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Chandanabhumma PP, Ratakonda S, Panko T, Cuculick J, Hauser P, Paasche-Orlow MK, Fetters MD, McKee MM. Examining the differences of perceptions and experience with online health information accessibility between deaf and hearing individuals: A qualitative study. Patient Educ Couns 2024; 122:108169. [PMID: 38325209 DOI: 10.1016/j.pec.2024.108169] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/06/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Describe and compare the experiences and preferences of Deaf and hearing individuals with different levels of health literacy in accessing, interpreting, and acting upon online health information. METHODS We conducted semi-structured interviews with 17 Deaf and 10 hearing participants with high and low health literacy from three healthcare sites. We conducted thematic analysis of the transcripts to explore information navigation experiences, information sources and dissemination preferences. RESULTS We found thematic differences between Deaf and hearing participants with high and low health literacy in terms of information needs, information search experiences, information search perceptions, and preferred information dissemination approaches. Relative to hearing counterparts, Deaf participants were more likely to encounter challenges in accessing and understanding online information. Deaf participants with low health literacy were more likely to rely on visual graphics to support their understanding of the information than those with high health literacy. Deaf participants advocated for tailored approaches to disseminate health information to Deaf communities. CONCLUSION Our findings suggest that differences in online health information navigation experiences and accessibility may inform disparities in health literacy outcomes between Deaf and hearing individuals. PRACTICE IMPLICATIONS Online health information should be presented in a manner accessible to Deaf community members.
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Affiliation(s)
| | | | - Tiffany Panko
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | - Jessica Cuculick
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | - Peter Hauser
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, NY, USA
| | | | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michael M McKee
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Brush BL, Lee SYD, Gabrysiak A, Jensen M, Wilson-Powers E, Coombe CM, Paul Chandanabhumma P, Valerio M, Israel BA, Lachance L. A CBPR-Enhanced Delphi Method: The Measurement Approaches to Partnership Success Case Study. Health Educ Behav 2024; 51:212-217. [PMID: 35189738 PMCID: PMC10040148 DOI: 10.1177/10901981221076400] [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] [Indexed: 02/03/2023]
Abstract
As part of a 5-year study to develop and validate an instrument for measuring success in long-standing community-based participatory research (CBPR) partnerships, we utilized the Delphi method with a panel of 16 community and academic CBPR experts to assess face and content validity of the instrument's broad concepts of success and measurement items. In addition to incorporating quantitative and qualitative feedback from two online surveys, we included a 2-day face-to-face meeting with the Expert Panel to invite open discussion and diversity of opinion in line with the CBPR principles framing and guiding the study. The face-to-face meeting allowed experts to review the survey data (with maintained anonymity), convey their perspectives, and offer interpretations that were untapped in the online surveys. Using a CBPR approach facilitated a synergistic process that moved above and beyond the consensus achieved in the initial Delphi rounds, to enhance the Delphi technique and the development of items in the instrument.
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Affiliation(s)
| | | | - Adena Gabrysiak
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Chris M. Coombe
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Melissa Valerio
- University of Texas Health Science Center School of Public Health, Houston, TX
| | | | - Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI
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Lachance L, Brush BL, Mentz G, Lee SYD, Chandanabhumma PP, Coombe CM, DeMajo R, Gabrysiak A, Jensen M, Reyes AG, Rowe Z, Schulz AJ, Wilson-Powers E, Israel BA. Validation of the Measurement Approaches to Partnership Success (MAPS) Questionnaire. Health Educ Behav 2024; 51:218-228. [PMID: 38083870 DOI: 10.1177/10901981231213352] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Conceptualizing and testing factors that contribute to the success of community-academic partnerships are critical to understanding their contributions to the health and well-being of communities. Most measures to date focus on factors that contribute to the development of new partnerships, and only a few have been adequately tested and validated. Methods. The Measurement Approaches to Partnership Success (MAPS) study followed a community-based participatory research (CBPR) approach and a multiphase process that included the construction and pilot testing of a questionnaire, and a national survey to validate the psychometric properties of the questionnaire in long-standing CBPR partnerships (existing ≥ six years). All members within partnerships were recruited to complete the survey (55 partnerships with 563 partners). We used confirmatory factor analysis (CFA), Cronbach's alpha statistics, and a pairwise correlations approach to assess discriminant and convergent validity, and assessed internal consistency, and test-retest reliability. Results. All MAPS Questionnaire dimensions demonstrated strong validity and reliability and demonstrated agreement over time. Conclusion. The MAPS Questionnaire includes seven dimensions and 81 items related to the MAPS conceptual model and provides a scientific, in-depth measurement tool that allows long-standing CBPR partnerships to evaluate their work toward achieving health equity.
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Affiliation(s)
- Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Graciela Mentz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan School of Medicine, Department of Anesthesia, Ann Arbor, MI USA
| | | | | | - Chris M Coombe
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ricardo DeMajo
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Adena Gabrysiak
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
| | | | - Amy J Schulz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Barbara A Israel
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Mangus CW, James TG, Parker SJ, Duffy E, Chandanabhumma PP, Cassady CM, Bellolio F, Pasupathy KS, Manojlovich M, Singh H, Mahajan P. Frontline Providers' and Patients' Perspectives on Improving Diagnostic Safety in the Emergency Department: A Qualitative Study. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00072-2. [PMID: 38643047 DOI: 10.1016/j.jcjq.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Few studies have described the insights of frontline health care providers and patients on how the diagnostic process can be improved in the emergency department (ED), a setting at high risk for diagnostic errors. The authors aimed to identify the perspectives of providers and patients on the diagnostic process and identify potential interventions to improve diagnostic safety. METHODS Semistructured interviews were conducted with 10 ED physicians, 15 ED nurses, and 9 patients/caregivers at two separate health systems. Interview questions were guided by the ED-Adapted National Academies of Sciences, Engineering, and Medicine Diagnostic Process Framework and explored participant perspectives on the ED diagnostic process, identified vulnerabilities, and solicited interventions to improve diagnostic safety. The authors performed qualitative thematic analysis on transcribed interviews. RESULTS The research team categorized vulnerabilities in the diagnostic process and intervention opportunities based on the ED-Adapted Framework into five domains: (1) team dynamics and communication (for example, suboptimal communication between referring physicians and the ED team); (2) information gathering related to patient presentation (for example, obtaining the history from the patients or their caregivers; (3) ED organization, system, and processes (for example, staff schedules and handoffs); (4) patient education and self-management (for example, patient education at discharge from the ED); and (5) electronic health record and patient portal use (for example, automatic release of test results into the patient portal). The authors identified 33 potential interventions, of which 17 were provider focused and 16 were patient focused. CONCLUSION Frontline providers and patients identified several vulnerabilities and potential interventions to improve ED diagnostic safety. Refining, implementing, and evaluating the efficacy of these interventions are required.
