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Krishnappa V, Ludwick R, Sompalle S, Baughman KR. Impact of Chronic Conditions, Healthcare Utilization, and Demographics on Advance Care Planning. Am J Hosp Palliat Care 2023; 40:378-386. [PMID: 36202631 DOI: 10.1177/10499091221132286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Unraveling the intricacies of what factors influence advance care planning (ACP) is an ongoing research challenge. Research shows much ACP is crisis-based and takes place at the end of life. Complicating this late-stage approach may be demographic differences based on race, ethnicity and socioeconomic status. Objective: We examined the relationship between demographic factors, chronic health conditions, and healthcare utilization in predicting who was most likely to engage in ACP activities, including designating a durable power of attorney for healthcare (DPOAHC), having a living will, and discussing wishes with family or others. Methods: We conducted a secondary analysis using 2018 Health and Retirement Study (HRS) exit data provided by a proxy for the deceased participant that matched the 2016 survey participant data (N = 884). Generalized linear mixed models were used for the analysis. Results: The number of chronic health conditions and healthcare utilization were not associated with ACP activities, but several of the demographic variables showed strong associations. Participants who were female, white, older, and from a higher socioeconomic status were more likely to have engaged in ACP. Conclusion: People continue to defer ACP discussions and documentation end of life or when facing medical crises. More needs to be done to reach out to younger adults, racial minorities, and those with lower socioeconomic status to encourage them to engage in ACP.
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Affiliation(s)
- Vinod Krishnappa
- Department of Internal Medicine, University of North Carolina Health Southeastern, Lumberton, NC, USA
| | - Ruth Ludwick
- College of Nursing, 4229Kent State University, Kent, OH, USA
| | - Saiaravind Sompalle
- College of Medicine, 6969Northeast Ohio Medical University, Rootstown, OH, USA
| | - Kristin R Baughman
- Department of Family and Community Medicine, 6969Northeast Ohio Medical University, Rootstown, OH, USA
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Ludwick R, Baughman KR. Education, Policy, and Advocacy in Predicting Use of Do-Not-Hospitalize Orders in Skilled Nursing Facilities. J Gerontol Nurs 2022; 48:45-52. [PMID: 36286504 DOI: 10.3928/00989134-20221003-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nurses and social workers are uniquely positioned to advocate for patients' wishes for do-not-hospitalize (DNH) directives. The purpose of the current study was to explore the impact of DNH education, policy, and advocacy on the use of DNH orders by nurses (RNs and licensed practical nurses [LPNs]) and social workers employed in skilled nursing facilities (SNFs). This multisite secondary analysis used cross-sectional survey data and analyzed responses of RNs, LPNs, and social workers (N = 354) from 29 urban SNFs. Mixed model regression was used to examine possible predictors of frequency of DNH orders within SNFs while adjusting for random effects. Results showed that having a DNH written policy, education on DNH orders, and having an advanced care planning advocate in the facility were strongly associated with a higher reported frequency of DNH discussions with residents and their families (p < 0.01 for each variable). [Journal of Gerontological Nursing, 48(11), 45-52.].
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Baughman KR, Ludwick R, Jarjoura D, Yeager M, Kropp D. Multi-Site Study of Provider Self-Efficacy and Beliefs in Explaining Judgments About Need and Responsibility for Advance Care Planning. Am J Hosp Palliat Care 2021; 38:1276-1281. [PMID: 33291962 PMCID: PMC8490652 DOI: 10.1177/1049909120979977] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We examined the impact of advance care planning (ACP) self-efficacy and beliefs in explaining skilled nursing facility (SNF) provider judgments about resident need and provider responsibility for initiating ACP conversations. RESEARCH DESIGN AND METHODS This observational multi-site study of 348 registered nurses, licensed practical nurses, and social workers within 29 SNFs used an anonymous survey in which providers judged vignettes with assigned situational features of a typical SNF resident. Mixed modeling was used to analyze the vignette responses. RESULTS Providers who had more negative beliefs about ACP were less likely to judge residents in need of ACP and less likely to feel responsible for ensuring ACP took place. Self-efficacy did not have a significant impact on judgments of need, but did significantly increase judgments of responsibility for ensuring ACP conversations. Providers with the highest levels of ACP self-efficacy were most likely to feel responsible for ensuring ACP conversations. In an exploratory analysis, these relationships remained the same whether responding to high or low risk residents (i.e., based on risk of hospitalization, type of diagnosis, functional status, and rate of declining health). DISCUSSION AND IMPLICATIONS Both negative beliefs about ACP and self-efficacy in one's ability to conduct ACP discussions were associated with professional judgments regarding ACP. The findings illustrate the importance of addressing negative beliefs about ACP and increasing provider ACP self-efficacy through education and policies that empower nurses and social workers.
