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Nurmohamed NS, van Rosendael AR, Danad I, Ngo-Metzger Q, Taub PR, Ray KK, Figtree G, Bonaca MP, Hsia J, Rodriguez F, Sandhu AT, Nieman K, Earls JP, Hoffmann U, Bax JJ, Min JK, Maron DJ, Bhatt DL. Atherosclerosis evaluation and cardiovascular risk estimation using coronary computed tomography angiography. Eur Heart J 2024:ehae190. [PMID: 38606889 DOI: 10.1093/eurheartj/ehae190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Clinical risk scores based on traditional risk factors of atherosclerosis correlate imprecisely to an individual's complex pathophysiological predisposition to atherosclerosis and provide limited accuracy for predicting major adverse cardiovascular events (MACE). Over the past two decades, computed tomography scanners and techniques for coronary computed tomography angiography (CCTA) analysis have substantially improved, enabling more precise atherosclerotic plaque quantification and characterization. The accuracy of CCTA for quantifying stenosis and atherosclerosis has been validated in numerous multicentre studies and has shown consistent incremental prognostic value for MACE over the clinical risk spectrum in different populations. Serial CCTA studies have advanced our understanding of vascular biology and atherosclerotic disease progression. The direct disease visualization of CCTA has the potential to be used synergistically with indirect markers of risk to significantly improve prevention of MACE, pending large-scale randomized evaluation.
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Affiliation(s)
- Nick S Nurmohamed
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States
| | | | - Ibrahim Danad
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
| | - Pam R Taub
- Section of Cardiology, Department of Medicine, University of California, San Diego, CA, United States
| | - Kausik K Ray
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Gemma Figtree
- Faculty of Medicine and Health, University of Sydney, Australia, St Leonards, Australia
| | - Marc P Bonaca
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Judith Hsia
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Fatima Rodriguez
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexander T Sandhu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Koen Nieman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - James P Earls
- Cleerly, Inc., Denver, CO, United States
- Department of Radiology, The George Washington University School of Medicine, Washington, DC, United States
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - David J Maron
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, Box 1030, New York, NY 10029, United States
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Cervantes-Ortega M, Palma AM, Rook KS, Biegler KA, Davis KC, Janio EA, Kilgore DB, Dow E, Ngo-Metzger Q, Sorkin DH. Health-Related Social Control and Perceived Stress Among High-Risk Latina Mothers with Type 2 Diabetes and Their At-Risk Adult Daughters. Int J Behav Med 2023; 30:814-823. [PMID: 36650345 PMCID: PMC10350477 DOI: 10.1007/s12529-022-10145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Diabetes-related multi-morbidity and cultural factors place Latinas with diabetes at increased risk for stress, which can threaten illness management. Families provide an ideal focus for interventions that seek to strengthen interpersonal resources for illness management and, in the process, to reduce stress. The current study sought to examine whether participating in a dyadic intervention was associated with reduced perceived stress and, furthermore, whether this association was mediated by persuasion and pressure, two forms of health-related social control. METHOD Latina mothers with diabetes and their at-risk adult daughters participated in either (1) a dyadic intervention that encouraged constructive collaboration to improve health behaviors and reduce stress, or (2) a usual-care minimal control condition. Actor-partner interdependence model analysis was used to estimate the effect of the intervention on dyads' perceived stress, and mother-daughter ratings of health-related social control as potential mediators. RESULTS Results revealed that participating in the intervention was associated with significantly reduced perceived stress for daughters, but not for mothers (β = - 3.00, p = 0.02; β = - 0.57, p = 0.67, respectively). Analyses also indicated that the association between the intervention and perceived stress was mediated by persuasion, such that mothers' who experienced more health-related persuasion exhibited significantly less post-intervention perceived stress (indirect effect = - 1.52, 95% CI = [- 3.12, - 0.39]). Pressure exerted by others, however, did not evidence a mediating mechanism for either mothers or daughters. CONCLUSION These findings buttress existing research suggesting that persuasion, or others' attempts to increase participants' healthy behaviors in an uncritical way, may be a driving force in reducing perceived stress levels.
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Affiliation(s)
| | - Anton M Palma
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, 92697, USA
| | - Karen S Rook
- Department of Psychological Science, University of California, Irvine, Irvine, CA, 92697, USA
| | - Kelly A Biegler
- Department of Medicine, University of California, Irvine, Irvine, CA, 92697, USA
| | - Katelyn C Davis
- Department of Medicine, University of California, Irvine, Irvine, CA, 92697, USA
| | - Emily A Janio
- Department of Medicine, University of California, Irvine, Irvine, CA, 92697, USA
| | - David B Kilgore
- Department of Family Medicine, University of California, Irvine, Irvine, CA, 92697, USA
| | - Emily Dow
- Department of Family Medicine, University of California, Irvine, Irvine, CA, 92697, USA
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, 91101, USA
| | - Dara H Sorkin
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, 92697, USA.
- Department of Medicine, University of California, Irvine, Irvine, CA, 92697, USA.
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Chao CR, Cannizzaro NT, Hahn EE, Tewari D, Ngo-Metzger Q, Hsu C, Shen E, Wride P, Hodeib M, Gould M, Mittman BS. A study protocol for a cluster randomized pragmatic trial for comparing strategies for implementing primary HPV testing for routine cervical cancer screening in a large health care system. Contemp Clin Trials 2023; 124:106994. [PMID: 36336248 DOI: 10.1016/j.cct.2022.106994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Limited guidance exists regarding implementation strategies that best facilitate cancer screening practice substitution and achieve optimal stakeholder-centered outcomes. Here we describe the protocol for a randomized pragmatic trial comparing two implementation strategies to facilitate substitution of primary HPV screening for Pap and HPV co-testing to perform routine cervical cancer screening of women aged 30-65 years at Kaiser Permanente Southern California (KPSC). METHODS Twelve service areas within KPSC will be randomized to a "centrally-administered system-wide implementation + local-tailored implementation" strategy or a "centrally-administered system-wide implementation only" strategy. The centrally-administered strategy comprises clinician and staff educational activities. Sites in the local-tailored arm will then conduct a structured local needs assessment followed by site-specific selection and deployment of implementation interventions. Surveys and interviews will be conducted among women and providers from the primary care and ob/gyn departments prior to the system-wide transition, shortly after the transition, and after the completion of local-tailored interventions. A stakeholder advisory committee will assist with study design, defining stakeholder-centered outcomes, and developing data collection tools. RESULTS The primary outcome of interest is uptake of primary HPV screening. Secondary provider-centered outcomes include provider knowledge, delivery of patient education, satisfaction with the practice substitution process, and resistance to primary HPV screening. Secondary patient-centered outcomes include patient knowledge, stigma, and satisfaction with the screening process. Intervention fidelity will also be measured via surveys. CONCLUSIONS Findings from this study will help inform future use of a local-tailored implementation strategy for adopting primary HPV screening at large health care systems. Findings may also be applicable to other types of practice substitution.
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Affiliation(s)
- Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Nancy T Cannizzaro
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Devansu Tewari
- Department of Obstetrics and Gynecology, Kaiser Permanente, Irvine, Gynecologic Oncology Division, KPSC - Orange County Women's Health Services, 6650 Alton Pkwy, Irvine, CA 92618, USA.
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 South Los Robles Ave., Pasadena, CA, 91101, USA.
| | - Chunyi Hsu
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Patricia Wride
- Department of Obstetrics and Gynecology, Kaiser Permanente, Irvine, Gynecologic Oncology Division, KPSC - Orange County Women's Health Services, 6650 Alton Pkwy, Irvine, CA 92618, USA.
| | - Melissa Hodeib
- Department of Obstetrics and Gynecology, Kaiser Permanente, KPSC Riverside Medical Center, 10800 Magnolia Ave, Riverside, CA 92505, USA.
| | - Michael Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 South Los Robles Ave., Pasadena, CA, 91101, USA.
| | - Brian S Mittman
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
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Ngo-Metzger Q. Diabetes Screening: Different Thresholds for Different Racial/Ethnic Groups. Ann Intern Med 2022; 175:895-896. [PMID: 35533385 DOI: 10.7326/m22-1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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5
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Klabunde CN, Ellis EM, Villani J, Neilson E, Schwartz K, Vogt EA, Ngo-Metzger Q. Characteristics of Scientific Evidence Informing Changed U.S. Preventive Services Task Force Insufficient Evidence Statements. Am J Prev Med 2022; 62:e77-e86. [PMID: 34657771 DOI: 10.1016/j.amepre.2021.07.014] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The U.S. Preventive Services Task Force (USPSTF) issues "Insufficient Evidence" (I) statements when scientific evidence is inadequate for making recommendations about clinical preventive services. Insufficient Evidence statements may be changed to definitive recommendations if new research closes evidence gaps. This study examines the characteristics of evidence that informed changes from I statements to definitive recommendations, including NIH's role as a funder. METHODS A total of 11 USPSTF Insufficient Evidence statements that were changed between 2010 and 2019 were assessed. Study designs, bibliometric influence, and funding sources for scientific articles cited in USPSTF evidence reviews were characterized for each I statement. Data were analyzed in 2019-2020. RESULTS Most I statements (82%) changed to a B grade; an average of 8.4 years elapsed between issuing the I statement and releasing the definitive recommendation. An average of 63 (range=19-253) articles were included in each USPSTF evidence review. NIH support was cited in 28.8% of articles, on average. The proportion of NIH-funded articles reporting RCT designs was similar to that of non-NIH-funded articles (64.5% vs 59.5%). A higher proportion of NIH-funded articles were rated good quality for study design (39.0%) than the proportion of non-NIH-funded articles (24.4%). Bibliometric influence measured by relative citation ratios was higher for NIH-funded (mean=14.78) than for non-NIH-funded (mean=5.07) articles. CONCLUSIONS Study designs and funding supports varied widely across topics, but overall, NIH was the largest single funder of evidence informing 11 changed USPSTF I statements. Enhanced efforts by NIH and other stakeholders to address I statement evidence gaps are needed.