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Brush BL, Israel B, Coombe CM, Lee SYD, Jensen M, Wilson-Powers E, Gabrysiak A, Chandanabhumma PP, Baker E, Jones M, Lachance L. The Measurement Approaches to Partnership Success (MAPS) Questionnaire and Facilitation Guide: A Validated Measure of CBPR Partnership Success. Health Promot Pract 2023:15248399231206088. [PMID: 37846092 DOI: 10.1177/15248399231206088] [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: 10/18/2023]
Abstract
Partnerships that effectively engage in certain key structural and process functions are more likely to meet their research goals and contribute to longer-term health equity outcomes. Ongoing evaluation of partnerships' level of achievement of these key functions, along with their fidelity to the guiding principles of community-based participatory research (CBPR), is therefore essential to understand how they can achieve desired partnership outcomes. This article describes the validated Measurement Approaches to Partnership Success (MAPS) Questionnaire and the use of an accompanying Facilitation Guide in helping members of CBPR partnerships evaluate their partnership's state of development and interpret findings to improve its structure, processes, and outcomes. We describe the conceptual framework guiding the development of the MAPS Questionnaire and its 81-item across seven key outcome dimensions, along with 28 items measuring precursor characteristics of CBPR partnership outcomes. The Facilitation Guide provides general guidelines for sharing, interpreting, and applying results within partnerships using a participatory process, definitions and items for each dimension, an example of presenting summary means, and dimension-specific reflective questions for discussion. We offer recommendations for practical uses of the MAPS Questionnaire and Facilitation Guide. Whether used as a comprehensive tool or by dimension, the MAPS Questionnaire is conceptually sound and empirically validated for evaluating how CBPR partnerships can achieve long-standing success. CBPR partnerships at any stage of development will find the MAPS Questionnaire and Facilitation Guide useful in measuring and interpreting indicators of partnership success, sharing results, and improving their ability to contribute to achieving health equity goals.
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Affiliation(s)
- Barbara L Brush
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Barbara Israel
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Chris M Coombe
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Adena Gabrysiak
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | | | - Marita Jones
- Healthy Native Communities Partnership, Inc., Shiprock, NM, USA
| | - Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Borchmann O, Weis N, Hansen ABE, Storgaard M, Fetters MD, Chandanabhumma PP, Moseholm E. Patient-reported outcomes in clinical HIV care: protocol for a single-centre, multistage, mixed-methods study in Denmark. BMJ Open 2023; 13:e077303. [PMID: 37709310 PMCID: PMC10503392 DOI: 10.1136/bmjopen-2023-077303] [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: 07/03/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION People with HIV-1 (PWH) have worse health-related quality of life (HRQoL) compared with the general population. Using patient-reported outcomes (PROs) may help reorient the focus of HIV care towards improving HRQoL. This study aims to develop, implement and evaluate the use of PROs in HIV care. METHODS AND ANALYSIS This is a Danish single-centre, multistage mixed-methods study consisting of four substudies (studies I-IV). Study I is a qualitative focus group interview study aiming to identify relevant PRO domains, and barriers and benefits to PRO use. Participants are 5-10 PWH and 5-10 HIV healthcare providers (HCPs). Data are thematically analysed. Results will guide the design of a PRO measure (PROM). Study II is a quantitative study aiming to assess PWH's willingness and ability to engage with PRO. All PWH are consecutively invited to complete the PROMs before their next consultations. Demographic data are collected at enrolment. Differences between PWH who do/do not complete the PROMs are assessed. Study III is a quantitative before-and-after study aiming to assess the impact of PRO use on HCP awareness. Participants are all who complete the PROMs in Study II. In contrast to study II, HCPs are notified of the PROM results. The number of problems documented by the HCP in patients' medical records during studies II and III are compared using χ2 tests. Multiple regression models are used to identify factors associated with HCP awareness. Study IV is a qualitative study aiming to explore PWH and HCP experiences of using PROs. Participants are 15-20 PWH and 10-15 HCP. Data are collected from participant observation of PRO consultations and individual interviews. Data are analysed thematically. ETHICS AND DISSEMINATION This study is approved by the Danish Data Protection Agency. Participants will provide written consent prior to participation. Results will be published in peer-reviewed journals.
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Affiliation(s)
- Olivia Borchmann
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Ann-Brit Eg Hansen
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus Universitetshospital, Aarhus, Denmark
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
| | - P Paul Chandanabhumma
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Ellen Moseholm
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
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Zhou S, Yang G, Hou H, Zhang M, Grady KL, Chenoweth CE, Aaronson KD, Pienta M, Fetters MD, Paul Chandanabhumma P, Stewart JW, Cabrera L, Malani PN, Pagani FD, Likosky DS. Infections following left ventricular assist device implantation and 1-year health-related quality of life. J Heart Lung Transplant 2023; 42:1307-1315. [PMID: 37187319 PMCID: PMC10527882 DOI: 10.1016/j.healun.2023.05.006] [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: 11/11/2022] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Left ventricular assist device (LVAD) implantation leads to substantial and sustained improvement in health-related quality of life (HRQOL) among patients. Infection following device implantation remains an important and frequent complication and adversely affects patient-reported HRQOL. METHODS Patients in The Society of Thoracic Surgeons' Interagency Registry for Mechanically Assisted Circulatory Support receiving a primary LVAD between April 2012 to October 2016 were included. The primary exposure was one-year post-implant infection, characterized by: (1) any infection; (2) total number of infections and (3) type (LVAD-specific, LVAD-related, non-LVAD). The association between infection and the primary composite adverse outcome (defined as EuroQoL Visual Analog Scale< 65, too sick to complete the survey, or death at 1-year) was estimated using inverse probability weighting and Cox regression. RESULTS The study cohort included 11,618 patients from 161 medical centers with 4,768 (41.0%) patients developing an infection, and 2,282 (19.6%) patients having> 1 infection during the follow up period. The adjusted odds ratio for the primary composite adverse outcome was 1.22 (95% CI, 1.19-1.24, p < 0.001) for each additional infection. Each additional infection was associated with a 3.49% greater probability of the primary composite outcome and was associated with worse performance across multiple dimensions of HRQOL as assessed by the EQ-5D for patients who survived to 1 year. CONCLUSIONS For patients undergoing LVAD implantation, each additional infection within the first post-implantation year was associated with an incremental negative effect on survival free of impaired HRQOL.
