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Adeyemi O, Walker L, Bermudez E, Cuthel AM, Zhao N, Siman N, Goldfeld K, Brody AA, Bouillon-Minois JB, DiMaggio C, Chodosh J, Grudzen CR. Emergency Nurses' Perceived Barriers and Solutions to Engaging Patients With Life-Limiting Illnesses in Serious Illness Conversations: A United States Multicenter Mixed-Method Analysis. J Emerg Nurs 2024; 50:225-242. [PMID: 37966418 PMCID: PMC10939973 DOI: 10.1016/j.jen.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/27/2023] [Accepted: 09/06/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION This study aimed to assess emergency nurses' perceived barriers toward engaging patients in serious illness conversations. METHODS Using a mixed-method (quant + QUAL) convergent design, we pooled data on the emergency nurses who underwent the End-of-Life Nursing Education Consortium training across 33 emergency departments. Data were extracted from the End-of-Life Nursing Education Consortium post-training questionnaire, comprising a 5-item survey and 1 open-ended question. Our quantitative analysis employed a cross-sectional design to assess the proportion of emergency nurses who report that they will encounter barriers in engaging seriously ill patients in serious illness conversations in the emergency department. Our qualitative analysis used conceptual content analysis to generate themes and meaning units of the perceived barriers and possible solutions toward having serious illness conversations in the emergency department. RESULTS A total of 2176 emergency nurses responded to the survey. Results from the quantitative analysis showed that 1473 (67.7%) emergency nurses reported that they will encounter barriers while engaging in serious illness conversations. Three thematic barriers-human factors, time constraints, and challenges in the emergency department work environment-emerged from the content analysis. Some of the subthemes included the perceived difficulty of serious illness conversations, delay in daily throughput, and lack of privacy in the emergency department. The potential solutions extracted included the need for continued training, the provision of dedicated emergency nurses to handle serious illness conversations, and the creation of dedicated spaces for serious illness conversations. DISCUSSION Emergency nurses may encounter barriers while engaging in serious illness conversations. Institutional-level policies may be required in creating a palliative care-friendly emergency department work environment.
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Affiliation(s)
- Oluwaseun Adeyemi
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
| | | | | | - Allison M. Cuthel
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
| | - Nicole Zhao
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook NY
| | - Nina Siman
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
| | - Keith Goldfeld
- New York University Grossman School of Medicine, Department of Population Health, New York, New York, USA
| | - Abraham A. Brody
- New York University Rory Meyers College of Nursing, New York, NY, USA; Hartford Institute for Geriatric Nursing, New York, NY, USA; Division of Geriatric Medicine and Palliative Care, Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Jean-Baptiste Bouillon-Minois
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
- Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Charles DiMaggio
- New York University Grossman School of Medicine, Department of Surgery, New York, New York, USA
| | - Joshua Chodosh
- New York University Grossman School of Medicine, Department of Population Health, New York, New York, USA
- New York University Grossman School of Medicine, Department of Medicine, New York, New York, USA
| | - Corita R. Grudzen
- New York University Grossman School of Medicine, Department of Surgery, New York, New York, USA
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Scherer JS, Bieber B, de Pinho NA, Masud T, Robinson B, Pecoits-Filho R, Schiedell J, Goldfeld K, Chodosh J, Charytan DM. Conservative Kidney Management Practice Patterns and Resources in the United States: A Cross-Sectional Analysis of CKDopps (Chronic Kidney Disease Outcomes and Practice Patterns Study) Data. Kidney Med 2023; 5:100726. [PMID: 37928753 PMCID: PMC10624579 DOI: 10.1016/j.xkme.2023.100726] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Rationale & Objective Conservative kidney management (CKM) is a viable treatment option for many patients with chronic kidney disease. However, CKM practices and resources in the United States are not well described. We undertook this study to gain a better understanding of factors influencing uptake of CKM by describing: (1) characteristics of patients who choose CKM, (2) provider practice patterns relevant to CKM, and (3) CKM resources available to providers. Study Design Cross-sectional study. Setting & Participants This study is a cross-sectional analysis of data from US nephrology clinics enrolled in the chronic kidney disease Outcomes and Practice Patterns Study (CKDopps) collected between 2014 and 2020. Data for this study includes chart-abstracted characteristics of patients with an estimated glomerular filtration rate ≤30mL/min/1.73m2 (n=1018) and available information on whether a decision had been made to pursue CKM at the time of kidney failure, patient (n=407) reports of discussions about forgoing dialysis, and provider (n=26) responses about CKM delivery and available resources in their health systems. Analytical Approach Descriptive statistics were used to report patient demographics, clinical information, provider demographics, and clinic characteristics. Results Among data from 1018 patients, 68 (7%) were recorded as planning for CKM. These patients were older, had more comorbidities, and were more likely to require assistance with transfers. Of the 407 patient surveys, 18% reported a conversation about forgoing dialysis with their nephrologist. A majority of providers felt comfortable discussing CKM; however, no clinics had a dedicated clinic or protocol for CKM. Limitations Inconsistent survey terminology and unlinked patient and provider responses. Conclusions Few patients reported discussion of forgoing dialysis with their providers and even fewer anticipated a choice of CKM on reaching kidney failure. Most providers were comfortable discussing CKM, but practiced in clinics that lacked dedicated resources. Further research is needed to improve the implementation of a CKM pathway. Plain-Language Summary For older comorbid adults with kidney failure, conservative kidney management (CKM) can be an appropriate treatment choice. CKM is a holistic approach with treatment goals of maximizing quality of life and preventing progression of chronic kidney disease (CKD) without initiation of dialysis. We investigated US CKM practices and found that among 1018 people with CKD, only 7% were planning for CKM. Of 407 surveyed patients, 18% reported a conversation with their provider about forgoing dialysis. In contrast, most providers felt comfortable discussing CKM; however, none reported working in an environment with a dedicated CKM clinic or protocol. Our data show the need for further CKM education in the United States as well as dedicated resources for its delivery.
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Affiliation(s)
- Jennifer S. Scherer
- NYU Grossman School of Medicine, Department of Internal Medicine, Division of Geriatrics and Palliative Care, New York, NY
- NYU Grossman School of Medicine, Department of Internal Medicine, Division of Nephrology, New York, NY
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Natalia Alencar de Pinho
- CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris Saclay, Université Versailles Saint-Quentin en Yvelines, Institut national de la santé et de la recherche médicale (Inserm), Equipe Epidémiologie Clinique, Villejuif, France
| | - Tahsin Masud
- Emory University, Department of Internal Medicine, Atlanta, GA
| | - Bruce Robinson
- University of Michigan, Department of Internal Medicine, Division of Nephrology, Ann Arbor, MI
| | | | - Joy Schiedell
- NYU Grossman School of Medicine, Department of Population Health, Division of Biostatistics, New York, NY
| | - Keith Goldfeld
- NYU Grossman School of Medicine, Department of Population Health, Division of Biostatistics, New York, NY
| | - Joshua Chodosh
- NYU Grossman School of Medicine, Department of Internal Medicine, Division of Geriatrics and Palliative Care, New York, NY
- VA New York Harbor Healthcare System, New York, NY
| | - David M. Charytan
- NYU Grossman School of Medicine, Department of Internal Medicine, Division of Nephrology, New York, NY
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Islam NS, Wyatt LC, Ali SH, Zanowiak JM, Mohaimin S, Goldfeld K, Lopez P, Kumar R, Beane S, Thorpe LE, Trinh-Shevrin C. Integrating Community Health Workers into Community-Based Primary Care Practice Settings to Improve Blood Pressure Control Among South Asian Immigrants in New York City: Results from a Randomized Control Trial. Circ Cardiovasc Qual Outcomes 2023; 16:e009321. [PMID: 36815464 PMCID: PMC10033337 DOI: 10.1161/circoutcomes.122.009321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/16/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Blood pressure (BP) control is suboptimal in minority communities, including Asian populations. We evaluate the feasibility, adoption, and effectiveness of an integrated CHW-led health coaching and practice-level intervention to improve hypertension control among South Asian patients in New York City, Project IMPACT (Integrating Million Hearts for Provider and Community Transformation). The primary outcome was BP control, and secondary outcomes were systolic BP and diastolic BP at 6-month follow-up. METHODS A randomized-controlled trial took place within community-based primary care practices that primarily serve South Asian patients in New York City between 2017 and 2019. A total of 303 South Asian patients aged 18-85 with diagnosed hypertension and uncontrolled BP (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) within the previous 6 months at 14 clinic sites consented to participate. After completing 1 education session, individuals were randomized into treatment (n=159) or control (n=144) groups. Treatment participants received 4 additional group education sessions and individualized health coaching over a 6-month period. A mixed effect generalized linear model with a logit link function was used to assess intervention effectiveness for controlled hypertension (Yes/No), adjusting for practice level random effect, age, sex, baseline systolic BP, and days between BP measurements. RESULTS Among the total enrolled population, mean age was 56.8±11.2 years, and 54.1% were women. At 6 months among individuals with follow-up BP data (treatment, n=154; control, n=137), 68.2% of the treatment group and 41.6% of the control group had controlled BP (P<0.001). In final adjusted analysis, treatment group participants had 3.7 [95% CI, 2.1-6.5] times the odds of achieving BP control at follow-up compared with the control group. CONCLUSIONS A CHW-led health coaching intervention was effective in achieving BP control among South Asian Americans in New York City primary care practices. Findings can guide translation and dissemination of this model across other communities experiencing hypertension disparities. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03159533.
