, Cleveland, OH, US
| | - Sophia K McKinley
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, US
| | - Sareh Parangi
- Association of Women Surgeons, Chicago, IL, US
- Department of Surgery, Massachusetts General Hospital, Boston, MA, US
| | - Karen Donelan
- Institute On Healthcare Systems, Heller School of Social Policy and Management, Brandeis University, Boston, MA, US
| | - Kerri Palamara
- Department of Medicine, Massachusetts General Hospital, Boston, MA, US
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14
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Donelan K, Wolfe J, Wilson A, Michael C, Chau C, Krane D, Silverman P, Becker JE, Cheng D, Cella E, Bird B, Levison JH, Skotko BG, Bartels SJ. Group Home Staff Experiences With Work and Health in the COVID-19 Pandemic in Massachusetts. JAMA Health Forum 2023; 4:e230445. [PMID: 37027164 PMCID: PMC10082407 DOI: 10.1001/jamahealthforum.2023.0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Importance Direct reports of the experiences of staff working in group homes for people with serious mental illness (SMI) and/or intellectual or developmental disabilities (ID/DD) are rarely reported. Hearing from workers about their experiences in the COVID-19 pandemic may inform future workforce and public policy. Objective To gather baseline data on worker experience with the perceived effects of COVID-19 on health and work in the pandemic prior to initiating an intervention to mitigate the spread of COVID-19 and to measure differences in worker experience by gender, race, ethnicity, education, and resident population served (persons with SMI and/or IDD/DD). Design, Setting, and Participants This mixed-mode, cross-sectional survey study was conducted using online then paper-based self-administration from May to September 2021 at the end of the first year of the pandemic. Staff working in 415 group homes that provided care within 6 Massachusetts organizations serving adults aged 18 years or older with SMI and/or ID/DD were surveyed. The eligible survey population included a census of staff who were currently employed in participating group homes during the study period. A total of 1468 staff completed or partially completed surveys. The overall survey response rate was 44% (range by organization, 20% to 52%). Main Outcomes and Measures Self-reported experiential outcomes were measured in work, health, and vaccine completion. Bivariate and multivariate analyses explore experiences by gender, race, ethnicity, education, trust in experts and employers, and population served. Results The study population included 1468 group home staff (864 [58.9%] women; 818 [55.7%] non-Hispanic Black; 98 [6.7%] Hispanic or Latino). A total of 331 (22.5%) group home staff members reported very serious perceived effects on health; 438 (29.8%) reported very serious perceived effects on mental health; 471 (32.1%) reported very serious perceived effects on health of family and friends; and 414 reported very serious perceived effects (28.2%) on access to health services, with statistically significant differences observed by race and ethnicity. Vaccine acceptance was higher among persons with higher educational attainment and trust in scientific expertise and lower among persons who self-reported as Black or Hispanic/Latino. A total of 392 (26.7%) respondents reported needing support for health needs, and 290 (19.8%) respondents reported needing support for loneliness or isolation. Conclusions and Relevance In this survey study, approximately one-third of group home workers reported serious personal health and access to health care barriers during the first year of the COVID-19 pandemic in Massachusetts. Addressing unmet health needs and access to health and mental health services, including inequities and disparities by race, ethnicity, and education, should benefit staff health and safety, as well as that of the individuals with disabilities who rely on them for support and care.
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Affiliation(s)
- Karen Donelan
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | | | - Anna Wilson
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Carie Michael
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Cindy Chau
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston
| | - David Krane
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | - Jessica E Becker
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - David Cheng
- Biostatistics Center, Massachusetts General Hospital, Boston
| | | | - Bruce Bird
- Vinfen Corporation, Cambridge, Massachusetts
- Kennedy Krieger Institute, Baltimore, Maryland
| | - Julie H Levison
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Stephen J Bartels
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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15
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Santoro SL, Cabrera M, Co J, Constantine M, Haugen K, Krell K, Skotko BG, Winickoff JP, Donelan K. Health in Down syndrome: creating a conceptual model. J Intellect Disabil Res 2023; 67:323-351. [PMID: 36650105 PMCID: PMC9992291 DOI: 10.1111/jir.13007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 05/28/2023]
Abstract
BACKGROUND Down syndrome (DS) has a unique medical and psychological profile that could impact how health is defined on three dimensions: physical, social and mental well-being. METHODS In 2021, we presented our proposed conceptual model to three expert panels, four focus groups of parents of individuals with DS age 0-21 years and four focus groups of individuals with DS age 13-21 years through videoconferencing technology. Participants gave feedback and discussed the concept of health in DS. RESULTS Feedback from participants resulted in iterative refinement of our model, retaining the three dimensions of health, and modifying constructs within those dimensions. Experts and parents agreed that individuals with DS have unique health concerns that necessitate the creation and validation of a syndrome-specific health model. We present key themes that we identified and a final conceptual model of health for individuals with DS. CONCLUSION Health in DS is a multi-dimensional, multi-construct model focused on relevant constructs of causal and effect indicators. This conceptual model can be used in future research to develop a syndrome-specific measure of health status.
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Affiliation(s)
- Stephanie L. Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Maria Cabrera
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - John Co
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston MA
| | | | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian G. Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jonathan P. Winickoff
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston MA
| | - Karen Donelan
- Health Policy Research Center, The Mongan Institute, Survey Research Unit, Massachusetts General Hospital, Boston, Massachusetts
- Institute of Healthcare Systems, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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16
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O'Reilly-Jacob M, Zwilling J, Perloff J, Freeman P, Brown E, Donelan K. Early implementation of full-practice authority: A survey of Massachusetts nurse practitioners. J Am Assoc Nurse Pract 2023; 35:235-241. [PMID: 36927709 DOI: 10.1097/jxx.0000000000000853] [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] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/03/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND In January 2021, Massachusetts granted nurse practitioners (NPs) full-practice authority (FPA). Little is known about how FPA changes the day-to-day work of NPs. PURPOSE To examine changes in practice barriers and care delivery in the early stages of FPA. METHODOLOGY Descriptive analysis of a web-based survey of clinically active NPs in Massachusetts from October to December 2021, using Fisher exact tests to examine the associations between the perception that FPA improved work and other variables. RESULTS Survey response rate was 50.3% ( N = 147). Overall, 79% of NPs believe that clinical work is unchanged by FPA. Practicing outside institutions is a significant predictor of FPA improving work ( p < .05). Larger proportions of respondents feel that efficiency (22%), patient centeredness (20%), and timeliness (20%) are improved by FPA compared with effectiveness (16%), equity (14%), and safety (10%). Almost half of those reporting that FPA improves overall care also report improved efficiency (50%, p < .0001), but only 22% report improved safety ( p < .05). Of those believing that FPA improved work, a minority no longer need physician review of new controlled substance prescriptions (29%, p < .01), a practice agreement (32%, p < .05), or physician signature on clinical documentation (22%, p < .05). CONCLUSIONS Almost 1 year after FPA was passed in Massachusetts, the large majority of NPs report no changes in their day-to-day work, suggesting that FPA implementation is slow. IMPLICATIONS Concerted efforts by regulators, employers, and individual NPs are needed to ensure that legislated FPA is effectively implemented inside organizations and among payers.
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Affiliation(s)
| | - Jana Zwilling
- College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, North Dakota
| | - Jennifer Perloff
- Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Patricia Freeman
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Emily Brown
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Karen Donelan
- Schneider Institutes for Health Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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Mellinger TJ, Forester BP, Vogeli C, Donelan K, Gulla J, Vetter M, Vienneau M, Ritchie CS. Correction: Impact of dementia care training on nurse care managers’ interactions with family caregivers. BMC Geriatr 2023; 23:192. [PMID: 36997880 PMCID: PMC10064703 DOI: 10.1186/s12877-023-03827-z] [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: 04/01/2023] Open
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18
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Toribio M, Cetlin M, Fulda ES, Chu SM, Gómez Tejeda Zañudo J, Poteat T, Donelan K, Zanni MV. Hormone Prescription and HIV Screening/Preventive Practices Among Clinicians Providing Care for Transgender Individuals. Transgend Health 2023; 8:64-73. [PMID: 36824383 PMCID: PMC9942173 DOI: 10.1089/trgh.2021.0118] [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] [Indexed: 11/13/2022] Open
Abstract
Purpose Through a survey-based approach, we sought to investigate regional differences in gender-affirming hormone therapy (GAHT) prescribing practices, as well as HIV screening and prevention practices among clinicians providing care to transgender individuals. Methods Our survey was disseminated between December 2019 and January 2021 to clinicians who prescribe GAHT within New England (United States). Between-group differences in GAHT prescribing and HIV screening/prevention practices were evaluated by practice setting and subspecialty. Results Of the 20 survey respondents, 55% practiced in health care settings affiliated with an academic institution, 45% practiced in a community-based health care setting, and 30% were Endocrinologists. Clinicians in community-based health care settings reported more frequently prescribing oral 17β-estradiol (p=0.02) and spironolactone (p=0.007) for feminizing GAHT compared with clinicians in health care settings affiliated with an academic institution, who reported more frequently prescribing leuprolide (p=0.03). For masculinizing GAHT, clinicians from health care settings affiliated with an academic institution reported more frequently prescribing topical testosterone (p=0.03). There were no significant between-group differences in reported barriers to initiation or reasons for stopping GAHT. While non-Endocrinologists reported "often" or "always" offering HIV screening, most Endocrinologists reported "rarely" or "never" offering HIV screening and "rarely" or "never" offering pre-exposure or postexposure prophylaxis to their transgender patients. Conclusions Regional GAHT prescribing practices varied by setting. Additional research is needed to better understand whether these differences translate to differences in GAHT efficacy and side-effects. Further, HIV screening/prevention practices varied by subspecialty. Integrated GAHT and HIV screening/prevention across subspecialties could help reduce the disproportionate burden of HIV faced by the transgender community.