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Affiliation(s)
- Shiwei Zhou
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI.
| | - Guangyu Yang
- Institute of Statistics and Big Data, Renmin University of China, People's Republic of China
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Kathleen L Grady
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Carol E Chenoweth
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI
| | - Keith D Aaronson
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI
| | - Michael Pienta
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI
| | | | | | - James W Stewart
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT
| | - Lourdes Cabrera
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, MI
| | - Preeti N Malani
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, Ann Arbor, MI
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8
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Zhou S, Yang G, Zhang M, Pienta M, Chenoweth CE, Pagani FD, Aaronson KD, Fetters MD, Chandanabhumma PP, Cabrera L, Hou H, Malani PN, Likosky DS. Mortality following durable left ventricular assist device implantation by timing and type of first infection. J Thorac Cardiovasc Surg 2023; 166:570-579.e4. [PMID: 34895722 PMCID: PMC9094062 DOI: 10.1016/j.jtcvs.2021.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/24/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although infections are common after left ventricular assist device implantation, the relationship between timing and type of first infection with regard to mortality is less well understood. METHODS The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support patients receiving a primary left ventricular assist device from April 2012 to May 2017 were included. The primary exposure was defined 3 ways: any infection, timing of first infection (early: ≤90 days; intermediate: 91-180 days; late: >180 days), and type (ventricular assist device specific, ventricular assist device related, non-ventricular assist device). The association between first infection and all-cause mortality was estimated using Cox regression. RESULTS The cohort included 12,957 patients at 166 centers (destination therapy: 47.4%, bridge-to-transplant: 41.2%). First infections were most often non-ventricular assist device (54.2%). Rates of first infection were highest in the early interval (10.7/100 person-months). Patients with any infection had a significantly higher adjusted hazard of death (hazard ratio, 2.63; 2.46-2.86). First infection in the intermediate interval was associated with the largest increase in adjusted hazard of death (hazard ratio, 3.26; 2.82-3.78), followed by late (hazard ratio, 3.13; 2.77-3.53) and early intervals (hazard ratio, 2.37; 2.16-2.60). Ventricular assist device-related infections were associated with the largest increase in hazard of death (hazard ratio, 3.02; 2.69-3.40), followed by ventricular assist device specific (hazard ratio, 2.92; 2.57-3.32) and non-ventricular assist device (hazard ratio, 2.42; 2.20-2.65). CONCLUSIONS Relative to those without infection, patients with any postimplantation infection had an increased risk of death. Ventricular assist device-related infections and infections occurring in the intermediate interval were associated with the largest increase in risk of death. After left ventricular assist device implantation, infection prevention strategies should target non-ventricular assist device infections in the first 90 days, then shift to surveillance/prevention of driveline infections after 90 days.
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Affiliation(s)
- Shiwei Zhou
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich.
| | - Guangyu Yang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mich
| | - Michael Pienta
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Keith D Aaronson
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | | | | | - Lourdes Cabrera
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
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Abstract
The care delivered to patients with cardiovascular disease involves coordination among a multitude of clinical team members spanning diverse inpatient and outpatient settings. The majority of quality improvement interventions in cardiovascular care have been developed based on quantitative evidence, which neither fully accounts for multilevel determinants (eg, patient, clinician, and institution) nor contextualization from key informants. The rigor and effectiveness of these interventions would be enhanced by mixed-methods studies whose strengths include (1) the use of qualitative research methodologies (eg, eliciting patient or clinician perspectives on barriers and facilitators of best practices) and (2) integrating qualitative and quantitative data and analyses to understand more fully effective strategies for achieving optimal care and outcomes for these patients across diverse settings. This article illustrates the application of a complex mixed-methods design to advance an evidence-based, customizable infection prevention toolkit for durable left ventricular assist device therapy. The study (1) uses quantitative clinical data merged with Medicare claims to evaluate interhospital variability in the incidence of infection; (2) uses qualitative methods to understand local practice patterns across low- and high-performing centers; and (3) integrates both data sources to gain a comprehensive understanding of the overall findings.
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Affiliation(s)
- P Paul Chandanabhumma
- Mixed Methods Program, Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor (P.P.C., M.D.F.)
| | - Shiwei Zhou
- Department of Internal Medicine, Division of Infectious Diseases (S.Z.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael D Fetters
- Mixed Methods Program, Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor (P.P.C., M.D.F.)
| | - Donald S Likosky
- Department of Cardiac Surgery (D.S.L.), Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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10
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Chandanabhumma PP, Fàbregues S, Oetzel J, Duran B, Ford CL. Examining the influence of group diversity on the functioning of community-based participatory research partnerships: A mixed methods study. Am J Community Psychol 2023; 71:242-254. [PMID: 36342500 PMCID: PMC10788307 DOI: 10.1002/ajcp.12626] [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] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 08/08/2022] [Accepted: 09/13/2022] [Indexed: 05/07/2023]
Abstract
Public health has endorsed the use of community-based participatory research (CBPR) to address health inequities involving diverse and marginalized communities. However, few studies have examined how group diversity among members of CBPR partnerships influenced how well the partnerships achieve their goals of addressing health inequities through equitable collaboration. We conducted secondary, convergent, mixed methods analysis to (1) evaluate the association between group diversity and participatory decision-making within CBPR partnerships, and (2) identify the perceived characteristics, benefits, and challenges of group diversity within CBPR partnerships. Using data from a cross-site study of federally funded CBPR partnerships, we analyzed and integrated data from surveys of 163 partnerships (n = 448 partners) and seven in-depth case study interviews (n = 55 partners). Quantitatively, none of the measured characteristics of group diversity was associated with participatory decision-making within the partnerships. Qualitatively, we found that partnerships mainly benefited from membership differences in functional characteristics (e.g., skillset) but faced challenges from membership differences in sociocultural characteristics (e.g., gender and race). The integrated findings suggest the need to further understand how emergent group characteristics and how practices that engage in group diversity contribute to collective functioning of the partnerships. Attention to this area can help promote health equity achievements of CBPR partnerships.
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Affiliation(s)
| | - Sergi Fàbregues
- Department of Psychology and Education, Universitat Oberta de Catalunya, Barcelona, Spain
| | - John Oetzel
- School of Management and Marketing, University of Waikato, Hamilton, New Zealand
| | - Bonnie Duran
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Chandra L. Ford
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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11
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Schoneich S, Plegue M, Waidley V, McCabe K, Wu J, Chandanabhumma PP, Shetty C, Frank CJ, Oshman L. Incidence of Newborn Drug Testing and Variations by Birthing Parent Race and Ethnicity Before and After Recreational Cannabis Legalization. JAMA Netw Open 2023; 6:e232058. [PMID: 36884249 PMCID: PMC9996400 DOI: 10.1001/jamanetworkopen.2023.2058] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
IMPORTANCE Thirty-seven US states and the District of Columbia mandate reporting newborns with suspected prenatal substance exposure to the state, and punitive policies that link prenatal substance exposure to newborn drug testing (NDT) may lead to disproportionate reporting of Black parents to Child Protective Services. The impact of recreational cannabis legalization on racial disproportionality in NDT is unknown. OBJECTIVES To examine variations in the incidence and results of NDT by birthing parent race and ethnicity, variables associated with variation, and changes after statewide legalization of recreational cannabis. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted from 2014 to 2020 with 26 366 live births to 21 648 birthing people who received prenatal care at an academic medical center in the Midwestern United States. Data were analyzed from June 2021 to August 2022. EXPOSURES Variables included birthing parent age, race, ethnicity, marital status, zip code, insurance type, prenatal and newborn diagnoses codes, and prenatal urine drug test orders and results. MAIN OUTCOME AND MEASURES The primary outcome was an NDT order. Secondary outcomes were substances detected. RESULTS Among 26 366 newborns of 21 648 birthing people (mean [SD] age at delivery, 30.5 [5.2] years), most birthing parents were White (15 338 [71.6%]), were non-Hispanic (20 125 [93.1%]), and had private insurance coverage (16 159 [74.8%]). The incidence of NDT ordering was 4.7% overall (1237 newborns). Clinicians ordered more NDTs for Black compared with White newborns (207 of 2870 [7.3%] vs 335 of 17 564 [1.9%]; P < .001) when the birthing parent had no prenatal urine drug test, a presumably low-risk group. Overall, 471 of 1090 NDTs (43.3%) were positive for only tetrahydrocannabinol (THC). NDTs were more likely to be positive for opioids in White compared with Black newborns (153 of 693 [22.2%] vs 29 of 308 [9.4%]; P < .001) and more likely to be positive for THC in Black compared with White newborns (207 of 308 [67.2%] vs 359 of 693 [51.8%]; P < .001). Differences remained consistent after state recreational cannabis legalization in 2018. Newborn drug tests were more likely to be positive for THC after legalization vs before legalization (248 of 360 [68.9%] vs 366 of 728 [50.3%]; P < .001) with no significant interaction with race and ethnicity groups. CONCLUSIONS AND RELEVANCE In this study, clinicians ordered NDTs more frequently for Black newborns when no drug testing was done during pregnancy. These findings call for further exploration of how structural and institutional racism contribute to disproportionate testing and subsequent Child Protective Services investigation, surveillance, and criminalization of Black parents.