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Affiliation(s)
- Nadia S Islam
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Laura C Wyatt
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Shahmir H Ali
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, (S.H.A.)
| | - Jennifer M Zanowiak
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Sadia Mohaimin
- School of Osteopathic Medicine, University of the Incarnate Word (S.M.)
| | - Keith Goldfeld
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Priscilla Lopez
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | | | | | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
| | - Chau Trinh-Shevrin
- Department of Population Health, New York University Grossman School of Medicine (N.S.I., L.C.W., J.M.Z., K.G., P.L., L.E.T., C.T.-S.)
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Adeyemi O, Ginsburg AD, Kaur R, Cuthel A, Zhao N, Siman N, Goldfeld K, Emlet LL, DiMaggio C, Yamarik R, Bouillon-Minois JB, Chodosh J, Grudzen CR. Serious Illness Communication Skills Training for Emergency Physicians and Advanced Practice Providers: A Multi-Method Assessment of the Reach and Effectiveness of the Intervention. Res Sq 2023:rs.3.rs-2561749. [PMID: 36865121 PMCID: PMC9980220 DOI: 10.21203/rs.3.rs-2561749/v1] [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] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Background EM Talk is a communication skills training program designed to improve emergency providers' serious illness conversational skills. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study aims to assess the reach of EM Talk and its effectiveness. Methods EM Talk is one of the components of Primary Palliative Care for Emergency Medicine (EM) intervention. It consisted of one 4-hour training session during which professional actors used role-plays and active learning to train providers to deliver serious/bad news, express empathy, explore patients' goals, and formulate care plans. After the training, emergency providers filled out an optional post-intervention survey, which included course reflections. Using a multi-method analytical approach, we analyzed the reach of the intervention quantitatively and the effectiveness of the intervention qualitatively using conceptual content analysis of open-ended responses. Results A total of 879 out of 1,029 (85%) EM providers across 33 emergency departments completed the EM Talk training, with the training rate ranging from 63-100%. From the 326 reflections, we identified meaning units across the thematic domains of improved knowledge, attitude, and practice. The main subthemes across the three domains were the acquisition of discussion tips and tricks, improved attitude toward engaging qualifying patients in serious illness (SI) conversations, and commitment to using these learned skills in clinical practice. Conclusion Effectively engaging qualifying patients in serious illness conversations requires appropriate communication skills. EM Talk has the potential to improve emergency providers' knowledge, attitude, and practice of SI communication skills. Trial registration NCT03424109.
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Haber Y, Fu SS, Rogers E, Richter K, Tenner C, Dognin J, Goldfeld K, Gold HT, Sherman SE. A novel opt-in vs opt-out approach to referral-based treatment of tobacco use in Veterans Affairs (VA) primary care clinics: A provider-level randomized controlled trial protocol. Contemp Clin Trials 2022; 116:106716. [PMID: 35276337 DOI: 10.1016/j.cct.2022.106716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022]
Abstract
To determine whether an opt-out approach is effective for referral to treatment for tobacco use, we designed a clinical reminder for nurses in a primary care setting that provides a referral for patients who smoke cigarettes. We will use a two-arm, cluster-randomized design to assign nurses at the VA New York Harbor Healthcare System to test which mode of referral (opt-in vs opt-out) is more effective. All patients will be referred to evidence-based treatment for tobacco cessation including counseling from the New York State Quitline, and VetsQuit, a text messaging-based system for tobacco cessation counseling. We will measure patient engagement with the referral both in the short and long term to determine if referral modality had an impact on tobacco cessation treatment. We will also measure nurse engagement with the referral before, during, and after the implementation of the reminder to determine whether an opt-out approach is cost effective at the health system level. At the conclusion of this project, we expect to have developed and tested an opt-out system for increasing tobacco cessation treatment for Veterans in VA primary care and to have a thorough understanding of factors associated with implementation. Trial Registration:Clinicaltrials.govIdentifierNCT03477435.
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Affiliation(s)
- Yaa Haber
- VA New York Harbor Healthcare System, New York, NY, USA; Department of Medicine, VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA.
| | - Steven S Fu
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Erin Rogers
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Kim Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Craig Tenner
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Medicine, New York, NY, USA
| | - Joanna Dognin
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Medicine, New York, NY, USA; Department of Psychology, VA New York Harbor Healthcare System, New York, NY, USA
| | - Keith Goldfeld
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Heather T Gold
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - Scott E Sherman
- VA New York Harbor Healthcare System, New York, NY, USA; NYU Grossman School of Medicine, Department of Population Health, New York, NY, USA; NYU Grossman School of Medicine, Department of Medicine, New York, NY, USA
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Dickson VV, Blustein J, Weinstein B, Goldfeld K, Radcliffe K, Burlingame M, Grudzen CR, Sherman SE, Smilowitz J, Chodosh J. Providing Hearing Assistance to Veterans in the Emergency Department: A Qualitative Study. J Emerg Nurs 2022; 48:266-277. [PMID: 35172928 DOI: 10.1016/j.jen.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Effective communication is essential to good health care, and hearing loss disrupts patient-provider communication. For the more than 2 million veterans with severe hearing loss, communication is particularly challenging in noisy health care environments such as emergency departments. The purpose of this qualitative study was to describe patient and provider perspectives of feasibility and potential benefit of providing a hearing assistance device, a personal amplifier, during visits to an emergency department in an urban setting affiliated with the Department of Veterans Affairs. METHODS This qualitative descriptive study was conducted in parallel with a randomized controlled study. We completed a semistructured interview with 11 veterans and 10 health care providers to elicit their previous experiences with patient-provider communication in the ED setting and their perspectives on hearing screening and using the personal amplifier in the emergency department. Interview data were analyzed using content analysis and Atlas.ti V8.4 software (Scientific Software Development GmbH, Berlin, Germany). RESULTS The veteran sample (n = 11) had a mean age of 80.3 years (SD = 10.2). The provider sample included 7 nurses and 3 physicians. In the ED setting, hearing loss disrupts patient-provider communication. Screening for hearing loss in the emergency department was feasible except in urgent/emergent cases. The use of the personal amplifier made communication more effective and less effortful for both veterans and providers. DISCUSSION Providing the personal amplifier improved the ED experience for veterans and offers a promising intervention that could improve health care quality and safety for ED patient populations.
