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154. Disparities in cardiovascular risk factors by race/ethnicity among adult survivors of childhood cancer: A report from the Childhood Cancer Survivorship Study (CCSS).

Author

Noyd, David H, primary, Yasui, Yutaka, additional, Li, Nan, additional, Chow, Eric Jessen, additional, Bhatia, Smita, additional, Landstrom, Andrew, additional, Gilchrist, Susan, additional, Tonorezos, Emily S., additional, Zullig, Leah L., additional, Casillas, Jacqueline N., additional, Berkman, Amy Madelon, additional, Ness, Kirsten K., additional, Mulrooney, Daniel A., additional, Leisenring, Wendy M., additional, Howell, Carrie R., additional, Shoag, Jamie Michelle, additional, Kirchhoff, Anne C., additional, Howell, Rebecca M., additional, Armstrong, Gregory T., additional, and Oeffinger, Kevin C., additional

Published
2021
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156. Implementation of Social Needs Screening in Primary Care: A Qualitative Study Using the Health Equity Implementation Framework

Author

Drake, Connor, primary, Batchelder, Heather, additional, Lian, Tyler, additional, Cannady, Meagan, additional, Weinberger, Morris, additional, Eisenson, Howard, additional, Esmaili, Emily, additional, Lewinski, Allison, additional, Zullig, Leah L., additional, Haley, Amber, additional, Edelman, David, additional, and Shea, Christopher M., additional

Published
2021
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160. Subgroups of High-Risk Veterans Affairs Patients Based on Social Determinants of Health Predict Risk of Future Hospitalization

Author

Blalock, Dan V., primary, Maciejewski, Matthew L., additional, Zulman, Donna M., additional, Smith, Valerie A., additional, Grubber, Janet, additional, Rosland, Ann-Marie, additional, Weidenbacher, Hollis J., additional, Greene, Liberty, additional, Zullig, Leah L., additional, Whitson, Heather E., additional, Hastings, Susan N., additional, and Hung, Anna, additional

Published
2021
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163. Organizational Characteristics of Hospitals Meeting STRIDE Program Adoption Benchmarks to Support Mobility for Hospitalized Persons

Author

Zullig, Leah L., Drake, Connor, Webster, Amy, Tucker, Matthew, Choate, Ashley, Stechuchak, Karen M., Coffman, Cynthia J., Kappler, Caitlin B., Meyer, Cassie, Van Houtven, Courtney H., Allen, Kelli D., Hughes, Jaime M., Sperber, Nina, and Hastings, Susan Nicole

Abstract

There are few validated contextual measures predicting adoption of evidence-based programs. Variation in context at clinical sites can hamper dissemination. We examined organizational characteristics of Veterans Affairs hospitals implementing STRIDE, a hospital walking program, and characteristics’ influences on program adoption. Using a parallel mixed-method design, we describe context and organizational characteristics by program adoption. Organizational characteristics included: organizational resilience, implementation climate, organizational readiness to implement change, highest complexity sites versus others, material support, adjusted length of stay (LOS) above versus below national median, and improvement experience. We collected intake forms at hospital launch and qualitative interviews with staff members at 4 hospitals that met the initial adoption benchmark, defined as completing supervised walks with 5+ unique hospitalized Veterans during months 5 to 6 after launch with low touch implementation support. We identified that 31% (n = 11 of 35) of hospitals met adoption benchmarks. Seven percent of highest complexity hospitals adopted compared to 48% with lower complexity. Forty-three percent that received resources adopted compared to 29% without resources. Thirty-six percent of hospitals with above-median LOS adopted compared to 23% with below-median. Thirty-five percent with at least some implementation experience adopted compared to 0% with very little to no experience. Adopters reported higher organizational resilience than non-adopters (mean = 23.5 [SD = 2.6] vs 22.7 [SD = 2.6]). Adopting hospitals reported greater organizational readiness to change than those that did not (mean = 4.2 [SD = 0.5] vs 3.8 [SD = 0.6]). Qualitatively, all sites reported that staff were committed to implementing STRIDE. Participants reported additional barriers to adoption including challenges with staffing and delays associated with hiring staff. Adopters reported that having adequate staff facilitated implementation. Implementation climate did not have an association with meeting STRIDE program adoption benchmarks in this study. Contextual factors which may be simple to assess, such as resource availability, may influence adoption of new programs without intensive implementation support.