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Affiliation(s)
- Carrie N Klabunde
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland.
| | - Erin M Ellis
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland
| | - Jennifer Villani
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland
| | - Elizabeth Neilson
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland
| | - Kat Schwartz
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland
| | - Elizabeth A Vogt
- Office of Disease Prevention, Division of Program Coordination Planning and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Davidson KW, Krist AH, Tseng CW, Simon M, Doubeni CA, Kemper AR, Kubik M, Ngo-Metzger Q, Mills J, Borsky A. Incorporation of Social Risk in US Preventive Services Task Force Recommendations and Identification of Key Challenges for Primary Care. JAMA 2021; 326:1410-1415. [PMID: 34468692 DOI: 10.1001/jama.2021.12833] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE In its mission to improve health, the US Preventive Services Task Force (USPSTF) recognizes the strong relationship between a person's health and social and economic circumstances as well as persistent inequities in health care delivery. OBJECTIVE To assess how social risks have been considered in USPSTF recommendation statements and identify current gaps in evidence needed to expand the systematic inclusion of social risks in future recommendations. EVIDENCE The USPSTF commissioned a technical brief that reviewed existing literature on screening and interventions for social risk factors and also audited the 85 USPSTF recommendation statements active as of December 2019 to determine how social risks were addressed in clinical preventive services recommendations. FINDINGS Among the 85 USPSTF recommendation statements reviewed, 14 were focused on preventive services that considered health-related social risks. Social risks were commonly referenced in parts of USPSTF recommendations, with 57 of 85 recommendations including some comment on social risks within the recommendation statement, although many comments were not separate prevention services. Social risks were commented on in USPSTF recommendations as part of risk assessment, as a marker of worse health outcomes from the condition of focus, as a consideration for clinicians when implementing the preventive service, and as a research need or gap on the topic. CONCLUSIONS AND RELEVANCE This report identified how social risks have been considered in the USPSTF recommendation statements. It serves as a benchmark and foundation for ongoing work to advance the goal of ensuring that health equity and social risks are incorporated in USPSTF methods and recommendations.
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Affiliation(s)
- Karina W Davidson
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | | | - Chyke A Doubeni
- Family Medicine and Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota
| | | | | | - Quyen Ngo-Metzger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Justin Mills
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Amanda Borsky
- Agency for Healthcare Research and Quality, Rockville, Maryland
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Hahn EE, Munoz-Plaza C, Altman DE, Hsu C, Cannizzaro NT, Ngo-Metzger Q, Wride P, Gould MK, Mittman BS, Hodeib M, Tewari KS, Ajamian LH, Eskander RN, Tewari D, Chao CR. De-implementation and substitution of clinical care processes: stakeholder perspectives on the transition to primary human papillomavirus (HPV) testing for cervical cancer screening. Implement Sci Commun 2021; 2:108. [PMID: 34556189 PMCID: PMC8461958 DOI: 10.1186/s43058-021-00211-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/06/2021] [Indexed: 12/27/2022] Open
Abstract
Background New cervical cancer screening guidelines recommend primary human papillomavirus (HPV) testing for women age 30–65 years. Healthcare organizations are preparing to de-implement the previous recommended strategies of Pap testing or co-testing (Pap plus HPV test) and substitute primary HPV testing. However, there may be significant challenges to the replacement of this entrenched clinical practice, even with an evidence-based substitution. We sought to identify stakeholder-perceived barriers and facilitators to this substitution within a large healthcare system, Kaiser Permanente Southern California. Methods We conducted semi-structured qualitative interviews with clinician, administrative, and patient stakeholders regarding (a) acceptability and feasibility of the planned substitution; (b) perceptions of barriers and facilitators, with an emphasis on those related to the de-implementation/implementation cycle of substitution; and (c) perceived readiness to change. Our interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). Using a team coding approach, we developed an initial coding structure refined during iterative analysis; the data were subsequently organized thematically into domains, key themes, and sub-themes using thematic analysis, followed by framework analysis informed by CFIR. Results We conducted 23 interviews: 5 patient and 18 clinical/administrative. Clinicians perceived that patients feel more tests equals better care, and clinicians and patients expressed fear of missed cancers (“…it’ll be more challenging convincing the patient that only one test is…good enough to detect cancer.”). Patients perceived practice changes resulting in “less care” are driven by the desire to cut costs. In contrast, clinicians/administrators viewed changing from two tests to one as acceptable and a workflow efficiency (“…It’s very easy and half the work.”). Stakeholder-recommended strategies included focusing on the increased efficacy of primary HPV testing and developing clinician talking points incorporating national guidelines to assuage “cost-cutting” fears. Conclusions Substitution to replace an entrenched clinical practice is complex. Leveraging available facilitators is key to ease the process for clinical and administrative stakeholders—e.g., emphasizing the efficiency of going from two tests to one. Identifying and addressing clinician and patient fears regarding cost-cutting and perceived poorer quality of care is critical for substitution. Multicomponent and multilevel strategies for engagement and education will be required. Trial registration ClinicalTrials.gov, #NCT04371887 Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00211-z.
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Affiliation(s)
- Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA. .,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Corrine Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA
| | - Danielle E Altman
- Center for Health Living, Kaiser Permanente Southern California, Pasadena, USA
| | - Chunyi Hsu
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA
| | - Nancy T Cannizzaro
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Patricia Wride
- Southern California Permanente Medical Group, Pasadena, USA
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Brian S Mittman
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA
| | - Melissa Hodeib
- Southern California Permanente Medical Group, Pasadena, USA
| | - Krishnansu S Tewari
- Department of Gynecologic Oncology, University of California Irvine, Irvine, CA, USA
| | - Lena H Ajamian
- Southern California Permanente Medical Group, Pasadena, USA
| | - Ramez N Eskander
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Devansu Tewari
- Southern California Permanente Medical Group, Pasadena, USA
| | - Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Nau C, Bruxvoort K, Navarro RA, Chevez SG, Hogan TA, Ironside KR, Ludwig SM, Ngo-Metzger Q, Mourra NR, Young DR, Sangha N, Turner BP, Li IX, Padilla A, Chen A, Hong V, Yau V, Tartof S. COVID-19 Inequities Across Multiple Racial and Ethnic Groups: Results From an Integrated Health Care Organization. Ann Intern Med 2021; 174:1183-1186. [PMID: 33872046 PMCID: PMC8082524 DOI: 10.7326/m20-8283] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Claudia Nau
- Kaiser Permanente Southern California, Pasadena, California
| | | | - Ronald A Navarro
- South Bay Medical Center, Kaiser Permanente Southern California, Harbor City, California
| | - Shari G Chevez
- Kaiser Permanente Southern California, Pasadena, California
| | - Tiffany A Hogan
- Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, California
| | - Kristen R Ironside
- Los Angeles Medical Center, Kaiser Permanente Southern California, Pasadena, California
| | - Stacey M Ludwig
- Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, California
| | | | - Natalie R Mourra
- Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, California
| | | | - Navdeep Sangha
- Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, California
| | - Branden P Turner
- West Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, California
| | - Iona Xia Li
- Kaiser Permanente Southern California, Pasadena, California
| | | | - Aiyu Chen
- Kaiser Permanente Southern California, Pasadena, California
| | - Vennis Hong
- Kaiser Permanente Southern California, Pasadena, California
| | | | - Sara Tartof
- Kaiser Permanente Southern California, Pasadena, California
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Borsky AE, Zuvekas SH, Kent EE, de Moor JS, Ngo-Metzger Q, Soni A. Understanding the characteristics of US cancer survivors with informal caregivers. Cancer 2021; 127:2752-2761. [PMID: 33945632 DOI: 10.1002/cncr.33535] [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] [Received: 12/31/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although informal caregivers such as family and friends provide people with cancer needed physical care and emotional support, little is known about which individuals have access to such caregivers. The purpose of this article is to provide a nationally representative description of the sociodemographic characteristics of cancer survivors who have or had an informal caregiver in the United States. METHODS Cross-sectional data were taken from the Experiences With Cancer Survivorship Supplement of the Medical Expenditure Panel Survey in 2011, 2016, and 2017. People were cancer survivors from diagnosis until the end of life. The study population consisted of adult survivors of cancer other than nonmelanoma skin cancer who were treated for cancer less than 3 years before the survey and were living in the community (n = 720). The main outcome measure was whether or not the cancer survivor reported having an informal caregiver. RESULTS In the United States, 55.2% of cancer survivors reported having an informal caregiver during or after their cancer treatment. The relationship of the caregiver to the survivor varied by sex: males were more likely to have a spouse as their caregiver, and females were more likely to have a child as their caregiver. In multivariate analyses, cancer survivors who were female, were married, were of a race/ethnicity other than White, or were in poor health were more likely to have an informal caregiver. CONCLUSIONS Future research can examine whether those without informal caregivers might need more formal support as they undergo cancer treatment and transition into cancer survivorship.