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Park H, Tarpey T, Liu M, Goldfeld K, Wu Y, Wu D, Li Y, Zhang J, Ganguly D, Ray Y, Paul SR, Bhattacharya P, Belov A, Huang Y, Villa C, Forshee R, Verdun NC, Yoon HA, Agarwal A, Simonovich VA, Scibona P, Burgos Pratx L, Belloso W, Avendaño-Solá C, Bar KJ, Duarte RF, Hsue PY, Luetkemeyer AF, Meyfroidt G, Nicola AM, Mukherjee A, Ortigoza MB, Pirofski LA, Rijnders BJA, Troxel A, Antman EM, Petkova E. Development and Validation of a Treatment Benefit Index to Identify Hospitalized Patients With COVID-19 Who May Benefit From Convalescent Plasma. JAMA Netw Open 2022; 5:e2147375. [PMID: 35076698 PMCID: PMC8790670 DOI: 10.1001/jamanetworkopen.2021.47375] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/15/2021] [Indexed: 12/20/2022] Open
Abstract
Importance Identifying which patients with COVID-19 are likely to benefit from COVID-19 convalescent plasma (CCP) treatment may have a large public health impact. Objective To develop an index for predicting the expected relative treatment benefit from CCP compared with treatment without CCP for patients hospitalized for COVID-19 using patients' baseline characteristics. Design, Setting, and Participants This prognostic study used data from the COMPILE study, ie, a meta-analysis of pooled individual patient data from 8 randomized clinical trials (RCTs) evaluating CCP vs control in adults hospitalized for COVID-19 who were not receiving mechanical ventilation at randomization. A combination of baseline characteristics, termed the treatment benefit index (TBI), was developed based on 2287 patients in COMPILE using a proportional odds model, with baseline characteristics selected via cross-validation. The TBI was externally validated on 4 external data sets: the Expanded Access Program (1896 participants), a study conducted under Emergency Use Authorization (210 participants), and 2 RCTs (with 80 and 309 participants). Exposure Receipt of CCP. Main Outcomes and Measures World Health Organization (WHO) 11-point ordinal COVID-19 clinical status scale and 2 derivatives of it (ie, WHO score of 7-10, indicating mechanical ventilation to death, and WHO score of 10, indicating death) at day 14 and day 28 after randomization. Day 14 WHO 11-point ordinal scale was used as the primary outcome to develop the TBI. Results A total of 2287 patients were included in the derivation cohort, with a mean (SD) age of 60.3 (15.2) years and 815 (35.6%) women. The TBI provided a continuous gradation of benefit, and, for clinical utility, it was operationalized into groups of expected large clinical benefit (B1; 629 participants in the derivation cohort [27.5%]), moderate benefit (B2; 953 [41.7%]), and potential harm or no benefit (B3; 705 [30.8%]). Patients with preexisting conditions (diabetes, cardiovascular and pulmonary diseases), with blood type A or AB, and at an early COVID-19 stage (low baseline WHO scores) were expected to benefit most, while those without preexisting conditions and at more advanced stages of COVID-19 could potentially be harmed. In the derivation cohort, odds ratios for worse outcome, where smaller odds ratios indicate larger benefit from CCP, were 0.69 (95% credible interval [CrI], 0.48-1.06) for B1, 0.82 (95% CrI, 0.61-1.11) for B2, and 1.58 (95% CrI, 1.14-2.17) for B3. Testing on 4 external datasets supported the validation of the derived TBIs. Conclusions and Relevance The findings of this study suggest that the CCP TBI is a simple tool that can quantify the relative benefit from CCP treatment for an individual patient hospitalized with COVID-19 that can be used to guide treatment recommendations. The TBI precision medicine approach could be especially helpful in a pandemic.
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Affiliation(s)
- Hyung Park
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Thaddeus Tarpey
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
- Department of Environmental Medicine, New York University Grossman School of Medicine, New York
| | - Keith Goldfeld
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Yinxiang Wu
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Danni Wu
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Yi Li
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Jinchun Zhang
- Biostatistics and Research Decision Sciences, Merck Research Labortory, Merck & Co Inc, Rahway, New Jersey
| | - Dipyaman Ganguly
- Translational Research Unit of Excellence, Council Of Scientific And Industrial Research–Indian Institute of Chemical Biology, Kolkata, India
| | - Yogiraj Ray
- Infectious Disease, Beleghata General Hospital, Kolkata, India
- School of Tropical Medicine, Kolkata, India
| | | | | | - Artur Belov
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Analytics and Benefit-Risk Assessment Team, US Food and Drug Administration, Silver Spring, Maryland
| | - Yin Huang
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Analytics and Benefit-Risk Assessment Team, US Food and Drug Administration, Silver Spring, Maryland
| | - Carlos Villa
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Analytics and Benefit-Risk Assessment Team, US Food and Drug Administration, Silver Spring, Maryland
| | - Richard Forshee
- Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Analytics and Benefit-Risk Assessment Team, US Food and Drug Administration, Silver Spring, Maryland
| | - Nicole C. Verdun
- Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Hyun ah Yoon
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Anup Agarwal
- Indian Council of Medical Research, New Delhi, India
| | - Ventura Alejandro Simonovich
- Clinical Pharmacology Section, Department of Internal Medicine and Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Paula Scibona
- Clinical Pharmacology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Leandro Burgos Pratx
- Transfusional Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Waldo Belloso
- Department of Research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Katharine J Bar
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rafael F. Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Priscilla Y. Hsue
- Zuckerberg San Francisco General, University of California, San Francisco
| | | | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - André M. Nicola
- Hospital Universitário de Brasília, University of Brasília, Brasília, Brazil
| | | | - Mila B. Ortigoza
- Departments of Medicine and Microbiology, New York University Grossman School of Medicine, New York
| | - Liise-anne Pirofski
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Bart J. A. Rijnders
- Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andrea Troxel
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
| | - Elliott M. Antman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eva Petkova
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine
- Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
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Troxel AB, Petkova E, Goldfeld K, Liu M, Tarpey T, Wu Y, Wu D, Agarwal A, Avendaño-Solá C, Bainbridge E, Bar KJ, Devos T, Duarte RF, Gharbharan A, Hsue PY, Kumar G, Luetkemeyer AF, Meyfroidt G, Nicola AM, Mukherjee A, Ortigoza MB, Pirofski LA, Rijnders BJA, Rokx C, Sancho-Lopez A, Shaw P, Tebas P, Yoon HA, Grudzen C, Hochman J, Antman EM. Association of Convalescent Plasma Treatment With Clinical Status in Patients Hospitalized With COVID-19: A Meta-analysis. JAMA Netw Open 2022; 5:e2147331. [PMID: 35076699 PMCID: PMC8790669 DOI: 10.1001/jamanetworkopen.2021.47331] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022] Open
Abstract
Importance COVID-19 convalescent plasma (CCP) is a potentially beneficial treatment for COVID-19 that requires rigorous testing. Objective To compile individual patient data from randomized clinical trials of CCP and to monitor the data until completion or until accumulated evidence enables reliable conclusions regarding the clinical outcomes associated with CCP. Data Sources From May to August 2020, a systematic search was performed for trials of CCP in the literature, clinical trial registry sites, and medRxiv. Domain experts at local, national, and international organizations were consulted regularly. Study Selection Eligible trials enrolled hospitalized patients with confirmed COVID-19, not receiving mechanical ventilation, and randomized them to CCP or control. The administered CCP was required to have measurable antibodies assessed locally. Data Extraction and Synthesis A minimal data set was submitted regularly via a secure portal, analyzed using a prespecified bayesian statistical plan, and reviewed frequently by a collective data and safety monitoring board. Main Outcomes and Measures Prespecified coprimary end points-the World Health Organization (WHO) 11-point ordinal scale analyzed using a proportional odds model and a binary indicator of WHO score of 7 or higher capturing the most severe outcomes including mechanical ventilation through death and analyzed using a logistic model-were assessed clinically at 14 days after randomization. Results Eight international trials collectively enrolled 2369 participants (1138 randomized to control and 1231 randomized to CCP). A total of 2341 participants (median [IQR] age, 60 [50-72] years; 845 women [35.7%]) had primary outcome data as of April 2021. The median (IQR) of the ordinal WHO scale was 3 (3-6); the cumulative OR was 0.94 (95% credible interval [CrI], 0.74-1.19; posterior probability of OR <1 of 71%). A total of 352 patients (15%) had WHO score greater than or equal to 7; the OR was 0.94 (95% CrI, 0.69-1.30; posterior probability of OR <1 of 65%). Adjusted for baseline covariates, the ORs for mortality were 0.88 at day 14 (95% CrI, 0.61-1.26; posterior probability of OR <1 of 77%) and 0.85 at day 28 (95% CrI, 0.62-1.18; posterior probability of OR <1 of 84%). Heterogeneity of treatment effect sizes was observed across an array of baseline characteristics. Conclusions and Relevance This meta-analysis found no association of CCP with better clinical outcomes for the typical patient. These findings suggest that real-time individual patient data pooling and meta-analysis during a pandemic are feasible, offering a model for future research and providing a rich data resource.
