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Tsai J, Kinney RL, Elbogen EB, Gluff J. Systematic Review of Financial Interventions for Adults Experiencing Behavioral Health Conditions. Psychiatr Serv 2024:appips20230271. [PMID: 38321921 DOI: 10.1176/appi.ps.20230271] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The authors reviewed the literature on finance-based interventions used to improve clinical and psychosocial outcomes among adults experiencing mental disorders, substance use disorders, or both. METHODS A systematic review of the peer-reviewed literature, published from 1900 to 2022, was conducted. Only studies with participants with a mental disorder or a substance use disorder, a structured finance-based intervention or program, a quantitative dependent variable in a behavioral health outcomes domain, and a defined research design were included. Studies were rated with a quality assessment tool, and overall evidence (levels I-VII) for the outcomes was rated. RESULTS In total, 544 articles were identified, screened for eligibility, and reduced to 55 articles. These articles were rated by two independent raters, and 18 articles were ultimately included. Of these 18 articles, four reported findings of randomized controlled trials (RCTs), one conducted a secondary analysis of an RCT, and the remaining articles were observational studies. The most studied intervention was representative payeeship, which reduced substance use and enhanced money management, showing the strongest evidence for improving outcomes among adults with behavioral health conditions. Weaker evidence suggested that financial education and assistance interventions could improve health care utilization and other psychosocial outcomes among individuals with mental or substance use disorders. CONCLUSIONS Level II-V evidence indicates that finance-based interventions can improve outcomes among adults experiencing behavioral health conditions. Further research is needed to assess the impact of interventions beyond representative payee programs on objectively measured outcomes.
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Affiliation(s)
- Jack Tsai
- National Center on Homelessness Among Veterans, Homeless Programs Office, U.S. Department of Veterans Affairs (VA), Washington, D.C. (Tsai, Kinney, Gluff); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai); National Veterans Financial Resource Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, VA, Denver (Elbogen); Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina (Elbogen)
| | - Rebecca L Kinney
- National Center on Homelessness Among Veterans, Homeless Programs Office, U.S. Department of Veterans Affairs (VA), Washington, D.C. (Tsai, Kinney, Gluff); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai); National Veterans Financial Resource Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, VA, Denver (Elbogen); Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina (Elbogen)
| | - Eric B Elbogen
- National Center on Homelessness Among Veterans, Homeless Programs Office, U.S. Department of Veterans Affairs (VA), Washington, D.C. (Tsai, Kinney, Gluff); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai); National Veterans Financial Resource Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, VA, Denver (Elbogen); Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina (Elbogen)
| | - Jeffrey Gluff
- National Center on Homelessness Among Veterans, Homeless Programs Office, U.S. Department of Veterans Affairs (VA), Washington, D.C. (Tsai, Kinney, Gluff); School of Public Health, University of Texas Health Science Center at Houston, Houston (Tsai); National Veterans Financial Resource Center, Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, VA, Denver (Elbogen); Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina (Elbogen)
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Kinney RL, Szymkowiak D, Tsai J. Growing Concern About Unsheltered Homelessness Among Veterans: Clinical Characteristics and Engagement in Health Care Services. Public Health Rep 2024:333549241227155. [PMID: 38323557 DOI: 10.1177/00333549241227155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVES Veteran homelessness has declined in the past decade, but the proportion of unsheltered homeless veterans has increased. We identified characteristics of unsheltered homelessness in a large contemporary veteran cohort and examined outpatient and inpatient encounters before and after intake to US Department of Veterans Affairs (VA) homeless programs. METHODS National data from the Homeless Operations Management Evaluation System (HOMES) database and the Corporate Data Warehouse were analyzed on 191 204 veterans experiencing housing instability from January 2018 through December 2021. We used hierarchical multivariate logistic regressions to model associations between sheltered status and veteran correlates. Repeated-measures analysis of variance assessed changes in care utilization after intake in homeless programs. RESULTS Age <50 years (odds ratio [OR] = 1.3; 95% CI, 1.2-1.4), Hispanic ethnicity (OR = 1.2; 95% CI, 1.1-1.3), some college education (OR = 1.1; 95% CI, 1.0-1.1), and a bachelor's degree (OR = 1.2; 95% CI, 1.1-1.2) were associated with veteran unsheltered homelessness. Unsheltered veterans were more likely to have a VA service-connected disability (OR = 1.4; 95% CI, 1.4-1.5), military sexual trauma (OR = 1.1; 95% CI, 1.0-1.1), and/or combat exposure (OR = 1.1; 95% CI, 1.0-1.1). Unsheltered and sheltered homeless veterans had an increase in outpatient encounters and a decrease in inpatient care after intake to the VA homeless program. CONCLUSIONS Contemporary unsheltered homeless veterans are younger and Hispanic with some college education. Innovative public health approaches that better engage and reduce barriers to entry need to be tested for a diverse unsheltered homeless population.