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Affiliation(s)
- Amanda E Borsky
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Erin E Kent
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Quyen Ngo-Metzger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Anita Soni
- Agency for Healthcare Research and Quality, Rockville, Maryland
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10
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Miller MJ, Xu L, Qin J, Hahn EE, Ngo-Metzger Q, Mittman B, Tewari D, Hodeib M, Wride P, Saraiya M, Chao CR. Impact of COVID-19 on Cervical Cancer Screening Rates Among Women Aged 21-65 Years in a Large Integrated Health Care System - Southern California, January 1-September 30, 2019, and January 1-September 30, 2020. MMWR Morb Mortal Wkly Rep 2021; 70:109-113. [PMID: 33507893 PMCID: PMC7842810 DOI: 10.15585/mmwr.mm7004a1] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Davidson KW, Kemper AR, Doubeni CA, Tseng CW, Simon MA, Kubik M, Curry SJ, Mills J, Krist A, Ngo-Metzger Q, Borsky A. Developing Primary Care-Based Recommendations for Social Determinants of Health: Methods of the U.S. Preventive Services Task Force. Ann Intern Med 2020; 173:461-467. [PMID: 32658576 DOI: 10.7326/m20-0730] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of the U.S. Preventive Services Task Force (USPSTF) is to provide evidence-based recommendations on primary care screening, behavioral counseling, and preventive medications. A person's health is strongly influenced by social determinants of health, such as economic and social conditions; therefore, preventive recommendations that address these determinants would be ideal. However, differing social determinants have been proposed by a wide range of agencies and organizations, little prevention evidence is available, and responsible parties are in competition, all of which make the creation of evidence-based prevention recommendations for social determinants of health challenging. This article highlights social determinants already included in USPSTF recommendations and proposes a process by which others may be considered for primary care preventive recommendations. In many ways, incorporating social determinants of health into evidence-based recommendations is an evolving area. By reviewing the evidence on the effects of screening and interventions on social determinants relevant to primary care, the USPSTF will continue to provide recommendations on clinical preventive services to improve the health of all Americans.
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Affiliation(s)
- Karina W Davidson
- Center for Personalized Health, Northwell Health, New York, New York (K.W.D.)
| | - Alex R Kemper
- Nationwide Children's Hospital, Columbus, Ohio (A.R.K.)
| | | | - Chien-Wen Tseng
- University of Hawaii and Pacific Health Research and Education Institute, Honolulu, Hawaii (C.T.)
| | | | - Martha Kubik
- Temple University, Philadelphia, Pennsylvania (M.K.)
| | | | - Justin Mills
- Agency for Healthcare Research and Quality, Rockville, Maryland (J.M., A.B.)
| | - Alex Krist
- Fairfax Family Medicine Residency Program, Fairfax, and Virginia Commonwealth University, Richmond, Virginia (A.K.)
| | | | - Amanda Borsky
- Agency for Healthcare Research and Quality, Rockville, Maryland (J.M., A.B.)
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Affiliation(s)
- Joann G Elmore
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Q Ngo-Metzger
- Bernard J. Tyson School of Medicine, Kaiser Permanente, Pasadena, California
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13
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Krist AH, Davidson KW, Ngo-Metzger Q, Mills J. Social Determinants as a Preventive Service: U.S. Preventive Services Task Force Methods Considerations for Research. Am J Prev Med 2019; 57:S6-S12. [PMID: 31753280 DOI: 10.1016/j.amepre.2019.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Abstract
The body of research on social determinants of health is rapidly accumulating. The U.S. Preventive Services Task Force is conducting evaluations to consider the inclusion of screening and counseling for social risks as a clinical preventive service. Yet, for many social risks, evidence is still likely needed before the U.S. Preventive Services Task Force can recommend universal screening or counseling. This manuscript offers a brief review of the social determinants of health that may be germane to the U.S. Preventive Services Task Force, the methods the U.S. Preventive Services Task Force uses to evaluate relevant evidence, and current evidence gaps for social risks. Key methods for making clinical preventive service recommendations are applied for considering the integration of social and clinical care. These methods include determining the certainty of the evidence, assessing the net benefit, defining appropriate prevention frameworks, defining health outcomes versus intermediate outcomes, fully assessing the harms, and defining to what populations and care contexts the evidence applies. This road map for research is intended to spark ingenuity and purpose in the next generation of research studies, thereby ensuring that future recommendations to address and prevent social risks in primary care are informed by high-quality evidence. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia.
| | | | - Quyen Ngo-Metzger
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Justin Mills
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland
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Kirby JB, Zuvekas SH, Borsky AE, Ngo-Metzger Q. Rural Residents With Mental Health Needs Have Fewer Care Visits Than Urban Counterparts. Health Aff (Millwood) 2019; 38:2057-2060. [DOI: 10.1377/hlthaff.2019.00369] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James B. Kirby
- James B. Kirby is a senior researcher in the Center for Financing, Access, and Cost Trends at the Agency for Healthcare Research and Quality (AHRQ), in Rockville, Maryland
| | - Samuel H. Zuvekas
- Samuel H. Zuvekas is a senior adviser in the Center for Financing, Access, and Cost Trends, AHRQ
| | - Amanda E. Borsky
- Amanda E. Borsky is a dissemination and implementation adviser in the Center for Evidence and Practice Improvement, AHRQ
| | - Quyen Ngo-Metzger
- Quyen Ngo-Metzger is a professor of health systems science at the Kaiser Permanente School of Medicine, in Pasadena, California. At the time this article was written, she was scientific director, US Preventive Services Task Force Program, Center for Evidence and Practice Improvement, AHRQ
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15
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Krist AH, Davidson KW, Ngo-Metzger Q. What Evidence Do We Need Before Recommending Routine Screening for Social Determinants of Health? Am Fam Physician 2019; 99:602-605. [PMID: 31083876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Alex H Krist
- Virginia Commonwealth University, Richmond, VA, USA
| | | | - Quyen Ngo-Metzger
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA
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Shafer PR, Borsky A, Ngo-Metzger Q, Miller T, Meyers D. The Practice Gap: National Estimates of Screening and Counseling for Alcohol, Tobacco, and Obesity. Ann Fam Med 2019; 17:161-163. [PMID: 30858260 PMCID: PMC6411410 DOI: 10.1370/afm.2363] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/04/2018] [Accepted: 12/28/2018] [Indexed: 11/09/2022] Open
Abstract
Tobacco use, lack of physical activity and poor diet, and alcohol consumption are leading causes of death in the United States. We estimated screening and counseling rates by using a nationally representative sample of adults aged 35 years and older with a preventive care supplement to the 2014 Medical Expenditure Panel Survey. Receipt of the recommended level of services ranged from nearly two-thirds (64.2% for obesity, 61.9% for tobacco use) to less than one-half (41.0% for alcohol misuse). There is significant room for improving care delivery, but primary care practices probably also need additional resources to raise screening and counseling rates.
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Affiliation(s)
- Paul R Shafer
- Agency for Healthcare Research and Quality, Rockville, Maryland .,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda Borsky
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Therese Miller
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - David Meyers
- Agency for Healthcare Research and Quality, Rockville, Maryland
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17
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Ngo-Metzger Q, Adsul P. Screening for Cervical Cancer. Am Fam Physician 2019; 99:253-254. [PMID: 30763054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Quyen Ngo-Metzger
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
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Borsky A, Zhan C, Miller T, Ngo-Metzger Q, Bierman AS, Meyers D. Few Americans Receive All High-Priority, Appropriate Clinical Preventive Services. Health Aff (Millwood) 2019; 37:925-928. [PMID: 29863918 DOI: 10.1377/hlthaff.2017.1248] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [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: 11/05/2022]
Abstract
As of 2015, only 8 percent of US adults ages thirty-five and older had received all of the high-priority, appropriate clinical preventive services recommended for them. Nearly 5 percent of adults did not receive any such services. Further delivery system-level efforts are needed to increase the use of preventive services.