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Affiliation(s)
- Andrea B. Troxel
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Eva Petkova
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Keith Goldfeld
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Mengling Liu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Environmental Health, NYU Grossman School of Medicine, New York, New York
| | - Thaddeus Tarpey
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Yinxiang Wu
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Danni Wu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Anup Agarwal
- Indian Council of Medical Research, New Delhi, Delhi, India
| | | | - Emma Bainbridge
- Zuckerberg San Francisco General, University of California San Francisco, San Francisco
| | - Katherine J. Bar
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Timothy Devos
- Department of Hematology, University Hospitals Leuven and Department of Microbiology and Immunology, Laboratory of Molecular Immunology (Rega Institute), KU Leuven, Leuven, Belgium
| | - Rafael F. Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Arvind Gharbharan
- Section of Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Priscilla Y. Hsue
- Zuckerberg San Francisco General, University of California San Francisco, San Francisco
| | - Gunjan Kumar
- Indian Council of Medical Research, New Delhi, Delhi, India
| | - Annie F. Luetkemeyer
- Zuckerberg San Francisco General, University of California San Francisco, San Francisco
| | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - André M. Nicola
- Hospital Universitário de Brasília, University of Brasília, Brasília, Brazil
| | | | - Mila B. Ortigoza
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
- Department of Microbiology, NYU Grossman School of Medicine, New York, New York
| | - Liise-anne Pirofski
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Bart J. A. Rijnders
- Section of Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Casper Rokx
- Section of Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Pamela Shaw
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, Seattle
| | - Pablo Tebas
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Hyun-Ah Yoon
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
| | - Corita Grudzen
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York
| | - Judith Hochman
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Elliott M. Antman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Waddell EN, Springer SA, Marsch LA, Farabee D, Schwartz RP, Nyaku A, Reeves R, Goldfeld K, McDonald RD, Malone M, Cheng A, Saunders EC, Monico L, Gryczynski J, Bell K, Harding K, Violette S, Groblewski T, Martin W, Talon K, Beckwith N, Suchocki A, Torralva R, Wisdom JP, Lee JD. Long-acting buprenorphine vs. naltrexone opioid treatments in CJS-involved adults (EXIT-CJS). J Subst Abuse Treat 2021; 128:108389. [PMID: 33865691 PMCID: PMC8384640 DOI: 10.1016/j.jsat.2021.108389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
The EXIT-CJS (N = 1005) multisite open-label randomized controlled trial will compare retention and effectiveness of extended-release buprenorphine (XR-B) vs. extended-release naltrexone (XR-NTX) to treat opioid use disorder (OUD) among criminal justice system (CJS)-involved adults in six U.S. locales (New Jersey, New York City, Delaware, Oregon, Connecticut, and New Hampshire). With a pragmatic, noninferiority design, this study hypothesizes that XR-B (n = 335) will be noninferior to XR-NTX (n = 335) in retention-in-study-medication treatment (the primary outcome), self-reported opioid use, opioid-positive urine samples, opioid overdose events, and CJS recidivism. In addition, persons with OUD not eligible or interested in the RCT will be recruited into an enhanced treatment as usual arm (n = 335) to examine usual care outcomes in a quasi-experimental observational cohort.
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Affiliation(s)
- Elizabeth Needham Waddell
- School of Public Health and OHSU School of Medicine, Oregon Health & Science University, United States of America
| | | | | | | | | | - Amesika Nyaku
- The State University of New Jersey, New Jersey Medical School, United States of America
| | - Rusty Reeves
- Rutgers, University Correctional Health Care, Rutgers - Robert Wood Johnson Medical School, United States of America
| | | | | | - Mia Malone
- Friends Research Institute, United States of America
| | - Anna Cheng
- Friends Research Institute, United States of America
| | | | - Laura Monico
- Friends Research Institute, United States of America
| | | | | | - Kasey Harding
- Community Health Center, Inc, United States of America
| | | | | | | | - Kasey Talon
- ROAD to a Better Life, United States of America
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10
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Chodosh J, Goldfeld K, Weinstein BE, Radcliffe K, Burlingame M, Dickson V, Grudzen C, Sherman S, Smilowitz J, Blustein J. The HEAR-VA Pilot Study: Hearing Assistance Provided to Older Adults in the Emergency Department. J Am Geriatr Soc 2021; 69:1071-1078. [PMID: 33576037 DOI: 10.1111/jgs.17037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Poor communication is a barrier to care for people with hearing loss. We assessed the feasibility and potential benefit of providing a simple hearing assistance device during an emergency department (ED) visit, for people who reported difficulty hearing. DESIGN Randomized controlled pilot study. SETTING The ED of New York Harbor Manhattan Veterans Administration Medical Center. PARTICIPANTS One hundred and thirty-three Veterans aged 60 and older, presenting to the ED, likely to be discharged to home, who either (1) said that they had difficulty hearing, or (2) scored 10 or greater (range 0-40) on the Hearing Handicap Inventory-Survey (HHI-S). INTERVENTION Subjects were randomized (1:1), and intervention subjects received a personal amplifier (PA; Williams Sound Pocketalker 2.0) for use during their ED visit. MEASUREMENTS Three survey instruments: (1) six-item Hearing and Understanding Questionnaire (HUQ); (2) three-item Care Transitions Measure; and (3) three-item Patient Understanding of Discharge Information. Post-ED visit phone calls to assess ED returns. RESULTS Of the 133 subjects, 98.3% were male; mean age was 76.4 years (standard deviation (SD) = 9.2). Mean HHI-S score was 19.2 (SD = 8.3). Across all HUQ items, intervention subjects reported better in-ED experience than controls. Seventy-five percent of intervention subjects agreed or strongly agreed that ability to understand what was said was without effort versus 56% for controls. Seventy-five percent of intervention subjects versus 36% of controls said clinicians provided them with an explanation about presenting problems. Three percent of intervention subjects had an ED revisit within 3 days compared with 9.0% controls. CONCLUSION Veterans with hearing difficulties reported improved in-ED experiences with use of PAs, and were less likely to return to the ED within 3 days. PAs may be an important adjunct to older patient ED care but require validation in a larger more definitive randomized controlled trial.
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Affiliation(s)
- Joshua Chodosh
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Keith Goldfeld
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Barbara E Weinstein
- Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Audiology Program, Graduate Center, City University of New York, New York, New York, USA
| | - Kate Radcliffe
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Victoria Dickson
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Corita Grudzen
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.,Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Scott Sherman
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jessica Smilowitz
- VA New York Harbor Healthcare System, New York, New York, USA.,Division of Geriatrics and Palliative Care, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Jan Blustein
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.,Robert F. Wagner Graduate School of Public Service, New York University, New York, New York, USA
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11
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Tamura K, Wilson JS, Goldfeld K, Puett RC, Klenosky DB, Harper WA, Troped PJ. Accelerometer and GPS Data to Analyze Built Environments and Physical Activity. Res Q Exerc Sport 2019; 90:395-402. [PMID: 31199713 PMCID: PMC6701185 DOI: 10.1080/02701367.2019.1609649] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/12/2019] [Indexed: 05/08/2023]
Abstract
Purpose: Most built environment studies have quantified characteristics of the areas around participants' homes. However, the environmental exposures for physical activity (PA) are spatially dynamic rather than static. Thus, merged accelerometer and global positioning system (GPS) data were utilized to estimate associations between the built environment and PA among adults. Methods: Participants (N = 142) were recruited on trails in Massachusetts and wore an accelerometer and GPS unit for 1-4 days. Two binary outcomes were created: moderate-to-vigorous PA (MVPA vs. light PA-to-sedentary); and light-to-vigorous PA (LVPA vs. sedentary). Five built environment variables were created within 50-meter buffers around GPS points: population density, street density, land use mix (LUM), greenness, and walkability index. Generalized linear mixed models were fit to examine associations between environmental variables and both outcomes, adjusting for demographic covariates. Results: Overall, in the fully adjusted models, greenness was positively associated with MVPA and LVPA (odds ratios [ORs] = 1.15, 95% confidence interval [CI] = 1.03, 1.30 and 1.25, 95% CI = 1.12, 1.41, respectively). In contrast, street density and LUM were negatively associated with MVPA (ORs = 0.69, 95% CI = 0.67, 0.71 and 0.87, 95% CI = 0.78, 0.97, respectively) and LVPA (ORs = 0.79, 95% CI = 0.77, 0.81 and 0.81, 95% CI = 0.74, 0.90, respectively). Negative associations of population density and walkability with both outcomes reached statistical significance, yet the effect sizes were small. Conclusions: Concurrent monitoring of activity with accelerometers and GPS units allowed us to investigate relationships between objectively measured built environment around GPS points and minute-by-minute PA. Negative relationships between street density and LUM and PA contrast evidence from most built environment studies in adults. However, direct comparisons should be made with caution since most previous studies have focused on spatially fixed buffers around home locations, rather than the precise locations where PA occurs.