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Affiliation(s)
| | - Melissa Plegue
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor
| | - Victoria Waidley
- Department of Family Medicine, University of California, San Diego
| | - Katharine McCabe
- Reilly Center for Science, Technology, and Values, University of Notre Dame, South Bend, Indiana
| | - Justine Wu
- Department of Family Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - P. Paul Chandanabhumma
- Department of Family Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Carol Shetty
- Department of Family Medicine, University of Michigan, Ann Arbor
| | | | - Lauren Oshman
- Department of Family Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Chandanabhumma PP, Gabrysiak A, Brush BL, Coombe CM, Eng E, Jensen M, Lachance L, Shepard P, Wallerstein NB, Israel BA. Cultivating an Ecosystem: A Qualitative Exploration of Sustainability in Long-Standing Community-Based Participatory Research Partnerships. Prog Community Health Partnersh 2023; 17:e5. [PMID: 37934431 PMCID: PMC10651163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Background: While sustainability is crucial to the success of community-based participatory research (CBPR) partnerships, there is a lack of conceptual clarity on what defines sustainability and what characterizes sustainability-promoting practices in long-standing (in existence ≥ 6 years) CBPR partnerships. Objectives: The aim of this article is to explore the definition of sustainability, as well as practices that influence sustainability from the perspectives of academic and community experts in long-standing CBPR partnerships. Methods: This qualitative analysis is part of Measurement Approaches to Partnership Success (MAPS), a participatory mixed methods validity study that examined “success” and its contributing factors in long-standing CBPR partnerships. Thematic analysis of 21 semi-structured interviews was conducted, including 10 academic and 11 community experts of long-standing CBPR partnerships. Results: The key defining components of sustainability we identified include: distinguishing between sustaining the work of the partnership and ongoing relationships among partners; working towards a common goal over time; and enduring changes that impact the partnership. We further identified strengthening and capacity building practices at multiple levels of the partnership that served to promote the sustainability of the partnership’s work and of ongoing relationships among partners. Conclusions: Sustainability can be understood as supporting an ecosystem that surrounds the beneficial relationships between academic and community partners. Ongoing evaluation and application of practices that promote the sustainability of partnership activities and relationships may strengthen the long-term effectiveness of CBPR partnerships in advancing health equity.
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Affiliation(s)
| | - Adena Gabrysiak
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Chris M. Coombe
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Eugenia Eng
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Nina B. Wallerstein
- Center for Participatory Research, College of Population Health, University of New Mexico, Albuquerque, NM
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Chandanabhumma PP, Gabrysiak A, Brush BL, Coombe CM, Eng E, Jensen M, Lachance L, Shepard P, Wallerstein NB, Israel BA. Cultivating an ecosystem: A qualitative exploration of sustainability in long-standing community-based participatory research (CBPR) partnerships. Prog Community Health Partnersh 2023; 17:e5. [PMID: 38062914 PMCID: PMC10651163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background While sustainability is crucial to the success of community-based participatory research (CBPR) partnerships, there is a lack of conceptual clarity on what defines sustainability and what characterizes sustainability-promoting practices in long-standing (in existence ≥ 6 years) CBPR partnerships. Objectives The aim of this article is to explore the definition of sustainability, as well as practices that influence sustainability from the perspectives of academic and community experts in long-standing CBPR partnerships. Methods This qualitative analysis is part of Measurement Approaches to Partnership Success (MAPS), a participatory mixed methods validity study that examined "success" and its contributing factors in long-standing CBPR partnerships. Thematic analysis of 21 semi-structured interviews was conducted, including 10 academic and 11 community experts of long-standing CBPR partnerships. Results The key defining components of sustainability we identified include: distinguishing between sustaining the work of the partnership and ongoing relationships among partners; working towards a common goal over time; and enduring changes that impact the partnership. We further identified strengthening and capacity building practices at multiple levels of the partnership that served to promote the sustainability of the partnership's work and of ongoing relationships among partners. Conclusions Sustainability can be understood as supporting an ecosystem that surrounds the beneficial relationships between academic and community partners. Ongoing evaluation and application of practices that promote the sustainability of partnership activities and relationships may strengthen the long-term effectiveness of CBPR partnerships in advancing health equity.
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Affiliation(s)
| | - Adena Gabrysiak
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Chris M. Coombe
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Eugenia Eng
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Nina B. Wallerstein
- Center for Participatory Research, College of Population Health, University of New Mexico, Albuquerque, NM
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Chandanabhumma PP, Gabrysiak A, Brush BL, Coombe CM, Eng E, Jensen M, Lachance L, Shepard P, Wallerstein NB, Israel BA. Cultivating an Ecosystem: A Qualitative Exploration of Sustainability in Long-Standing Community-Based Participatory Research Partnerships. Prog Community Health Partnersh 2023; 17:393-404. [PMID: 37934438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND While sustainability is crucial to the success of community-based participatory research (CBPR) partnerships, there is a lack of conceptual clarity on what defines sustainability and what characterizes sustainability-promoting practices in long-standing (in existence 6 years or longer) CBPR partnerships. OBJECTIVES The aim of this article is to explore the definition of sustainability, as well as practices that influence sustainability from the perspectives of academic and community experts in long-standing CBPR partnerships. METHODS This qualitative analysis is part of Measurement Approaches to Partnership Success, a participatory mixed methods validity study that examined "success" and its contributing factors in long-standing CBPR partnerships. Thematic analysis of 21 semistructured interviews was conducted, including 10 academic and 11 community experts of long-standing CBPR partnerships. RESULTS The key defining components of sustainability we identified include: distinguishing between sustaining the work of the partnership and ongoing relationships among partners; working towards a common goal over time; and enduring changes that impact the partnership. We further identified strengthening and capacity building practices at multiple levels of the partnership that served to promote the sustainability of the partnership's work and of ongoing relationships among partners. CONCLUSIONS Sustainability can be understood as supporting an ecosystem that surrounds the beneficial relationships between academic and community partners. Ongoing evaluation and application of practices that promote the sustainability of partnership activities and relationships may strengthen the long-term effectiveness of CBPR partnerships in advancing health equity.