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Affiliation(s)
- Rebecca L Kinney
- VA National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Washington, DC, USA
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Dorota Szymkowiak
- VA National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Washington, DC, USA
| | - Jack Tsai
- VA National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Washington, DC, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Relyea MR, Kinney RL, DeRycke EC, Haskell S, Mattocks KM, Bastian LA. Evaluating an Enterprise-Wide Initiative to enhance healthcare coordination for rural women Veterans using the RE-AIM framework. Front Health Serv 2024; 3:1237701. [PMID: 38282637 PMCID: PMC10811198 DOI: 10.3389/frhs.2023.1237701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
Introduction The Veterans Health Administration (VA) Office of Rural Health (ORH) and Office of Women's Health Services (OWH) in FY21 launched a three-year Enterprise-Wide Initiative (EWI) to expand access to preventive care for rural, women Veterans. Through this program, women's health care coordinators (WHCC) were funded to coordinate mammography, cervical cancer screening and maternity care for women Veterans at selected VA facilities. We conducted a mixed-methods evaluation using the RE-AIM framework to assess the program implementation. Materials and methods We collected quantitative data from the 14 program facilities on reach (i.e., Veterans served by the program), effectiveness (e.g., cancer screening compliance, communication), adoption, and maintenance of women's health care coordinators (WHCC) in FY2022. Implementation of the program was examined through semi-structured interviews with the facility WHCC funding initiator (e.g., the point of contact at facility who initiated the request for WHCC funding), WHCCs, and providers. Results Reach. The number of women Veterans and rural women Veterans served by the WHCC program grew (by 50% and 117% respectively). The program demonstrated effectiveness as screening rates increased for cervical and breast cancer screening (+0.9% and +.01%, respectively). Also, maternity care coordination phone encounters with Veterans grew 36%. Adoption: All facilities implemented care coordinators by quarter two of FY22. Implementation. Qualitative findings revealed facilitators and barriers to successful program implementation and care coordination. Maintenance: The EWI facilitated the recruitment and retention of WHCCs at respective VA facilities over time. Implications In rural areas, WHCCs can play a critical role in increasing Reach and effectiveness. The EWI demonstrated to be a successful care coordination model that can be feasibly Adopted, Implemented, and Maintained at rural VA facilities.
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Affiliation(s)
- Mark R. Relyea
- VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Rebecca L. Kinney
- VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
- Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Eric C. DeRycke
- VA Connecticut Healthcare System, West Haven, CT, United States
| | - Sally Haskell
- VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Kristin M. Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, United States
- Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Lori A. Bastian
- VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
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Kinney RL, Copeland LA, Kroll-Desrosiers AR, Walker L, Marteeny V, Mattocks KM. Newborn Outcomes Among Veterans Utilizing VHA Maternity Benefits, 2016-2020. Mil Med 2023; 188:e1252-e1259. [PMID: 34718702 DOI: 10.1093/milmed/usab457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Public Law 111-163 Section 206 of the Caregivers and Veteran Omnibus Health Services Act amended the Veterans Health Administration's (VHA) medical benefits package to include 7 days of medical care for newborns delivered by Veterans. We examined the newborn outcomes among a cohort of women Veterans receiving VHA maternity benefits and care coordination. MATERIALS AND METHODS We conducted a secondary analysis of phone interview data from Veterans enrolled in the COMFORT (Center for Maternal and Infant Outcomes Research in Translation) study 2016-2020. Multivariable regression estimated associations with newborn outcomes (preterm birth; low birthweight). RESULTS During the study period, 829 infants were born to 811 Veterans. Mothers reported "excellent health" for 94% of infants. The prevalence of preterm birth was slightly higher in our cohort (11% vs. 10%), as were low birthweight (9%) deliveries, compared to the general population (8.28%). Additionally, 42% of infants in our cohort required follow-up care for non-routine health conditions; 11% were uninsured at 2 months of age. Adverse newborn outcomes were more common for mothers who were older in age, self-identified as non-white in race and/or of Hispanic ethnicity, had a diagnosis of posttraumatic stress disorder, or had gestational comorbidities. CONCLUSIONS The current VHA maternity coverage appears to be an effective policy for ensuring the well-being and health care coverage for the majority of Veterans and their newborns in the first days of life, thereby reducing the risk of inadequate prenatal and neonatal care. Future research should examine costs associated with extending coverage to 14 days or longer, comparing those to the projected excess costs of neonatal health problems. VHA policy should continue to support expanding care and resources through the Maternity Care Coordinator model.
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Affiliation(s)
- Rebecca L Kinney
- VA Central Western Massachusetts Healthcare System, Leeds, MA 01053, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Laurel A Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, MA 01053, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Aimee R Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, MA 01053, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Lorrie Walker
- VA Central Western Massachusetts Healthcare System, Leeds, MA 01053, USA
| | - Valerie Marteeny
- VA Central Western Massachusetts Healthcare System, Leeds, MA 01053, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA 01053, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA
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Copeland LA, Kinney RL, Kroll-Desrosiers AR, Shivakumar G, Mattocks KM. Medications with Potential for Fetal Risk Prescribed to Veterans. J Womens Health (Larchmt) 2022; 31:1450-1458. [PMID: 35352967 DOI: 10.1089/jwh.2021.0529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Women service members of the past 20 years experienced high rates of traumatizing events resulting in pharmacological treatment. Post-military lives may include having children. Typically, Veterans Health Administration (VHA) patients' pregnancies are managed outside the VHA. This study examined medication exposures during pregnancy. Materials and Methods: The Center for Maternal and Infant Outcomes Research in Translation (COMFORT) study collected primary survey data and linked secondary health care data from the VHA from 2015 to 2021. Medication fills and covariates were extracted for three 9-month periods: preconception, pregnancy, and postpartum. Multiple regression assessed factors associated with use during pregnancy of selective serotonin reuptake inhibitor (SSRI)/serotonin norepinephrine reuptake inhibitor (SNRI) or of non-recommended, potentially risky drugs, and of discontinuation of those medications from prepregnancy to pregnancy. Results: The cohort comprised 501 women-29% Black, 65% White, and 6% other races, of whom 63% had 50%-100% service-connected disability. During pregnancy, 36% had a pain-related disorder, 19% major depression, and 18% post-traumatic stress disorder. The median number of drug classes prescribed during pregnancy was 5. The use of SSRI/SNRI antidepressants dropped from 36% preconception to 26% during pregnancy including new starts; 15% discontinued SSRI/SNRI. Comorbidity predicted medication use. Depression predicted discontinuing SSRI/SNRI during pregnancy; no predictors of discontinuing potentially risky drugs were identified. Conclusions: Based on prescriptions filled within the VHA only-ignoring potential community-based fills-women veterans were prescribed numerous medications during pregnancy and discontinued antidepressants alarmingly. Veterans of childbearing potential should receive counseling about medication use before pregnancy occurs. Their non-VHA obstetricians and VHA providers should share information to optimize outcomes, reviewing medications as soon as pregnancy is detected as well as after pregnancy concludes.