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Affiliation(s)
- Kosuke Tamura
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jeffrey S. Wilson
- Department of Geography, Indiana University-Purdue University Indianapolis, Indianapolis, IN
| | - Keith Goldfeld
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Robin C. Puett
- Maryland Institute of Applied Environmental Health, School of Public Heath, University of Maryland, College Park, MD
| | - David B. Klenosky
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - William A. Harper
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN
| | - Philip J. Troped
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA
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12
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Lopez PM, Divney A, Goldfeld K, Zanowiak J, Gore R, Kumar R, Laughlin P, Sanchez R, Beane S, Trinh-Shevrin C, Thorpe L, Islam N. Feasibility and Outcomes of an Electronic Health Record Intervention to Improve Hypertension Management in Immigrant-serving Primary Care Practices. Med Care 2019; 57 Suppl 6 Suppl 2:S164-S171. [PMID: 31095056 PMCID: PMC6527132 DOI: 10.1097/mlr.0000000000000994] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND South Asians experience a disproportionate burden of high blood pressure (BP) in the United States, arguably the most preventable risk factor for cardiovascular disease. OBJECTIVE We report 12-month results of an electronic health record (EHR)-based intervention, as a component of a larger project, "Implementing Million Hearts for Provider and Community Transformation." The EHR intervention included launching hypertension patient registries and implementing culturally tailored alerts and order sets to improve hypertension control among patients treated in 14 New York City practices located in predominantly South Asian immigrant neighborhoods. DESIGN Using a modified stepped-wedge quasi-experimental study design, practice-level EHR data were extracted, and individual-level data were obtained on a subset of patients insured by a Medicaid insurer via their data warehouse. The primary aggregate outcome was change in proportion of hypertensive patients with controlled BP; individual-level outcomes included average systolic BP (SBP) and diastolic BP (DBP) at last clinic visit. Qualitative interviews were conducted to assess intervention feasibility. MEASURES Hypertension was defined as having at least 1 hypertension ICD-9/10 code. Well-controlled hypertension was defined as SBP<140 and DBP<90 mm Hg. RESULTS Postintervention, we observed a significant improvement in hypertension control at the practice level, adjusting for age and sex patient composition (adjusted relative risk, 1.09; 95% confidence interval, 1.04-1.14). Among the subset of Medicaid patients, we observed a significant reduction in average SBP and DBP adjusting for time, age, and sex, by 1.71 and 1.13 mm Hg, respectively (P<0.05). Providers reported feeling supported and satisfied with EHR components. CONCLUSIONS EHR initiatives in practices serving immigrants and minorities may enhance practice capabilities to improve hypertension control.
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Affiliation(s)
- Priscilla M. Lopez
- NYU School of Medicine, Department of Population Health, NY, NY
- NYU-CUNY Prevention Research Center
| | - Anna Divney
- NYU-CUNY Prevention Research Center
- CUNY Graduate School of Public Health and Health Policy, NY, NY
| | - Keith Goldfeld
- NYU School of Medicine, Department of Population Health, NY, NY
| | - Jennifer Zanowiak
- NYU School of Medicine, Department of Population Health, NY, NY
- NYU-CUNY Prevention Research Center
| | - Radhika Gore
- NYU School of Medicine, Department of Population Health, NY, NY
| | | | | | | | | | - Chau Trinh-Shevrin
- NYU School of Medicine, Department of Population Health, NY, NY
- NYU-CUNY Prevention Research Center
| | - Lorna Thorpe
- NYU School of Medicine, Department of Population Health, NY, NY
- NYU-CUNY Prevention Research Center
| | - Nadia Islam
- NYU School of Medicine, Department of Population Health, NY, NY
- NYU-CUNY Prevention Research Center
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13
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Berland N, Lugassy D, Fox A, Goldfeld K, Oh SY, Tofighi B, Hanley K. Use of online opioid overdose prevention training for first-year medical students: A comparative analysis of online versus in-person training. Subst Abus 2019; 40:240-246. [PMID: 30767715 DOI: 10.1080/08897077.2019.1572048] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: In response to the opioid epidemic and efforts to expand substance use education in medical school, the authors introduced opioid overdose prevention training (OOPT) with naloxone for all first-year medical students (MS1s) as an adjunct to required basic life support training (BLST). The authors previously demonstrated improved knowledge and preparedness following in-person OOPT with BLST; however, it remains unclear whether online-administered OOPT would produce comparable results. In this study, the authors perform a retrospective comparison of online-administered OOPT with in-person-administered OOPT. Objectives: To compare the educational outcomes: knowledge, preparedness, and attitudes, for online versus in-person OOPT. Methods: In-person OOPT was administered in 2014 and 2015 during BLST, whereas online OOPT was administered in 2016 during BLST pre-work. MS1s completed pre- and post-training tests covering 3 measures: knowledge (11-point scale), attitudes (66-point scale), and preparedness (60-point scale) to respond to an opioid overdose. Online scores from 2016 and in-person scores from 2015 were compared across all 3 measures using analysis of covariance (ANCOVA) methods. Results: After controlling for pre-test scores, there were statistical, but no meaningful, differences across all measures for in-person- and online-administered training. The estimated differences were knowledge: -0.05 (0.5%) points (95% confidence interval [CI]: -0.47, 0.36); attitudes: 0.65 (1.0%) points (95% CI: -0.22, 1.51); and preparedness: 2.16 (3.6%) points (95% CI: 1.04, 3.28). Conclusions: The educational outcomes of online-administered OOPT compared with in-person-administered OOPT were not meaningfully different. These results support the use of online-administered OOPT. As our study was retrospective, based on data collected over multiple years, further investigation is needed in a randomized controlled setting, to better understand the educational differences of in-person and online training. Further expanding OOPT to populations beyond medical students would further improve generalizability.
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Affiliation(s)
- Noah Berland
- Kings County Hospital, SUNY Downstate Medical Center , Brooklyn , New York , USA
| | - Daniel Lugassy
- Department of Emergency Medicine and Toxicology, New York University School of Medicine , New York , New York , USA
| | - Aaron Fox
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine , Bronx , New York , USA
| | - Keith Goldfeld
- Department of Population health, New York University School of Medicine , New York , New York , USA
| | - So-Young Oh
- Institute for Innovations in Medical Education, New York University School of Medicine , New York , New York , USA
| | - Babak Tofighi
- Department of Population health, New York University School of Medicine , New York , New York , USA
| | - Kathleen Hanley
- Department of Medicine, New York University School of Medicine , New York , New York , USA
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14
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Krebs P, Rogers E, Greenspan A, Goldfeld K, Lei L, Ostroff JS, Garrett BE, Momin B, Henley SJ. Utility of Using Cancer Registry Data to Identify Patients for Tobacco Treatment Trials. J Registry Manag 2019; 46:30-36. [PMID: 32010425 PMCID: PMC6993933] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Many tobacco dependent cancer survivors continue to smoke after diagnosis and treatment. This study investigated the extent to which hospital-based cancer registries could be used to identify smokers in order to offer them assistance in quitting. The concordance of tobacco use coded in the registry was compared with tobacco use as coded in the accompanying Electronic Health Records (EHRs). METHODS We gathered data from three hospital-based cancer registries in New York City during June 2014 to December 2016. For each patient identified as a current combustible tobacco user in the cancer registries, we abstracted tobacco use data from their EHR to independently code and corroborate smoking status. We calculated the proportion of current smokers, former smokers, and never smokers as indicated in the EHR for the hospitals, cancer site, cancer stage, and sex. We used a logistic regression model to estimate the log odds of the registry-based smoking status correctly predicting the EHR-based smoking status. RESULTS Agreement in current smoking status between the registry-based smoking status and the EHR-based smoking status was 65%, 71%, and 90% at the three participating hospitals. Logistic regression results indicated that agreement in smoking status between the registry and the EHRs varied by hospital, cancer type, and stage, but not by age and sex. CONCLUSIONS The utility of using tobacco use data in cancer registries for population-based tobacco treatment interventions is dependent on multiple factors including accurate entry into EHR systems, updated data, and consistent smoking status definitions and registry coding protocols. Our study found that accuracy varied across the three hospitals and may not be able to inform interventions at these hospitals at this time. Several changes may be needed to improve the coding of tobacco use status in EHRs and registries.