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Affiliation(s)
- Mabel Toribio
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Madeline Cetlin
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Evelynne S. Fulda
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah M. Chu
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge Gómez Tejeda Zañudo
- Eli and Edythe L. Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karen Donelan
- Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Markella V. Zanni
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Kats DJ, Skotko BG, de Graaf G, Skladzien E, Hooper BT, Mordi R, Mykhailenko T, Buckley F, Patsiogiannis V, Krell K, Haugen K, Donelan K. Designing an international survey for organisations serving people with Down syndrome. J Appl Res Intellect Disabil 2023; 36:497-506. [PMID: 36655393 DOI: 10.1111/jar.13071] [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: 03/15/2022] [Revised: 12/10/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Down syndrome is the most common liveborn genetic condition. However, there are no surveys measuring societal services and supports for people with Down syndrome. We developed a questionnaire so that initiatives could be targeted towards countries most in need of assistance. METHOD We formed a geographically diverse group of physicians, family members of people with Down syndrome, and members of Down syndrome not-for-profit organisations to create a survey of societal services and supports. We used a modified Delphi method and disseminated the survey to Down syndrome non-profit organisations worldwide. RESULTS Our survey consists of 61 items categorised within five domains: Education, Community Inclusion, Independence, Healthcare, and Social and Policy Issues. CONCLUSIONS We developed a survey to measure societal services and supports available to people with Down syndrome as perceived by organisational leaders. Our methods might serve as a blueprint for other populations of people with intellectual and developmental disabilities.
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Affiliation(s)
- Daniel J Kats
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Gert de Graaf
- Dutch Down Syndrome Foundation, Meppel, The Netherlands
| | | | | | - Rose Mordi
- Down Syndrome Foundation Nigeria, Lagos, Nigeria
| | | | | | - Vasiliki Patsiogiannis
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kavita Krell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kelsey Haugen
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen Donelan
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA.,Health Policy Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Mellinger TJ, Forester BP, Vogeli C, Donelan K, Gulla J, Vetter M, Vienneau M, Ritchie CS. Impact of dementia care training on nurse care managers' interactions with family caregivers. BMC Geriatr 2023; 23:16. [PMID: 36631767 PMCID: PMC9832603 DOI: 10.1186/s12877-022-03717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Nurse care managers (NCM) operate through care management programs to provide care for persons living with dementia (PLWD) and interact regularly with their family caregivers; however, most do not receive formal instruction in dementia care or caregiver support. CRESCENT (CaReEcoSystem primary Care Embedded demeNtia Treatment) is a telephone-based dementia care intervention adapted from the Care EcoSystem model designed to equip NCMs with these tools. For this study, we aimed to measure intervention fidelity and understand how dementia care training impacted NCMs' provision of dementia care management services during interactions with caregivers of PLWD. METHODS We recruited 30 active NCMs; 15 were randomly assigned to receive training. For each nurse, we randomly selected 1-3 patients with a diagnosis of dementia in each nurse's care during January-June 2021 for a total of 54 medical charts. To assess training uptake and fidelity, we identified documentation by NCMs of CRESCENT protocol implementation in the medical records. To understand how the training impacted the amount and types of dementia care management services provided in interactions with family caregivers, we compared attention to key dementia topic areas between trained NCMs (intervention) and untrained NCMs (control). RESULTS Within the trained group only, community resources for PLWD, followed by safety, medication reconciliation, and advanced care planning topic areas were addressed most frequently (> 30%), while behavior management was addressed least frequently (12%). Trained NCMs were more likely to document addressing aspects of caregiver wellbeing (p = 0.03), community resources (p = 0.002), and identification of behavior (p = 0.03) and safety issues (p = 0.02) compared to those without training. There was no difference between groups in the amount of care coordination provided (p = 0.64). CONCLUSION Results from this study demonstrate that focused dementia care training enriches care conversations in important topic areas for PLWD and family caregivers. Future research will clarify how best to sustain and optimize high quality dementia care in care management programs with special attention to the NCM-family caregiver relationship. TRIAL NUMBER NCT04556097.
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Affiliation(s)
- Taylor J. Mellinger
- grid.32224.350000 0004 0386 9924Mass General Brigham, Boston, USA ,Idaho College of Osteopathic Medicine, Meridian, USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, USA
| | - Brent P. Forester
- grid.32224.350000 0004 0386 9924Mass General Brigham, Boston, USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, USA ,grid.240206.20000 0000 8795 072XMcLean Hospital, Belmont, USA
| | - Christine Vogeli
- grid.32224.350000 0004 0386 9924Mass General Brigham, Boston, USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, USA ,grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, USA
| | - Karen Donelan
- grid.38142.3c000000041936754XHarvard Medical School, Boston, USA ,grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, USA ,grid.253264.40000 0004 1936 9473Brandeis University, Waltham, USA
| | - Joy Gulla
- grid.32224.350000 0004 0386 9924Mass General Brigham, Boston, USA
| | - Michael Vetter
- grid.253264.40000 0004 1936 9473Brandeis University, Waltham, USA
| | - Maryann Vienneau
- grid.32224.350000 0004 0386 9924Mass General Brigham, Boston, USA
| | - Christine S. Ritchie
- grid.32224.350000 0004 0386 9924Mass General Brigham, Boston, USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, USA ,grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, USA
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21
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Stein SL, Chu JT, Merrill A, McKinley SA, Parengi S, Donelan K, Palamara K. Implementation of a Coaching Program by a National Surgical Association. J Surg Educ 2022; 79:1471-1479. [PMID: 35995676 DOI: 10.1016/j.jsurg.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework for implementation science, we describe the implementation and impact of a virtual coaching program designed and conducted through a national surgical organization. DESIGN The Association of Women Surgeons recruited and trained surgical faculty as coaches with no prior training in positive psychology to coach surgical residents. Coaching pairs completed three coaching sessions center on strength recognition, personal and professional fulfillment, and work life integration. SETTING The initial coaching training was in person at a national conference, while subsequent training sessions and all coaching sessions were held remotely. PARTICIPANTS A total of 75 coaches were trained and 121 surgical residents participated in the program. RESULTS Coachees noted improvement in goal setting, self-confidence, and working relationships. Coaches noted improvement in communication skills both during and outside of the coaching experience. Eighty-six percent of coaches recommended implementing a coaching program at their home institution. This program has served as model for additional programs through other associations and institutions. CONCLUSIONS The Coaching Project demonstrates the feasibility implementing a coaching project for coaching surgical residents, teaching new communication skills to coaches, while providing wellness benefits to coachees.
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Affiliation(s)
- Sharon L Stein
- UH RISES: Research in Surgical Outcomes and Effectiveness Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Association of Women Surgeons, Chicago, Illinois.
| | - Jacqueline T Chu
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrea Merrill
- Association of Women Surgeons, Chicago, Illinois; Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | - Sophia A McKinley
- Association of Women Surgeons, Chicago, Illinois; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sareh Parengi
- Association of Women Surgeons, Chicago, Illinois; Department of Surgery, Newton Wellesley Hospital, Newton, Massachusetts
| | | | - Kerri Palamara
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Carter J, Donelan K, Thorndike AN. Patient Perspectives on Home-Based Care and Remote Monitoring in Heart Failure: A Qualitative Study. J Prim Care Community Health 2022; 13:21501319221133672. [PMID: 36305386 PMCID: PMC9619261 DOI: 10.1177/21501319221133672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION As individual interventions, home-based care and remote monitoring have been shown to help prevent hospitalizations for those with heart failure (HF) although both interventions have been limited by scalability and technical constraints, respectively. Few qualitative studies have explored patient perspectives, including acceptability, barriers, and facilitators of HF care inclusive of both interventions. The objective of this study is to explore patient perceptions on HF management at home, the use of home-based remote monitoring, and the value of home-based care. METHODS Qualitative interviews (N = 27) were conducted via phone (12/2020-3/2021) with adults with HF. A framework analysis was used to identify main themes along with verbatim transcription for coding and analyses. There were 5 key interview domains: general HF knowledge, perceptions of the value of home-based care, unmet needs related to the social determinants of health (SDOH), experience with healthcare technology and remote monitoring, and challenges in HF home management. RESULTS Five major themes emerged. Patients reported: (1) home-based care plan instructions are understood; (2) following medication, diet, and fluid management instructions are challenging due to difficult adherence to and implementation at home; (3) financial limitations serve as barriers to acquiring healthy food; (4) home-based support is a valuable component of managing medications, diet, and fluid; (5) despite limited use of technology, strong willingness to use remote monitoring is present amongst most. CONCLUSIONS Participants reported understanding of care plan instructions and challenges adhering to care plans at home. Barriers included needing more home-based support for medications, diet, and fluid management and requiring additional assistance with financial barriers related to unmet social needs. A combined intervention inclusive of remote monitoring and home-based support has potential to improve home-based strategies and clinical outcomes for HF patients.