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Affiliation(s)
- Kristin R. Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Ruth Ludwick
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Kent State University, OH, USA
| | | | - Mia Yeager
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Denise Kropp
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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Johnson CT, Fischbein R, Baughman KR. Geospatial Analysis of Rurality and Food Banks in Appalachian Ohio. J Appalach Health 2021; 3:110-119. [PMID: 35770029 PMCID: PMC9192117 DOI: 10.13023/jah.0303.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Food insecurity is a problem for individuals across Ohio, including those living in Appalachia. Adequate access to resources that help combat food insecurity is important for these populations. Purpose To examine how rurality relates to food insecurity and need for food resources, as well as availability of those resources including food pantries and soup kitchens, in 15 northern Ohio Appalachian counties. Methods A cross-sectional study with a geographical analysis was conducted using data from the American Community Survey census data, County Health Rankings data, and regional foodbank websites. Results Rural counties had a higher ratio of potential clients per service for food insecurity than did non-rural counties. They also had slightly more children eligible for free or reduced-price lunches than non-rural counties. However, the non-rural counties had slightly higher percentages of residents classified as food insecure and with limited access to healthy food. Implications There are more potential clients per service for food insecurity in rural counties compared to non-rural counties. To promote greater access, additional food pantries should be opened in rural counties.
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Blackie M, Baughman KR, Palmisano B, Sanders M, Sperling D, Scott E, Radwany S, Drost J, Thomas J. Building Provider-Caregiver Partnerships: Curricula for Medical Students and Residents. Acad Med 2019; 94:1483-1488. [PMID: 31135398 DOI: 10.1097/acm.0000000000002806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PROBLEM A disconnect exists between caregivers and health care providers, resulting in fragmented communication, which increases caregiver stress and compromises patient care. Although providers have a responsibility to recognize caregiver burden, they receive scant training on issues important to caregivers. APPROACH From 2014 to 2017, as part of the Building Caregiver Partnerships Through Interprofessional Education project-a collaborative effort between Northeast Ohio Medical University and Summa Health-the authors developed curricula to foster effective partnerships between health care providers and caregivers by exposing medical students and residents to highly personal caregiving narratives. The curricula center on a short film featuring 4 families representing diverse caregiving experiences. The authors crafted several discussion guides, case-based learning exercises, structured clinical encounters, team-based simulations, and clinical cases as companion educational tools for the film. OUTCOMES Medical students reported the educational tools piloted to be valuable in broadening their understanding of caregivers' needs, while residents reported the educational tools piloted to also be valuable in improving their communication and building partnerships with caregivers. Undergraduate and graduate faculty reported finding the pilots valuable. NEXT STEPS Future goals include conducting an outcome evaluation, based on ACGME milestones, to identify and examine clinical outcomes to determine whether communication increases and quality of care improves as a result of the project. The authors would also like to include caregivers in the evaluation. Finally, because caregiving is best addressed from a team approach, the authors plan to pilot the project at other health professions programs.