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Affiliation(s)
- Laurel A Copeland
- Research Service, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Rebecca L Kinney
- Research Service, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Aimee R Kroll-Desrosiers
- Research Service, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Geetha Shivakumar
- Research Service, VA North Texas Health Care System, Dallas, Texas, USA
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kristin M Mattocks
- Research Service, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Kroll-Desrosiers A, Kinney RL, Marteeny V, Mattocks KM. Exploring the Acceptability of Expanded Perinatal Depression Care Practices Among Women Veterans. J Gen Intern Med 2022; 37:762-769. [PMID: 36042083 PMCID: PMC9427169 DOI: 10.1007/s11606-022-07573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Veterans receive obstetrical care from community-based providers contracted through the Veterans Health Administration (VA); however, Veterans remain eligible for VA mental healthcare in the perinatal period. To date, few studies have focused specifically on the mental health needs of Veterans during the perinatal period. OBJECTIVE To examine the acceptability of more comprehensive perinatal mental healthcare screening and treatment in VA care, we explored pregnant and postpartum Veteran perspectives of United States Preventive Services Task Force (USPSTF) recommendations that aim to expand mental health counseling for the prevention and treatment of perinatal depression. DESIGN Semi-structured interviews with pregnant and postpartum Veterans enrolled in VA care, integrated with quantitative survey data. PARTICIPANTS Pregnant and postpartum Veterans (n=27) who had delivered infants or were due by February 2020. APPROACH Framework analysis with an inductive approach was utilized to understand our data, interpret and code our transcripts, and develop themes. KEY RESULTS Fewer than half (44%) of the women reported seeing a mental health provider at the beginning of their pregnancy. We found that Veterans support USPSTF recommendations in the VA, consider mental healthcare to be very important during the perinatal period, would like better access to mental healthcare resources and peer support networks, and suggest that perinatal depression screening could be more extensive. CONCLUSIONS These findings support the implementation of more comprehensive perinatal depression prevention policies and practices within VA care. Understanding the real-world feasibility and prevailing barriers to comprehensive perinatal depression care is needed to inform implementation of the USPSTF recommendations or a similar intervention tailored for VA care.
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Affiliation(s)
- Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA.
- University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Rebecca L Kinney
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Valerie Marteeny
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
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Holzhauer CG, Kroll-Desrosiers A, Kinney RL, Copeland LA, Bastian LA, Mattocks KM. Prenatal Stress Exposure and Post-traumatic Stress Disorder Associated With Risk of Postpartum Alcohol Misuse Among Women Veterans. Womens Health Issues 2021; 31:596-602. [PMID: 34148828 PMCID: PMC10500562 DOI: 10.1016/j.whi.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Maternal alcohol misuse during the postpartum period is associated with negative maternal and infant outcomes. This study examined whether greater stress exposure in the year before the baby's birth and maternal post-traumatic stress disorder (PTSD) were associated with postpartum alcohol misuse among a sample of women veterans. Maternal PTSD was also examined as a moderator of the association between stress exposure and postpartum alcohol misuse. METHODS Data were drawn from the Center for Maternal and Infant Outcomes Research in Translation study, a multisite prospective cohort study of pregnant and postpartum women veterans. Interviews were conducted within 12 weeks after birth. At this post-birth interview, women reported whether they experienced stressful events (e.g., loss of job, military deployment, separation/divorce) in the year before birth. PTSD diagnosis and postpartum scores on the Alcohol Use Disorders Identification Test (AUDIT-C) were derived from the Department of Veterans Affairs medical records. RESULTS Models testing main and interaction effects showed a statistically significant association of both PTSD (p = .02) and stress exposure (p = .04), as well as significant interaction of PTSD and stress exposure (p = .03) with AUDIT-C scores postpartum, after controlling for marital status, age, and race. Specifically, compared with women without PTSD, those with PTSD had higher overall AUDIT-C scores postpartum, regardless of stress exposure. For women without PTSD, more stress exposure before birth was associated with higher AUDIT-C scores during the postpartum phase. CONCLUSIONS PTSD diagnosis and life stressors before infant birth predicted maternal alcohol misuse during the postpartum period. Identifying such risk factors is an initial step in preventing alcohol misuse, with the goal of enhancing postpartum health for the birthing parent and infant.