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Affiliation(s)
- Jocelyn Carter
- Massachusetts General Hospital, Boston, MA, USA,Jocelyn Carter, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Blake 15, Boston, MA 02114, USA.
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23
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Santoro SL, Donelan K, Constantine M. Proxy-report in individuals with intellectual disability: A scoping review. J Appl Res Intellect Disabil 2022; 35:1088-1108. [PMID: 35676858 PMCID: PMC9378492 DOI: 10.1111/jar.13013] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 04/04/2022] [Accepted: 05/20/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Views can be collected from individuals (self-report) or others on their behalf (proxy-report). OBJECTIVE We aimed to review the literature on methods and statistical approaches used to evaluate observer versus self-report responses from individuals with intellectual disability or Down syndrome. METHODS A series of key questions related to statistical approaches and data collection methods were formulated a priori to inform the search strategy and review process. These addressed the topics of self-report in individuals with intellectual disability, including Down syndrome. Using the National Library of Medicine database, PubMed, detailed literature searches were performed. The quality of available evidence was then evaluated, the existing literature was summarised, and knowledge gaps and research needs were identified. RESULTS Fifty relevant original articles were identified which addressed at least one key question. Study details, including: research design, internal validity, external validity, and relevant results are presented. Review of studies of individuals with intellectual disability which used a variety of statistical approaches showed mixed agreement between self-report and proxy-report. CONCLUSION Few studies identified to-date have used self-report from individuals with Down syndrome, but lessons from the existing intellectual disability literature can guide researchers to incorporate self-report from individuals with Down syndrome in the future.
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Affiliation(s)
- Stephanie L. Santoro
- Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen Donelan
- Institute on Healthcare Systems, Brandeis University, Waltham, Massachusetts, United States
- Survey Research and Implementation Unit, Division of Clinical Research, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Melissa Constantine
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
- Evidera Inc, Bethesda, Maryland, USA
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Park ER, Kirchhoff AC, Kuhlthau KA, Perez GK, McDonald A, Galbraith AA, Battaglia TA, Ponzani C, Foor A, Mann K, Waters AR, Armstrong GT, Leisenring WM, Bliss CC, Wang C, Lopez A, Donelan K. A health insurance navigation intervention tool (HINT) for survivors of childhood cancer: Randomized pilot trial results from the Childhood Cancer Survivor Study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6508] [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
6508 Background: Childhood cancer survivors are vulnerable to being underinsured and health insurance-related financial burden. Low health insurance literacy reduces survivors’ ability to utilize health insurance. We conducted a pilot randomized controlled trial (RCT) to assess a virtually delivered health insurance navigation tool (HINT) intervention to improve health insurance literacy (HIL) and decrease financial burden. Methods: Using a multiphase, mixed methods design, we developed and tested a theoretically-driven 4-session intervention that included: 1) Learning About Survivorship Healthcare Needs, 2) Learning About Your Plan in Relation to Policy, 3) Navigating Your Plan and Obstacles, and 4) Managing Care Costs. Eligible CCSS participants were insured and had wireless device access. We assessed feasibility and preliminary efficacy of HINT versus enhanced usual care (EUC; health insurance booklet) on HIL (16-item instrument assessing knowledge and confidence with health insurance terms and activity, ACA provisions knowledge (8-items), psychological financial burden (7-items assessing worry due to medical costs), and satisfaction with health insurance coverage (1 item) using multivariable linear regression. Results: From 8/20 to 5/2021, 82 participants enrolled (39.7% participation rate); 53.7% female; 82% white, 7% Hispanic, and 7% black; 52.4% <40 years of age; and 57.3% from a Medicaid expansion state. 25.6% reported previously being uninsured. 57.3% were diagnosed <10 years of age, and 40.1% had ≥1 severe chronic health condition. There were gaps in health insurance literacy (HIL mean 28.5, sd=9.0; 16-60 (high-low); 39.0% were not familiar with the Affordable Care Act (ACA), and many lacked ACA provisions knowledge (e.g., appeals for coverage denials (56.1%). 82% completed 4 sessions; 92.6% completed the 5-month follow-up survey. Compared to EUC, HINT significantly improved HIL, ACA provisions knowledge, psychological financial hardship, and health insurance satisfaction (p’s ≤ 0.03). Conclusions: Findings affirm health insurance literacy gaps among a national sample of insured long-term survivors. Results support the feasibility and preliminary efficacy of HINT on improving health insurance literacy, satisfaction, and psychological financial burden. HINT is the first intervention to demonstrate improvements in long-term survivors’ health insurance literacy and psychological financial burden. Clinical trial information: NCT04520061. [Table: see text]
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Affiliation(s)
- Elyse R. Park
- Department of Psychiatry and Medicine, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | | | | | | | - Karely Mann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Austin R. Waters
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | | | | | - Cathy Wang
- Massachusetts General Hospital, Boston, MA
| | - Ana Lopez
- Massachusetts General Hospital, Boston, MA
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Leslie CJ, Donelan K, Nicholas P, Buglione M, Smith DL. Health Literacy Profiles of Early Intervention Providers: Use of the Health Literacy Questionnaire. Health Lit Res Pract 2022; 6:e128-e136. [PMID: 35680120 PMCID: PMC9179036 DOI: 10.3928/24748307-20220523-01] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Early intervention (EI) providers work with parents of children with or who have risk factors of developmental delay or disability through Part C of the Individuals with Disabilities Education Act. Many parents in the United States have low health literacy; therefore, EI providers should be aware of and address families' health literacy needs. EI providers need to be health literate themselves to implement evidence-based recommended practices. Objective: This study aimed to measure health literacy levels of interdisciplinary EI providers and investigate associations between health literacy levels and demographic variables. Methods: A survey containing the Health Literacy Questionnaire (HLQ) was completed by EI providers working at 10 EI centers in Massachusetts. Scale scores were calculated and compared across demographic variables, including EI job role, age, years of EI experience, and highest education level. Key Results: Of 715 EI providers invited to participate, 376 surveys were completed (52.6% response rate). Most participants were women (92.6%, n = 348), reported race as White (85.4%, n = 321), had a mean age of 43.1 years (standard deviation [SD] 12.9) ranging from 20 to 74 years, and English as their primary language (89.6%, n = 337). EI providers scored the lowest on HLQ Scale 5 “Appraisal of health information” (mean [M] = 2.99 (SD 0.50) [confidence interval (CI) 2.93, 3.04]), and Scale 7 “Navigating the healthcare system” (M = 3.83 (SD 0.58) [CI 3.77, 3.89]). EI providers having stronger health literacy profiles were generally older, with a higher education level, were licensed providers, or had more years of EI work experience. Conclusions: EI providers require adequate health literacy to manage their health needs and to effectively provide services to EI families. Study results may inform future targeted professional development to support improvement of EI providers' health literacy skills, including appraisal of health information and navigation of the health care system. [HLRP: Health Literacy Research and Practice. 2022;6(2):e128–e136.] Plain Language Summary: EI providers' health literacy profiles have not been previously investigated. Study results reveal EI providers struggled with health literacy skills of appraising health information and navigating the health care system, which are vital for EI practice. Health Literacy Questionnaire results can inform targeted professional development to improve EI providers' health literacy levels and their clinical practice.