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Affiliation(s)
- Michael Blackie
- M. Blackie is associate professor, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois. K.R. Baughman is associate professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. B. Palmisano is assistant professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. M. Sanders is associate professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. D. Sperling is associate professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio. E. Scott is attending physician, Massachusetts General Hospital, Boston, Massachusetts. S. Radwany is professor, Departments of Medicine and Hospice and Palliative Medicine, The Ohio State University, Columbus, Ohio. J. Drost is geriatric fellowship associate program director, Senior Services, Summa Health, Akron, Ohio. J. Thomas is professor, Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio
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Baughman KR, Palmisano B, Sanders M, Blackie M, Sperling D, Scott E, Radwany S, Drost J. Use of Film to Sensitize Medical Students to Issues of Family Caregiving. PRiMER 2019; 3:14. [PMID: 32537585 DOI: 10.22454/primer.2019.254302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background and Objective Families are the backbone of our long-term care system, managing complicated illnesses, providing direct care, and assisting with the day-to-day functioning of elderly patients. Medical education, however, provides students with little, if any, exposure to the challenges faced by family caregivers or how best to communicate with them to optimize patient care. We assessed the value of an educational program combining film and discussion as a means of sensitizing third-year medical students to caregiver issues. During their family medicine clerkship, third-year medical students at Northeast Ohio Medical University view the film, No Roadmap: Caregiver Journeys and discuss issues of family caregiving. Methods A mixed-methods approach was used to evaluate the program, including a qualitative focus group with clerkship preceptors and ongoing quantitative student evaluations. Results Preceptors reported that students related to the film in highly personal ways, often recounting experiences within their own families, and gained a greater appreciation of caregivers. Three years of student evaluations (n=403) were used to validate preceptor comments. Students agreed that the program helped them establish a comfortable relationship with caregivers, increased their awareness of caregiver challenges and rewards, and provided valuable insights into caregiver experiences. Conclusions Film depicting compelling narratives of caregiver journeys, coupled with guided discussion, is a valuable strategy for increasing student awareness of the important role of caregivers.
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Affiliation(s)
- Kristin R Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Barbara Palmisano
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Margaret Sanders
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Michael Blackie
- Department of Medical Education, University of Illinois at Chicago, College of Medicine, Chicago, IL
| | - David Sperling
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Erin Scott
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA
| | - Steven Radwany
- Division of Palliative Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
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Baughman KR, Ludwick R, Jarjoura D, Kropp D, Shenoy V. Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments. Gerontologist 2019; 59:338-346. [PMID: 28958015 DOI: 10.1093/geront/gnx129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/28/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. We examined the professional judgments of SNF providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed and feelings of responsibility for ensuring ACP discussions. RESEARCH DESIGN AND METHODS Nurses and social workers (n = 350) within 29 urban SNFs completed surveys and rated vignettes describing eight typical SNF residents. Linear mixed modeling was used to examine factors that impacted ratings of need for ACP and responsibility for ensuring ACP. RESULTS Neither the race of the provider, resident, nor the interaction of the two were associated with either outcome variable. In contrast, providers rated (on a 9-point scale) residents at high risk for hospitalization as more in need of ACP (estimate = 0.86, confidence interval [CI] 0.65, 1.07) and felt more responsible for ensuring ACP (estimate = 0.60, CI 0.42, 0.78). DISCUSSION AND IMPLICATIONS Research on ACP is continuing to evolve and these results show the primacy of disease trajectory variables on providers' judgments about ACP. Differences between providers indicate a need for stronger policies and education. Further, research comparing rural, suburban, and urban SNFs is needed to explore possible forms of structural racism such as residential and SNF segregation.
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Affiliation(s)
- Kristin R Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown
| | - Ruth Ludwick
- Nursing Administration, University Hospitals Portage Medical Center Ravenna, Ohio
- College of Nursing, Kent State University, Ohio
| | | | - Denise Kropp
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown
| | - Vimal Shenoy
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown
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Aultman J, Baughman KR, Ludwick R. A broader understanding of care managers' attitudes of advance care planning: A concurrent nested design. J Clin Nurs 2018; 27:3572-3582. [PMID: 29775994 DOI: 10.1111/jocn.14531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine barriers of advance care planning (ACP) experienced by care managers (CMs) through a mixed methods approach. A concurrent nested design was used to acquire a deeper understanding of ACP and to identify nuances between quantitative and qualitative data. BACKGROUND Past quantitative studies on providers have identified barriers related to time, culture, knowledge, responsibility and availability of legal documents. These barriers, and accompanying attitudes and feelings, have been taken at face value without rich qualitative data to identify under what conditions and to what extent a barrier impacts care. DESIGN A two-part multisite, mixed methods study was conducted using surveys and focus groups. METHODS Surveys were completed by 458 CMs at 10 Area Agencies on Aging and 62 participated in one of eight focus groups. Data were analysed using a concurrent nested design with individual data analysis and a merged data approach. RESULTS There were three main distinctions between the quantitative and qualitative data. First, while CMs reported on the survey that ACP was not too time consuming, focus group data revealed that time was an issue especially related to competing priorities. Second on the survey 60% of the CMS reported they had enough knowledge, but qualitative data revealed about more nuances. Last, the reported comfort levels in the quantitative data were less overt in the qualitative date where additional feelings and attitudes were revealed, for example, frustration with families, preferences for more physician involvement. CONCLUSIONS Care managers reported their attitudes about ACP, clarified through a rigorous mixed methods analysis. Care managers can successfully lead ACP discussions, but require further education, resources and team-based guidance. RELEVANCE TO CLINICAL PRACTICE Advance care planning is essential for reducing emotional, social and financial burdens associated with healthcare decision-making, and CMs can positively impact ACP discussions when appropriately supported by the clinical community. The many nuances in the ACP process that we found illustrate the need for ongoing discussions, education and research on this important topic.