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Affiliation(s)
- Cathryn Glanton Holzhauer
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry & Division of Addiction, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Aimee Kroll-Desrosiers
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Rebecca L Kinney
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Laurel A Copeland
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry & Division of Addiction, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Kinney RL, Haskell S, Relyea MR, DeRycke EC, Walker L, Bastian LA, Mattocks KM. Coordinating women's preventive health care for rural veterans. J Rural Health 2021; 38:630-638. [PMID: 34310743 DOI: 10.1111/jrh.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE As the number of women veterans receiving care from the Veterans Health Administration (VHA) continues to increase, so does the need to access gender-specific preventive health care services through the VHA. In rural areas, women veterans are the numeric minority, so many preventive screenings are performed outside of the VA by community providers. As the numbers of veterans utilizing both VHA and non-VHA providers for their preventive care continue to increase, so does the need to coordinate this care. This research examines the role of the Women Veterans' Care Coordinator (WVCC) at rural facilities and their perceptions of coordinating preventive care. METHODS Between March and July 2019, semi-structured telephone interviews were conducted with WVCCs at 26 rural VA facilities. Each interview was digitally recorded and transcribed verbatim. Transcripts were loaded into Atlas.ti for further analysis. Once the codes were refined, the investigators coded the 26 interviews independently and conferred to achieve consensus on the underlying themes. FINDINGS Five themes arose from the WVCC interviews: (1) Rural women veterans have varying needs of coordination; (2) Fragmented communication between the VA and non-VA care settings hinders effective coordination; (3) Difficulties in prioritizing rural care coordination; (4) Care coordination impacts patient care; and (5) WVCC recommendations to improve rural care coordination. CONCLUSIONS The recent addition of WVCCs to rural facilities has expanded the VA's reach to veterans living in the most rural areas. As a result, many of these women are now receiving timely, quality, and coordinated health care.
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Affiliation(s)
- Rebecca L Kinney
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Sally Haskell
- VA CT Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Mark R Relyea
- VA CT Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Eric C DeRycke
- VA CT Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Lorrie Walker
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
| | - Lori A Bastian
- VA CT Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA.,University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Kroll-Desrosiers A, Holzhauer CG, Russo L, DeRycke EC, Kinney RL, Bastian LA, Mattocks KM. Factors Associated With Quitting Smoking During Pregnancy Among Women Veterans. Womens Health Issues 2021; 31:408-413. [PMID: 34049763 DOI: 10.1016/j.whi.2021.04.006] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Little is known about the rates of smoking among pregnant veterans. Our objective was to examine rates of smoking during pregnancy and factors associated with quitting smoking during pregnancy. METHODS We used data from a cohort study of pregnant veterans from 15 Veterans Health Administration facilities nationwide. Veterans who reported smoking during pregnancy were included in this analysis. Poisson regression models were used to estimate the relative risk (RR) of quitting smoking during pregnancy. RESULTS Overall, 133 veterans reported smoking during pregnancy. Among this group of women who smoked, the average age was 31.6 years, 20% were Black, and 14% were Hispanic/Latino. More than one-half of women (65%) who reported smoking at the start of pregnancy quit smoking during pregnancy. Multivariable models, adjusted for history of deployment and age, indicated that prenatal care initiation at 12 or fewer weeks compared with more than 13 weeks (relative risk [RR], 2.06; 95% confidence interval [CI], 1.18-3.58), living without household smokers compared with any household smokers (RR, 1.58; 95% CI, 1.14-2.17), and first pregnancy (RR, 1.51; 95% CI, 1.17-1.95) were significant predictors of quitting versus persistent smoking during pregnancy. CONCLUSIONS Women veterans who quit smoking may be different than those who continue to smoke during pregnancy. Establishing prenatal care early in pregnancy, which likely includes counseling about smoking cessation, seems to be an important factor in quitting. Those for whom it is not a first pregnancy and who live with other smokers may especially benefit from such counseling.
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Affiliation(s)
- Aimee Kroll-Desrosiers
- Research and Development, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Cathryn Glanton Holzhauer
- Research and Development, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lindsey Russo
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Eric C DeRycke
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Rebecca L Kinney
- Research and Development, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- Research and Development, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Population & Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Sadasivam RS, Cutrona SL, Kinney RL, Marlin BM, Mazor KM, Lemon SC, Houston TK. Collective-Intelligence Recommender Systems: Advancing Computer Tailoring for Health Behavior Change Into the 21st Century. J Med Internet Res 2016; 18:e42. [PMID: 26952574 PMCID: PMC4802103 DOI: 10.2196/jmir.4448] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 10/15/2015] [Accepted: 01/23/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND What is the next frontier for computer-tailored health communication (CTHC) research? In current CTHC systems, study designers who have expertise in behavioral theory and mapping theory into CTHC systems select the variables and develop the rules that specify how the content should be tailored, based on their knowledge of the targeted population, the literature, and health behavior theories. In collective-intelligence recommender systems (hereafter recommender systems) used by Web 2.0 companies (eg, Netflix and Amazon), machine learning algorithms combine user profiles and continuous feedback ratings of content (from themselves and other users) to empirically tailor content. Augmenting current theory-based CTHC with empirical recommender systems could be evaluated as the next frontier for CTHC. OBJECTIVE The objective of our study was to uncover barriers and challenges to using recommender systems in health promotion. METHODS We conducted a focused literature review, interviewed subject experts (n=8), and synthesized the results. RESULTS We describe (1) limitations of current CTHC systems, (2) advantages of incorporating recommender systems to move CTHC forward, and (3) challenges to incorporating recommender systems into CTHC. Based on the evidence presented, we propose a future research agenda for CTHC systems. CONCLUSIONS We promote discussion of ways to move CTHC into the 21st century by incorporation of recommender systems.