Published
2024
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165. Interventions to Improve Adherence to Cardiovascular Medication: What About Gender Differences? A Systematic Literature Review

Author

Vervloet,Marcia, Korevaar,Joke C, Leemrijse,Chantal J, Paget,John, Zullig,Leah L, van Dijk,Liset, Vervloet,Marcia, Korevaar,Joke C, Leemrijse,Chantal J, Paget,John, Zullig,Leah L, and van Dijk,Liset

Abstract

Marcia Vervloet,1 Joke C Korevaar,1 Chantal J Leemrijse,1 John Paget,1 Leah L Zullig,2,3 Liset van Dijk1,4 1Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; 2Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA; 3Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina, USA; 4University of Groningen, Groningen Research Institute of Pharmacy, Department of Pharmacotherapy, -Epidemiology and -Economics, Groningen, the NetherlandsCorrespondence: Marcia VervloetNivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht 3500 BN, the NetherlandsTel +31 30 2729713Email M.Vervloet@nivel.nlBackground: Compared to men, women have lower treatment rates for cardiovascular disease (CVD), are at higher risk for medication non-adherence and have different reasons for being non-adherent. The aim of this study was to synthesize and evaluate gender-specific adherence-promoting interventions for cardiovascular medication and gender-specific effects of gender-neutral interventions.Methods: A systematic literature search was performed in PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from January 2007 to October 2019. Intervention studies (with control group) aimed at improving cardiovascular medication adherence with minimally 14 weeks follow-up were included. Two reviewers independently screened titles and abstracts. Full text was obtained for selected abstracts and screened for final inclusion. Data extraction included gender-specific targeting or analysis.Results: The search identified 6502 citations. After screening title and abstract, full text was obtained from 127 potentially eligible articles. Ultimately, 11 articles were included that analyzed gender differences in gender-neutral interventions. Two reported a gender-specific intervention effect. Using an electronic remi

Published
2020

166. Does Antiretroviral Therapy Packaging Matter? Perceptions and Preferences of Antiretroviral Therapy Packaging for People Living with HIV in Northern Tanzania

Author

Muiruri,Charles, Jazowski,Shelley A., Semvua,Seleman K., Karia,Francis P., Knettel,Brandon A., Zullig,Leah L, Ramadhani,Habib O, Mmbaga,Blandina T, Bartlett,John A, Bosworth,Hayden B, Muiruri,Charles, Jazowski,Shelley A., Semvua,Seleman K., Karia,Francis P., Knettel,Brandon A., Zullig,Leah L, Ramadhani,Habib O, Mmbaga,Blandina T, Bartlett,John A, and Bosworth,Hayden B

Abstract

Charles Muiruri,1– 3 Shelley A Jazowski,1,4 Seleman K Semvua,3 Francis P Karia,3 Brandon A Knettel,2 Leah L Zullig,1,5 Habib O Ramadhani,3,6 Blandina T Mmbaga,2,3 John A Bartlett,2,3 Hayden B Bosworth1,5,7– 9 1Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; 2Duke Global Health Institute, Duke University, Durham, NC, USA; 3Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 4Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 5Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA; 6Division of Epidemiology & Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA; 7Duke Heart Center Nursing Research Program, School of Nursing, Duke University, Durham, NC, USA; 8Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; 9Division of General Internal Medicine, Duke University, Durham, NC, USACorrespondence: Charles MuiruriDepartment of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Suite 210, Durham, NC 27701, USATel +1 9196603212Email charles.muiruri@duke.eduIntroduction: Despite improvements in treatment (eg, reduction in pill intake), antiretroviral therapy (ART) is dispensed in socially inefficient and uneconomical packaging. To make pills less conspicuous and decrease the risk of being stigmatized, people living with HIV (PLWH) often engage in self-repackaging – the practice of transferring ART from original packaging to alternative containers. This behavior has been associated with ART nonadherence and failure to achieve viral load suppression. While much of the literature on ART packaging has centered around medication adherence, patients stated preferences for ART packaging and packaging a

Published
2020

172. Patient-Reported Social and Behavioral Determinants of Health and Estimated Risk of Hospitalization in High-Risk Veterans Affairs Patients

Author

Zulman, Donna M., primary, Maciejewski, Matthew L., additional, Grubber, Janet M., additional, Weidenbacher, Hollis J., additional, Blalock, Dan V., additional, Zullig, Leah L., additional, Greene, Liberty, additional, Whitson, Heather E., additional, Hastings, Susan N., additional, and Smith, Valerie A., additional

Published
2020
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174. Improvement Science and Implementation Science in Cancer Care: Identifying Areas of Synergy and Opportunities for Further Integration

Author

Check, Devon K., primary, Zullig, Leah L., additional, Davis, Melinda M., additional, Davies, Louise, additional, Chambers, David, additional, Fleisher, Linda, additional, Kaplan, Samantha J., additional, Proctor, Enola, additional, Ramanadhan, Shoba, additional, Schroeck, Florian R., additional, Stover, Angela M., additional, and Koczwara, Bogda, additional

Published
2020
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179. Does Antiretroviral Therapy Packaging Matter? Perceptions and Preferences of Antiretroviral Therapy Packaging for People Living with HIV in Northern Tanzania