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Affiliation(s)
- Catherine J. Leslie
- Address correspondence to Catherine J. Leslie, PhD, MOT, OTR/L, CEIS, PO Box 290007, Boston, MA 02129;
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Kehlenbrink S, Mahboob O, Al-Zubi S, Boulle P, Aebischer Perone S, Alani AH, Kiapi L, Miller L, Hering H, Woodman M, Donelan K, Kayden S, Porneala BC, Rosner B, Meigs JB. An inter-humanitarian agency study of diabetes care and surveillance in humanitarian settings. Lancet Diabetes Endocrinol 2022; 10:159-162. [PMID: 35143782 DOI: 10.1016/s2213-8587(22)00036-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Sylvia Kehlenbrink
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Sara Al-Zubi
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Laura Miller
- International Rescue Committee, New York, NY, USA
| | - Heiko Hering
- UN High Commissioner for Refugees, Geneva, Switzerland
| | | | - Karen Donelan
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie Kayden
- Division of International Emergency Medicine and Humanitarian Programs, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Humanitarian Initiative, Cambridge, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Bianca C Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Bernard Rosner
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - James B Meigs
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
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Magudia K, Sugi MD, Balthazar P, Donelan K, Gupta RT, Maturen KE. The SCARD Fellowship Policy and the Abdominal Imaging Fellowship: A Follow-up Survey After the First Year. Acad Radiol 2022; 29:287-293. [PMID: 33341373 DOI: 10.1016/j.acra.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/06/2020] [Accepted: 12/06/2020] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES To assess resident and fellowship program director (PD) perceptions of the abdominal radiology fellowship application process following the first cycle in which an embargo on interviews until December 1, 2019 was set according to the Society of Chairs of Academic Radiology Departments (SCARD) timeline for the 2021-2022 abdominal imaging fellowship year. MATERIALS AND METHODS Eligible study participants included fellowship PDs of all abdominal imaging programs in the United States and residents that attended the Society of Abdominal Radiology (SAR) 2020 Annual Meeting. A questionnaire was developed by content and survey experts, pilot tested, and administered from May to June 2020. RESULTS A total of 39% (36/92) of all PDs and 30% (46/152) of all individuals identified as residents with valid email addresses that attended the SAR 2020 Annual Meeting responded to the survey with an overall response rate of 34%. Only 42% of PDs and 33% of residents supported moving to a match, while 62% of PDs and 70% of residents thought that a match would limit the autonomy of applicants. While most PDs and residents also agreed that the first iteration of the SCARD timeline allowed residents to make a more informed choice, the majority of PDs were dissatisfied with their experience. Most PDs and residents additionally want applications to be accepted no earlier than July and/or August of the R3 year (initial SCARD guidelines did not restrict timing), interviews to begin on November 1st or earlier of the R3 year (compared to December 1st set in the first iteration of the guidelines), and a gap of 2-4 weeks between the date of first interviews and notification of first offers (initial SCARD guidelines did not restrict timing). Lastly, an overwhelming majority of PDs and residents agreed that SAR should enforce the abdominal imaging fellowship application process. CONCLUSION Following the first cycle of abdominal imaging fellowship applications conducted according to the SCARD guidelines, a majority of trainees and PDs felt the changes were favorable and were opposed to a formal match. Specific suggestions for improvement were elicited from stakeholders and will be incorporated for the next cycle.
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Palamara K, Chu JT, Chang Y, Yu L, Cosco D, Higgins S, Tulsky A, Mourad R, Singh S, Steinhauser K, Donelan K. Who Benefits Most? A Multisite Study of Coaching and Resident Well-being. J Gen Intern Med 2022; 37:539-547. [PMID: 34100238 PMCID: PMC8858365 DOI: 10.1007/s11606-021-06903-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/30/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Coaching has been shown to improve resident well-being; however, not all benefit equally. OBJECTIVE Assess predictors of changes in resident physician well-being and burnout in a multisite implementation of a Professional Development Coaching Program. DESIGN Pre- and post-implementation surveys administered to participant cohorts at implementation sites in their intern year. Effect size was calculated comparing pre- and post-intervention paired data. PARTICIPANTS In total, 272 residents in their intern year at five internal medicine residency programs (Boston Medical Center, University Hospitals Cleveland Medical Center, Duke University, Emory University, Massachusetts General Hospital). Analyses included 129 residents with paired data. INTERVENTIONS Interns were paired with a faculty coach trained in positive psychology and coaching skills and asked to meet quarterly with coaches. MAIN MEASURES Primary outcomes included Maslach Burnout Inventory depersonalization (DP) and emotional exhaustion (EE) subscales, and the PERMA well-being scale. Key predictors included site, demographics, intolerance of uncertainty, hardiness-resilience, gratitude, and coping. Program moderators included were reflection, goal setting, and feedback. KEY RESULTS Well-being (PERMA) changed from baseline to follow-up in all participants; females showed a decline and males an increase (-1.41 vs. .83, p = 0.04). Self-reflection was associated with positive change in PERMA (mean positive change 1.93, p = 0.009). Burnout (EE) declined in non-Hispanic white residents vs. Black/Asian/Hispanic/other residents (-1.86, p = 0.021). Burnout improved with increased goal setting. CONCLUSION Coaching programs should consider tailored approaches to support residents whose well-being is impacted by gender and/or race, and who have higher intolerance of uncertainty and lower resilience at baseline. Coaching skills of goal setting and reflection may positively affect interns and teach coping skills.
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Affiliation(s)
- Kerri Palamara
- Center for Physician Well-Being, Department of Medicine, Massachusetts General Hospital, Fruit Street, Boston, MA, USA.
| | - Jacqueline T Chu
- Center for Physician Well-Being, Department of Medicine, Massachusetts General Hospital, Fruit Street, Boston, MA, USA
| | - Yuchiao Chang
- Center for Physician Well-Being, Department of Medicine, Massachusetts General Hospital, Fruit Street, Boston, MA, USA
| | - Liyang Yu
- Center for Physician Well-Being, Department of Medicine, Massachusetts General Hospital, Fruit Street, Boston, MA, USA
| | - Dominique Cosco
- Department of Medicine, Washington University at St. Louis, St. Louis, MO, USA
| | - Stacy Higgins
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Asher Tulsky
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ronda Mourad
- Department of Medicine, University Hospitals Cleveland, Cleveland, OH, USA
| | - Simran Singh
- Department of Medicine, University Hospitals Cleveland, Cleveland, OH, USA
| | - Karen Steinhauser
- Departments of Population Health Sciences and Medicine, Duke University, Durham, NC, USA
| | - Karen Donelan
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
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Harrington SG, Wood M, Porter KK, Gupta Y, Esfahani SA, Daye D, Kilcoyne A, Donelan K, Narayan AK. Promoting Lactation Support: Challenges and Solutions to Supporting Breastfeeding Radiologists. Acad Radiol 2022; 29:175-180. [PMID: 33293255 DOI: 10.1016/j.acra.2020.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/13/2020] [Accepted: 11/14/2020] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES Although the evidence for the benefits of breastfeeding is strong, parents are often unable to continue breastfeeding upon returning from maternity leave for a variety of reasons. Breastfeeding parents in medicine face unique challenges upon returning to the workforce after maternity leave. Current research on breastfeeding radiologists is limited. The objective of this research is to evaluate breastfeeding barriers and identify potential solutions to help radiologists reach their breastfeeding goals. MATERIALS AND METHODS A 17-question survey was developed from validated surveys and pilot tested using focus groups. The survey was emailed to members of the American Association for Women in Radiology and promoted through social media. Bivariate analyses were performed using chi-square tests. p values <0.05 were considered statistically significant. Institutional review board deemed that this anonymous voluntary survey met criteria for exemption. RESULTS 50 respondents met criteria for study inclusion (estimated response rate 42%). Of the respondents, 60% were trainees, 80% practiced in academic institutions and 92% were full-time. 100% intended to breastfeed, of whom 56% met personal breastfeeding goals (12-month median duration). Available lactation facilities included: Dedicated lactation room (38%), private space (58%), hospital grade pump (30%), refrigerator (46%), dedicated PACS (8%). Cited workplace challenges included lack of time (82%), lack of space (34%), and unsupportive work culture (42%). Having adequate time was associated with meeting breastfeeding goals (p = 0.028). No other factors were statistically significant (p > 0.05). CONCLUSION Almost half of breastfeeding radiologists (44%) did not meet breastfeeding goals, citing a variety of facility-based and institutional barriers. Among these, having sufficient time to pump/breastfeed was associated with achieving breastfeeding goals. Given the barriers faced by breastfeeding radiologists, there is an opportunity to make structural and cultural changes to provide lactation support at work.
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Buerhaus PI, Staiger DO, Auerbach DI, Yates MC, Donelan K. Nurse Employment During The First Fifteen Months Of The COVID-19 Pandemic. Health Aff (Millwood) 2022; 41:79-85. [PMID: 34982625 DOI: 10.1377/hlthaff.2021.01289] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Analysis of Current Population Survey data suggests a tightening labor market for registered nurses, licensed practical nurses, and nursing assistants, marked by falling employment and rising wages through June 2021. Unemployment rates remain higher in nonhospital settings and among registered nurses and nursing assistants who are members of racial and ethnic minority groups.