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Affiliation(s)
- Julie Aultman
- Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Kristin R Baughman
- Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Ruth Ludwick
- College of Nursing, Kent State University, Kent, Ohio
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Baughman KR, Bonfine N, Dugan SE, Adams R, Gallagher M, Olds RS, Piatt E, Ritter C. Disease Burden Among Individuals with Severe Mental Illness in a Community Setting. Community Ment Health J 2016; 52:424-32. [PMID: 26611625 DOI: 10.1007/s10597-015-9973-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 11/13/2015] [Indexed: 11/25/2022]
Abstract
This study examines the prevalence of comorbid physical health conditions within a community sample of individuals with severe mental illness (SMI), compares them to a matched national sample without SMI, and identifies which comorbidities create the greatest disease burden for those with SMI. Self-reported health status, co-morbid medical conditions and perceived disease burden were collected from 203 adults with SMI. Prevalence of chronic health conditions was compared to a propensity-matched sample without SMI from the National Comorbidity Survey-Replication (NCS-R). Compared to NCS-R sample without SMI, our sample with SMI had a higher prevalence of seven out of nine categories of chronic health conditions. Chronic pain and headaches, as well as the number of chronic conditions, were associated with increased disease burden for individuals with SMI. Further investigation of possible interventions, including effective pain management, is needed to improve the health status of this population.
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Affiliation(s)
- Kristin R Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA.
| | - Natalie Bonfine
- Department of Psychiatry, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Sara E Dugan
- Pharmacy Practice Department, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
| | - Richard Adams
- Department of Sociology, Kent State University, 215 Merrill Hall, PO Box 5190, Kent, OH, 44242, USA
| | - Mary Gallagher
- Department of Sociology, Kent State University at Stark, 6000 Frank Ave NW, North Canton, OH, 44720, USA
| | - R Scott Olds
- Department of Family and Community Medicine, University of New Mexico, 1 University of New Mexico Bldg 177, Albuquerque, NM, 87131, USA
| | - Elizabeth Piatt
- Department of Sociology, Hiram College, 6832 Hinsdale St, Hiram, OH, 44234, USA
| | - Christian Ritter
- Department of Psychiatry, Northeast Ohio Medical University, 1409 State Route 44, PO Box 95, Rootstown, OH, 44272, USA
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Baughman KR, Ludwick R, Fischbein R, McCormick K, Meeker J, Hewit M, Drost J, Kropp D. Development of a Scale to Assess Physician Advance Care Planning Self-Efficacy. Am J Hosp Palliat Care 2016; 34:435-441. [DOI: 10.1177/1049909115625612] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Although patients prefer that physicians initiate advance care planning (ACP) conversations, few physicians regularly do so. Physicians may be reluctant to initiate ACP conversations because they lack self-efficacy in their skills. Yet, no validated scale on self-efficacy for ACP exists. Our objective was to develop a scale that measures physicians’ ACP self-efficacy (ACP-SE) and to investigate the validity of the tool. Methods: Electronic questionnaires were administered to a random sample of family medicine physicians (n = 188). Exploratory factor analysis was performed to determine whether the scale was multidimensional. An initial assessment of the scale’s validity was also conducted. Results: The exploratory factor analysis indicated that a single factor was appropriate using all 17 items. A single, unidimensional scale was created by averaging the 17 items, yielding good internal consistency (Cronbach α = 0.95). The average scale score was 3.94 (standard deviation = 0.71) on a scale from 1 to 5. The scale was moderately correlated with a global single-item measure of self-efficacy for ACP ( r = .79, P < .001), and the scale differentiated between physician groups based on how much ACP they were doing, how recently they had an ACP conversation, formal training on ACP, and knowledge of ACP. In a multivariate analysis, the ACP-SE scale was a strong predictor of the percentage of patients with chronic life-limiting diseases with whom the physician discussed ACP. Conclusion: The final ACP-SE scale included 17 items and demonstrated high internal consistency.