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Affiliation(s)
- Rajani Shankar Sadasivam
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, United States.
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Kinney RL, Lemon SC, Person SD, Pagoto SL, Saczynski JS. The association between patient activation and medication adherence, hospitalization, and emergency room utilization in patients with chronic illnesses: a systematic review. Patient Educ Couns 2015; 98:545-52. [PMID: 25744281 DOI: 10.1016/j.pec.2015.02.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/26/2015] [Accepted: 02/07/2015] [Indexed: 05/20/2023]
Abstract
OBJECTIVE A systematic review of the published literature on the association between the PAM (Patient Activation Measure) and hospitalization, emergency room use, and medication adherence among chronically ill patient populations. METHODS A literature search of several electronic databases was performed. Studies published between January 1, 2004 and June 30, 2014 that used the PAM measure and examined at least one of the outcomes of interest among a chronically ill study population were identified and systematically assessed. RESULTS Ten studies met the eligibility criteria. Patients who scored in the lower PAM stages (Stages 1 and 2) were more likely to have been hospitalized. Patients who scored in the lowest stage were also more likely to utilize the emergency room. The relationship between PAM stage and medication adherence was inconclusive in this review. CONCLUSION Chronically ill patients reporting low stages of patient activation are at an increased risk for hospitalization and ER utilization. PRACTICAL IMPLICATIONS Future research is needed to further understand the relationship between patient activation and medication adherence, hospitalization and/or ER utilization in specific chronically ill (e.g. diabetic, asthmatic) populations. Research should also consider the role of patient activation in the development of effective interventions which seek to address the outcomes of interest.
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Affiliation(s)
- Rebecca L Kinney
- Department of Quantitative Health Sciences, University of Massachusetts, Medical School, Worcester, USA.
| | - Stephenie C Lemon
- Department of Medicine, University of Massachusetts, Medical School, Worcester, USA
| | - Sharina D Person
- Department of Quantitative Health Sciences, University of Massachusetts, Medical School, Worcester, USA
| | - Sherry L Pagoto
- Department of Medicine, University of Massachusetts, Medical School, Worcester, USA
| | - Jane S Saczynski
- Department of Quantitative Health Sciences, University of Massachusetts, Medical School, Worcester, USA; Department of Medicine, University of Massachusetts, Medical School, Worcester, USA
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Mattocks KM, Sullivan JC, Bertrand C, Kinney RL, Sherman MD, Gustason C. Perceived Stigma, Discrimination, and Disclosure of Sexual Orientation Among a Sample of Lesbian Veterans Receiving Care in the Department of Veterans Affairs. LGBT Health 2015; 2:147-53. [PMID: 26790121 DOI: 10.1089/lgbt.2014.0131] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Many lesbian women experience stigma and discrimination from their healthcare providers as a result of their sexual orientation. Additionally, others avoid disclosure of their sexual orientation to their providers for fear of mistreatment. With the increasing number of lesbian, gay, bisexual, and transgender (LGBT) veterans seeking care from the Veterans Health Administration (VHA), it is important to understand lesbian veterans' experiences with stigma, discrimination, and disclosure of sexual orientation. This article examines lesbian veterans' experiences with perceived stigma and discrimination in VHA healthcare, their perspectives on disclosure of sexual orientation to VHA providers, and their recommendations for improvements in VHA healthcare to create a welcoming environment for lesbian veterans. METHODS This is a mixed methods study of twenty lesbian veterans at four VHA facilities. The women veterans participated in a one-hour interview and then completed an anonymous survey. RESULTS Ten percent of lesbian veterans had experienced mistreatment from VHA staff or providers, but nearly 50% feared that their Veterans Affairs (VA) providers would mistreat them if they knew about their sexual orientation. A majority of lesbian veterans (70%) believed that VHA providers should never ask about sexual orientation or should only ask if the veteran wanted to discuss it. A majority (80%) believed the VHA had taken steps to create a welcoming environment for LBGT veterans. CONCLUSION Though many lesbian veterans have fears of stigma and discrimination in the context of VHA care, few have experienced this. Most lesbian veterans believed the VHA was trying to create a welcoming environment for its LGBT veterans. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.