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Affiliation(s)
- Amanda Borsky
- Amanda Borsky ( ) is a dissemination and implementation adviser in the Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality (AHRQ), in Rockville, Maryland
| | - Chunliu Zhan
- Chunliu Zhan is a health scientist administrator at AHRQ
| | - Therese Miller
- Therese Miller is deputy director of the Center for Evidence and Practice Improvement, AHRQ
| | - Quyen Ngo-Metzger
- Quyen Ngo-Metzger is scientific director, US Preventive Services Task Force Program, Center for Evidence and Practice Improvement, AHRQ
| | - Arlene S Bierman
- Arlene S. Bierman is director of the Center for Evidence and Practice Improvement, AHRQ
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19
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Ngo-Metzger Q, Zuvekas SH, Bierman AS. Estimated Impact of US Preventive Services Task Force Recommendations on Use and Cost of Statins for Cardiovascular Disease Prevention. J Gen Intern Med 2018; 33:1317-1323. [PMID: 29855861 PMCID: PMC6082218 DOI: 10.1007/s11606-018-4497-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/26/2018] [Accepted: 05/11/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND US Preventive Services Task Force (USPSTF) released new recommendations on statin use for atherosclerotic cardiovascular disease (ASCVD) prevention. The Affordable Care Act (ACA) mandates USPSTF recommendations with an "A" or "B" grade receive insurance coverage without copayment. We assessed the potential impact of these recommendations. OBJECTIVE To assess the US population meeting criteria for statin use and factors associated with use, and calculate associated costs. DESIGN AND MEASURES We estimated 10-year ASCVD event risk scores from National Health and Nutrition Examination Survey data using Pooled Cohort Equations from the American College of Cardiology/American Heart Association and applied them to Medical Expenditure Panel Survey data. We estimated the population meeting USPSTF criteria and calculated the number of statin prescription fills and out-of-pocket and total costs. We assessed associations between statin use and sociodemographic and health characteristics and national trends in use from 1996 to 2014. PARTICIPANTS A nationally representative sample of people aged ≥ 40 years, representing 150 million people living in the USA. KEY RESULTS Of 26.8 million adults recommended for statins, only 41.8% were taking them. Female sex, Hispanic ethnicity, uninsured status, or living in the South was associated with lower odds of using statins. Under ACA, people with private insurance would avoid out-of-pocket cost of $9 for each generic prescription, resulting in savings of approximately $44 in annual costs. ACA's mandate for insurance coverage would result in a $193 million shift in out-of-pocket cost for statins from patients to private insurers. CONCLUSIONS New USPSTF recommendations may result in decreased out-of-pocket costs and expanded access to statins. Previous research has shown that eliminating copayments increased adherence and decreased rates of ASCVD events without increasing overall healthcare costs. Future research will determine whether the USPSTF's recommendations will result in similar findings.
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Affiliation(s)
- Quyen Ngo-Metzger
- Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD, USA.
| | - Samuel H Zuvekas
- Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Arlene S Bierman
- Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, Rockville, MD, USA
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Sorkin DH, Rook KS, Campos B, Marquez B, Solares J, Mukamel DB, Marcus B, Kilgore D, Dow E, Ngo-Metzger Q, Nguyen DV, Biegler K. Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters. Contemp Clin Trials 2018; 69:10-20. [PMID: 29597006 PMCID: PMC5964027 DOI: 10.1016/j.cct.2018.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention. PURPOSE Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. METHODS Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group. RESULTS The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention. CONCLUSION Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02741037.
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Affiliation(s)
- Dara H Sorkin
- Department of Medicine, University of California, Irvine, Irvine, CA, USA.
| | - Karen S Rook
- Department of Psychology and Social Behavior, University of California Irvine, Irvine, CA, USA
| | - Belinda Campos
- Department of Chicano/Latino Studies, University of California Irvine, Irvine, CA, USA
| | - Becky Marquez
- School of Public Health, Brown University, Providence, RI, USA
| | | | - Dana B Mukamel
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Bess Marcus
- School of Public Health, Brown University, Providence, RI, USA
| | - David Kilgore
- Department of Family Medicine, University of California Irvine, Irvine, CA, USA
| | - Emily Dow
- Department of Family Medicine, University of California Irvine, Irvine, CA, USA
| | - Quyen Ngo-Metzger
- Department of Medicine, University of California, Irvine, Irvine, CA, USA; US Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Danh V Nguyen
- Department of Medicine, University of California, Irvine, Irvine, CA, USA; Biostatistics, Epidemiology and Research Design, University of California Irvine, Irvine, CA, USA
| | - Kelly Biegler
- Department of Medicine, University of California, Irvine, Irvine, CA, USA
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21
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Villani J, Ngo-Metzger Q, Vincent IS, Klabunde CN. Sources of Funding for Research in Evidence Reviews That Inform Recommendations of the US Preventive Services Task Force. JAMA 2018; 319:2132-2133. [PMID: 29800165 PMCID: PMC6584316 DOI: 10.1001/jama.2018.5404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study characterizes the sources of funding for the research included in systematic reviews that form the basis for US Preventive Services Task Force recommendation statements.
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Affiliation(s)
- Jennifer Villani
- Office of Disease Prevention, National Institutes of Health, Rockville, Maryland
| | | | - Isaah S. Vincent
- Office of Disease Prevention, National Institutes of Health, Rockville, Maryland
| | - Carrie N. Klabunde
- Office of Disease Prevention, National Institutes of Health, Rockville, Maryland
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22
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Ngo-Metzger Q, Moyer V, Grossman D, Ebell M, Woo M, Miller T, Brummer T, Chowdhury J, Kato E, Siu A, Phillips W, Davidson K, Phipps M, Bibbins-Domingo K. Conflicts of Interest in Clinical Guidelines: Update of U.S. Preventive Services Task Force Policies and Procedures. Am J Prev Med 2018; 54:S70-S80. [PMID: 29254528 DOI: 10.1016/j.amepre.2017.06.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/09/2017] [Accepted: 06/30/2017] [Indexed: 11/24/2022]
Abstract
The U.S. Preventive Services Task Force (USPSTF) provides independent, objective, and scientifically rigorous recommendations for clinical preventive services. A primary concern is to avoid even the appearance of members having special interests that might influence their ability to judge evidence and formulate unbiased recommendations. The conflicts of interest policy for the USPSTF is described, as is the formal process by which best practices were incorporated to update the policy. The USPSTF performed a literature review, conducted key informant interviews, and reviewed conflicts of interest policies of ten similar organizations. Important findings included transparency and public accessibility; full disclosure of financial relationships; disclosure of non-financial relationships (that create the potential for bias and compromise a member's objective judgment); disclosure of family members' conflicts of interests; and establishment of appropriate reporting periods. Controversies in best practices include the threshold of financial disclosures, ease of access to conflicts of interest policies and declarations, vague definition of non-financial biases, and request for family members' conflicts of interests (particularly those that are non-financial in nature). The USPSTF conflicts of interest policy includes disclosures for immediate family members, a clear non-financial conflicts of interest definition, long look-back period and application of the policy to prospective members. Conflicts of interest is solicited from all members every 4 months, formally reviewed, adjudicated, and made publicly available. The USPSTF conflicts of interest policy is publicly available as part of the USPSTF Procedure Manual. A continuous improvement process can be applied to conflicts of interest policies to enhance public trust in members of panels, such as the USPSTF, that produce clinical guidelines and recommendations.
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Affiliation(s)
| | - Virginia Moyer
- Maintenance of Certification and Quality, the American Board of Pediatrics, Chapel Hill, North Carolina
| | - David Grossman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Department of Health Services and Pediatrics, University of Washington, Seattle, Washington
| | - Mark Ebell
- College of Public Health, University of Georgia, Athens, Georgia
| | - Meghan Woo
- Abt Associates, Cambridge, Massachusetts
| | - Therese Miller
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Joya Chowdhury
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Elisabeth Kato
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Albert Siu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - William Phillips
- School of Medicine, School of Public Health, University of Washington, Seattle, Washington
| | - Karina Davidson
- Departments of Medicine, Cardiology, and Psychiatry, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New York
| | - Maureen Phipps
- Warren Alpert Medical School, School of Public Health, Brown University, Providence, Rhode Island
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Mabry-Hernandez IR, Curry SJ, Phillips WR, García FA, Davidson KW, Epling JW, Ngo-Metzger Q, Bierman AS. U.S. Preventive Services Task Force Priorities for Prevention Research. Am J Prev Med 2018; 54:S95-S103. [PMID: 29254531 DOI: 10.1016/j.amepre.2017.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/07/2017] [Accepted: 08/07/2017] [Indexed: 01/23/2023]
Abstract
The U.S. Preventive Services Task Force (USPSTF) makes recommendations about clinical preventive services. The USPSTF examines chains of direct and indirect evidence to demonstrate the effectiveness of a clinical preventive service. Missing links across the chains of evidence reflect gaps in the research. Evidence gaps can occur for preventive services that receive a letter grade recommendation and those that receive an I statement (insufficient evidence). This article describes the types of evidence gaps that the USPSTF encounters across its various recommendations and how the USPSTF identifies and communicates these gaps to researchers and policymakers, who can help generate the needed evidence. Common types of evidence gaps include limited evidence in primary care settings and populations, a lack of appropriate health outcomes, limited evidence linking behavior change to health outcomes, and a lack of evidence for effective preventive services in diverse populations. The USPSTF annual report to Congress focuses on the evidence gaps of new recommendations from the past year and is sent to leading research funding agencies. The Office of Disease Prevention at NIH uses this report to help direct future funding opportunities that may address these evidence gaps. The USPSTF plays a critical role in highlighting the information needed to advance the science to optimize the use of clinical preventive services in primary care.