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Affiliation(s)
| | | | | | | | - Lei Lei
- NYU School of Medicine, New York, NY
| | | | - Bridgette E Garrett
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Behnoosh Momin
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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15
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Hanley K, Bereket S, Tuchman E, More FG, Naegle MA, Kalet A, Goldfeld K, Gourevitch MN. Evaluation of the Substance Abuse Research and Education Training (SARET) program: Stimulating health professional students to pursue careers in substance use research. Subst Abus 2018; 39:476-483. [PMID: 29565782 DOI: 10.1080/08897077.2018.1449167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND We developed and implemented the Substance Abuse Research Education and Training (SARET) program for medical, dental, nursing, and social work students to address the dearth of health professionals pursuing research and careers in substance use disorders (SUD). SARET has 2 main components: (1) a novel online curriculum addressing core SUD research topics, to reach a large number of students; (2) a mentored summer research experience for in-depth exposure. METHODS Modules were integrated into the curricula of the lead institution, and of 5 external schools. We assessed the number of Web modules completed and their effect on students' interest in SUD research. We also assessed the impact of the mentorship experience on participants' attitudes and early career trajectories, including current involvement in SUD research. RESULTS Since 2008, over 24,000 modules have been completed by approximately 9700 individuals. In addition to integration of the modules into curricula at the lead institution, all 5 health-professional partner schools integrated at least 1 module and approximately 5500 modules were completed by individuals outside the lead institution. We found an increase in interest in SUD research after completion of the modules for students in all 4 disciplines. From 2008 to 2015, 76 students completed summer mentorships; 8 students completed year-long mentorships; 13 published in SUD-related journals, 18 presented at national conferences, and 3 are actively engaged in SUD-related research. Mentorship participants reported a positive influence on their attitudes towards SUD-related clinical care, research, and interprofessional collaboration, leading in some cases to changes in career plans. CONCLUSIONS A modular curriculum that stimulates clinical and research interest in SUD can be successfully integrated into medical, dental, nursing, and social work curricula. The SARET program of mentored research participation fostered early research successes and influenced career choice of some participants. Longer-term follow-up will enable us to assess more distal careers of the program.
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Affiliation(s)
- Kathleen Hanley
- a Department of Medicine, New York University School of Medicine , New York , New York , USA
| | - Sewit Bereket
- b Department of Population Health, New York University School of Medicine , New York , New York , USA
| | - Ellen Tuchman
- c New York University Silver School of Social Work , New York , New York , USA
| | - Frederick G More
- d Department of Epidemiology & Health Promotion , New York University College of Dentistry , New York , New York , USA
| | | | - Adina Kalet
- f Department of Medicine , New York University School of Medicine , New York , New York , USA
| | - Keith Goldfeld
- b Department of Population Health, New York University School of Medicine , New York , New York , USA
| | - Marc N Gourevitch
- b Department of Population Health, New York University School of Medicine , New York , New York , USA
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Lopez PM, Zanowiak J, Goldfeld K, Wyka K, Masoud A, Beane S, Kumar R, Laughlin P, Trinh-Shevrin C, Thorpe L, Islam N. Protocol for project IMPACT (improving millions hearts for provider and community transformation): a quasi-experimental evaluation of an integrated electronic health record and community health worker intervention study to improve hypertension management among South Asian patients. BMC Health Serv Res 2017; 17:810. [PMID: 29207983 PMCID: PMC5717844 DOI: 10.1186/s12913-017-2767-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/24/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge. METHODS Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control (<140 mmHg systolic blood pressure (BP) and <90 mmHg diastolic BP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled. DISCUSSION Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices. TRIAL REGISTRATION This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017.
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Affiliation(s)
- Priscilla M. Lopez
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Jennifer Zanowiak
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Keith Goldfeld
- Department of Population Health, NYU School of Medicine, New York, USA
| | - Katarzyna Wyka
- CUNY Graduate School of Public Health and Health Policy, New York, USA
| | | | | | | | | | - Chau Trinh-Shevrin
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Lorna Thorpe
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
| | - Nadia Islam
- Department of Population Health, NYU School of Medicine, New York, USA
- NYU-CUNY Prevention Research Center, New York, USA
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Bhatraju EP, Grossman E, Tofighi B, McNeely J, DiRocco D, Flannery M, Garment A, Goldfeld K, Gourevitch MN, Lee JD. Public sector low threshold office-based buprenorphine treatment: outcomes at year 7. Addict Sci Clin Pract 2017; 12:7. [PMID: 28245872 PMCID: PMC5331716 DOI: 10.1186/s13722-017-0072-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 02/02/2017] [Indexed: 11/28/2022] Open
Abstract
Background Buprenorphine maintenance for opioid dependence remains of limited availability among underserved populations, despite increases in US opioid misuse and overdose deaths. Low threshold primary care treatment models including the use of unobserved, “home,” buprenorphine induction may simplify initiation of care and improve access. Unobserved induction and long-term treatment outcomes have not been reported recently among large, naturalistic cohorts treated in low threshold safety net primary care settings. Methods This prospective clinical registry cohort design estimated rates of induction-related adverse events, treatment retention, and urine opioid results for opioid dependent adults offered buprenorphine maintenance in a New York City public hospital primary care office-based practice from 2006 to 2013. This clinic relied on typical ambulatory care individual provider-patient visits, prescribed unobserved induction exclusively, saw patients no more than weekly, and did not require additional psychosocial treatment. Unobserved induction consisted of an in-person screening and diagnostic visit followed by a 1-week buprenorphine written prescription, with pamphlet, and telephone support. Primary outcomes analyzed were rates of induction-related adverse events (AE), week 1 drop-out, and long-term treatment retention. Factors associated with treatment retention were examined using a Cox proportional hazard model among inductions and all patients. Secondary outcomes included overall clinic retention, buprenorphine dosages, and urine sample results. Results Of the 485 total patients in our registry, 306 were inducted, and 179 were transfers already on buprenorphine. Post-induction (n = 306), week 1 drop-out was 17%. Rates of any induction-related AE were 12%; serious adverse events, 0%; precipitated withdrawal, 3%; prolonged withdrawal, 4%. Treatment retention was a median 38 weeks (range 0–320) for inductions, compared to 110 (0–354) weeks for transfers and 57 for the entire clinic population. Older age, later years of first clinic visit (vs. 2006–2007), and baseline heroin abstinence were associated with increased treatment retention overall. Conclusions Unobserved “home” buprenorphine induction in a public sector primary care setting appeared a feasible and safe clinical practice. Post-induction treatment retention of a median 38 weeks was in line with previous naturalistic studies of real-world office-based opioid treatment. Low threshold treatment protocols, as compared to national guidelines, may compliment recently increased prescriber patient limits and expand access to buprenorphine among public sector opioid use disorder patients.
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Affiliation(s)
- Elenore Patterson Bhatraju
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Ellie Grossman
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Babak Tofighi
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Jennifer McNeely
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA.,Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Danae DiRocco
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Mara Flannery
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Ann Garment
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA
| | - Keith Goldfeld
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Marc N Gourevitch
- Department of Population Health, NYU School of Medicine, 227 East 30th St, New York, NY, 10016, USA
| | - Joshua D Lee
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, New York, NY, USA. .,Department of Population Health, NYU School of Medicine, 227 East 30th St #712, New York, NY, 10016, USA.
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18
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Brotman LM, Dawson-McClure S, Kamboukos D, Huang KY, Calzada EJ, Goldfeld K, Petkova E. Effects of ParentCorps in Prekindergarten on Child Mental Health and Academic Performance: Follow-up of a Randomized Clinical Trial Through 8 Years of Age. JAMA Pediatr 2016; 170:1149-1155. [PMID: 27695851 PMCID: PMC5642293 DOI: 10.1001/jamapediatrics.2016.1891] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Low-income minority children living in urban neighborhoods are at high risk for mental health problems and underachievement. ParentCorps, a family-centered, school-based intervention in prekindergarten, improves parenting and school readiness (ie, self-regulation and preacademic skills) in 2 randomized clinical trials. The longer-term effect on child mental health and academic performance is not known. Objective To examine whether ParentCorps delivered as an enhancement to prekindergarten programs in high-poverty urban schools leads to fewer mental health problems and increased academic performance in the early elementary school years. Design, Setting, and Participants This is a 3-year follow-up study of a cluster randomized clinical trial of ParentCorps in public schools with prekindergarten programs in New York City. Ten elementary schools serving a primarily low-income, black student population were randomized in 2005, and 4 consecutive cohorts of prekindergarten students were enrolled from September 12, 2005, through December 31, 2008. We report follow-up for the 3 cohorts enrolled after the initial year of implementation. Data analysis was performed from September 1, 2014, to December 31, 2015. Interventions ParentCorps included professional development for prekindergarten and kindergarten teachers and a program for parents and prekindergarten students (13 two-hour group sessions delivered after school by teachers and mental health professionals). Main Outcomes and Measures Annual teacher ratings of mental health problems and academic performance and standardized tests of academic achievement in kindergarten and second grade by testers masked to the intervention or control group randomization. Results A total of 1050 children (4 years old; 518 boys [49.3%] and 532 girls [50.7%]) in 99 prekindergarten classrooms participated in the trial (88.1% of the prekindergarten population), with 792 students enrolled from 2006 to 2008. Most families in the follow-up study (421 [69.6%]) were low income; 680 (85.9%) identified as non-Latino black, 78 (9.8%) as Latino, and 34 (4.3%) as other. Relative to their peers in prekindergarten programs, children in ParentCorps-enhanced prekindergarten programs had lower levels of mental health problems (Cohen d = 0.44; 95% CI, 0.08-0.81) and higher teacher-rated academic performance (Cohen d = 0.21; 95% CI, 0.02-0.39) in second grade. Conclusions and Relevance Intervention in prekindergarten led to better mental health and academic performance 3 years later. Family-centered early intervention has the potential to prevent problems and reduce disparities for low-income minority children. Trial Registration clinicaltrials.gov Identifier: NCT01670227.