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Affiliation(s)
- Kristin R. Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Ruth Ludwick
- Nursing Research, University Hospitals Portage Medical Center, University Hospitals Portage Medical Center, Ravenna, OH, USA
- College of Nursing, Kent State University, Kent, OH, USA
| | - Rebecca Fischbein
- Department of Health Policy and Management, College of Public Health, Kent State University, Kent, OH, USA
| | - Kenelm McCormick
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Family Practice Center, Summa Barberton Hospital, Barberton, OH, USA
- HMC Hospice of the Western Reserve, Cleveland, OH, USA
| | - James Meeker
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Mike Hewit
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Jennifer Drost
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Summa Health System Senior and Post-Acute Services, Akron, OH, USA
| | - Denise Kropp
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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Baughman KR, Burke RC, Hewit MS, Sudano JJ, Meeker J, Hull SK. Associations between Difficulty Paying Medical Bills and Forgone Medical and Prescription Drug Care. Popul Health Manag 2015; 18:358-66. [DOI: 10.1089/pop.2014.0128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristin R. Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Ryan C. Burke
- College of Public Health, Kent State University, Kent, Ohio
| | - Michael S. Hewit
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Joseph J. Sudano
- Epidmiology and Biostatistics, Case Western Reserve University School of Medicine, Center for Health Care Research and Policy, Case Western Reserve University and The MetroHealth System, Cleveland, Ohio
| | - James Meeker
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Sharon K. Hull
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, North Carolina
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Baughman KR, Ludwick R, Palmisano B, Hazelett S, Sanders M. The Relationship Between Organizational Characteristics and Advance Care Planning Practices. Am J Hosp Palliat Care 2014; 32:510-5. [DOI: 10.1177/1049909114530039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Organizational characteristics may impede the uniform adoption of advance care planning (ACP) best practices. We conducted telephone interviews with site directors of a Midwestern state’s Medicaid waiver program administered by the Area Agencies on Aging and surveyed the 433 care managers (registered nurses and social workers) employed within these 9 agencies. Care managers at 2 agencies reported more frequent ACP discussions and higher levels of confidence. Both sites had ACP training programs, follow-up protocols, and informational packets available for consumers that were not consistently available at the other agencies. The findings point to the need for consistent educational programs and policies on ACP and more in depth examination of the values, beliefs, and resources that account for organizational differences in ACP.
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Affiliation(s)
- Kristin R. Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | | | - Barbara Palmisano
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Susan Hazelett
- Health Services Research and Education Institute, Summa Health System, Akron, OH, USA
| | - Margaret Sanders
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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Abstract
Our objective was to better understand the values and ethical dilemmas surrounding advance care planning through stories told by registered nurses and licensed social workers, who were employed as care managers within Area Agencies on Aging. We conducted eight focus groups in which care managers were invited to tell their stories and answer open-ended questions focusing on their interactions with consumers receiving home-based long-term care. Using narrative analysis to understand how our participants thought through particular experiences and what they valued, we identified seven themes representative of their work with consumers and families: humility, respect, responsibilities, boundaries, empowerment, courage, and veracity.
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Hazelett S, Baughman KR, Palmisano BR, Sanders M, Ludwick RE. Factors Associated With Advance Care Planning Discussions by Area Agency on Aging Care Managers. Am J Hosp Palliat Care 2013; 30:759-63. [DOI: 10.1177/1049909112475153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Initiating advance care planning (ACP) discussions in the home may prevent avoidable hospitalizations by elucidating goals of care. Area agencies on aging care managers (AAACMs) work in the home with high-risk consumers. Purpose: To determine which AAACM characteristics contribute to an increased frequency of ACP discussions. Method: Cross-sectional investigator-generated surveys administered to AAACMs at 3 AAAs in Ohio. Results: Of 289 AAACMs, 182 (63%) responded. The more experience and comfort AAACMs felt with ACP discussions, the more likely they were to initiate ACP discussions. Discussion: It may be necessary to build interactive educational experiences where, for example, AAACMs are asked to fill out their own advance directives and/or facilitate others in ACP discussions to improve experience and comfort with ACP discussions.