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Affiliation(s)
| | | | | | | | - Karen Donelan
- Karen Donelan, Brandeis University, Waltham, Massachusetts
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31
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DesRoches C, Chang Y, Kim J, Mukunda S, Norman L, Dittus RS, Donelan K. Who wants to work in geriatrics: Findings from a national survey of physicians and nurse practitioners. Nurs Outlook 2022; 70:309-314. [DOI: 10.1016/j.outlook.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/22/2021] [Accepted: 10/23/2021] [Indexed: 11/15/2022]
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Forester B, Donelan K, Vogeli C, Ritchie C. Adaptation of the Care Ecosystem Intervention for Individuals with Dementia in a High-Risk, Care Management Program. Innov Aging 2021. [PMCID: PMC8682045 DOI: 10.1093/geroni/igab046.665] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
The Care Ecosystem (CareEco) model is a telephone-based dementia care program providing standardized, personalized and scalable support and education for caregivers and persons living with dementia (PLWD), medication guidance, and promotion of proactive decision-making. It has demonstrated improvement in quality of life for PLWD and reduced unnecessary healthcare expenditures. We initiated a pragmatic, embedded randomized pilot trial of an adapted CareEco model for nurses who provide high-risk care management and are embedded in primary care practices within a large healthcare system. Outcomes include feasibility of collecting emergency department visits, usability and acceptability of the intervention by nurse care managers, caregiver strain, behavioral symptoms of dementia and healthcare expenditures. Challenges of implementation include engaging key care management leaders, adaptation of the CareEco training modules for nurses, identification of primary caregivers, training and reinforcing knowledge and skills of the nurses, embedding clinical assessments into care manager workflows and integration with the EMR.
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Affiliation(s)
- Brent Forester
- McLean Hospital, McLean Hospital, Massachusetts, United States
| | - Karen Donelan
- Heller School for Social Policy Management, Brandeis University, Waltham, Massachusetts, United States
| | | | - Christine Ritchie
- Massachusetts General Hospital, Boston, Massachusetts, United States
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Jimenez RB, Johnson AE, Horick NK, Hlubocky FJ, Lei Y, Matsen CB, Mayer EL, Collyar DE, LeBlanc TW, Donelan K, Mello MM, Peppercorn JM. Do you mind if I record?: Perceptions and practice regarding patient requests to record clinic visits in oncology. Cancer 2021; 128:275-283. [PMID: 34633655 DOI: 10.1002/cncr.33910] [Citation(s) in RCA: 4] [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: 05/06/2021] [Revised: 06/22/2021] [Accepted: 08/06/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Audio recordings of oncology clinic discussions can help patients retain and understand information about their disease and treatment decisions. Access to this tool relies on acceptance of recordings by oncologists. This is the first study to evaluate experience and attitudes of oncologists toward patients recording clinic visits. METHODS Medical, radiation, and surgical oncologists from 5 US cancer centers and community affiliates were surveyed to evaluate clinicians' experience, beliefs, and practices regarding patient-initiated recordings. RESULTS Among 360 oncologists (69% response rate), virtually all (93%) have experienced patients seeking to record visits. Although 75% are comfortable with recording, 25% are uncomfortable and 56% report concerns ranging from less thorough discussions to legal liability. Most (85%) always agree when patients ask to record, but 15% never or selectively allow recording. Although 51% believe recording is positive for the patient-physician relationship, a sizable minority report that it can lead to less detailed conversations (28%) or avoidance of difficult topics, including prognosis (33%). Views did not vary based on subspecialty, practice setting, or geographic region, but older age and years in practice were associated with more positive views of recording. The majority of clinicians (72%) desire institutional policies to govern guidelines about recordings. CONCLUSIONS Most oncologists are comfortable with patient requests to record visits, but a sizable minority remain uncomfortable, and access to recording varies solely on physician preference. This difference in care delivery may benefit from institutional policies that promote access while addressing legitimate physician concerns over privacy and appropriate use of recordings.
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Affiliation(s)
- Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew E Johnson
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nora K Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Fay J Hlubocky
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Yvonne Lei
- Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Cindy B Matsen
- Department of Surgery, Division of Surgical Oncology, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah
| | - Erica L Mayer
- Division of Medical Oncology, Department of Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Karen Donelan
- Health Policy Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle M Mello
- Stanford Health Policy and the Department of Medicine, Stanford University School of Medicine, Stanford, California.,Stanford Law School, Stanford, California.,Freeman-Spogli Institute for International Studies, Stanford, California
| | - Jeffrey M Peppercorn
- Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Donelan K, Agaronnik N, Lagu T, Campbell EG. Use of Accessible Weight Scales and Examination Tables/Chairs for Patients with Significant Mobility Limitations by Physicians Nationwide. Jt Comm J Qual Patient Saf 2021; 47:615-626. [PMID: 34364797 PMCID: PMC8464497 DOI: 10.1016/j.jcjq.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mobility limitations are the most common disability type among the 61 million Americans with disability. Studies of patients with mobility limitations suggest that inaccessible medical diagnostic equipment poses significant barriers to care. METHODS The study team surveyed randomly selected US physicians nationwide representing seven specialties about their reported use of accessible weight scales and exam tables/chairs when caring for patients with mobility limitations. A descriptive analysis of responses was performed, and multivariable logistic regression was used to examine associations between accessible equipment and participants' characteristics. RESULTS The 714 participants (survey response rate = 61.0%) were primarily male, White, and urban, and had practiced for 20 or more years. Among those reporting routinely recording patients' weights (n = 399), only 22.6% (standard error [SE] = 2.2) reported always or usually using accessible weight scales for patients with significant mobility limitations. To determine weights of patients with mobility limitations, 8.1% always, 24.3% usually, and 40.0% sometimes asked patients. Physicians practicing ≥ 20 years were much less likely than other physicians to use accessible weight scales: odds ratio (OR) = 0.51 (95% confidence interval [CI] = 0.26-0.99). Among participants seeing patients with significant mobility limitations (n = 584), only 40.3% (SE = 2.2) always or usually used accessible exam tables or chairs. Specialists were much more likely than primary care physicians to use accessible exam tables/chairs: OR = 1.96 (95% CI = 1.29-2.99). CONCLUSION More than 30 years after enactment of the Americans with Disabilities Act, most physicians surveyed do not use accessible equipment for routine care of patients with chronic significant mobility limitations.
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Auerbach DI, Levy DE, Maramaldi P, Dittus RS, Spetz J, Buerhaus PI, Donelan K. Optimal Staffing Models To Care For Frail Older Adults In Primary Care And Geriatrics Practices In The US. Health Aff (Millwood) 2021; 40:1368-1376. [PMID: 34495726 DOI: 10.1377/hlthaff.2021.00401] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Different staffing configurations in primary and geriatric care practices could have implications for how best to deliver services that are essential for a growing population of older adults. Using data from a 2018 survey of physicians (MDs) and nurse practitioners (NPs) working in primary and geriatric care, we assessed whether different configurations were associated with better or worse performance on a number of standard process measures indicative of comprehensive, high-quality primary care. Practices with a large concentration of MDs had the highest estimated labor costs. Practices high in NPs and physician assistants (PAs) were most common in states that grant full scope of practice to NPs. The high-NP/PA configuration was associated with a 17-percentage-point greater probability of facilitating patient visits and a 26-percentage-point greater probability of providing the full bundle of primary care services compared with the high-MD model. Team-based configurations had a 27.7-percentage-point greater probability of providing the full bundle of primary care services. The complex needs of older adults may be best served by team-based practices with a broad provider mix that can provide a range of services in the office and the community.
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Affiliation(s)
- David I Auerbach
- David I. Auerbach is an external adjunct faculty member at the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, in Bozeman, Montana, and is senior director for research and cost trends at the Massachusetts Health Policy Commission, in Boston, Massachusetts
| | - Douglas E Levy
- Douglas E. Levy is an associate professor in the Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, in Boston
| | - Peter Maramaldi
- Peter Maramaldi is a professor in the School of Social Work, Simmons University, in Boston
| | - Robert S Dittus
- Robert S. Dittus is the Albert and Bernard Werthan Professor of Medicine at Vanderbilt University; chief innovation officer and senior vice president for the Vanderbilt Health Affiliated Network; and director of the Geriatric Research, Education, and Clinical Center at the Veterans Affairs Tennessee Valley Healthcare System, in Nashville, Tennessee
| | - Joanne Spetz
- Joanne Spetz is director and Brenda and Jeffrey L. Kang Presidential Chair in Healthcare Finance at the Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco, in San Francisco, California
| | - Peter I Buerhaus
- Peter I. Buerhaus is a professor of nursing and director of the Center for Interdisciplinary Health Workforce Studies, both in the College of Nursing, Montana State University
| | - Karen Donelan
- Karen Donelan is the Stuart H. Altman Chair in U.S. Health Policy at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts. At the time this work was performed, she was a senior scientist at the Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, and an associate professor in the Department of Medicine at Harvard Medical School, in Boston
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36
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Fine DR, Weinstock K, Plakas I, Mackin S, Wright J, Gaeta JM, Donelan K, Baggett TP. Experience with a Mobile Addiction Program among People Experiencing Homelessness. J Health Care Poor Underserved 2021; 32:1145-1154. [PMID: 34421018 DOI: 10.1353/hpu.2021.0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A mobile addiction-focused outreach program designed to improve access to care for people experiencing homelessness was implemented in response to the opioid overdose crisis. This innovative program was readily accepted among participants and can inform the development of similar programs delivering addiction-focused care to people experiencing homelessness elsewhere.
