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Background: Care partners are key members of patients' health care teams, yet little is known about their experiences accessing patient information via electronic portals.Objective: To better understand the characteristics and perceptions of care partners who read patients' electronic visit notes.Patient Involvement: Focus groups with diverse patients from a community health center provided input into survey development.Methods: We contacted patient portal users at 3 geographically distinct sites in the US via email in 2017 for an online survey including open ended questions which we qualitatively analyzed.Results: Respondents chose whether to answer as care partners (N = 874) or patients (N = 28,782). Among care partner respondents, 44% were spouses, 43% children/other family members, and 14% friends/neighbors/other. Both care partners and patients reported that access to electronic notes was very important for promoting positive health behaviors, but care partners' perceptions of importance were consistently more positive than patients' perceptions of engagement behaviors. Open-ended comments included positive benefits such as: help with remembering the plan for care, coordinating care with other doctors, decreasing stress of care giving, improving efficiency of visits, and supporting patients from a geographical distance. They also offered suggestions for improving electronic portal and note experience for care partners such as having a separate log on for care partners; having doctors avoid judgmental language in their notes; and the ability to prompt needed medical care for patients.Discussion: Care partners value electronic access to patients' health information even more than patients. The majority of care partners were family members, whose feedback is important for improving portal design that effectively engages these care team members.Practical Value: Patient care in the time of COVID-19 increasingly requires social distancing which may place additional burden on care partners supporting vulnerable patients. Access to patient notes may promote quality of care by keeping care partners informed, and care partner's input should be used to optimize portal design and electronic access to patient information. [ABSTRACT FROM AUTHOR]

Objective: Chronic disease management can require daily attention, and increased levels of patient activation and engagement. We examined whether patients with diabetes perceive a greater benefit to having electronic access to their doctors' clinic notes compared to patients without diabetes. We hypothesized that easy electronic access to these notes may help patients with self-care by improving education and communication.Methods: Survey of patients with and without diabetes in Massachusetts and Pennsylvania about perceptions of potential benefits and risks of reading their visit notes via an electronic patient information portal. Administrative data were used to identify patients with diabetes; we compared their perceptions to those of patients without diabetes.Results: The majority of patients (both with and without diabetes) perceived a positive impact of using the portal. Patients with diabetes were significantly more likely to believe that having access to and reading their notes would help them take their medication better and take better care of themselves.Conclusions: Patients with chronic diseases such as diabetes might receive an even greater benefit from access to their doctors' notes than the general patient population.Practice Implications: Doctors should encourage their patients with diabetes (or other chronic diseases) to use patient portals. [ABSTRACT FROM AUTHOR]

Objective Demonstrate the feasibility of implementing a collaborative care program for poorly-controlled type 2 diabetes and complex behavioral health disorders in an urban academically-affiliated safety net primary care clinic. Methods This retrospective cohort study evaluates multidisciplinary team care approach to diabetes in a safety net clinic, and included 634 primary care clinic patients with hemoglobin A1c (HbA1c) > 9%. HbA1c, blood pressure, and depression severity were assessed at the initial visit and at the end of treatment, and compared to those of patients who were not referred to the team. Results The 151 patients referred to the program between March 2013 and November 2014 had a higher initial mean HbA1c: 10.6% vs. 9.4%, and were more likely to have depression (p = 0.006), anxiety (p = 0.04), and bipolar disorder (p = 0.03), compared to the 483 patients who were not referred. During the 18-month study period, there was a mean decrease in HbA1c of 0.9 (10.6 to 9.4) among those referred to the team, compared to a mean decrease of 0.2 (9.4 to 9.2) among those not referred. This was a significantly greater percent change in HbA1c (p = 0.008). Conclusion The integration of behavioral healthcare into chronic care management of patients with diabetes is a promising strategy to improve outcomes among the high risk population in safety net settings. [ABSTRACT FROM AUTHOR]

South Gobi province is at the center of Mongolia’s mining boom, where companies began exporting minerals over dirt-track roads in the early 2000s. This paper examines recent controversies surrounding road dust near the Oyu Tolgoi copper–gold mine, the so-called coal road from Tavan Tolgoi mines, and the Chinese border. At the time of the research, local residents, particularly nomadic herders, were concerned that dust produced from unpaved mining roads was coating the pasture, causing illnesses among livestock, and endangering their livelihoods in the region. The presence of dust rendered mining an uncomfortably intimate experience as state and corporate actors negotiated responsibility for infrastructure development. The paper builds on the concept “technologies of distantiation” to reveal the complex ways that dust from unpaved roads creates distances and disconnections between people, livelihoods, and landscapes, representing an enclosure of the pasture. Methods for the paper include interviews, focus groups, and participant observation conducted in South Gobi province and Ulaanbaatar in 2010, 2011, and 2012 as well as follow-up research carried out in spring 2015. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Mammography quality assurance programs have been in place for more than a decade. We studied radiologists' self-reported performance goals for accuracy in screening mammography and compared them to published recommendations.Materials and Methods: A mailed survey of radiologists at mammography registries in seven states within the Breast Cancer Surveillance Consortium (BCSC) assessed radiologists' performance goals for interpreting screening mammograms. Self-reported goals were compared to published American College of Radiology (ACR) recommended desirable ranges for recall rate, false-positive rate, positive predictive value of biopsy recommendation (PPV2), and cancer detection rate. Radiologists' goals for interpretive accuracy within desirable range were evaluated for associations with their demographic characteristics, clinical experience, and receipt of audit reports.Results: The survey response rate was 71% (257 of 364 radiologists). The percentage of radiologists reporting goals within desirable ranges was 79% for recall rate, 22% for false-positive rate, 39% for PPV2, and 61% for cancer detection rate. The range of reported goals was 0%-100% for false-positive rate and PPV2. Primary academic affiliation, receiving more hours of breast imaging continuing medical education, and receiving audit reports at least annually were associated with desirable PPV2 goals. Radiologists reporting desirable cancer detection rate goals were more likely to have interpreted mammograms for 10 or more years, and >1000 mammograms per year.Conclusion: Many radiologists report goals for their accuracy when interpreting screening mammograms that fall outside of published desirable benchmarks, particularly for false-positive rate and PPV2, indicating an opportunity for education. [ABSTRACT FROM AUTHOR]