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Affiliation(s)
| | - Kristin R. Baughman
- Department of Family & Community Medicine, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Barbara R. Palmisano
- Department of Family & Community Medicine, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Margaret Sanders
- Department of Family & Community Medicine, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Ruth E. Ludwick
- Nursing Research, Summa Robinson Memorial Hospital, Ravenna, OH, USA
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Baughman KR, Ludwick R, Merolla D, Palmisano B, Hazelett S, Allen KR, Sanders M. Disentangling Consumer and Provider Predictors of Advance Care Planning. Am J Hosp Palliat Care 2012; 30:717-25. [PMID: 23125397 DOI: 10.1177/1049909112464692] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Factorial surveys were used to examine community-based long-term care providers' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP. These variables explained 10% of the variance in judgments. Providers' beliefs about ACP predicted judgments of need for ACP and comfort level in discussing ACP. Provider characteristics explained more variance in comfort levels (44%) than in judgments of need (20%). This study demonstrates the need for tailored educational programs to increase comfort levels and address ACP misconceptions.
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Affiliation(s)
- Kristin R Baughman
- 1Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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Logue EE, Jarjoura DG, Sutton KS, Smucker WD, Baughman KR, Capers CF. Longitudinal Relationship between Elapsed Time in the Action Stages of Change and Weight Loss. ACTA ACUST UNITED AC 2012; 12:1499-508. [PMID: 15483215 DOI: 10.1038/oby.2004.187] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study was to examine the longitudinal relationship between the elapsed time in the action and maintenance stages of change for multiple target behaviors and weight loss or gain. RESEARCH METHODS AND PROCEDURES The research design was a prospective cohort study of overweight and obese primary care patients randomized to an obesity management intervention based on the Transtheoretical Model and a chronic disease paradigm. The target behaviors included increased planned exercise and usual physical activity, decreased dietary fat, increased fruit and vegetable consumption, and increased dietary portion control. The participants were 329 middle-aged men and women with elevated body mass indices recruited from 15 primary care practices in Northeastern Ohio; 28% of the participants were African Americans. The main outcomes were weight loss (5% or more) or weight gain (5% or more) after 18 or 24 months of follow-up. RESULTS There were significant (p < 0.05) longitudinal relationships between the number of periods (0 to 4) in action or maintenance for each of the five target behaviors, or a composite score taken across the five target behaviors, and weight loss. In all cases, there was a significant (p < 0.05) stepped (graded) relationship between the time in action or maintenance and weight loss (or gain). DISCUSSION The data support the concept of applying the Transtheoretical Model to the problem of managing obesity in primary care settings. The remaining challenge is to identify those factors that reliably move patients into the action and maintenance stages for long periods.
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Affiliation(s)
- Everett E Logue
- Department of Family Practice, Summa Health System, 525 East Market Street, Suite 290, Akron, OH 44309-2090, USA.
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Baughman KR, Ludwick RE, Merolla DM, Palmisano BR, Hazelett S, Winchell J, Hewit M. Professional judgments about advance care planning with community-dwelling consumers. J Pain Symptom Manage 2012; 43:10-9. [PMID: 21763100 DOI: 10.1016/j.jpainsymman.2011.03.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 03/12/2011] [Accepted: 03/15/2011] [Indexed: 10/18/2022]
Abstract
CONTEXT There is limited research on how community-based long-term care (CBLTC) providers' personal characteristics and attitudes affect their decisions to initiate advance care planning (ACP) conversations with consumers. OBJECTIVES To examine judgments by CBLTC providers as to whether a consumer was in need of ACP and to compare the relative influence of situational features of the consumer with the influence of personal characteristics of the CBLTC provider. METHODS Factorial surveys with vignettes with randomly assigned situational features of a hypothetical consumer were obtained from 182 CBLTC providers at three Area Agencies on Aging located in the Midwestern U.S. Measures included the consumer's situational features, such as demographics, diagnosis, pain level, level of functioning, and caregiver involvement. Personal characteristics of the CBLTC provider included demographics, discipline, past experience with ACP, and attitudes toward ACP. RESULTS Hierarchical linear models indicated that most variability in ACP decisions was the result of differences among CBLTC providers (64%) rather than consumers' situational features. Positive decisions to discuss ACP were associated with consumers who needed assistance with legal issues and had a cancer diagnosis; these variables explained 8% of the vignette level variance. Significant personal characteristics of the CBLTC provider included a nursing background, less direct contact with consumers, past experience with ACP, and positive attitudes toward ACP; these variables explained 41% of the person-level variance. CONCLUSION This study shows the lack of normative consensus about ACP and highlights the need for consistent educational programs regarding the role of the CBLTC provider in the ACP process.