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Affiliation(s)
- Laurie Miller Brotman
- Center for Early Childhood Health and Development, Department of Population Health, New York University Langone Medical Center, New York
| | - Spring Dawson-McClure
- Center for Early Childhood Health and Development, Department of Population Health, New York University Langone Medical Center, New York
| | - Dimitra Kamboukos
- Center for Early Childhood Health and Development, Department of Population Health, New York University Langone Medical Center, New York
| | - Keng-Yen Huang
- Center for Early Childhood Health and Development, Department of Population Health, New York University Langone Medical Center, New York
| | - Esther J Calzada
- Center for Early Childhood Health and Development, Department of Population Health, New York University Langone Medical Center, New York2now with the School of Social Work, University of Texas at Austin
| | - Keith Goldfeld
- Center for Early Childhood Health and Development, Department of Population Health, New York University Langone Medical Center, New York
| | - Eva Petkova
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, New York
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McDonald RD, Tofighi B, Laska E, Goldfeld K, Bonilla W, Flannery M, Santana-Correa N, Johnson CW, Leibowitz N, Rotrosen J, Gourevitch MN, Lee JD. Corrigendum to "Extended-release naltrexone opioid treatment at jail reentry (XOR)" [Contemp. Clin. Trials 49 (2016) 57-64]. Contemp Clin Trials 2016; 51:96. [PMID: 27743800 DOI: 10.1016/j.cct.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ryan D McDonald
- Department of Population Health, New York University School of Medicine, United States
| | - Babak Tofighi
- Department of Population Health, New York University School of Medicine, United States
| | - Eugene Laska
- Department of Psychiatry, New York University, United States
| | - Keith Goldfeld
- Department of Population Health, New York University School of Medicine, United States
| | - Wanda Bonilla
- Department of Population Health, New York University School of Medicine, United States
| | - Mara Flannery
- Department of Population Health, New York University School of Medicine, United States
| | - Nadina Santana-Correa
- Department of Population Health, New York University School of Medicine, United States
| | - Christopher W Johnson
- New York City Health + Hospital Corporation, Correctional Health Services, United States
| | - Neil Leibowitz
- New York City Health + Hospital Corporation, Correctional Health Services, United States
| | - John Rotrosen
- Department of Psychiatry, New York University, United States
| | - Marc N Gourevitch
- Department of Population Health, New York University School of Medicine, United States
| | - Joshua D Lee
- Department of Population Health, New York University School of Medicine, United States; Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, United States.
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20
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McDonald RD, Tofighi B, Laska E, Goldfeld K, Bonilla W, Flannery M, Santana-Correa N, Johnson CW, Leibowitz N, Rotrosen J, Gourevitch MN, Lee JD. Extended-release naltrexone opioid treatment at jail reentry (XOR). Contemp Clin Trials 2016; 49:57-64. [PMID: 27178765 PMCID: PMC5455014 DOI: 10.1016/j.cct.2016.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Extended-release naltrexone (XR-NTX) is an injectable monthly sustained-release mu opioid receptor antagonist, which blocks the typical effects of heroin and other opioid agonists. Use of XR-NTX among opioid dependent persons leaving jails and prisons is increasing despite scant high-quality evidence regarding XR-NTX's effectiveness at re-entry. METHODS This 24-week, open-label randomized controlled trial examines the effectiveness of XR-NTX as opioid relapse prevention at release from jail (N=85) compared to enhanced treatment as usual (ETAU, N=85). A third, non-randomized, quasi-experimental naturalistic arm of participants who have newly initiated a jail-to-community methadone treatment program (MTP, N=85) allows for comparisons to a methadone standard-of-care. RESULTS We describe the rationale, design, and primary and secondary outcomes of the study. The primary outcome is an opioid relapse event; the primary contrast is a time-to-relapse comparison of XR-NTX and ETAU over a 24-week treatment phase. Secondary outcomes are rates of: (a) post-release opioid treatment participation, (b) opioid, alcohol, and cocaine use, (c) injection drug use and HIV sexual risk behaviors, (d) overdose (fatal and non-fatal) and all-cause mortality, and, (e) re-incarceration. CONCLUSIONS XR-NTX is a potentially important, effective treatment and relapse prevention option for a large US population of persons with opioid use disorders leaving jails. This study will estimate XR-NTX's effectiveness relative to existing standards of care, including counseling-only treatment-as-usual and methadone maintenance.
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Affiliation(s)
- Ryan D McDonald
- Department of Population Health, New York University School of Medicine, United States
| | - Babak Tofighi
- Department of Population Health, New York University School of Medicine, United States
| | - Eugene Laska
- Department of Psychiatry, New York University, United States
| | - Keith Goldfeld
- Department of Population Health, New York University School of Medicine, United States
| | - Wanda Bonilla
- Department of Population Health, New York University School of Medicine, United States
| | - Mara Flannery
- Department of Population Health, New York University School of Medicine, United States
| | - Nadina Santana-Correa
- Department of Population Health, New York University School of Medicine, United States
| | - Christopher W Johnson
- New York City Health+Hospital Corporation, Correctional Health Services, United States
| | - Neil Leibowitz
- New York City Health+Hospital Corporation, Correctional Health Services, United States
| | - John Rotrosen
- Department of Psychiatry, New York University, United States
| | - Marc N Gourevitch
- Department of Population Health, New York University School of Medicine, United States
| | - Joshua D Lee
- Department of Population Health, New York University School of Medicine, United States; Division of General Internal Medicine and Clinical Innovation, New York University School of Medicine, United States.
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21
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Hajizadeh N, Goldfeld K. Burden of Transitions After Invasive Mechanical Ventilation for U.S. Individuals with Severe Chronic Obstructive Pulmonary Disease: Opportunity to Prepare for Preference-Congruent End-of-Life Care? J Am Geriatr Soc 2016; 64:434-5. [PMID: 26889846 DOI: 10.1111/jgs.13967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Negin Hajizadeh
- Department of Medicine, Hofstra North Shore LIJ School of Medicine, Manhasset, New York
| | - Keith Goldfeld
- Department of Population Health, School of Medicine, New York University, New York, New York
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22
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Ogedegbe G, Shah NR, Phillips C, Goldfeld K, Roy J, Guo Y, Gyamfi J, Torgersen C, Capponi L, Bangalore S. Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitor-Based Treatment on Cardiovascular Outcomes in Hypertensive Blacks Versus Whites. J Am Coll Cardiol 2015; 66:1224-1233. [PMID: 26361152 DOI: 10.1016/j.jacc.2015.07.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/04/2015] [Accepted: 07/06/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Clinical trial evidence suggests poorer outcomes in blacks compared with whites when treated with an angiotensin-converting enzyme (ACE) inhibitor-based regimen, but this has not been evaluated in clinical practice. OBJECTIVES This study evaluated the comparative effectiveness of an ACE inhibitor-based regimen on a composite outcome of all-cause mortality, stroke, and acute myocardial infarction (AMI) in hypertensive blacks compared with whites. METHODS We conducted a retrospective cohort study of 434,646 patients in a municipal health care system. Four exposure groups (Black-ACE, Black-NoACE, White-ACE, White-NoACE) were created based on race and treatment exposure (ACE or NoACE). Risk of the composite outcome and its components was compared across treatment groups and race using weighted Cox proportional hazard models. RESULTS Our analysis included 59,316 new users of ACE inhibitors, 47% of whom were black. Baseline characteristics were comparable for all groups after inverse probability weighting adjustment. For the composite outcome, the race treatment interaction was significant (p = 0.04); ACE use in blacks was associated with poorer cardiovascular outcomes (ACE vs. NoACE: 8.69% vs. 7.74%; p = 0.05) but not in whites (6.40% vs. 6.74%; p = 0.37). Similarly, the Black-ACE group had higher rates of AMI (0.46% vs. 0.26%; p = 0.04), stroke (2.43% vs. 1.93%; p = 0.05), and congestive heart failure (3.75% vs. 2.25%; p < 0.0001) than the Black-NoACE group. However, the Black-ACE group was no more likely to develop adverse effects than the White-ACE group. CONCLUSIONS ACE inhibitor-based therapy was associated with poorer cardiovascular outcomes in hypertensive blacks but not in whites. These findings confirm clinical trial evidence that hypertensive blacks have poorer outcomes than whites when treated with an ACE inhibitor-based regimen.