Author

Muiruri, Charles, primary, Jazowski, Shelley A., additional, Semvua, Seleman K., additional, Karia, Francis P., additional, Knettel, Brandon A., additional, Zullig, Leah L, additional, Ramadhani, Habib O, additional, Mmbaga, Blandina T, additional, Bartlett, John A, additional, and Bosworth, Hayden B, additional

Published
2020
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182. Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case–control analysis

Author

Zullig,Leah L, Smith,Valerie A, Lindquist,Jennifer H, Williams,Christina D, Weinberger,Morris, Provenzale,Dawn, Jackson,George L, Kelley,Michael J, Danus,Susanne, and Bosworth,Hayden B

Subjects
Cancer Management and Research, humanities
Abstract

Leah L Zullig,1,2 Valerie A Smith,1,2 Jennifer H Lindquist,1 Christina D Williams,3,4 Morris Weinberger,1,5 Dawn Provenzale,1,4 George L Jackson,1,2 Michael J Kelley,6–8 Susanne Danus,1 Hayden B Bosworth1,2,91Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; 2Department of Population Health Sciences, Duke University, Durham, NC, USA; 3Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA; 4Cooperative Studies Program Epidemiology Center, Durham, NC, USA; 5Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA; 6Office of Specialty Care Services, Department of Veterans Affairs, Washington, DC, USA; 7Hematology-Oncology Service, Durham Veterans Affairs Medical Center, Durham, NC, USA; 8Department of Medicine, Duke University, Durham, NC, USA; 9Departments of Psychiatry and School of Nursing, Duke University, Durham, NC, USAPurpose: The growing number of colorectal cancer (CRC) survivors often have multiple chronic conditions. Comparing nonmetastatic CRC survivors and matched noncancer controls, our objectives were to determine the odds of CRC survivors being diagnosed with cardiovascular disease (CVD)-related chronic conditions and their likelihood of control during the year after CRC diagnosis.Patients and methods: We retrospectively identified patients diagnosed with nonmetastatic CRC in the Veterans Affairs health care system from fiscal years 2009 to 2012 and matched each with up to 3 noncancer control patients. We used logistic regression to assess differences in the likelihood of being diagnosed with CVD-related chronic conditions and control between nonmetastatic CRC survivors and noncancer controls.Results: We identified 9,758 nonmetastatic CRC patients and matched them to 29,066 noncancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched noncancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR=1.57, 95% CI=1.49–1.64) and 7% higher odds of controlled blood pressure (OR=1.07, 95% CI 1.02, 1.13) in the subsequent year. Compared to matched noncancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR=0.50, 95% CI=0.48–0.52) and lower odds of low-density lipoprotein (LDL) control (OR 0.88, 95% CI 0.81–0.94). There were no significant differences between groups for diabetes diagnoses or control.Conclusion: Compared to noncancer controls, nonmetastatic CRC survivors have 1) greater likelihood of being diagnosed with hypertension and worse blood pressure control in the year following diagnosis; 2) lower likelihood of being diagnosed with hyperlipidemia or LDL control; and 3) comparable diabetes diagnoses and control. There may be a need for hypertension control interventions targeting cancer survivors.Keywords: Veterans Affairs, colorectal neoplasms, cancer survivors, cardiovascular disease, comorbidity, chronic disease management

Published
2019

183. Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework.

Author

Drake, Connor, Batchelder, Heather, Lian, Tyler, Cannady, Meagan, Weinberger, Morris, Eisenson, Howard, Esmaili, Emily, Lewinski, Allison, Zullig, Leah L., Haley, Amber, Edelman, David, and Shea, Christopher M.

Subjects
HEALTH equity, PRIMARY care, FRAMES (Social sciences), MOTIVATIONAL interviewing, MEDICAL personnel, CRITICALLY ill
Abstract

Background: Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients' health outcomes. To our knowledge, this is the first study to apply an implementation science framework to identify implementation factors and best practices for social needs screening and response.Methods: Guided by the Health Equity Implementation Framework (HEIF), we collected qualitative data from clinicians and patients to evaluate barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE), a standardized social needs screening and response protocol, in a federally qualified health center. Eligible patients who received the PRAPARE as a standard of care were invited to participate in semi-structured interviews. We also obtained front-line clinician perspectives in a semi-structured focus group. HEIF domains informed a directed content analysis.Results: Patients and clinicians (i.e., case managers) reported implementation barriers and facilitators across multiple domains (e.g., clinical encounters, patient and provider factors, inner context, outer context, and societal influence). Implementation barriers included structural and policy level determinants related to resource availability, discrimination, and administrative burden. Facilitators included evidence-based clinical techniques for shared decision making (e.g., motivational interviewing), team-based staffing models, and beliefs related to alignment of the PRAPARE with patient-centered care. We found high levels of patient acceptability and opportunities for adaptation to increase equitable adoption and reach.Conclusion: Our results provide practical insight into the implementation of the PRAPARE or similar social needs screening and response protocols in primary care at the individual encounter, organizational, community, and societal levels. Future research should focus on developing discrete implementation strategies to promote social needs screening and response, and associated multisector care coordination to improve health outcomes and equity for vulnerable and marginalized patient populations. [ABSTRACT FROM AUTHOR]

Published
2021
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184. Accelerating Implementation of Virtual Care in an Integrated Health Care System: Future Research and Operations Priorities.