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Affiliation(s)
- Iris R Mabry-Hernandez
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland.
| | - Susan J Curry
- College of Public Health, University of Iowa, Iowa City, Iowa
| | - William R Phillips
- Department of Family Medicine, University of Washington, Seattle, Washington
| | | | - Karina W Davidson
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - John W Epling
- Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Quyen Ngo-Metzger
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Arlene S Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland
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24
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Ngo-Metzger Q, Gottfredson R. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. Am Fam Physician 2017; 96:805-806. [PMID: 29431375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Quyen Ngo-Metzger
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
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25
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Ngo-Metzger Q, Rajupet S. Screening for Colorectal Cancer. Am Fam Physician 2017; 95:653-654. [PMID: 28671397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Quyen Ngo-Metzger
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
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26
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Bibbins-Domingo K, Whitlock E, Wolff T, Ngo-Metzger Q, Phillips WR, Davidson KW, Krist AH, Lin JS, Mangione CM, Kurth AE, García FAR, Curry SJ, Grossman DC, Landefeld CS, Epling JW, Siu AL. Developing Recommendations for Evidence-Based Clinical Preventive Services for Diverse Populations: Methods of the U.S. Preventive Services Task Force. Ann Intern Med 2017; 166:565-571. [PMID: 28265649 DOI: 10.7326/m16-2656] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The U.S. Preventive Services Task Force (USPSTF) summarizes the principles and considerations that guide development of its recommendations for diverse U.S. populations. It uses these principles through each step in the evidence-based guideline process: developing the research plan, conducting the evidence review, developing the recommendation, and communicating to guideline users. Three recent recommendations provide examples of how the USPSTF has used these principles: the 2015 recommendation on screening for abnormal blood glucose and type 2 diabetes; the 2016 recommendation on screening for breast cancer; and the recommendation on screening for prostate cancer, which is currently in progress. A more comprehensive list of recommendations that includes considerations for specific populations is also provided.
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Affiliation(s)
- Kirsten Bibbins-Domingo
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Evelyn Whitlock
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Tracy Wolff
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Quyen Ngo-Metzger
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - William R Phillips
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Karina W Davidson
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Alex H Krist
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Jennifer S Lin
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Carol M Mangione
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Ann E Kurth
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Francisco A R García
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Susan J Curry
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - David C Grossman
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - C Seth Landefeld
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - John W Epling
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
| | - Albert L Siu
- From University of California, San Francisco, San Francisco, California; Patient-Centered Outcomes Research Institute, Washington, DC; Agency for Healthcare Research and Quality, Rockville, Maryland; University of Washington and Group Health Research Institute, Seattle, Washington; Columbia University and Mt. Sinai Medical Center, New York, New York; Virginia Commonwealth University, Richmond, Virginia; Kaiser Permanente Research Affiliates Evidence-based Practice Center, Portland, Oregon; University of California, Los Angeles, Los Angeles, California; Yale University, New Haven, Connecticut; Pima County Department of Health, Tucson, Arizona; University of Iowa, Iowa City, Iowa; University of Alabama at Birmingham, Birmingham, Alabama; and State University of New York Upstate Medical University, Syracuse, New York
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Choi SE, Ngo-Metzger Q, Billimek J, Greenfield S, Kaplan SH, Sorkin DH. Contributors to Patients' Ratings of Quality of Care Among Ethnically Diverse Patients with Type 2 Diabetes. J Immigr Minor Health 2017; 18:382-9. [PMID: 25740551 DOI: 10.1007/s10903-015-0173-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We examined racial/ethnic differences in patients' ratings of components of interpersonal quality [participatory decision making (PDM) style, being treated as an equal partner, and feelings of trust], and evaluated the association between each of these components and patients' ratings of overall healthcare quality among non-Hispanic white (NHW), Vietnamese American, and Mexican American patients with type 2 diabetes. The findings indicated that although all three components were significantly associated with ratings of overall healthcare quality, the significant interactions between race/ethnicity and both PDM style (β = -0.09, p < 0.01) and equal partner (β = -0.06, p < 0.05) for the Vietnamese American patients suggested that the relationship between these components and patients' ratings of healthcare quality were less strong among Vietnamese American patients than among the NHW patients. Understanding racial/ethnic differences in the components of interpersonal quality that are associated with patients' ratings of overall healthcare quality is an important step for improving patients' experiences of their own care.
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Affiliation(s)
- Sarah E Choi
- Program in Nursing Science, University of California, Irvine, 100B Berk Hall, Irvine, CA, 92617-3959, USA.
| | - Quyen Ngo-Metzger
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
| | - John Billimek
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
| | - Sheldon Greenfield
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
| | - Sherrie H Kaplan
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
| | - Dara H Sorkin
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
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Wittie M, Ngo-Metzger Q, Lebrun-Harris L, Shi L, Nair S. Enabling Quality: Electronic Health Record Adoption and Meaningful Use Readiness in Federally Funded Health Centers. J Healthc Qual 2017; 38:42-51. [PMID: 24612263 DOI: 10.1111/jhq.12067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Health Resources and Services Administration has supported the adoption of electronic health records (EHRs) by federally funded health centers for over a decade; however, little is known about health centers' current EHR adoption rates, progress toward Meaningful Use, and factors related to adoption. We analyzed cross-sectional data from all 1,128 health centers in 2011, which served over 20 million patients during that year. As of 2011, 80% of health centers reported using an EHR, and high proportions reported using many advanced EHR functionalities. There were no indications of disparities in EHR adoption by census region, urban/rural location, patient sociodemographic composition, physician staffing, or health center funding; however, there were small variations in adoption by total patient cost and percent of revenue from grants. Findings revealed no evidence of a digital divide among health centers, indicating that health centers are implementing EHRs, in keeping with their mission to reduce health disparities.
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Shi L, Lebrun-Harris LA, Chen LR, Parasuraman SR, Zhu J, Ngo-Metzger Q, Sripipatana A. Preventive Counseling Services during Primary Care Visits: A Comparison of Health Centers versus Other Physician Offices. J Health Care Poor Underserved 2016; 26:519-35. [PMID: 25913348 DOI: 10.1353/hpu.2015.0028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We compared preventive counseling services provided by health centers versus other physician offices. Cross-sectional data came from the 2008 National Ambulatory Medical Care Survey, including 25,177 patient visits in physician offices and 3,345 patient visits in health centers. Despite serving disproportionately more vulnerable patients, health centers provided comparable rates of preventive counseling services, compared with other physician offices: health education (39% vs. 36%), disease management (34% vs. 41%), asthma education (21% vs. 13%), tobacco education (19% for both), and weight reduction education (6% vs. 9%) (p>.05 for all). Adjusted analyses showed no association between health care setting and preventive counseling.
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Lee KC, Ngo-Metzger Q, Wolff T, Chowdhury J, LeFevre ML, Meyers DS. Sexually Transmitted Infections: Recommendations from the U.S. Preventive Services Task Force. Am Fam Physician 2016; 94:907-915. [PMID: 27929270] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The U.S. Preventive Services Task Force (USPSTF) has issued recommendations on behavioral counseling to prevent sexually transmitted infections (STIs) and recommendations about screening for individual STIs. Clinicians should obtain a sexual history to assess for behaviors that increase a patient's risk. Community and population risk factors should also be considered. The USPSTF recommends intensive behavioral counseling for all sexually active adolescents and for adults whose history indicates an increased risk of STIs. These interventions can reduce STI acquisition and risky sexual behaviors, and increase condom use and other protective behaviors. The USPSTF recommends screening for chlamydia and gonorrhea in all sexually active women 24 years and younger, and in older women at increased risk. It recommends screening for human immunodeficiency virus (HIV) infection in all patients 15 to 65 years of age regardless of risk, as well as in younger and older patients at increased risk of HIV infection. The USPSTF also recommends screening for hepatitis B virus infection and syphilis in persons at increased risk. All pregnant women should be tested for hepatitis B virus infection, HIV infection, and syphilis. Pregnant women 24 years and younger, and older women with risk factors should be tested for gonorrhea and chlamydia. The USPSTF recommends against screening for asymptomatic herpes simplex virus infection. There is inadequate evidence to determine the optimal interval for repeat screening; clinicians should rescreen patients when their sexual history reveals new or persistent risk factors.
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Affiliation(s)
- Karen C Lee
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - Tracy Wolff
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Joya Chowdhury
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - David S Meyers
- Agency for Healthcare Research and Quality, Rockville, MD, USA
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Nguyen H, Sorkin DH, Billimek J, Kaplan SH, Greenfield S, Ngo-Metzger Q. Complementary and alternative medicine (CAM) use among non-Hispanic white, Mexican American, and Vietnamese American patients with type 2 diabetes. J Health Care Poor Underserved 2016; 25:1941-55. [PMID: 25418251 DOI: 10.1353/hpu.2014.0178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study examines the use of complementary and alternative medicine (CAM) by ethnicity/race among patients with type 2 diabetes. SUBJECTS AND METHODS Four hundred and ten (410) patients with type 2 diabetes recruited from an academic-medical center completed a survey assessing CAM use, diabetes status, and sociodemographic characteristics. RESULTS Several significant ethnic/racial differences were observed in CAM use (both in the types of providers seen as well as in the herbs and dietary supplements used). Although White patients reported using CAM in addition to their diabetes medication (mean [SD] 4.9 [0.4] on a scale from 1=never to 5=always) more frequently than Mexican American patients (3.1 [1.6], p<.05), Mexican American patients (1.4 [1.1]) used CAM instead of their diabetes medications more frequently than non-Hispanic White patients (1.0 [0.1], p<.05). More Mexican American (66.7%) and Vietnamese American patients (73.7%) than non-Hispanic Whites (11.8%, p=.002) described CAM practitioners as being closer to their cultural traditions than Western practitioners, whereas Vietnamese [End Page 1941] patients were more likely to describe use of herbs and supplements as closer to their cultural traditions (84.5% versus 15.3% for White and 30.9% for Mexican American patients, p <.001). CONCLUSIONS Considering the variability and perceptions in CAM use, providers should discuss with their patients how their CAM use may influence diabetes management behaviors.
