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Ramraj R, Garcia A, Mosen D, Waiwaiole L, Smith N. Utility of Fecal Calprotectin in Evaluation of Chronic Gastrointestinal Symptoms in Primary Care. Clin Pediatr (Phila) 2018; 57:1058-1063. [PMID: 29192504 DOI: 10.1177/0009922817744607] [Citation(s) in RCA: 9] [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] [Indexed: 01/26/2023]
Abstract
Fecal calprotectin (FC) is a marker of intestinal inflammation. Data are limited on utility of routine FC testing in pediatric primary care. Participants 0 to 18 years old who had an FC test in the years 2010-2014 were retrospectively identified. Those with less than a year of follow-up or a prior diagnosis of inflammatory bowel disease (IBD) were excluded. In all, 84% (689/822) had normal FC; no participant with normal FC was diagnosed with IBD in the subsequent 12 months. Also, 16% (133/822) had elevated FC, and 31% of those (42/133) were diagnosed with IBD. FC values for IBD and non-IBD groups were 1084 µg/g (interquartile range [IQR] = 514.4-2000) and 27.05 µg/g (IQR = 15.6-62.6; P < .001), respectively. Abdominal pain was the primary indication. In this cohort, sensitivity of FC for IBD is 100%, and specificity is 88%. The FC test can be an excellent tool in the primary care setting to exclude IBD and avoid unnecessary referrals and colonoscopies.
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Affiliation(s)
- Ramya Ramraj
- 1 Kaiser Permanente Northwest, Portland, OR, USA.,2 Oregon Health & Science University, Portland, OR, USA
| | - Amy Garcia
- 2 Oregon Health & Science University, Portland, OR, USA
| | - David Mosen
- 3 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Lisa Waiwaiole
- 3 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Ning Smith
- 3 Kaiser Permanente Center for Health Research, Portland, OR, USA
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Banegas MP, Dickerson JF, Kent EE, de Moor JS, Virgo KS, Guy GP, Ekwueme DU, Zheng Z, Nutt S, Pace L, Varga A, Waiwaiole L, Schneider J, Robin Yabroff K. Exploring barriers to the receipt of necessary medical care among cancer survivors under age 65 years. J Cancer Surviv 2018; 12:28-37. [PMID: 28852970 PMCID: PMC6993114 DOI: 10.1007/s11764-017-0640-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 12/07/2016] [Accepted: 08/19/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE With increasing cancer care costs and greater patient cost-sharing in the USA, understanding access to medical care among cancer survivors is imperative. This study aims to identify financial, psychosocial, and cancer-related barriers to the receipt of medical care, tests, or treatments deemed necessary by the doctor or patient for cancer among cancer survivors age < 65 years. METHODS We used data on 4321 cancer survivors aged 18-64 years who completed the 2012 LIVESTRONG Survey. Multivariable logistic regression was used to identify risk factors associated with the receipt of necessary medical care, including sociodemographic, financial hardship, debt amount, caregiver status, and cancer-related variables. RESULTS Approximately 28% of cancer survivors were within 1 year, and 43% between 1 and 5 years, since their last treatment at the time of survey. Nearly 9% of cancer survivors reported not receiving necessary medical care. Compared to survivors without financial hardship, the likelihood of not receiving necessary medical care significantly increased as the amount of debt increased among those with financial hardship (RRFinancial hardship w/< $10,000 debt = 1.94, 95% CI 1.55-2.42, and RR RRFinancial hardship w/≥ $10,000 debt = 3.41, 95% CI 2.69-4.33, p < 0.001). Survivors who reported lack of a caregiver, being uninsured, and not receiving help understanding medical bills were significantly more likely to not receive necessary medical care. CONCLUSION We identified key financial and insurance risk factors that may serve as significant barriers to the receipt of necessary medical care among cancer survivors age < 65 in the USA IMPLICATIONS FOR CANCER SURVIVORS: The majority of cancer survivors reported receiving medical care either they or their doctors deemed necessary. However, identifying potentially modifiable barriers to receipt of necessary medical cancer care among cancer survivors age < 65 is imperative for developing interventions to ensure equitable access to care and reducing cancer disparities.