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Chandanabhumma PP, Gabrysiak A, Brush BL, Coombe CM, Eng E, Jensen M, Lachance L, Shepard P, Wallerstein NB, Israel BA. Cultivating an Ecosystem: A Qualitative Exploration of Sustainability in Long-Standing Community-Based Participatory Research Partnerships. Prog Community Health Partnersh 2023; 17:e5. [PMID: 38682363 PMCID: PMC10651163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background: While sustainability is crucial to the success of community-based participatory research (CBPR) partnerships, there is a lack of conceptual clarity on what defines sustainability and what characterizes sustainability-promoting practices in long-standing (in existence ≥ 6 years) CBPR partnerships. Objectives: The aim of this article is to explore the definition of sustainability, as well as practices that influence sustainability from the perspectives of academic and community experts in long-standing CBPR partnerships. Methods: This qualitative analysis is part of Measurement Approaches to Partnership Success (MAPS), a participatory mixed methods validity study that examined “success” and its contributing factors in long-standing CBPR partnerships. Thematic analysis of 21 semi-structured interviews was conducted, including 10 academic and 11 community experts of long-standing CBPR partnerships. Results: The key defining components of sustainability we identified include: distinguishing between sustaining the work of the partnership and ongoing relationships among partners; working towards a common goal over time; and enduring changes that impact the partnership. We further identified strengthening and capacity building practices at multiple levels of the partnership that served to promote the sustainability of the partnership’s work and of ongoing relationships among partners. Conclusions: Sustainability can be understood as supporting an ecosystem that surrounds the beneficial relationships between academic and community partners. Ongoing evaluation and application of practices that promote the sustainability of partnership activities and relationships may strengthen the long-term effectiveness of CBPR partnerships in advancing health equity.
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Affiliation(s)
| | - Adena Gabrysiak
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Chris M. Coombe
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Eugenia Eng
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Nina B. Wallerstein
- Center for Participatory Research, College of Population Health, University of New Mexico, Albuquerque, NM
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Funk RJ, Pagani FD, Hou H, Zhang M, Yang G, Malani PN, Chandanabhumma PP, Cabrera L, Kim KD, Likosky DS. Care fragmentation predicts 90-day durable ventricular assist device outcomes. Am J Manag Care 2022; 28:e444-e451. [PMID: 36525664 PMCID: PMC10405264 DOI: 10.37765/ajmc.2022.89280] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To examine whether fragmentation of care is associated with worse in-hospital and 90-day outcomes following durable ventricular assist device (VAD) implant. STUDY DESIGN Cohort study. METHODS This study was conducted using Medicare claims linked to the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) among patients undergoing VAD implant between July 2009 and April 2017. Medicare data were used to measure fragmentation of the multidisciplinary care delivery network for the treating hospital, based on providers' history of shared patients within the previous year. STS Intermacs data were used for risk adjustment and outcomes ascertainment. Hospitals were sorted into terciles based on the degree of network fragmentation, measured as the mean number of links separating providers in the network. Multivariable regression was used to associate network fragmentation with 90-day death or infection risk. RESULTS The cohort included 5159 patients who underwent VAD implant, with 11.2% dying and 27.6% experiencing an infection within 90 days after implant. After adjustment, a 1-unit increase in network fragmentation was associated with an increase of 0.179 in the probability of in-hospital infection and an increase of 0.183 in the probability of 90-day infection (both P < .05). Similar results were observed in models of the numbers of in-hospital and 90-day infections. Network fragmentation was predictive of the probability of 90-day mortality, although this relationship was not significant after adjustment. CONCLUSIONS Care delivery network fragmentation is associated with higher in-hospital and 90-day infection rates following durable VAD implant. These networks may serve as novel targets for enhancing outcomes for patients undergoing VAD implant.
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Affiliation(s)
- Russell J Funk
- Carlson School of Management, University of Minnesota, 321 19th Ave S, #3-354, Minneapolis, MN 55455.
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17
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Minc SD, Chandanabhumma PP, Sedney CL, Haggerty TS, Davidov DM, Pollini RA. Mixed methods research: A primer for the vascular surgeon. Semin Vasc Surg 2022; 35:447-455. [PMID: 36414361 PMCID: PMC10152512 DOI: 10.1053/j.semvascsurg.2022.09.003] [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] [Received: 08/01/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022]
Abstract
Mixed methods research is an approach that intentionally integrates both quantitative and qualitative research methods to answer a research question. The hallmark of mixed methods research is a focus on designing studies that integrate both quantitative and qualitative data, yielding greater results than either method could yield on its own. There are a number of fundamental concepts that are essential to conducting mixed methods research. These include a methodological approach that employs one of the three core study designs, involvement of a multidisciplinary team that includes both methodological and subject matter experts, and meticulous planning to ensure that the data collected can ultimately be integrated to yield findings that answer the original research question to the investigators' (and funders') satisfaction. In this article, we will discuss mixed methods research designs, data sources typically used in mixed methods research, and common data analysis and integration strategies. We will also provide examples of mixed methods research projects that have been used in vascular surgery. The intent of this article was to provide an overview of the field of mixed methods research, enabling the reader to critically assess mixed methods research studies in the literature and consider how this methodology might benefit their own research endeavors.
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Affiliation(s)
- Samantha Danielle Minc
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, School of Medicine, West Virginia University, 1 Medical Center Drive, PO Box 8003, Morgantown, WV, 26506; Department of Occupational Health and Environmental Sciences, School of Public Health, West Virginia University, Morgantown, WV.