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Affiliation(s)
- Kristin M Mattocks
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
| | - J Cherry Sullivan
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Christina Bertrand
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Rebecca L Kinney
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
| | - Michelle D Sherman
- 3 Department of Psychology, University of Minnesota , St. Paul, Minnesota
| | - Carolyn Gustason
- 1 Department of Research and Education, VA Central Western Massachusetts Healthcare System , Leeds, Massachusetts
- 4 Department of Nursing, University of Massachusetts , Amherst, Massachusetts
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13
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English TM, Kinney RL, Davis MJ, Kamberi A, Chan W, Sadasivam RS, Houston TK. Identification of Relationships Between Patients Through Elements in a Data Warehouse Using the Familial, Associational, and Incidental Relationship (FAIR) Initiative: A Pilot Study. JMIR Med Inform 2015; 3:e9. [PMID: 25803561 PMCID: PMC4376146 DOI: 10.2196/medinform.3738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/16/2014] [Accepted: 01/16/2015] [Indexed: 12/05/2022] Open
Abstract
Background Over the last several years there has been widespread development of medical data warehouses. Current data warehouses focus on individual cases, but lack the ability to identify family members that could be used for dyadic or familial research. Currently, the patient’s family history in the medical record is the only documentation we have to understand the health status and social habits of their family members. Identifying familial linkages in a phenotypic data warehouse can be valuable in cohort identification and in beginning to understand the interactions of diseases among families. Objective The goal of the Familial, Associational, & Incidental Relationships (FAIR) initiative is to identify an index set of patients’ relationships through elements in a data warehouse. Methods Using a test set of 500 children, we measured the sensitivity and specificity of available linkage algorithm identifiers (eg, insurance identification numbers and phone numbers) and validated this tool/algorithm through a manual chart audit. Results Of all the children, 52.4% (262/500) were male, and the mean age of the cohort was 8 years old (SD 5). Of the children, 51.6% (258/500) were identified as white in race. The identifiers used for FAIR were available for the majority of patients: insurance number (483/500, 96.6%), phone number (500/500, 100%), and address (497/500, 99.4%). When utilizing the FAIR tool and various combinations of identifiers, sensitivity ranged from 15.5% (62/401) to 83.8% (336/401), and specificity from 72% (71/99) to 100% (99/99). The preferred method was matching patients using insurance or phone number, which had a sensitivity of 72.1% (289/401) and a specificity of 94% (93/99). Using the Informatics for Integrating Biology and the Bedside (i2b2) warehouse infrastructure, we have now developed a Web app that facilitates FAIR for any index population. Conclusions FAIR is a valuable research and clinical resource that extends the capabilities of existing data warehouses and lays the groundwork for family-based research. FAIR will expedite studies that would otherwise require registry or manual chart abstraction data sources.
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Affiliation(s)
- Thomas M English
- The University of Massachusetts Medical School, Division of Health Informatics & Implementation Science, Worcester, MA, United States.
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14
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Rocheleau M, Sadasivam RS, Baquis K, Stahl H, Kinney RL, Pagoto SL, Houston TK. An observational study of social and emotional support in smoking cessation Twitter accounts: content analysis of tweets. J Med Internet Res 2015; 17:e18. [PMID: 25589009 PMCID: PMC4319088 DOI: 10.2196/jmir.3768] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/05/2014] [Accepted: 12/09/2014] [Indexed: 12/04/2022] Open
Abstract
Background Smoking continues to be the number one preventable cause of premature death in the United States. While evidence for the effectiveness of smoking cessation interventions has increased rapidly, questions remain on how to effectively disseminate these findings. Twitter, the second largest online social network, provides a natural way of disseminating information. Health communicators can use Twitter to inform smokers, provide social support, and attract them to other interventions. A key challenge for health researchers is how to frame their communications to maximize the engagement of smokers. Objective Our aim was to examine current Twitter activity for smoking cessation. Methods Active smoking cessation related Twitter accounts (N=18) were identified. Their 50 most recent tweets were content coded using a schema adapted from the Roter Interaction Analysis System (RIAS), a theory-based, validated coding method. Using negative binomial regression, the association of number of followers and frequency of individual tweet content at baseline was assessed. The difference in followership at 6 months (compared to baseline) to the frequency of tweet content was compared using linear regression. Both analyses were adjusted by account type (organizational or not organizational). Results The 18 accounts had 60,609 followers at baseline and 68,167 at 6 months. A total of 24% of tweets were socioemotional support (mean 11.8, SD 9.8), 14% (mean 7, SD 8.4) were encouraging/engagement, and 62% (mean 31.2, SD 15.2) were informational. At baseline, higher frequency of socioemotional support and encouraging/engaging tweets was significantly associated with higher number of followers (socioemotional: incident rate ratio [IRR] 1.09, 95% CI 1.02-1.20; encouraging/engaging: IRR 1.06, 95% CI 1.00-1.12). Conversely, higher frequency of informational tweets was significantly associated with lower number of followers (IRR 0.95, 95% CI 0.92-0.98). At 6 months, for every increase by 1 in socioemotional tweets, the change in followership significantly increased by 43.94 (P=.027); the association was slightly attenuated after adjusting by account type and was not significant (P=.064). Conclusions Smoking cessation activity does exist on Twitter. Preliminary findings suggest that certain content strategies can be used to encourage followership, and this needs to be further investigated.
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Affiliation(s)
- Mary Rocheleau
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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15
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English TM, Malkani S, Kinney RL, Omer A, Dziewietin MB, Perugini R. Predicting Remission of Diabetes After RYGB Surgery Following Intensive Management to Optimize Preoperative Glucose Control. Obes Surg 2014; 25:1-6. [DOI: 10.1007/s11695-014-1339-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Anatchkova MD, Barysauskas C, Kinney RL, Lombardini L, Allison JJ. Abstract 347: Psychometric Evaluation of the Care Transition Measures in a sample of ACS patients: Results from Transitions, Risks, and Actions in Coronary Events - Center for Outcomes Research and Education (TRACE-CORE). Circ Cardiovasc Qual Outcomes 2014. [DOI: 10.1161/circoutcomes.7.suppl_1.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Quality of transitional care is associated with important health outcomes such as rehospitalization, increased medical errors, and costs. A widely used measure of the construct, the Care Transitions Measure (CTM-15), was developed and validated with relatively small samples and classical test theory approach. The short version of the measure (CTM-3) was recently included in the CAHPS® Hospital Survey. We aimed to conduct a psychometric evaluation of the CTM-15 in a large sample and evaluate whether an item response theory (IRT) based scoring would lead to better measurement precision.