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Nocon RS, Lee SM, Sharma R, Ngo-Metzger Q, Mukamel DB, Gao Y, White LM, Shi L, Chin MH, Laiteerapong N, Huang ES. Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings. Am J Public Health 2016; 106:1981-1989. [PMID: 27631748 DOI: 10.2105/ajph.2016.303341] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non-health center settings in a context of significant growth. METHODS Using fee-for-service Medicaid claims from 13 states in 2009, we compared patients receiving the majority of their primary care in federally qualified health centers with propensity score-matched comparison groups receiving primary care in other settings. RESULTS We found that health center patients had lower use and spending than did non-health center patients across all services, with 22% fewer visits and 33% lower spending on specialty care and 25% fewer admissions and 27% lower spending on inpatient care. Total spending was 24% lower for health center patients. CONCLUSIONS Our analysis of 2009 Medicaid claims, which includes the largest sample of states and more recent data than do previous multistate claims studies, demonstrates that the health center program has provided a cost-efficient setting for primary care for Medicaid enrollees.
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Affiliation(s)
- Robert S Nocon
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sang Mee Lee
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ravi Sharma
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Quyen Ngo-Metzger
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Dana B Mukamel
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yue Gao
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Laura M White
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Leiyu Shi
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marshall H Chin
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Neda Laiteerapong
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elbert S Huang
- At the time of this study, Robert S. Nocon and Sang Mee Lee were with the Department of Public Health Sciences, University of Chicago, Chicago, IL. Yue Gao, Marshall H. Chin, Neda Laiteerapong, and Elbert S. Huang were with the Department of Medicine, University of Chicago. Ravi Sharma is with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Quyen Ngo-Metzger is with the Agency for Healthcare Research and Quality, Rockville. Dana B. Mukamel and Laura M. White were with the Department of Medicine, University of California, Irvine. Leiyu Shi is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Biegler K, Mollica R, Sim SE, Nicholas E, Chandler M, Ngo-Metzger Q, Paigne K, Paigne S, Nguyen DV, Sorkin DH. Rationale and study protocol for a multi-component Health Information Technology (HIT) screening tool for depression and post-traumatic stress disorder in the primary care setting. Contemp Clin Trials 2016; 50:66-76. [PMID: 27394385 DOI: 10.1016/j.cct.2016.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
The prevalence rate of depression in primary care is high. Primary care providers serve as the initial point of contact for the majority of patients with depression, yet, approximately 50% of cases remain unrecognized. The under-diagnosis of depression may be further exacerbated in limited English-language proficient (LEP) populations. Language barriers may result in less discussion of patients' mental health needs and fewer referrals to mental health services, particularly given competing priorities of other medical conditions and providers' time pressures. Recent advances in Health Information Technology (HIT) may facilitate novel ways to screen for depression and other mental health disorders in LEP populations. The purpose of this paper is to describe the rationale and protocol of a clustered randomized controlled trial that will test the effectiveness of an HIT intervention that provides a multi-component approach to delivering culturally competent, mental health care in the primary care setting. The HIT intervention has four components: 1) web-based provider training, 2) multimedia electronic screening of depression and PTSD in the patients' primary language, 3) Computer generated risk assessment scores delivered directly to the provider, and 4) clinical decision support. The outcomes of the study include assessing the potential of the HIT intervention to improve screening rates, clinical detection, provider initiation of treatment, and patient outcomes for depression and post-traumatic stress disorder (PTSD) among LEP Cambodian refugees who experienced war atrocities and trauma during the Khmer Rouge. This technology has the potential to be adapted to any LEP population in order to facilitate mental health screening and treatment in the primary care setting.
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Affiliation(s)
- Kelly Biegler
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Richard Mollica
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Susan Elliott Sim
- Faculty of Information, University of Toronto, Toronto, Ontario, Canada
| | - Elisa Nicholas
- Department of Pediatrics, University of California, Irvine, Irvine, CA, United States; The Children's Clinic, Serving Children and Their Families, Long Beach, CA, United States
| | - Maria Chandler
- Department of Pediatrics, University of California, Irvine, Irvine, CA, United States; The Children's Clinic, Serving Children and Their Families, Long Beach, CA, United States
| | - Quyen Ngo-Metzger
- US Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, MD, United States
| | - Kittya Paigne
- The Community Medical Wellness Center, Long Beach, CA, United States
| | - Sompia Paigne
- The Community Medical Wellness Center, Long Beach, CA, United States
| | - Danh V Nguyen
- Department of Medicine, University of California, Irvine, Irvine, CA, United States; Biostatistics, Epidemiology and Research Design, University of California, Irvine, Irvine, CA, United States
| | - Dara H Sorkin
- Department of Medicine, University of California, Irvine, Irvine, CA, United States.
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Ngo-Metzger Q, Owings J. Screening for Abnormal Blood Glucose and Type 2 Diabetes Mellitus. Am Fam Physician 2016; 93:1025-1026. [PMID: 27304773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Quyen Ngo-Metzger
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
| | - John Owings
- Uniformed Services University of the Health Sciences, USA
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Ngo-Metzger Q, Blitz J. Screening for High Blood Pressure in Adults. Am Fam Physician 2016; 93:511-512. [PMID: 26977837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Quyen Ngo-Metzger
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
| | - Jason Blitz
- Uniformed Services University of the Health Sciences, USA
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Murray DM, Kaplan RM, Ngo-Metzger Q, Portnoy B, Olkkola S, Stredrick D, Kuczmarski RJ, Goldstein AB, Perl HI, O'Connell ME. Enhancing Coordination Among the U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, and National Institutes of Health. Am J Prev Med 2015; 49:S166-73. [PMID: 26296551 DOI: 10.1016/j.amepre.2015.04.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/08/2015] [Accepted: 04/27/2015] [Indexed: 01/28/2023]
Abstract
This paper focuses on the relationships among the U.S. Preventive Services Task Force (USPSTF); Agency for Healthcare Research and Quality (AHRQ); and NIH. After a brief description of the Task Force, AHRQ, NIH, and an example of how they interact, we describe the steps that have been taken recently by NIH to enhance their coordination. We also discuss several challenges that remain and consider potential remedies that NIH, AHRQ, and investigators can take to provide the USPSTF with the data it needs to make recommendations, particularly those pertaining to behavioral interventions.
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Affiliation(s)
- David M Murray
- Office of Disease Prevention, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland.
| | - Robert M Kaplan
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Barry Portnoy
- Office of Disease Prevention, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland
| | - Susanne Olkkola
- Office of Disease Prevention, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland
| | - Denise Stredrick
- Office of Disease Prevention, Division of Program Coordination, Planning, and Strategic Initiatives, Office of the Director, NIH, Bethesda, Maryland
| | - Robert J Kuczmarski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Amy B Goldstein
- Division of Services and Intervention Research, National Institute of Mental Health, NIH, Bethesda, Maryland
| | - Harold I Perl
- Prevention Research Branch, Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, NIH, Bethesda, Maryland
| | - Mary E O'Connell
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
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Mukamel DB, White LM, Nocon RS, Huang ES, Sharma R, Shi L, Ngo-Metzger Q. Comparing the Cost of Caring for Medicare Beneficiaries in Federally Funded Health Centers to Other Care Settings. Health Serv Res 2015. [PMID: 26213167 DOI: 10.1111/1475-6773.12339] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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: 12/21/2022] Open
Abstract
OBJECTIVE To compare total annual costs for Medicare beneficiaries receiving primary care in federally funded health centers (HCs) to Medicare beneficiaries in physician offices and outpatient clinics. DATA SOURCES/STUDY SETTINGS Part A and B fee-for-service Medicare claims from 14 geographically diverse states. The sample was restricted to beneficiaries residing within primary care service areas (PCSAs) with at least one HC. STUDY DESIGN We modeled separately total annual costs, annual primary care costs, and annual nonprimary care costs as a function of patient characteristics and PCSA fixed effects. DATA COLLECTION Data were obtained from the Centers for Medicare & Medicaid Services. PRINCIPAL FINDINGS Total median annual costs (at $2,370) for HC Medicare patients were lower by 10 percent compared to patients in physician offices ($2,667) and by 30 percent compared to patients in outpatient clinics ($3,580). This was due to lower nonprimary care costs in HCs, despite higher primary care costs. CONCLUSIONS HCs may offer lower total cost practice style to the Centers for Medicare & Medicaid Services, which administers Medicare. Future research should examine whether these lower costs reflect better management by HC practitioners or more limited access to specialty care by HC patients.