| | | | - Cara L Sedney
- Department of Neurosurgery, West Virginia University, School of Medicine, Morgantown, WV
| | - Treah S Haggerty
- Department of Family Medicine, West Virginia University, School of Medicine. Morgantown, WV
| | - Danielle M Davidov
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV; Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, WV
| | - Robin A Pollini
- Department of Behavioral Medicine and Psychiatry, School of Medicine, West Virginia University, Morgantown, WV; Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV
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Yang G, Zhang M, Zhou S, Hou H, Grady KL, Stewart JW, Chenoweth CE, Aaronson KD, Fetters MD, Chandanabhumma PP, Pienta MJ, Malani PN, Hider AM, Cabrera L, Pagani FD, Likosky DS. Incompleteness of health-related quality of life assessments before left ventricular assist device implant: A novel quality metric. J Heart Lung Transplant 2022; 41:1520-1528. [PMID: 35961829 PMCID: PMC10405265 DOI: 10.1016/j.healun.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/28/2022] [Revised: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Improved health-related quality of life (HRQOL) is an important outcome following durable left ventricular assist device (LVAD) implant. However, half of pre-implant HRQOL data are incomplete in The Society of Thoracic Surgeons' Intermacs registry. Pre-implant HRQOL incompleteness may reflect patient status or hospital resources to capture HRQOL data. We hypothesized that pre-implant HRQOL incompleteness predicts 90 day outcomes and serves as a novel quality metric. METHODS Risk factors for pre-implant HRQOL (EQ-5D-5L visual analog scale; 12-item Kansas City Cardiomyopathy Questionnaire "KCCQ") incompleteness were examined by stepwise logistic modeling. Direct standardization method was used to calculate adjusted incompleteness rates using a mixed effects logistic model. Hospitals were dichotomized as low or high based on median adjusted incompleteness rates. Andersen-Gill models were used to associate pre-implant HRQOL adjusted incompleteness rate with adverse events within 90 day post-implant. RESULTS The study cohort included 14,063 patients receiving a primary LVAD (4/2012-8/2017). HRQOL incompleteness at high-rate hospitals was more often due to administrative reasons (risk difference, EQ-5D: 10.1%; KCCQ-12: 11.6%) and less likely due to patient reasons (risk difference, EQ-5D: -8.9%; KCCQ-12: -11.4%). A 10% increase in the adjusted pre-implant EQ-5D incompleteness rate was significantly associated with higher risk of infection-related mortality (HR: 1.09), infection (HR: 1.05), and renal dysfunction (HR: 1.03). A 10% increase in the adjusted pre-implant KCCQ-12 incompleteness rate was significantly associated with higher risk of infection (HR: 1.04). CONCLUSIONS Hospital adjusted pre-implant HRQOL incompleteness was predictive of 90-day post-implant outcomes and may serve as a novel quality metric.
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Affiliation(s)
- Guangyu Yang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Shiwei Zhou
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kathleen L Grady
- Division of Cardiac Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James W Stewart
- Division of Cardiac Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Carol E Chenoweth
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Keith D Aaronson
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael D Fetters
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - P Paul Chandanabhumma
- Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michael J Pienta
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Preeti N Malani
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ahmad M Hider
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lourdes Cabrera
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
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Kim KD, Funk RJ, Hou H, Airhart A, Nassar K, Pagani FD, Zhang M, Chandanabhumma PP, Aaronson KD, Chenoweth CE, Hider A, Cabrera L, Likosky DS. Association Between Care Fragmentation and Total Spending After Durable Left Ventricular Device Implant: A Mediation Analysis of Health Care-Associated Infections Within a National Medicare-Society of Thoracic Surgeons Intermacs Linked Dataset. Circ Cardiovasc Qual Outcomes 2022; 15:e008592. [PMID: 36065815 PMCID: PMC9489640 DOI: 10.1161/circoutcomes.121.008592] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Care fragmentation is associated with higher rates of infection after durable left ventricular assist device (LVAD) implant. Less is known about the relationship between care fragmentation and total spending, and whether this relationship is mediated by infections. METHODS Total payments were captured from admission to 180 days post-discharge. Drawing on network theory, a measure of care fragmentation was developed based on the number of shared patients among providers (ie, anesthesiologists, cardiac surgeons, cardiologists, critical care specialists, nurse practitioners, physician assistants) caring for 4,987 Medicare beneficiaries undergoing LVAD implantation between July 2009 - April 2017. Care fragmentation was measured using average path length, which describes how efficiently information flows among network members; longer path length indicates greater fragmentation. Terciles based on the level of care fragmentation and multivariable regression were used to analyze the relationship between care fragmentation and LVAD payments and mediation analysis was used to evaluate the role of post-implant infections. RESULTS The patient cohort was 81% male, 73% white, 11% Intermacs Profile 1 with mean (SD) age of 63.1 years (11.1). The mean (SD) level of care fragmentation in provider networks was 1.7 (0.2) and mean (SD) payment from admission to 180 days post-discharge was $246,905 ($109,872). Mean (SD) total payments at the lower, middle, and upper terciles of care fragmentation were $250,135 ($111,924), $243,288 ($109,376), and $247,290 ($108,241), respectively. In mediation analysis, the indirect effect of care fragmentation on total payments, through infections, was positive and statistically significant (β=16032.5, p=0.008). CONCLUSIONS Greater care fragmentation in the delivery of care surrounding durable LVAD implantation is associated with a higher incidence of infections, and consequently, higher payments for Medicare beneficiaries. Interventions to reduce care fragmentation may reduce the incidence of infections and in turn enhance the value of care for patients undergoing durable LVAD implantation.
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Affiliation(s)
- K. Dennie Kim
- Strategy, Ethics, and Entrepreneurship, Darden School of Business, University of Virginia, Charlottesville, VA
| | - Russell J. Funk
- Department of Strategic Management and Entrepreneurship, Carlson School of Management, University of Minnesota, Minneapolis, MN
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | | | - Khalil Nassar
- University Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Francis D Pagani
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - P. Paul Chandanabhumma
- Mixed Methods Program, Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Keith D Aaronson
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Ahmad Hider
- University of Michigan Medical School, Ann Arbor, MI
| | - Lourdes Cabrera
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Donald S Likosky
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Chandanabhumma PP, Fetters MD, Pagani FD, Malani PN, Hollingsworth JM, Funk RJ, Aaronson KD, Zhang M, Kormos RL, Chenoweth CE, Shore S, Watt TMF, Cabrera L, Likosky DS. Correction: Understanding and Addressing Variation in Health Care–Associated Infections After Durable Ventricular Assist Device Therapy: Protocol for a Mixed Methods Study (Preprint). JMIR Res Protoc 2022; 11:e39663. [PMID: 35737967 PMCID: PMC9264132 DOI: 10.2196/39663] [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] [Received: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Paul Chandanabhumma
- Mixed Methods ProgramDepartment of Family MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Michael D Fetters
- Mixed Methods ProgramDepartment of Family MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Francis D Pagani
- Department of Cardiac SurgeryUniversity of MichiganAnn Arbor, MIUnited States
| | - Preeti N Malani
- Division of Infectious DiseasesDepartment of Internal MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | | | - Russell J Funk
- Department of Strategic Management and EntrepreneurshipCarlson School of ManagementUniversity of MinnesotaMinneapolis, MNUnited States
| | - Keith D Aaronson
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Min Zhang
- Department of BiostatisticsSchool of Public HealthUniversity of MichiganAnn Arbor, MIUnited States
| | - Robert L Kormos
- Department of Cardiothoracic SurgeryUniversity of Pittsburgh Medical CenterPittsburgh, PAUnited States
| | - Carol E Chenoweth
- Division of Infectious DiseasesDepartment of Internal MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Supriya Shore
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of MichiganAnn Arbor, MIUnited States
| | - Tessa M F Watt
- Department of Cardiac SurgeryUniversity of MichiganAnn Arbor, MIUnited States
| | - Lourdes Cabrera
- Department of Cardiac SurgeryUniversity of MichiganAnn Arbor, MIUnited States
| | - Donald S Likosky
- Department of Cardiac SurgeryUniversity of MichiganAnn Arbor, MIUnited States
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Daniel M, Park S, Seifert CM, Chandanabhumma PP, Fetters MD, Wilson E, Singh H, Pasupathy K, Mahajan P. Understanding diagnostic processes in emergency departments: a mixed methods case study protocol. BMJ Open 2021; 11:e044194. [PMID: 34561251 PMCID: PMC8475137 DOI: 10.1136/bmjopen-2020-044194] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Diagnostic processes in the emergency department (ED) involve multiple interactions among individuals who interface with information systems to access and record information. A better understanding of diagnostic processes is needed to mitigate errors. This paper describes a study protocol to map diagnostic processes in the ED as a foundation for developing future error mitigation strategies. METHODS AND ANALYSIS This study of an adult and a paediatric academic ED uses a prospective mixed methods case study design informed by an ED-specific diagnostic decision-making model (the modified ED-National Academies of Sciences, Engineering and Medicine (NASEM) model) and two cognitive theories (dual process theory and distributed cognition). Data sources include audio recordings of patient and care team interactions, electronic health record data, observer field notes and stakeholder interviews. Multiple qualitative analysis methods will be used to explore diagnostic processes in situ, including systems information flow, human-human and human-system interactions and contextual factors influencing cognition. The study has three parts. Part 1 involves prospective field observations of patients with undifferentiated symptoms at high risk for diagnostic error, where each patient is followed throughout the entire care delivery process. Part 2 involves observing individual care team providers over a 4-hour window to capture their diagnostic workflow, team coordination and communication across multiple patients. Part 3 uses interviews with key stakeholders to understand different perspectives on the diagnostic process, as well as perceived strengths and vulnerabilities, in order to enrich the ED-NASEM diagnostic model. ETHICS AND DISSEMINATION The University of Michigan Institutional Review Board approved this study, HUM00156261. This foundational work will help identify strengths and vulnerabilities in diagnostic processes. Further, it will inform the future development and testing of patient, provider and systems-level interventions for mitigating error and improving patient safety in these and other EDs. The work will be disseminated through journal publications and presentations at national and international meetings.