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Affiliation(s)
- Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York.
| | - Nirav R Shah
- Kaiser Permanente Southern California, Pasadena, California
| | | | - Keith Goldfeld
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Jason Roy
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yu Guo
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Joyce Gyamfi
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Christopher Torgersen
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine, New York, New York
| | - Louis Capponi
- New York City Health and Hospitals Corporation, New York, New York; Division of General Internal Medicine, New York University School of Medicine, New York, New York
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
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Blecker S, Shine D, Park N, Goldfeld K, Scott Braithwaite R, Radford MJ, Gourevitch MN. Association of weekend continuity of care with hospital length of stay. Int J Qual Health Care 2014; 26:530-7. [PMID: 24994844 DOI: 10.1093/intqhc/mzu065] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the association of physician continuity of care with length of stay, likelihood of weekend discharge, in-hospital mortality and 30-day readmission. DESIGN A cohort study of hospitalized medical patients. The primary exposure was the weekend usual provider continuity (UPC) over the initial weekend of care. This metric was adapted from an outpatient continuity of care index. Regression models were developed to determine the association between UPC and outcomes. SETTING An academic medical center. MAIN OUTCOME MEASURE Length of stay which was calculated as the number of days from the first Saturday of the hospitalization to the day of discharge. RESULTS Of the 3391 patients included in this study, the prevalence of low, moderate and high UPC for the initial weekend of hospitalization was 58.7, 22.3 and 19.1%, respectively. When compared with low continuity of care, both moderate and high continuity of care were associated with reduced length of stay, with adjusted rate ratios of 0.92 (95% CI 0.86-1.00) and 0.64 (95% CI 0.53-0.76), respectively. High continuity of care was associated with likelihood of weekend discharge (adjusted odds ratio 2.84, 95% CI 2.11-3.83) but was not significantly associated with mortality (adjusted odds ratio 0.72, 95% CI 0.29-1.80) or readmission (adjusted odds ratio 0.88, 95% CI 0.68-1.14) when compared with low continuity of care. CONCLUSIONS Increased weekend continuity of care is associated with reduced length of stay. Improvement in weekend cross-coverage and patient handoffs may be useful to improve clinical outcomes.
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Affiliation(s)
- Saul Blecker
- Department of Population Health, New York University School of Medicine, New York, NY, USA Department of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Daniel Shine
- Department of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Naeun Park
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Keith Goldfeld
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York, NY, USA Department of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Martha J Radford
- Department of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Marc N Gourevitch
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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24
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Blecker S, Ladapo J, Doran K, Goldfeld K, Katz S. Abstract 204: Emergency Department Visits for Heart Failure and Subsequent Hospitalization or Observation Unit Admission. Circ Cardiovasc Qual Outcomes 2014. [DOI: 10.1161/circoutcomes.7.suppl_1.204] [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
Background:
Although the majority of hospitalizations for heart failure (HF) originate in the emergency department (ED), many of these patients might be adequately treated and released in the ED or managed for a short period in an observation unit. Both ED and observation management have been shown to reduce costs and avoid the penalties related to rehospitalization. The purpose of this study was to examine trends in ED visits for HF and disposition following these visits. Because of increasing policy pressure to reduce rehospitalization for HF, we hypothesized that the number of HF patients hospitalized by ED providers decreased over time with a concurrent increase in admissions to the observation unit. We further hypothesized that the overall number of ED visits for HF decreased as a result of improved therapy for HF the last two decades.
Methods:
We used the National Hospital Ambulatory Medical Care Survey (NHAMCS) to estimate rates and characteristics of ED visits for HF between 2002 and 2010. The primary outcome was the discharge disposition from the ED. Regression models were fit to estimate trends and predictors of hospitalization and admission to an observation unit.
Results:
The number of ED visits for HF remained stable over the period, from 914,739 in 2002 to 848,634 in 2010 (annual change -0.7%; 95% CI -3.7% - +2.5%). Of these visits, 74.2% led to hospitalization while 3.1% led to observation unit admission (Figure). The likelihood of hospitalization did not change during the period (adjusted prevalence ratio (aPR) 1.00; 95% CI 0.99-1.01 for each additional year) while admission to observation increased annually (aPR 1.11; 95% CI 1.00-1.23). We observed significant regional differences: as compared to other regions, patients in the Northeast were more likely to be hospitalized (aPR 1.15; 95% CI 1.07-1.22) but less likely to be admitted to an observation unit (aPR 0.43; 95% CI 0.19-1.02).
Conclusions:
The number of ED visits for HF has remained stable in the last decade. Although observation unit admissions increased during this period, they constituted a relatively small number of dispositions and did not appear to attenuate the substantial number of ED visits that resulted in hospitalization. Opportunities may exist to reduce hospitalizations by increasing short term management of HF in the observation unit.
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Hajizadeh N, Goldfeld K, Crothers K. What happens to patients with COPD with long-term oxygen treatment who receive mechanical ventilation for COPD exacerbation? A 1-year retrospective follow-up study. Thorax 2014; 70:294-6. [PMID: 24826845 PMCID: PMC4345793 DOI: 10.1136/thoraxjnl-2014-205248] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We performed a retrospective cohort study of patients with chronic obstructive lung disease (COPD) on long-term oxygen treatment (LTOT) who received invasive mechanical ventilation for COPD exacerbation. Of the 4791 patients, 23% died in the hospital, and 45% died in the subsequent 12 months. 67% of patients were readmitted at least once in the subsequent 12 months, and 26.8% were discharged to a nursing home or skilled nursing facility within 30 days. We conclude that these patients have high mortality rates, both in-hospital and in the 12 months postdischarge. If patients survive, many will be readmitted to the hospital and discharged to nursing home. These potential outcomes may support informed critical care decision making and more preference congruent care.
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Affiliation(s)
- Negin Hajizadeh
- Hofstra North Shore LIJ School of Medicine and North Shore LIJ Health System, Department of Medicine, Manhasset, New York, USA
| | - Keith Goldfeld
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Kristina Crothers
- Division of Pulmonary and Critical Care, University of Washington School of Medicine, Seattle, Washington, USA
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Blecker S, Goldfeld K, Park N, Shine D, Austrian JS, Braithwaite RS, Radford MJ, Gourevitch MN. Electronic health record use, intensity of hospital care, and patient outcomes. Am J Med 2014; 127:216-21. [PMID: 24333204 PMCID: PMC3943995 DOI: 10.1016/j.amjmed.2013.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 10/16/2013] [Revised: 11/06/2013] [Accepted: 11/18/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes. METHODS We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed "electronic health record interactions." Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates. RESULTS Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25). CONCLUSIONS Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity.
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Affiliation(s)
- Saul Blecker
- Department of Population Health, New York University School of Medicine, New York; Department of Medicine, New York University Langone Medical Center, New York.
| | - Keith Goldfeld
- Department of Population Health, New York University School of Medicine, New York
| | - Naeun Park
- Department of Population Health, New York University School of Medicine, New York
| | - Daniel Shine
- Department of Medicine, New York University Langone Medical Center, New York
| | - Jonathan S Austrian
- Department of Medicine, New York University Langone Medical Center, New York
| | - R Scott Braithwaite
- Department of Population Health, New York University School of Medicine, New York; Department of Medicine, New York University Langone Medical Center, New York
| | - Martha J Radford
- Department of Medicine, New York University Langone Medical Center, New York
| | - Marc N Gourevitch
- Department of Population Health, New York University School of Medicine, New York
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