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Affiliation(s)
- Matthew P Banegas
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
| | - John F Dickerson
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Gery P Guy
- Division of Cancer Prevention and Control, U.S Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, U.S Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zhiyuan Zheng
- Economics & Healthcare Delivery Research, American Cancer Society, Atlanta, GA, USA
- School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | | | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Lisa Waiwaiole
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Jennifer Schneider
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - K Robin Yabroff
- Office of the Assistant Secretary for Planning and Evaluation, Washington, DC, USA
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Cruvinel E, Richter KP, Stoney C, Duffy S, Fellows J, Harrington KF, Rigotti NA, Sherman S, Tindle HA, Shireman TI, Shelley D, Waiwaiole L, Cummins S. CHARTing a Path to Pragmatic Tobacco Treatment Research. Am J Prev Med 2016; 51:630-6. [PMID: 27647063 PMCID: PMC5919279 DOI: 10.1016/j.amepre.2016.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION It is important to consider the degree to which studies are explanatory versus pragmatic to understand the implications of their findings for patients, healthcare professionals, and policymakers. Pragmatic trials test the effectiveness of interventions in real-world conditions; explanatory trials test for efficacy under ideal conditions. The Consortium of Hospitals Advancing Research on Tobacco (CHART) is a network of seven NIH-funded trials designed to identify effective programs that can be widely implemented in routine clinical practice. METHODS A cross-sectional analysis of CHART trial study designs was conducted to place each study on the pragmatic-explanatory continuum. After reliability training, six raters independently scored each CHART study according to ten PRagmatic Explanatory Continuum Indicator Summary (PRECIS) dimensions, which covered participant eligibility criteria, intervention flexibility, practitioner expertise, follow-up procedures, participant compliance, practitioner adherence, and outcome analyses. Means and SDs were calculated for each dimension of each study, with lower scores representing more pragmatic elements. Results were plotted on "spoke and wheel" diagrams. The rating process and analyses were performed in October 2014 to September 2015. RESULTS All seven CHART trials tended toward the pragmatic end of the spectrum, although there was a range from 0.76 (SD=0.23) to 1.85 (SD=0.58). Most studies included some explanatory design elements. CONCLUSIONS CHART findings should be relatively applicable to clinical practice. Funders and reviewers could integrate PRECIS criteria into their guidelines to better facilitate pragmatic research. CHART study protocols, coupled with scores reported here, may help readers improve the design of their own pragmatic trials.
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Affiliation(s)
- Erica Cruvinel
- Department of Psychology, Federal University of Juiz de Fora, Minas Gerais, Brazil.
| | - Kimber P Richter
- Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Catherine Stoney
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Sonia Duffy
- College of Nursing, Ohio State University, Columbus, Ohio; Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Jeffrey Fellows
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Kathleen F Harrington
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Nancy A Rigotti
- Department of Medicine and Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Scott Sherman
- Departments of Population Health, Medicine and Psychiatry; New York University School of Medicine, New York, New York
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Theresa I Shireman
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Lisa Waiwaiole
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Sharon Cummins
- Department of Family Medicine and Public Health, University of California, San Diego, California
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Banegas MP, Dickerson JF, Kent EE, de Moor J, Guy GP, Ekwueme DU, Virgo KS, Zheng Z, Nutt S, Pace L, Waiwaiole L, Varga AM, Schneider JL, Yabroff KR. Association of financial hardship with receipt of necessary medical care among adult cancer survivors. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18010] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Erin E. Kent
- National Cancer Institute at the National Institutes of Health, Rockville, MD
| | | | - Gery P Guy
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | | | | | - Lisa Waiwaiole
- Kaiser Permanente Center for Health Research, Portland, OR
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Fellows JL, Mularski R, Waiwaiole L, Funkhouser K, Mitchell J, Arnold K, Luke S. Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial. Trials 2012; 13:129. [PMID: 22853325 PMCID: PMC3517349 DOI: 10.1186/1745-6215-13-129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 06/08/2012] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of 'forced abstinence' for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231). METHODS/DESIGN The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW) and at Oregon Health & Science University (OHSU) hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR) follow-up calls, compared to usual care inpatient counseling (UC). In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at six months, self-reported seven-day, thirty-day, and continuous abstinence at twelve months, intervention dose response at six and twelve months for AR + IVR recipients, incremental cost-effectiveness of AR + IVR intervention compared to usual care at six and twelve months, and health-care utilization and expenditures at twelve months for AR + IVR recipients compared to UC. DISCUSSION This study will provide important evidence for the effectiveness and cost-effectiveness of linking hospital-based tobacco treatment specialists' services with discharge follow-up care. TRIAL REGISTRATION ClinicalTrials.gov: NCT01236079.
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Affiliation(s)
- Jeffrey L Fellows
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97227, USA
| | - Richard Mularski
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97227, USA
| | - Lisa Waiwaiole
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97227, USA
| | - Kim Funkhouser
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97227, USA
| | - Julie Mitchell
- Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Kathleen Arnold
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97227, USA
| | - Sabrina Luke
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR 97227, USA
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