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Affiliation(s)
- Michelle Daniel
- Emergency Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
| | - SunYoung Park
- School of Art and Design and School of Information, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Eric Wilson
- Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Kalyan Pasupathy
- Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA
| | - Prashant Mahajan
- Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
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22
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Abstract
Public health remains acutely affected by the historical legacy and ongoing processes of colonization. Although scholars have advocated for decolonization of public health systems, the principles and processes of decolonization have not been explicitly elaborated nor applied broadly within the field. To map these concepts, we conducted a scoping review of decolonization of the Indigenous-focused health behavior and education literature. Following the JBI (formerly Joanna Briggs Institute) scoping review framework, we conducted searches in PubMed, PsycINFO, and Web of Science using key search terms: "health education," "health behavior," "health promotion," "health practice" AND "decolonization" or "decolonial." We also conducted targeted searches of key journals to ensure review completeness. For selected articles, we examined the article content, focal population, country context and health condition(s). We assessed for the definition of decolonization (if provided), descriptions of decolonial processes used (if stated), and the application of the decolonial processes (e.g., for research, intervention, or critique, etc.). Characteristics of decolonial processes were grouped by those that were similarly described leading to the generation of common themes of reflection, action, and planning. Our review suggests that no clear norms exist in conceptualizing the definitions and processes of decolonization in the reviewed literature. A small proportion of the articles articulate decolonial processes in manners that are consistent, cohesive and attentive to the goals of decolonization. We believe that this review will encourage public health practitioners to consider meaningful approaches to challenging colonizing structures and engage with community partners to advance the visions of social justice and health equity.
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23
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Chandanabhumma PP, Narasimhan S. Towards health equity and social justice: an applied framework of decolonization in health promotion. Health Promot Int 2021; 35:831-840. [PMID: 31236575 DOI: 10.1093/heapro/daz053] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 11/14/2022] Open
Abstract
The pursuit of health equity and social justice lie at the heart of community-empowered health promotion practice. However, there is a need to address the colonial legacy and its contributions to health inequities. The process of decolonization is essential to eliminating the mechanisms that contributed to such inequities. To this end, we propose an Applied Decolonial Framework for Health Promotion that integrates decolonial processes into health promotion practice. We present characteristics of the framework, its values for health promotion transformations and considerations for using the framework in health promotion practice. The framework will help health promotion stakeholders attend to colonizing structures within the field and engage with communities to achieve social justice and health equity.
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Affiliation(s)
| | - Subasri Narasimhan
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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24
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Coombe CM, Chandanabhumma PP, Bhardwaj P, Brush BL, Greene-Moton E, Jensen M, Lachance L, Lee SD, Meisenheimer M, Minkler M, Muhammad M, Reyes AG, Rowe Z, Wilson-Powers E, Israel BA. A Participatory, Mixed Methods Approach to Define and Measure Partnership Synergy in Long-standing Equity-focused CBPR Partnerships. Am J Community Psychol 2020; 66:427-438. [PMID: 32744781 PMCID: PMC7772255 DOI: 10.1002/ajcp.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Understanding what contributes to success of community-based participatory research (CBPR) partnerships is essential to ensuring their effectiveness in addressing health disparities and health inequities. Synergy, the concept of accomplishing more together than separately, is central to partnership effectiveness. However, synergy specific to long-standing, equity-focused CBPR partnerships has not been closely examined. To address this, we defined and developed measures of partnership synergy as one dimension of a participatory mixed methods study, Measurement Approaches to Partnership Success (MAPS), to develop a validated instrument to measure success in long-standing CBPR partnerships. Framed by a conceptual model and scoping literature review, we conducted in-depth interviews with a national panel of academic and community experts in CBPR and equity to develop partnership synergy measures. Items were refined through an iterative process, including a three-stage Delphi process, comparison with existing measures, cognitive interviews, and pilot testing. Seven questionnaire items were developed to measure synergy arising from equitable partnerships bringing together diverse partners across power differences to promote equity. Defining and measuring synergy in the context of long-standing partnership success is central to understanding the role of synergy in collaborative approaches to research and action and can strengthen CBPR partnerships to promote healthy communities and advance health equity.
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Affiliation(s)
- Chris M. Coombe
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Prachi Bhardwaj
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | | | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI
| | - S.Y. Daniel Lee
- University of Michigan School of Public Health, Ann Arbor, MI
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25
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Chandanabhumma PP, Fetters MD, Pagani FD, Malani PN, Hollingsworth JM, Funk RJ, Aaronson KD, Zhang M, Kormos RL, Chenoweth CE, Shore S, Watt TMF, Cabrera L, Likosky DS. Authorship Correction: Understanding and Addressing Variation in Health Care-Associated Infections After Durable Ventricular Assist Device Therapy: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e18324. [PMID: 32525812 PMCID: PMC7317622 DOI: 10.2196/18324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 12/04/2022] Open
Abstract
[This corrects the article DOI: 10.2196/14701.].