Methods:
As part of TRACE-CORE 1545 participants were interviewed during hospitalization for ACS providing information on general health status (SF-36). At 1 month following discharge, patients completed CTM items, health utilization and care process questions. We evaluated the psychometric properties of the CTM using descriptive statistics, factor analyses, and item response theory analyses. We compared the measurement precision of CTM-15, CTM-3, and a CTM-IRT based score using relative validity (RV) coefficients.
Results:
Participants were 79% non-Hispanic white, 67% male, 27% with a college education or higher (27%) and average age of 62 years. The CTM scale had good internal consistency (Cronbach’s alpha=0.95), but demonstrated strong acquiescence bias (8.7% participants responded “Strongly agree”, 19% “Agree” to all 15 items) and limited score variability (5% <50score). A bi-factor model with one general factor with high item loadings and four secondary factors with lower item loadings, fit the data best supporting the assumption of essential unidimensionality of the measure. Review of item characteristic curves indicated presence of non-discriminating response categories in all items. IRT based item parameters were estimated for all items, but for five of the items there was evidence for model misfit. The CTM-15 differentiated between groups of patients defined by self-reported health status, health care utilization, and care transition process indicators. Differences between groups were small (2-3 points). There was no gain in measurement precision for the scale from IRT scoring. The CTM-3 was not significantly lower for patients reporting rehospitalization or emergency department visits.
Conclusion:
We identified psychometric challenges of the CTM, which may limit its value in research and practice. The strong acquiescence bias in the measure leads to highly skewed, clustered scores with restricted score variance and makes it difficult to differentiate between levels of care transition quality. In the absence of guidelines on meaningfully important differences, it is hard to determine whether detected statistically significant differences in care transition quality are important. These results are in line with emerging evidence of gaps in the validity of the measure.
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Anatchkova MD, Barysauskas CM, Kinney RL, Kiefe CI, Ash AS, Lombardini L, Allison JJ. Psychometric evaluation of the Care Transition Measure in TRACE-CORE: do we need a better measure? J Am Heart Assoc 2014; 3:e001053. [PMID: 24901109 PMCID: PMC4309102 DOI: 10.1161/jaha.114.001053] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The quality of transitional care is associated with important health outcomes such as rehospitalization and costs. The widely used Care Transitions Measure (CTM‐15) was developed with a classic test theory approach; its short version (CTM‐3) was included in the CAHPS Hospital Survey. We conducted a psychometric evaluation of both measures and explored whether item response theory (IRT) could produce a more precise measure. Methods and Results As part of the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education, 1545 participants were interviewed during an acute coronary syndrome hospitalization, providing information on general health status (Short Form‐36), CTM‐15, health utilization, and care process questions at 1 month postdischarge. We used classic and IRT analyses and compared the measurement precision of CTM‐15–, CTM‐3–, and CTM‐IRT–based score using relative validity. Participants were 79% non‐Hispanic white and 67% male, with an average age of 62 years. The CTM‐15 had good internal consistency (Cronbach's α=0.95) but demonstrated acquiescence bias (8.7% participants responded “Strongly agree” and 19% responded “Agree” to all items) and limited score variability. These problems were more pronounced for the CTM‐3. The CTM‐15 differentiated between patient groups defined by self‐reported health status, health care utilization, and care transition process indicators. Differences between groups were small (2 to 3 points). There was no gain in measurement precision from IRT scoring. The CTM‐3 was not significantly lower for patients reporting rehospitalization or emergency department visits. Conclusion We identified psychometric challenges of the CTM, which may limit its value in research and practice. These results are in line with emerging evidence of gaps in the validity of the measure.
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Affiliation(s)
- Milena D Anatchkova
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Constance M Barysauskas
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA (C.M.B.)
| | - Rebecca L Kinney
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Arlene S Ash
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Lisa Lombardini
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Jeroan J Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
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Sadasivam RS, Volz EM, Kinney RL, Rao SR, Houston TK. Share2Quit: Web-Based Peer-Driven Referrals for Smoking Cessation. JMIR Res Protoc 2013; 2:e37. [PMID: 24067329 PMCID: PMC3786127 DOI: 10.2196/resprot.2786] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/28/2013] [Indexed: 11/16/2022] Open
Abstract
Background Smoking is the number one preventable cause of death in the United States. Effective Web-assisted tobacco interventions are often underutilized and require new and innovative engagement approaches. Web-based peer-driven chain referrals successfully used outside health care have the potential for increasing the reach of Internet interventions. Objective The objective of our study was to describe the protocol for the development and testing of proactive Web-based chain-referral tools for increasing the access to Decide2Quit.org, a Web-assisted tobacco intervention system. Methods We will build and refine proactive chain-referral tools, including email and Facebook referrals. In addition, we will implement respondent-driven sampling (RDS), a controlled chain-referral sampling technique designed to remove inherent biases in chain referrals and obtain a representative sample. We will begin our chain referrals with an initial recruitment of former and current smokers as seeds (initial participants) who will be trained to refer current smokers from their social network using the developed tools. In turn, these newly referred smokers will also be provided the tools to refer other smokers from their social networks. We will model predictors of referral success using sample weights from the RDS to estimate the success of the system in the targeted population. Results This protocol describes the evaluation of proactive Web-based chain-referral tools, which can be used in tobacco interventions to increase the access to hard-to-reach populations, for promoting smoking cessation. Conclusions Share2Quit represents an innovative advancement by capitalizing on naturally occurring technology trends to recruit smokers to Web-assisted tobacco interventions.