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Affiliation(s)
- Dana B Mukamel
- Department of Medicine, University of California, Irvine, Irvine, CA
| | - Laura M White
- Department of Medicine, University of California, Irvine, Irvine, CA
| | - Robert S Nocon
- Biological Sciences Division, Medicine, General Internal Medicine, University of Chicago, Chicago, IL
| | - Elbert S Huang
- Biological Sciences Division, Medicine, General Internal Medicine, University of Chicago, Chicago, IL
| | - Ravi Sharma
- Department of Health and Human Services, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, MD
| | - Leiyu Shi
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Quyen Ngo-Metzger
- Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, MD
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Sorkin DH, Billimek J, August KJ, Ngo-Metzger Q, Kaplan SH, Reikes AR, Greenfield S. Mental health symptoms and patient-reported diabetes symptom burden: implications for medication regimen changes. Fam Pract 2015; 32:317-22. [PMID: 25846216 PMCID: PMC4542807 DOI: 10.1093/fampra/cmv014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
AIMS To examine the relative contribution of glycaemic control (HbA1C) and depressive symptoms on diabetes-related symptom burden (hypoglycaemia and hyperglycaemia) in order to guide medication modification. METHODS Secondary analysis of medical records data and questionnaires collected from a racially/ethnically diverse sample of adult patients with type 2 diabetes (n = 710) from seven outpatient clinics affiliated with an academic medical centre over a 1-year period as part of the Reducing Racial Disparities in Diabetes: Coached Care (R2D2C2) study. RESULTS Results from linear regression analysis revealed that patients with high levels of depressive symptoms had more diabetes-related symptom burden (both hypoglycaemia and hyperglycaemia) than patients with low levels of depressive symptoms (βs = 0.09-0.17, Ps < 0.02). Furthermore, results from two logistic regression analyses suggested that the odds of regimen intensification at 1-year follow-up was marginally associated with patient-reported symptoms of hypoglycaemia [adjusted odds ratio (aOR) = 1.24, 95% CI: 0.98-1.58; P = 0.08] and hyperglycaemia (aOR = 1.21, 95% CI: 1.00-1.46; P = 0.05), after controlling for patients' HbA1C, comorbidity, insulin use and demographics. These associations, however, were diminished for patients with high self-reported hypoglycaemia and high levels of depressive symptoms, but not low depressive symptoms (interaction terms for hypoglycaemia by depressive symptoms, aOR = 0.98, 95% CI: 0.97-0.99; P = 0.03). CONCLUSIONS Mental health symptoms are associated with higher levels of patient-reported of diabetes-related symptoms, but the association between diabetes-related symptoms and subsequent regimen modifications is diminished in patients with greater depressive symptoms. Clinicians should focus attention on identifying and treating patients' mental health concerns in order to address the role of diabetes-related symptom burden in guiding physician medication prescribing behaviour.
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Affiliation(s)
- Dara H Sorkin
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | - John Billimek
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | | | - Quyen Ngo-Metzger
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | - Sherrie H Kaplan
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | - Andrew R Reikes
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
| | - Sheldon Greenfield
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California, Irvine, CA, and
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Jones E, Lebrun-Harris LA, Sripipatana A, Ngo-Metzger Q. Access to mental health services among patients at health centers and factors associated with unmet needs. J Health Care Poor Underserved 2015; 25:425-36. [PMID: 24509036 DOI: 10.1353/hpu.2014.0056] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cross-sectional 2009 Health Center Patient Survey data describe the mental health status of health center patients, utilization of mental health services, and factors associated with unmet need for mental health treatment. One in five health center patients accessed mental health services in the past year, and over half of the patients who received counseling received this treatment at a health center. Patients who were unable to access mental health care cited affordability as a concern. Unmet need for mental health treatment was reported by one in three patients. Multivariate analysis found that the odds of reporting unmet need were higher for patients who lacked a usual source of care and patients with serious mental illness.
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Lebrun-Harris LA, Fiore MC, Tomoyasu N, Ngo-Metzger Q. Cigarette Smoking, Desire to Quit, and Tobacco-Related Counseling Among Patients at Adult Health Centers. Am J Public Health 2015; 105:180-188. [PMID: 24625147 DOI: 10.2105/ajph.2013.301691] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. We determined cigarette smoking prevalence, desire to quit, and tobacco-related counseling among a national sample of patients at health centers. Methods. Data came from the 2009 Health Center Patient Survey and the 2009 National Health Interview Survey. The analytic sample included 3949 adult patients at health centers and 27 731 US adults. Results. Thirty-one percent of health center patients were current smokers, compared with 21% of US adults in general. Among currently smoking health center patients, 83% desired to quit and 68% received tobacco counseling. In multivariable models, patients had higher adjusted odds of wanting to quit if they had indications of severe mental illness (adjusted odds ratio [AOR] = 3.26; 95% confidence interval [CI] = 1.19, 8.97) and lower odds if they had health insurance (AOR = 0.43; 95% CI = 0.22, 0.86). Patients had higher odds of receiving counseling if they had 2 or more chronic conditions (AOR = 2.05; 95% CI = 1.11, 3.78) and lower odds if they were Hispanic (AOR = 0.57; 95% CI = 0.34, 0.96). Conclusions. Cigarette smoking prevalence is substantially higher among patients at health centers than US adults in general. However, most smokers at health centers desire to quit. Continued efforts are warranted to reduce tobacco use in this vulnerable group.
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Affiliation(s)
- Lydie A Lebrun-Harris
- At the time of analysis and writing, Lydie A. Lebrun-Harris, Naomi Tomoyasu, and Quyen Ngo-Metzger were with the Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD. Michael C. Fiore is with the Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison
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Sharma R, Lebrun-Harris LA, Ngo-Metzger Q. Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents. Medicare Medicaid Res Rev 2014; 4:mmrr2014-004-03-a05. [PMID: 25243096 DOI: 10.5600/mmrr.004.03.a05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Determine the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). DATA SOURCES Data on elderly fee-for-service beneficiaries across 306 HRRs came from CMS' Geographic Variation in Medicare Spending and Utilization database (2010). We merged data on number of health center patients (HRSA's Uniform Data System) and number of low-income residents (American Community Survey). STUDY DESIGN We estimated access to primary care in each HRR by "health center penetration" (health center patients as a proportion of low-income residents). We calculated total Medicare spending (adjusted for population size, local input prices, and health risk). We assessed clinical quality by preventable hospital admissions, hospital readmissions, and emergency department visits. We sorted HRRs by health center penetration rate and compared spending and quality measures between the high- and low-penetration deciles. We also employed linear regressions to estimate spending and quality measures as a function of health center penetration. PRINCIPAL FINDINGS The high-penetration decile had 9.7% lower Medicare spending ($926 per capita, p=0.01) than the low-penetration decile, and no different clinical quality outcomes. CONCLUSIONS Compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings. Limited evidence suggests that these savings do not compromise clinical quality.
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Affiliation(s)
- Ravi Sharma
- Health Resources and Services Administration-Bureau of Primary Health Care
| | - Lydie A Lebrun-Harris
- Health Resources and Services Administration-Office of Planning, Analysis and Evaluation
| | - Quyen Ngo-Metzger
- Agency for Healthcare Research and Quality-Center for Primary Care, Prevention, and Clinical Partnerships
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Sorkin DH, Mavandadi S, Rook KS, Biegler KA, Kilgore D, Dow E, Ngo-Metzger Q. Dyadic collaboration in shared health behavior change: the effects of a randomized trial to test a lifestyle intervention for high-risk Latinas. Health Psychol 2014; 33:566-75. [PMID: 24884910 DOI: 10.1037/hea0000063] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study sought to evaluate the feasibility of a pilot, dyad-based lifestyle intervention, the Unidas por la Vida program, for improving weight loss and dietary intake among high-risk Mexican American mothers who have Type 2 diabetes and their overweight/obese adult daughters. METHOD Mother-daughter dyads (N = 89) were recruited from two federally qualified health centers and randomly assigned to either the Unidas intervention or to the control condition. The 16-week Unidas intervention consisted of the following: (a) four group meetings, (b) eight home visits, and (c) booster telephone calls by a lifestyle community coach. The control condition consisted of educational materials mailed to participants' homes. Participants completed surveys at T1 (baseline) and T2 (16 weeks) that assessed various demographic, social network involvement, and dietary variables. RESULTS Unidas participants lost significantly more weight at T2 (p < .003) compared with the control participants. Furthermore, intervention participants also were more likely to be eating foods with lower glycemic load (p < .001) and less saturated fat (p = .004) at T2. Unidas participants also reported a significant increase in health-related social support and social control (persuasion control only) and a decrease in undermining. CONCLUSIONS The Unidas program promoted weight loss and improved dietary intake, as well as changes in diet-related involvement of participants' social networks. The results from this study demonstrate that interventions that draw upon multiple people who share a health-risk have the potential to foster significant changes in lifestyle behaviors and in social network members' health-related involvement. Future research that builds on these findings is needed to elucidate the specific dyadic and social network processes that may drive health behavior change.