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Barreto EA, Guzikowski S, Michael C, Carter J, Betancourt JR, Tull A, Tan-McGrory A, Donelan K. The role of race, ethnicity, and language in care transitions. Am J Manag Care 2021; 27:e221-e225. [PMID: 34314122 DOI: 10.37765/ajmc.2021.88705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify areas where transition from hospital to community could be improved, with a special focus on racial, ethnic, and language differences. STUDY DESIGN A cross-sectional survey administered by postal mail and bilingual telephone interviewers. METHODS Patients were randomly selected within strata by race, ethnicity, and language proficiency. A total of 224 patients (response rate: 63.5%) who had recently experienced a hospital stay completed the survey. RESULTS Overall, 1 in 4 patients were alone at discharge. More than half of patients with limited English proficiency reported lack of access to medical interpreters and translated materials. We noted significant differences by race, ethnicity, and language in technology access and in patient-reported worries in the posthospital period. Hispanic or Latino patients and patients with limited English proficiency were less likely to report access to a computer and less likely to access the Patient Gateway portal. Black or African American patients were also less likely to use the Patient Gateway portal. Asian patients were more likely to be worried about getting home health services. CONCLUSIONS Our findings highlight the enhanced difficulties that diverse patients may experience when transitioning from hospital to community-based settings. When considering how to best address the complex needs of diverse populations, interventions must be sensitive to the presence or absence of others, potential digital divides, and medical interpretation.
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Affiliation(s)
- Esteban A Barreto
- MGH Equity and Community Health, Massachusetts General Hospital, 55 Fruit St, BUL 127, Boston, MA 02114.
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Carter J, Hassan S, Walton A, Yu L, Donelan K, Thorndike AN. Effect of Community Health Workers on 30-Day Hospital Readmissions in an Accountable Care Organization Population: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2110936. [PMID: 34014324 PMCID: PMC8138690 DOI: 10.1001/jamanetworkopen.2021.10936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Value-based care within accountable care organizations (ACOs) has magnified the importance of reducing preventable hospital readmissions. Community health worker (CHW) interventions may address patients' unmet psychosocial and clinical care needs but have been underused in inpatient and postdischarge care. OBJECTIVE To determine if pairing hospitalized patients with ACO insurance with CHWs would reduce 30-day readmission rates. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted in 6 general medicine hospital units within 1 academic medical center in Boston, Massachusetts. Participants included adults hospitalized from April 1, 2017, through March 31, 2019, who had ACO insurance and were at risk for 30-day readmission based on a hospital readmission algorithm. The main inclusion criterion was frequency of prior nonelective hospitalizations (≥2 in the past 3 months or ≥3 in the 12 months prior to enrollment). Data were analyzed from February 1, 2018, through March 3, 2021. INTERVENTION CHWs met with intervention participants prior to discharge and maintained contact for 30 days postdischarge to assist participants with clinical access and social resources via telephone calls, text messages, and field visits. CHWs additionally provided psychosocial support and health coaching, using motivational interviewing, goal-setting, and other behavioral strategies. The control group received usual care, which included routine care from primary care clinics and any outpatient referrals made by hospital case management or social work at the time of discharge. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day hospital readmissions. Secondary outcomes included 30-day missed primary care physician or specialty appointments. RESULTS A total of 573 participants were enrolled, and 550 participants (mean [SD] age, 70.1 [15.7] years; 266 [48.4%] women) were included in analysis, with 277 participants randomized to the intervention group and 273 participants randomized to the control group. At baseline, participants had a mean (SD) of 3 (0.8) hospitalizations in the prior 12 months. There were 432 participants (78.5%) discharged home and 127 participants (23.1%) discharged to a short rehabilitation stay prior to returning home. Compared with participants in the control group, participants in the intervention group were less likely to be readmitted within 30 days (odds ratio [OR], 0.44; 95% CI, 0.28-0.90) and to miss clinic appointments within 30 days (OR, 0.56; 95% CI, 0.38-0.81). A post hoc subgroup analysis showed that compared with control participants, intervention participants discharged to rehabilitation had a reduction in readmissions (OR, 0.09; 95% CI, 0.03-0.31), but there was no significant reduction for those discharged home (OR, 0.68; 95% CI, 0.41-1.12). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that pairing ACO-insured inpatient adults with CHWs reduced readmissions and missed outpatient visits 30 days postdischarge. The effect was significant for those discharged to short-term rehabilitation but not for those discharged home. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03085264.
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Affiliation(s)
- Jocelyn Carter
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Susan Hassan
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Anne Walton
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Liyang Yu
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Karen Donelan
- Mongan Institute, Massachusetts General Hospital, Boston
- Brandeis University, Waltham, Massachusetts
| | - Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Larsen D, Chu JT, Yu L, Chang Y, Donelan K, Palamara K. Correlating Burnout and Well-being in a Multisite Study of Internal Medicine Residents and Faculty. J Gen Intern Med 2021; 36:1422-1426. [PMID: 33674923 PMCID: PMC8131435 DOI: 10.1007/s11606-021-06653-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Dana Larsen
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Jacqueline T Chu
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Liyang Yu
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Yuchiao Chang
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Donelan
- Health Policy Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Kerri Palamara
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Santoro SL, Campbell A, Cottrell C, Donelan K, Majewski B, Oreskovic NM, Patsiogiannis V, Torres A, Skotko BG. Piloting the use of global health measures in a Down syndrome clinic. J Appl Res Intellect Disabil 2021; 34:1108-1117. [PMID: 33759305 PMCID: PMC8830489 DOI: 10.1111/jar.12866] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/17/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE People with Down syndrome (DS) have a unique medical profile which may impact views of health. We aimed to explore the use of global health measures in DS. METHODS Prospective survey in the Mass General Hospital Down Syndrome Program (MGH DSP) from December 2018 to July 2019 with Patient Reported Outcomes Measurement Information System (PROMIS)® instruments of global health. Analyses included use of scoring manuals, descriptive statistics and dependent samples t test. RESULTS Seventeen adolescents, 48 adults with DS and 88 caregivers returned surveys; 137 were complete. Incomplete responses and notes showed limitations of the instruments in this population. Global health T-scores did not differ from the available comparative standardized scores to these measures from PROMIS® reference population (p > 0.05). CONCLUSIONS In the MGH DSP, pilot global health instruments were completed by some adults with DS and caregivers, with some limitations and scores similar to the PROMIS® reference population.
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Affiliation(s)
- Stephanie L Santoro
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ashlee Campbell
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Clorinda Cottrell
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Karen Donelan
- Survey Research and Implementation Unit, Division of Clinical Research, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Ben Majewski
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Nicolas M Oreskovic
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Vasiliki Patsiogiannis
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Amy Torres
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Brian G Skotko
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Iezzoni LI, Rao SR, Ressalam J, Bolcic-Jankovic D, Agaronnik ND, Donelan K, Lagu T, Campbell EG. Physicians' Perceptions Of People With Disability And Their Health Care. Health Aff (Millwood) 2021; 40:297-306. [PMID: 33523739 PMCID: PMC8722582 DOI: 10.1377/hlthaff.2020.01452] [Citation(s) in RCA: 171] [Impact Index Per Article: 57.0] [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: 01/19/2023]
Abstract
More than sixty-one million Americans have disabilities, and increasing evidence documents that they experience health care disparities. Although many factors likely contribute to these disparities, one little-studied but potential cause involves physicians' perceptions of people with disability. In our survey of 714 practicing US physicians nationwide, 82.4 percent reported that people with significant disability have worse quality of life than nondisabled people. Only 40.7 percent of physicians were very confident about their ability to provide the same quality of care to patients with disability, just 56.5 percent strongly agreed that they welcomed patients with disability into their practices, and 18.1 percent strongly agreed that the health care system often treats these patients unfairly. More than thirty years after the Americans with Disabilities Act of 1990 was enacted, these findings about physicians' perceptions of this population raise questions about ensuring equitable care to people with disability. Potentially biased views among physicians could contribute to persistent health care disparities affecting people with disability.