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Affiliation(s)
- P Paul Chandanabhumma
- Mixed Methods Program, Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael D Fetters
- Mixed Methods Program, Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | | | - Russell J Funk
- Department of Strategic Management and Entrepreneurship, Carlson School of Management, University of Minnesota, Minneapolis, MN, United States
| | - Keith D Aaronson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Robert L Kormos
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Supriya Shore
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tessa M F Watt
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Lourdes Cabrera
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States
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26
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Chandanabhumma PP, Duran BM, Peterson JC, Pearson CR, Oetzel JG, Dutta MJ, Wallerstein NB. Space within the Scientific Discourse for the Voice of the Other? Expressions of Community Voice in the Scientific Discourse of Community-Based Participatory Research. Health Commun 2020; 35:616-627. [PMID: 30786730 DOI: 10.1080/10410236.2019.1581409] [Citation(s) in RCA: 5] [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: 06/09/2023]
Abstract
Community-based participatory research (CBPR) has captured public health attention and support because it is positioned as an approach that involves researchers and communities as equitable partners in addressing health disparities. However, it is unknown the extent to which CBPR creates a participatory space in the scientific discourse to signal "community voice," which we define as textual expression of community-centered perspectives on collective roles, interests, and worldviews. In this study, we utilized the culture-centered approach to examine the expression of community voice in the abstracts and public health relevance statements of 253 extramural CBPR projects in the U.S. that received funding from the National Institute of Health and Centers for Disease Control and Prevention in 2009. We found that project abstracts and public health relevance statements contain four textual domains, or potential sites of contest to signal the articulation of community agency and voice within the CBPR projects. These domains include: 1) the rationale for the community health issue, 2) the roles of community partners, 3) community-centered outcomes of the partnership, and 4) elements of participatory research process. The degree of culture-centeredness of the texts is suggested in the extent to which articulations of community agency and voice are signaled across the four domains. We conclude that the dynamics of CBPR may shape culture-centered expressions of problem identification, solution configuration, structural transformations, reflexivity, values, and agency in the project abstracts and public health relevance statements.
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Affiliation(s)
| | - Bonnie M Duran
- Indigenous Wellness Research Institute National Center of Excellence, University of Washington
| | | | - Cynthia R Pearson
- Indigenous Wellness Research Institute National Center of Excellence, University of Washington
| | - John G Oetzel
- Department of Management Communication, University of Waikato
| | - Mohan J Dutta
- School of Communication, Journalism and Marketing, Massey University
| | - Nina B Wallerstein
- Center for Participatory Research, Department of Family and Community Medicine, University of New Mexico
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27
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Chandanabhumma PP, Fetters MD, Pagani FD, Malani PN, Hollingsworth JM, Funk RJ, Aaronson KD, Zhang M, Kormos RL, Chenoweth CE, Shore S, Watt TMF, Cabrera L, Likosky DS. Understanding and Addressing Variation in Health Care-Associated Infections After Durable Ventricular Assist Device Therapy: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e14701. [PMID: 31909721 PMCID: PMC6996720 DOI: 10.2196/14701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/26/2019] [Accepted: 10/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Durable ventricular assist device (VAD) therapy is reserved for patients with advanced heart failure who have a poor estimated 1-year survival. However, despite highly protocolized management processes, patients are at a unique risk for developing a health care-associated infection (HAI). Few studies have examined optimal strategies for HAI prevention after durable VAD implantation, despite variability in rates across centers and their impact on short- and long-term outcomes. OBJECTIVE The objective of this study is to develop recommendations for preventing the most significant HAIs after durable VAD implantation. The study has 3 specific aims: (1) identify determinants of center-level variability in HAI rates, (2) develop comprehensive understanding of barriers and facilitators for achieving low center-level HAI rates, and (3) develop and disseminate a best practices toolkit for preventing HAIs that accommodates various center contexts. METHODS This is a sequential mixed methods study starting with a cross-sectional assessment of current practices. To address aim 1, we will conduct (1) a systematic review of HAI prevention studies and (2) in-depth quantitative analyses using administrative claims, in-depth clinical data, and organizational surveys of VAD centers. For aim 2, we will apply a mixed methods patient tracer assessment framework to conduct semistructured interviews, field observations, and document analysis informed by findings from aim 1 at 5 high-performing (ie, low HAIs) and 5 low-performing (ie, high HAI) centers, which will be examined using a mixed methods case series analysis. For aim 3, we will build upon the findings from the previous aims to develop and field test an HAI preventive toolkit, acquire stakeholder input at an annual cardiac surgical conference, disseminate the final version to VAD centers nationwide, and conduct follow-up surveys to assess the toolkit's adoption. RESULTS The project was funded by the Agency for Healthcare Research and Quality in 2018 and enrollment for the overall project is ongoing. Data analysis is currently under way and the first results are expected to be submitted for publication in 2019. CONCLUSIONS This mixed methods study seeks to quantitatively assess the determinants of HAIs across clinical centers and qualitatively identify the context-specific facilitators and barriers for attaining low HAI rates. The mixed data findings will be used to develop and disseminate a stakeholder-acceptable toolkit of evidence-based HAI prevention recommendations that will accommodate the specific contexts and needs of VAD centers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/14701.
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Affiliation(s)
- P Paul Chandanabhumma
- Mixed Methods Program, Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Michael D Fetters
- Mixed Methods Program, Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Preeti N Malani
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | | | - Russell J Funk
- Department of Strategic Management and Entrepreneurship, Carlson School of Management, University of Minnesota, Minneapolis, MN, United States
| | - Keith D Aaronson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Min Zhang
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Robert L Kormos
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Supriya Shore
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Tessa M F Watt
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Lourdes Cabrera
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, United States
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28
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Ford CL, Takahashi LM, Chandanabhumma PP, Ruiz ME, Cunningham WE. Anti-Racism Methods for Big Data Research: Lessons Learned from the HIV Testing, Linkage, & Retention in Care (HIV TLR) Study. Ethn Dis 2018; 28:261-266. [PMID: 30116096 DOI: 10.18865/ed.28.s1.261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/18/2022] Open
Abstract
Public Health Critical Race Praxis (PHCRP) contributes three functional elements to health equity studies: a race conscious orientation; an antiracism lexicon based on Critical Race Theory (CRT); and an integrated, reflexive approach. Few big data studies employ all three functional elements. Therefore, this article describes the application of PHCRP to the Human Immunodeficiency Virus Testing, Linkage and Retention in care (HIV TLR) study (N=3,476,741), which connects multiple large datasets to electronic medical records to examine contextual determinants of racial/ethnic disparities in HIV care continuum outcomes in southern California. As HIV TLR demonstrates, PHCRP's innovative tools and strategies help big data research maintain fidelity to CRT.
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Affiliation(s)
- Chandra L Ford
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,Department of Community Health Sciences, Fielding School of Public Health at UCLA, Los Angeles, CA
| | - Lois M Takahashi
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,Price School of Public Policy, University of Southern California, Los Angeles, CA
| | - P Paul Chandanabhumma
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,Department of Community Health Sciences, Fielding School of Public Health at UCLA, Los Angeles, CA
| | - Maria Elena Ruiz
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,School of Nursing, University of California at Los Angeles (UCLA), Los Angeles, CA
| | - William E Cunningham
- Center for the Study of Racism, Social Justice & Health, Fielding School of Public Health at UCLA, Los Angeles, CA.,Department of Health Services Research & General Internal Medicine, Geffen School of Medicine at UCLA, Los Angeles, CA
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