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Affiliation(s)
- Kristin R Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA.
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Baughman KR, Aultman J, Hazelett S, Palmisano B, O'Neill A, Ludwick R, Sanders M. Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process. J Gerontol Soc Work 2012; 55:721-737. [PMID: 23078607 DOI: 10.1080/01634372.2012.708389] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.
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Affiliation(s)
- Kristin R Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA.
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Abstract
Contradictory results have been reported for the association between antidepressant use and Restless Legs Syndrome (RLS). Our aim was to clarify the relationship and examine possible gender differences. We interviewed 1,693 veterans receiving primary care from the Cleveland VA Medical Center and obtained prescription drug information from their medical records. Overall, use of an antidepressant was associated with RLS for men (RR = 1.77, CI = 1.26, 2.48) but not for women (RR = 0.79, CI = 0.43, 1.47). Analyses of individual antidepressants revealed an association between RLS and fluoxetine for women (RR = 2.47, CI = 1.33, 4.56), and associations between RLS and citalopram, (RR = 2.09, CI = 1.20, 3.64), paroxetine (RR = 1.97, CI = 1.02, 3.79), and amitriptyline (RR = 2.40, CI = 1.45, 4.00) for men. We conclude that RLS may be associated with antidepressant use, but the association varies by gender and type of antidepressant. Antidepressant use is more strongly associated with RLS in men than in women.
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Affiliation(s)
- Kristin R Baughman
- Department of Behavioral and Community Health Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, Ohio 44272, USA.
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Abstract
OBJECTIVES We evaluated a fully structured interview for restless legs syndrome (RLS) for potential use in primary care settings and in epidemiological research. METHODS Seventy-four veterans were recruited at Veterans Affairs outpatient clinics. The interview was administered telephonically by trained non-clinicians (time 1) and readministered face to face (time 2). A physician conducted gold standard examinations. We calculated sensitivity, specificity and reproducibility. RESULTS Reproducibility was low (kappa = 0.34, P < 0.01), but was higher for interviews repeated within 1 year (kappa = 0.55, P < 0.01). Including those reporting > or =3 symptoms as cases, sensitivity ranged from 63% (time 1) to 75% (time 2). Specificity ranged from 88% to 71%. CONCLUSIONS The sensitivity and specificity reported here are lower than previously reported in specialty care. This interview for RLS might be useful for preliminary screening of patients with related complaints if followed by additional diagnostic maneuvers or might be used in observational epidemiological research.
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Affiliation(s)
- C C Bourguet
- Department of Community Health Sciences, Northeastern Ohio Universities College of Medicine, Rootstown, OH, USA
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Bourguet CC, Steiner RP, Ober SK, Baughman KR, Shapiro HD. 363: Insomnia and Daytime Sleepiness: Risk Attributable to Restless Legs Syndrome, BMI, Smoking, and Alcohol Among VA Outpatients. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s91b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C C Bourguet
- NEOhio Universities College of Medicine, Rootstown, OH 44272
| | - R P Steiner
- NEOhio Universities College of Medicine, Rootstown, OH 44272
| | - S K Ober
- NEOhio Universities College of Medicine, Rootstown, OH 44272
| | - K R Baughman
- NEOhio Universities College of Medicine, Rootstown, OH 44272
| | - H D Shapiro
- NEOhio Universities College of Medicine, Rootstown, OH 44272
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