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Affiliation(s)
- Lisa I Iezzoni
- Lisa I. Iezzoni is a professor of medicine at Harvard Medical School, based at the Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, in Boston, Massachusetts
| | - Sowmya R Rao
- Sowmya R. Rao is a statistician in the Biostatistics Center at Massachusetts General Hospital and at the Boston University School of Public Health
| | - Julie Ressalam
- Julie Ressalam is a senior research coordinator in the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado, in Aurora, Colorado
| | - Dragana Bolcic-Jankovic
- Dragana Bolcic-Jankovic is the director of survey operations and a research fellow in the Center for Survey Research at the University of Massachusetts Boston, in Boston, Massachusetts
| | - Nicole D Agaronnik
- Nicole D. Agaronnik is a medical student at Harvard Medical School. When this work was performed, she was a research assistant in the Mongan Institute Health Policy Center, Massachusetts General Hospital
| | - Karen Donelan
- Karen Donelan is the Stuart H. Altman Chair in U.S. Health Policy at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts. At the time this work was performed, she was a senior scientist at the Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, and an associate professor in the Department of Medicine at Harvard Medical School
| | - Tara Lagu
- Tara Lagu is an associate professor in the Institute for Healthcare Delivery and Population Science and the Department of Medicine at Baystate Health and the University of Massachusetts Medical School, in Springfield, Massachusetts
| | - Eric G Campbell
- Eric G. Campbell is a professor and director of research in the Center for Bioethics and Humanities, Anschutz Medical Campus, University of Colorado
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Chung J, Sarathy A, Hsieh YG, Estey G, Torres A, Patsiogiannis V, Donelan K, Skotko BG. Assessment of Stakeholder Engagement in a Down Syndrome Research Study. J Patient Cent Res Rev 2021; 8:64-67. [PMID: 33511255 DOI: 10.17294/2330-0698.1777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
There is growing recognition of the importance of engaging patients early in the design of research studies. For studies involving patients with intellectual and cognitive disabilities, researchers may consider engaging with family caregivers, health professionals, community advocates, and/or subject matter experts to provide a more multifaceted, surrogate perspective. Evaluating the engagement of these stakeholder groups in research is nascent, and tools are limited. Research studies involving these individuals provide the opportunity to test new methods of measurement of stakeholder engagement in research. We conducted a 3-year research study implementing and evaluating Down Syndrome Clinic to You, an online platform for caregivers of individuals with Down syndrome who do not have access to Down syndrome specialists. We established 3 key stakeholder groups - family caregivers, primary care physicians, and medical/scientific experts in the field - who were involved from grant-writing through preparation of the final report. To assess stakeholder engagement, we utilized the Patient Engagement in Research Scale, a validated instrument originally developed to evaluate patient engagement in arthritis research. Overall, results were suggestive of strong engagement levels by the key stakeholder groups. This study contributes to the limited available literature evaluating measures of stakeholder engagement in research.
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Affiliation(s)
- Jeanhee Chung
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Ashwini Sarathy
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, MA
| | - Yichuan Grace Hsieh
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA.,Department of Medicine, Harvard Medical School, Boston, MA
| | - Greg Estey
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, MA
| | - Vasiliki Patsiogiannis
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, MA
| | - Karen Donelan
- Department of Medicine, Harvard Medical School, Boston, MA.,Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Massachusetts General Hospital, Boston, MA.,Department of Pediatrics, Harvard Medical School, Boston, MA
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43
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Buerhaus PI, Chang Y, DesRoches C, Guzikowski S, Norman L, Donelan K. The roles and clinical activities of registered nurses and nurse practitioners in practices caring for older adults. Nurs Outlook 2021; 69:380-388. [PMID: 33422289 DOI: 10.1016/j.outlook.2020.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/23/2020] [Accepted: 11/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Population aging and physician shortages have motivated recommendations of increased use of registered nurses in care provision; little is known about RN and NP employment in primary care and geriatric practices or service types each provide. PURPOSE Determine current RN and NP employment frequency in practices in the U.S., identify services provided by RNs, and whether NP presence in practice is associated with the types and frequency of services provided by RNs. METHODS National survey of 410 primary care and geriatric clinicians. FINDINGS Only half of practices employed RNs. RNs most frequently provide teaching or education for chronic disease management. RNs provide significantly more primary care and geriatric services when practices employed a NP. DISCUSSION Reasons for RN underuse in practices should be identified, clinical placements in such practices should increase, and NP education programs should include care models using RNs to their full scope of practice.
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Affiliation(s)
- Peter I Buerhaus
- Center for Interdisciplinary Health Workforce Studies, College of Nursing, 206 Anna Pearl Sherrick Hall, Montana State University, Bozeman, MT
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.
| | - Catherine DesRoches
- Harvard Medical School, OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sophia Guzikowski
- Health Policy Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, MA
| | - Linda Norman
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN
| | - Karen Donelan
- Harvard Medical School, Health Policy Research Center, The Mongan Institute, Massachusetts General Hospital, Boston, MA
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44
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Santoro SL, Donelan K, Haugen K, Oreskovic NM, Torres A, Skotko BG. Transition to virtual clinic: Experience in a multidisciplinary clinic for Down syndrome. Am J Med Genet C Semin Med Genet 2021; 187:70-82. [PMID: 33385186 DOI: 10.1002/ajmg.c.31876] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 12/12/2022]
Abstract
The COVID-19 pandemic necessitated a rapid transition from in-person office visits to virtual visits in the Down syndrome specialty program at Massachusetts General Hospital (MGH DSP). We describe the clinic transition to virtual visits in April 2020 and reflect on our six-month experience in virtual visits. Clinic metrics were tracked. Electronic survey responses were collected from caregivers attending virtual visits. Input from the MGH DSP team was collected. From April to September 2020, we maintained patient volume (45 visits per month) and overall satisfaction score (6.7 out of 7) following a sudden, unanticipated transition to virtual visits. Survey of 17 caregivers attending virtual visits found that most were equipped with technology, had access to a private location, and most were able to access visit without any limitations. Caregivers appreciated the convenience of virtual visits but sometimes missed the personal connection of an in-person visit. Overall, though, virtual visits were frequently viewed as no different than office visits. Team members identified benefits and challenges of virtual visits, as well as lessons learned from this transition. We were able to maintain multidisciplinary, specialty care with optimal caregiver feedback and sustained number of patient visits.
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Affiliation(s)
- Stephanie L Santoro
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Karen Donelan
- Survey Research and Implementation Unit, Division of Clinical Research, Massachusetts General Hospital, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelsey Haugen
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicolas M Oreskovic
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Torres
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian G Skotko
- Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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45
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Park ER, Sylvia LG, Streck JM, Luberto CM, Stanton AM, Perez GK, Baim M, Bliss CC, Convery MS, Crute S, Denninger JW, Donelan K, Dossett ML, Fava M, Fredriksson S, Fricchione G, George N, Hall DL, Hart BR, Herman J, Hirschberg A, Holt D, Looby SE, Malloy L, Meek J, Mehta DH, Millstein RA, Mizrach H, Rosa K, Slawsby E, Stupinski AC, Traeger L, Vanderkruik R, Vogeli C, Wilhelm S. Launching a resiliency group program to assist frontline clinicians in meeting the challenges of the COVID-19 pandemic: Results of a hospital-based systems trial. Gen Hosp Psychiatry 2021; 68:111-112. [PMID: 33229013 PMCID: PMC7605784 DOI: 10.1016/j.genhosppsych.2020.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Elyse R. Park
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America,Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America,Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America,Corrresponding author at: Health Policy Research Center, Mongan Institute, Massachusetts Hospital and Harvard Medical School, 100 Cambridge Street, Suite 1600, Boston, MA 02114, USA
| | - Louisa G. Sylvia
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Joanna M. Streck
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America,Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Christina M. Luberto
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America,Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America,Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Amelia M. Stanton
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Giselle K. Perez
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America,Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Margaret Baim
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Cayley C. Bliss
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America
| | - Mary Susan Convery
- Social Service Department, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sydney Crute
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America
| | - John W. Denninger
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America,Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Karen Donelan
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America,Harvard Medical School, Boston, MA, United States of America
| | - Michelle L Dossett
- UC Davis Health, Department of Internal Medicine, Sacramento, CA, United States of America
| | - Maurizio Fava
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Stacie Fredriksson
- Home Base Program, Massachusetts General Hospital, Boston, MA, United States of America
| | - Gregory Fricchione
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America,Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Nevita George
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Daniel L. Hall
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America,Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Betsy Remington Hart
- Home Base Program, Massachusetts General Hospital, Boston, MA, United States of America
| | - John Herman
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - April Hirschberg
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Daphne Holt
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sara E. Looby
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA, United States of America
| | - Laura Malloy
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jocelyn Meek
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Darshan H. Mehta
- Harvard Medical School, Boston, MA, United States of America,Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America,Home Base Program, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rachel A. Millstein
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Helen Mizrach
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America
| | - Katherine Rosa
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ellen Slawsby
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - A. Clare Stupinski
- Home Base Program, Massachusetts General Hospital, Boston, MA, United States of America
| | - Lara Traeger
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rachel Vanderkruik
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
| | - Christine Vogeli
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, United States of America,Harvard Medical School, Boston, MA, United States of America
| | - Sabine Wilhelm
- Harvard Medical School, Boston, MA, United States of America,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States of America
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46
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Cohen CC, Barnes H, Buerhaus PI, Martsolf GR, Clarke SP, Donelan K, Tubbs-Cooley HL. Top priorities for the next decade of nursing health services research. Nurs Outlook 2020; 69:265-275. [PMID: 33386144 DOI: 10.1016/j.outlook.2020.12.004] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/28/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The U.S. health care system faces increasing pressures for reform. The importance of nurses in addressing health care delivery challenges cannot be overstated. PURPOSE To present a Nursing Health Services Research (NHSR) agenda for the 2020s. METHOD A meeting of an interdisciplinary group of 38 health services researchers to discuss five key challenges facing health care delivery (behavioral health, primary care, maternal/neonatal outcomes, the aging population, health care spending) and identify the most pressing and feasible research questions for NHSR in the coming decade. FINDINGS Guided by a list of inputs affecting health care delivery (health information technology, workforce, delivery systems, payment, social determinants of health), meeting participants identified 5 to 6 research questions for each challenge. Also, eight cross-cutting themes illuminating the opportunities and barriers facing NHSR emerged. DISCUSSION The Agenda can act as a foundation for new NHSR - which is more important than ever - in the 2020s.