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Affiliation(s)
- Dara H Sorkin
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California
| | - Shahrzad Mavandadi
- Mental Illness Research, Education, and Clinical Center, Philadelphia VA Medical Center
| | - Karen S Rook
- Department of Psychology and Social Behavior at the University of California
| | - Kelly A Biegler
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California
| | - David Kilgore
- Division of Family Medicine, University of California
| | - Emily Dow
- Division of Family Medicine, University of California
| | - Quyen Ngo-Metzger
- U.S. Preventive Services Task Force Program, U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, Center for Primary Care, Prevention, and Clinical Partnership
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Lebrun LA, Chowdhury J, Sripipatana A, Nair S, Tomoyasu N, Ngo-Metzger Q. Overweight/obesity and weight-related treatment among patients in U.S. federally supported health centers. Obes Res Clin Pract 2014; 7:e377-90. [PMID: 24304480 DOI: 10.1016/j.orcp.2012.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 04/17/2012] [Accepted: 04/25/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND We obtained the prevalence of overweight/obesity, weight-loss attempts, and weight-related counseling and treatment among U.S. adults who sought care in federally funded community health centers. We investigated whether racial/ethnic and gender disparities existed for these measures. METHODS Data came from the 2009 Health Center Patient Survey. Measures included body mass index (BMI), self-perceived weight, weight-loss attempts, being told of a weight problem, receipt of weight-related counseling, nutritionist referrals, weight-loss prescriptions, and cholesterol checks. We conducted bivariate analyses to determine distributions by race/ethnicity and gender, then ran logistic regressions to examine the effects of several sociodemographic factors on weight-loss attempts and on being told of a weight problem. RESULTS Overall, 76% of adult patients seen in health centers were overweight or obese (BMI ≥ 25.0 kg/m(2)); 55% of overweight patients, and 87% of obese patients correctly perceived themselves as overweight. There were no racial/ethnic differences in BMI categories or self-perceptions of weight. Females were more likely than males to be obese and also more likely to perceive themselves as overweight. About 60% of overweight/obese patients reported trying to lose weight in the past year. There were no racial/ethnic disparities favoring non-Hispanic White patients in weight-related treatment. Women were more likely than men to receive referrals to a nutritionist or weight-loss prescriptions. Overweight/obese patients had higher adjusted odds of a past-year weight-loss attempt if they perceived themselves as overweight (OR = 3.30, p < 0.0001), were female (OR = 1.95, p < 0.05), African American (OR = 3.34, p < 0.05), or Hispanic/Latino (OR = 2.14, p < 0.05). Overweight/obese patients had higher odds of being told they had a weight problem if they were Hispanic/Latino (OR = 2.56, p < 0.05) or if they had two or more chronic conditions (OR = 2.77, p < 0.01). CONCLUSIONS Patients seen in community health centers have high rates of overweight and obesity, even higher than the general U.S. population. Efforts to address weight problems during primary care visits are needed to reduce the burden of obesity and its sequellae among health center patients.
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Affiliation(s)
- Lydie A Lebrun
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, MD, USA.
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Ngo-Metzger Q, Fan T. Screening for lung cancer. Am Fam Physician 2014; 90:117-118. [PMID: 25077586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Quyen Ngo-Metzger
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
| | - Tina Fan
- U.S. Preventive Services Task Force Program, Agency for Healthcare Research and Quality, USA
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Laiteerapong N, Kirby J, Gao Y, Yu TC, Sharma R, Nocon R, Lee SM, Chin MH, Nathan AG, Ngo-Metzger Q, Huang ES. Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care. Health Serv Res 2014; 49:1498-518. [PMID: 24779670 DOI: 10.1111/1475-6773.12178] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 11/26/2022] Open
Abstract
OBJECTIVE To compare utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. DATA SOURCES A nationally representative sample of adults from the Medical Expenditure Panel Survey (2004-2008). STUDY DESIGN HC patients were defined as those with ≥50 percent of outpatient visits at HCs in the first panel year. Outcomes included utilization and preventive care receipt from the second panel year. We used negative binomial and logistic regression models with propensity score adjustment for confounding differences between HC and non-HC patients. PRINCIPAL FINDINGS Compared to non-HC patients, HC patients had fewer office visits (adjusted incidence rate ratio [aIRR], 0.63) and hospitalizations (aIRR, 0.43) (both p < .001). HC patients were more likely to receive breast cancer screening than non-HC patients (adjusted odds ratio [aOR] 2.78, p < .01). In subgroup analyses, uninsured HC patients had fewer outpatient and emergency room visits and were more likely to receive dietary advice and breast cancer screening compared to non-HC patients. CONCLUSIONS Health centers add value to the health care system by providing socially and medically disadvantaged patients with care that results in lower utilization and maintained or improved preventive care.
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Affiliation(s)
- Neda Laiteerapong
- University of Chicago, 5841 S. Maryland Ave., MC 2007, Chicago, IL, 60637
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Mukamel DB, Fortinsky RH, White A, Harrington C, White LM, Ngo-Metzger Q. The policy implications of the cost structure of home health agencies. Medicare Medicaid Res Rev 2014; 4:mmrr2014.004.01.a03. [PMID: 24949224 PMCID: PMC4062313 DOI: 10.5600/mmrr2014-004-01-a03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To examine the cost structure of home health agencies by estimating an empirical cost function for those that are Medicare-certified, ten years following the implementation of prospective payment. DESIGN AND METHODS 2010 national Medicare cost report data for certified home health agencies were merged with case-mix information from the Outcome and Assessment Information Set (OASIS). We estimated a fully interacted (by tax status) hybrid cost function for 7,064 agencies and calculated marginal costs as percent of total costs for all variables. RESULTS The home health industry is dominated by for-profit agencies, which tend to be newer than the non-profit agencies and to have higher average costs per patient but lower costs per visit. For-profit agencies tend to have smaller scale operations and different cost structures, and are less likely to be affiliated with chains. Our estimates suggest diseconomies of scale, zero marginal cost for contracting with therapy workers, and a positive marginal cost for contracting with nurses, when controlling for quality. IMPLICATIONS Our findings suggest that efficiencies may be achieved by promoting non-profit, smaller agencies, with fewer contract nursing staff. This conclusion should be tested further in future studies that address some of the limitations of our study.
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Affiliation(s)
- Dana B Mukamel
- University of California Irvine-Health Policy Research Institute
| | | | | | - Charlene Harrington
- University of California San Francisco-Department of Social and Behavioral Sciences
| | - Laura M White
- University of California Irvine-Health Policy Research Institute
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Sorkin DH, Biegler KA, Peyreda M, Kilgore D, Dow E, Ngo-Metzger Q. Unidas por la Vida (United for Life): implementing a culturally-tailored, community-based, family-oriented lifestyle intervention. J Health Care Poor Underserved 2014; 24:116-38. [PMID: 23727969 DOI: 10.1353/hpu.2013.0103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Unidas por la Vida, a behavioral weight-loss program, was developed for use among low-income, Mexican-American women with diabetes and their overweight/obese adult daughters. The program leverages community resources in a partnership between primary care and community-based organizations. This paper describes the program's implementation, lessons learned, and implications for sustainability.
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Affiliation(s)
- Dara H Sorkin
- Division of General Internal Medicine and Primary Care, Health Policy Research Institute, University of California-Irvine, CA 92617, USA.
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Lebrun-Harris LA, Tomoyasu N, Ngo-Metzger Q. Substance Use, Risk of Dependence, Counseling and Treatment among Adult Health Center Patients. J Health Care Poor Underserved 2014; 25:1217-30. [DOI: 10.1353/hpu.2014.0130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shi L, Lebrun-Harris LA, Daly CA, Sharma R, Sripipatana A, Hayashi AS, Ngo-Metzger Q. Reducing disparities in access to primary care and patient satisfaction with care: the role of health centers. J Health Care Poor Underserved 2013; 24:56-66. [PMID: 23377717 DOI: 10.1353/hpu.2013.0022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper examined disparities in access to and satisfaction with primary care among patients of different racial/ethnic groups and insurance coverage, in health centers and the nation overall. Data came from the 2009 Health Center Patient Survey and 2009 Medical Expenditure Panel Survey. Study outcomes included usual source of care, type of usual source of care, satisfaction with provider office hours, and satisfaction with overall care. Health center patients were more racially and ethnically diverse than national patients, and health center patients were more likely than national patients to be uninsured or publicly insured. No significant health care disparities in access to care existed among patients from different racial/ethnic and insurance groups among health centers, unlike low-income patients nationwide or the U.S. population in general. Additional focus on the uninsured, in health centers and other health care settings nationwide, is needed to enhance satisfaction with care among these patients.
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Affiliation(s)
- Leiyu Shi
- Johns Hopkins University, Bloomberg School of Public Health, Department of Health Policy and Management, in Baltimore, Maryland 21205, USA.
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Lebrun-Harris LA, Shi L, Zhu J, Burke MT, Sripipatana A, Ngo-Metzger Q. Effects of patient-centered medical home attributes on patients' perceptions of quality in federally supported health centers. Ann Fam Med 2013; 11:508-16. [PMID: 24218374 PMCID: PMC3823721 DOI: 10.1370/afm.1544] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 11/09/2022] Open
Abstract
PURPOSE We sought to assess patients' ratings of patient-centered medical home (PCMH) attributes and overall quality of care within federally supported health centers. METHODS Data were collected through the 2009 Health Center Patient Survey (n = 4,562), which consisted of in-person interviews and included a nationally representative sample of patients seen in health centers. Quality measures included patients' perceptions of overall quality of services, perceptions of quality of clinician advice/treatment, and likelihood of referring friends and relatives to the health center. PCMH attributes included (1) access to care getting to health center, (2) access to care during visit, (3) patient-centered communication with health care clinicians, (4) patient-centered communication with support staff, (5) self-management support for chronic conditions, (6) self-management support for behavioral risks, and (7) comprehensive preventive care. Bivariate analysis and logistic regressions were used to examine associations between patients' perceptions of PCMH attributes and patient-reported quality of care. RESULTS Eighty-four percent of patients reported excellent/very good overall quality of services, 81% reported excellent/very good quality of clinician care, and 84% were very likely to refer friends and relatives. Higher patient ratings on the access to care and patient-centered communication attributes were associated with higher odds of patient-reported high quality of care on the 3 outcome measures. CONCLUSIONS More than 80% of patients perceived high quality of care in health centers. PCMH attributes related to access to care and communication were associated with greater likelihood of patients reporting high-quality care.
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Affiliation(s)
- Lydie A Lebrun-Harris
- Office of Research and Evaluation, Office of Planning, Analysis and Evaluation, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
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