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Affiliation(s)
- Rajani S Sadasivam
- Division of Health Informatics & Implementation Science, Quantitative Health Sciences, The University of Massachusetts Medical School, Worcester, MA, United States.
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Sadasivam RS, Kinney RL, Delaughter K, Rao SR, Williams JH, Coley HL, Ray MN, Gilbert GH, Allison JJ, Ford DE, Houston TK. Who participates in Web-assisted tobacco interventions? The QUIT-PRIMO and National Dental Practice-Based Research Network Hi-Quit studies. J Med Internet Res 2013; 15:e77. [PMID: 23635417 PMCID: PMC3650921 DOI: 10.2196/jmir.2385] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 10/09/2012] [Revised: 02/01/2013] [Accepted: 02/21/2013] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Smoking is the most preventable cause of death. Although effective, Web-assisted tobacco interventions are underutilized and recruitment is challenging. Understanding who participates in Web-assisted tobacco interventions may help in improving recruitment. OBJECTIVES To understand characteristics of smokers participating in a Web-assisted tobacco intervention (Decide2Quit.org). METHODS In addition to the typical Google advertisements, we expanded Decide2Quit.org recruitment to include referrals from medical and dental providers. We assessed how the expanded recruitment of smokers changed the users' characteristics, including comparison with a population-based sample of smokers from the national Behavioral Risk Factors Surveillance Survey (BRFSS). Using a negative binomial regression, we compared demographic and smoking characteristics by recruitment source, in particular readiness to quit and association with subsequent Decide2Quit.org use. RESULTS The Decide2Quit.org cohort included 605 smokers; the 2010 BRFSS dataset included 69,992. Compared to BRFSS smokers, a higher proportion of Decide2Quit.org smokers were female (65.2% vs 45.7%, P=.001), over age 35 (80.8% vs 67.0%, P=.001), and had some college or were college graduates (65.7% vs 45.9%, P=.001). Demographic and smoking characteristics varied by recruitment; for example, a lower proportion of medical- (22.1%) and dental-referred (18.9%) smokers had set a quit date or had already quit than Google smokers (40.1%, P<.001). Medical- and dental-referred smokers were less likely to use Decide2Quit.org functions; in adjusted analysis, Google smokers (predicted count 17.04, 95% CI 14.97-19.11) had higher predicted counts of Web page visits than medical-referred (predicted count 12.73, 95% CI 11.42-14.04) and dental-referred (predicted count 11.97, 95% CI 10.13-13.82) smokers, and were more likely to contact tobacco treatment specialists. CONCLUSIONS Recruitment from clinical practices complimented Google recruitment attracting smokers less motivated to quit and less experienced with Web-assisted tobacco interventions.
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Affiliation(s)
- Rajani Shankar Sadasivam
- Division of Health Informatics & Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA.
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Sadasivam RS, Kinney RL, Lemon SC, Shimada SL, Allison JJ, Houston TK. Internet health information seeking is a team sport: analysis of the Pew Internet Survey. Int J Med Inform 2012; 82:193-200. [PMID: 23149121 DOI: 10.1016/j.ijmedinf.2012.09.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 09/20/2012] [Accepted: 09/29/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous studies examining characteristics of Internet health information seekers do not distinguish between those who only seek for themselves, and surrogate seekers who look for health information for family or friends. Identifying the unique characteristics of surrogate seekers would help in developing Internet interventions that better support these information seekers. OBJECTIVE To assess differences between self seekers versus those that act also as surrogate seekers. METHODS We analyzed data from the cross-sectional Pew Internet and American Life Project November/December 2008 health survey. Our dependent variable was self-report of type of health information seeking (surrogate versus self seeking). Independent variables included demographics, health status, and caregiving. After bivariate comparisons, we then developed multivariable models using logistic regression to assess characteristics associated with surrogate seeking. RESULTS Out of 1250 respondents who reported seeking health information online, 56% (N=705) reported being surrogate seekers. In multivariable models, compared with those who sought information for themselves only, surrogate seekers were more likely both married and a parent (OR=1.57, CI=1.08, 2.28), having good (OR=2.05, CI=1.34, 3.12) or excellent (OR=2.72, CI=1.70, 4.33) health status, being caregiver of an adult relative (OR=1.76, CI=1.34, 2.30), having someone close with a serious medical condition (OR=1.62, CI=1.21, 2.17) and having someone close to them facing a chronic illness (OR=1.55, CI=1.17, 2.04). CONCLUSIONS Our findings provide evidence that information needs of surrogate seekers are not being met, specifically of caregivers. Additional research is needed to develop new functions that support surrogate seekers.
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Affiliation(s)
- Rajani S Sadasivam
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA 01655-0002, USA.
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