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Affiliation(s)
| | - Hilary Barnes
- University of Delaware, School of Nursing, Newark, DE
| | - Peter I Buerhaus
- Center for Interdisciplinary Health Workforce Studies, Montana State University College of Nursing, Bozeman, MT
| | - Grant R Martsolf
- University of Pittsburgh School of Nursing, Department of Acute and Tertiary Care, RAND Corporation, Pittsburgh, PA
| | - Sean P Clarke
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Karen Donelan
- Health Policy Research Center, The Mongan Institute, Survey Research and Implementation Unit, Harvard Medical School, Boston, MA
| | - Heather L Tubbs-Cooley
- Martha S. Pitzer Center for Women, Children, and Youth, The Ohio State University College of Nursing, Columbus, OH
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47
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Jimenez R, Johnson A, Horick NK, Hlubocky FJ, Lei YY, Matsen CB, Mayer EL, Collyar DE, LeBlanc TW, Donelan K, Mello M, Peppercorn JM. Oncologist experiences regarding patient-recorded clinical encounters: Implications for the patient-doctor relationship. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.290] [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
290 Background: The high prevalence of smartphone use means that most patients can easily audio record medical consultations. Oncologists’ attitudes towards recording visits are unknown yet may impact patient care. Methods: A mail survey of oncologists practicing at 5 U.S. Alliance for Clinical Trials in Oncology sites collected information on clinicians’ beliefs, preferences, and practices regarding patient-initiated recordings, along with sociodemographic and practice characteristics. Descriptive statistics and bivariate analyses were calculated. Results: Of 523 eligible oncologists, 352 (67%) completed the survey. Median age was 47 years, 33% were female, and 86% worked in an academic setting. 53% were medical oncologists, 30% surgical oncologists, and 17% radiation oncologists. Virtually all (93%) reported experience with patients recording visits, 79% at least weekly. The majority (74%) perceived that patients record visits in order to help understand treatment choices. While 79% reported that they “always” agree to recordings, 26% reported discomfort. Nearly one-third (29%) reported concerns about liability, 26% felt recording made discussion less natural, and 18% felt recording changed the way they conveyed information. Although 86% agreed that patients have the right to record visits, nearly all felt physician permission was required and 53% reported having been previously recorded without permission. Only 51% believed recording had a positive impact on the patient-doctor relationship. One-quarter (28%) felt that recording led to a less detailed conversation and 33% felt it contributed to avoidance of difficult topics, such as prognosis. Most preferred the patient/family taking notes or having access to a written summary. Views did not vary significantly based on practice setting, specialty, or region of the country. Older age and greater years in practice were associated with both greater comfort with recording and the perception that recording has a positive impact on the patient-doctor relationship (p < 0.001). Conclusions: While most oncologists report comfort with audio recording and recognize benefits for patients, a substantial minority have reservations about its impact on clinical discussions and their liability exposure. Adopting clear institutional policies about recording could help address some concerns, such as surreptitious recording, while ensuring that patients’ interests are served.
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Affiliation(s)
| | | | - Nora K. Horick
- Massachusetts General Hospital Biostatistics Center, Boston, MA
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Tanguturi VK, Hidrue MK, Rigotti NA, Lehrhoff S, Donelan K, Del Carmen M, Wasfy JH. Does the addition of a child affect burnout differentially in male and female physicians? J Intern Med 2020; 288:481-483. [PMID: 32596935 DOI: 10.1111/joim.13118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Affiliation(s)
- V K Tanguturi
- From the, Department of Medicine, Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - M K Hidrue
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, MA, USA
| | - N A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Office of Women's Careers, Massachusetts General Hospital, Boston, MA, USA
| | - S Lehrhoff
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, MA, USA
| | - K Donelan
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - M Del Carmen
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, MA, USA.,Division of Gynecologic Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - J H Wasfy
- From the, Department of Medicine, Cardiology Division, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, MA, USA
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49
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Blumenthal KG, Harkness T, Phillips EJ, Ramsey A, Banerji A, Samarakoon U, Stone C, Fu X, Khan DA, Otani I, Camargo CA, Zhang Y, Donelan K, Blumenthal KG, Banerji A, Harkness T, Mancini CM, Samarakoon U, Ahola CM, Judd AD, Arman W, Phillips E, Stone C, Williams K, Osea RE, Ramsey A, Mustafa SS, Blue H, Otani I, Guyer A, Khan D. Patient Characteristics and Concerns about Drug Allergy: A Report from the United States Drug Allergy Registry. The Journal of Allergy and Clinical Immunology: In Practice 2020; 8:2958-2967. [DOI: 10.1016/j.jaip.2020.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
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50
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Chung J, Donelan K, Macklin EA, Schwartz A, Elsharkawi I, Torres A, Hsieh YG, Parker H, Lorenz S, Patsiogiannis V, Santoro SL, Wylie M, Clarke L, Estey G, Baker S, Bauer PE, Bull M, Chicoine B, Cullen S, Frey-Vogel A, Gallagher M, Hasan R, Lamb A, Majewski L, Mast J, Riddell T, Sepucha K, Skavlem M, Skotko BG. A randomized controlled trial of an online health tool about Down syndrome. Genet Med 2020; 23:163-173. [PMID: 32879436 DOI: 10.1038/s41436-020-00952-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE We sought to determine if a novel online health tool, called Down Syndrome Clinic to You (DSC2U), could improve adherence to national Down syndrome (DS) guidelines. We also sought to determine if primary care providers (PCPs) and caregivers are satisfied with this personalized online health tool. METHODS In a national, randomized controlled trial of 230 caregivers who had children or dependents with DS without access to a DS specialist, 117 were randomized to receive DSC2U and 113 to receive usual care. The primary outcome was adherence to five health evaluations indicated by national guidelines for DS. DSC2U is completed electronically, in all mobile settings, by caregivers at home. The outputs-personalized checklists-are used during annual wellness visits with the patient's PCP. RESULTS A total of 213 participants completed a 7-month follow-up evaluation. In the intention-to-treat analysis, the intervention group had a 1.6-fold increase in the number of indicated evaluations that were recommended by the primary care provider or completed compared with controls. Both caregivers and PCPs reported high levels of satisfaction with DSC2U. CONCLUSIONS DSC2U improved adherence to the national DS health-care guidelines with a novel modality that was highly valued by both caregivers and PCPs.
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Affiliation(s)
- Jeanhee Chung
- Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Karen Donelan
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Eric A Macklin
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alison Schwartz
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ibrahim Elsharkawi
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Amy Torres
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Yichuan Grace Hsieh
- Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Holly Parker
- Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen Lorenz
- Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vasiliki Patsiogiannis
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Stephanie L Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mark Wylie
- Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lloyd Clarke
- Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Greg Estey
- Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandra Baker
- Down Syndrome Association of Los Angeles, Los Angeles, CA, USA
| | | | - Marilyn Bull
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brian Chicoine
- Advocate Medical Group Adult Down Syndrome Center, Park Ridge, IL, USA
| | - Sarah Cullen
- Massachusetts Down Syndrome Congress, Boston, MA, USA
| | - Ariel Frey-Vogel
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Reem Hasan
- Department of Internal Medicine and Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Ashley Lamb
- Health and Wellness, University of New Hampshire, Durham, NH, USA
| | | | | | - Travis Riddell
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Karen Sepucha
- Health Decision Sciences Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
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