The growing and continued popularity of light rail transit systems in major United States metropolitan areas is leading to growing research on land use impacts, value generation, and contributions to gentrification. While various studies explore the fiscal and environmental influences of light rail transit development in the Denver Metropolitan Area, only recently have scholars turned their attention to gentrification and social influences. This paper analyzes how one station shapes residents' sense of place, providing more nuanced understandings of the role light rail and transit-oriented development affects perceptions of neighborhood character and place attachment. We argue that gentrification can be measured and understood not only quantitatively, but also by how people feel light rail influences their attachment to place. Residents within half a mile of the Evans Light Rail Station were randomly and anonymously surveyed with a series of demographic questions and asked to provide their experiences, observations, and opinions. With 166 household responses, we examine residents' perceptions of Evans Station and sense of place to investigate relationships between factors such as race, age, income, education, length of residency, and walking distance from the light rail station. Analysis of their responses creates a more nuanced understanding of the ways that light rail contributes to positive, neutral, and negative emotions associated with gentrification ranging from appreciation of increased accessibility, younger residents, increased property values, and new commercial development to complaints about increased density, higher rents, traffic, noise, and loss of community. [ABSTRACT FROM AUTHOR]

• More stimulant-using patients initiated under low-threshold conditions. • Lower short-term retention of stimulant-using patients in low-threshold group. • No significant difference between groups in overall initiation-with-retention. Office-based buprenorphine treatment is effective for opioid use disorder. Scant research has examined programmatic factors impacting successful initiation of treatment. To increase initiation of eligible patients, our buprenorphine program implemented changes to lower treatment thresholds. Most notable among these was elimination of a requirement that patients demonstrate abstinence from stimulants prior to initiating buprenorphine. This observational, retrospective study included patients screened for primary care-based buprenorphine treatment under high- and low-threshold conditions from 2015 to 2017. Background characteristics and treatment data were extracted from the electronic medical record and clinical registry. Chi-squared tests were used to compare proportions of patients initiated within 90 days of screening and retained to 60 days after initiation, under both conditions. Multivariate logistic regression was employed to compare relative odds of buprenorphine initiation after adjustment for several covariates. All analyses were stratified by recent stimulant use. The sample of 168 patients included 96 in the high-threshold group and 72 in the low-threshold group. Among patients with recent stimulant use, low-threshold conditions were associated with a higher proportion of patients initiated (69% versus 35%, p = 0.002) and higher relative odds of initiation (aOR = 7.01, 95% CI = 2.26–21.80) but also with a lower proportion of patients retained (63% versus 100%, p = 0.004). Among patients without recent stimulant use, low-threshold conditions did not change these measures by a statistically significant margin. Lower-threshold policies may increase buprenorphine treatment initiation for patients with co-occurring stimulant use. However, patients using stimulants may require additional supports to remain engaged. [ABSTRACT FROM AUTHOR]

Background: Persons with substance use disorders face major barriers to hepatitis C virus (HCV) treatment. Co-location of addiction and HCV treatment is appealing, yet there are limited data on outcomes using this model. This study evaluated HCV outcomes of patients treated with direct-acting antivirals (DAAs) by primary care providers in two sites of co-located addiction/HCV care.Methods: The study conducted a retrospective chart review for all patients receiving DAA treatment from 2016 to 2018 at 1) a hospital-based primary care clinic with an office-based buprenorphine program, and 2) a primary care clinic within an opioid treatment program (i.e. methadone clinic). The study classified patients into 3 groups according to treatment status: buprenorphine maintenance, methadone maintenance, or neither. Descriptive analyses compared patient demographics, clinical characteristics, adherence to monitoring and treatment, and the primary outcome of sustained virologic response at 12 weeks (SVR12), defined as an undetectable HCV viral load at least 12 weeks after completing treatment.Results: This study included 50 patients who initiated DAA treatment. The majority of patients were unemployed (74.0%), did not smoke tobacco (54.0%), and had psychiatric comorbidities (80.0%). Many also experienced homelessness during treatment (22.0%) and experienced previous incarceration (36.0%). Only a few had recently injected drugs (4.0%). Seven of 7 (100%) patients were treated with buprenorphine, 21 of 24 (87.5%) patients were treated with methadone, and 17 of 19 (89.5%) patients receiving no opioid addiction treatment fully completed HCV DAA treatment. When including patients with missing SVR12 data with the cohort that did not achieve cure, we observe that 44 of 50 patients (88.0%) achieved SVR12. Excluding patients missing SVR12 data, we observed that 44 of 46 patients (95.7%) achieved SVR12.Conclusion: Persons with substance use disorders treated with DAAs in co-located primary care and addiction treatment settings can achieve high rates of cure despite significant comorbidities and barriers. DAA treatment should be expanded to co-located HCV and addiction settings. [ABSTRACT FROM AUTHOR]