Author

Lewinski, Allison A., Sullivan, Caitlin, Allen, Kelli D., Crowley, Matthew J., Gierisch, Jennifer M., Goldstein, Karen M., Gray, Kaileigh, Hastings, Susan N., Jackson, George L., McCant, Felicia, Shapiro, Abigail, Tucker, Matthew, Turvey, Carolyn, Zullig, Leah L., and Bosworth, Hayden B.

Subjects
INTEGRATED health care delivery, TELEMEDICINE, OPERATIONS research, PHYSICIANS, MEDICAL personnel, INTEGRATIVE medicine
Abstract

Background: Virtual care is critical to Veterans Health Administration (VHA) efforts to expand veterans' access to care. Health care policies such as the Veterans Access, Choice, and Accountability (CHOICE) Act and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act impact how the VHA provides care. Research on ways to refine virtual care delivery models to meet the needs of veterans, clinicians, and VHA stakeholders is needed. Objective: Given the importance of virtual approaches for increasing access to high-quality VHA care, in December 2019, we convened a Think Tank, Accelerating Implementation of Virtual Care in VHA Practice, to consider challenges to virtual care research and practice across the VHA, discuss novel approaches to using and evaluating virtual care, assess perspectives on virtual care, and develop priorities to enhance virtual care in the VHA. Methods: We used a participatory approach to develop potential priorities for virtual care research and activities at the VHA. We refined these priorities through force-ranked prioritization and group discussion, and developed solutions for selected priorities. Results: Think Tank attendees (n = 18) consisted of VHA stakeholders, including operations partners (e.g., Office of Rural Health, Office of Nursing Services, Health Services Research and Development), clinicians (e.g., physicians, nurses, psychologists, physician assistants), and health services researchers. We identified an initial list of fifteen potential priorities and narrowed these down to four. The four priorities were (1) scaling evidence-based practices, (2) centralizing virtual care, (3) creating high-value care within the VHA with virtual care, and (4) identifying appropriate patients for virtual care. Conclusion: Our Think Tank took an important step in setting a partnered research agenda to optimize the use of virtual care within the VHA. We brought together research and operations stakeholders and identified possibilities, partnerships, and potential solutions for virtual care. [ABSTRACT FROM AUTHOR]

Published
2021
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185. The INSPIRE Population Survey: development, dissemination and respondent characteristics.

Author

Siqeca, Flaka, Obas, Katrina, Yip, Olivia, Stenz, Samuel, Vounatsou, Penelope, Briel, Matthias, Schwenkglenks, Matthias, Quinto, Carlos, Blozik, Eva, Zeller, Andreas, Zullig, Leah L., De Geest, Sabina, and Deschodt, Mieke

Subjects
DEMOGRAPHIC surveys, OLDER people, MARKETING channels, TARGET marketing, MARKETING strategy
Abstract

Background: Most older adults prefer to continue living at home despite increasing care needs and demand for services. To aid in maintaining independence, integrated care models for community-dwelling older people are promoted as the most cost-effective approach. The implementation of such care models is challenging and often the end-users are not involved or their needs are not considered. We conducted a population survey in order to understand the needs and preferences of home-dwelling older adults living in Canton Basel-Landschaft, Switzerland. The aims of this paper are to chronicle the development of the INSPIRE Population Survey, outline its variables and measurements, describe the marketing strategy utilized for survey dissemination and report on the response rate and respondent characteristics.Methods: The INSPIRE Population Survey, conducted between March and August 2019, is a cross-sectional survey of older adults aged 75 and older living at home in Canton Basel-Landschaft. The questionnaire was developed by expert input and stakeholder involvement. Its readability and acceptability were pilot-tested with older people. To ensure the likelihood of a high and representative response rate, a meticulous step-by-step marketing strategy was developed prior to the dissemination of the questionnaire.Results: The overall response rate was 30.7% (n = 8,846), with variations between 20.6 and 34.5% across the different care regions in the canton. A generally higher response rate was found in the care regions with a higher density and which bordered the urban city of Basel. We received support from local stakeholders, policy makers and media through using a broad combination of marketing channels and targeting our community partners who have a strong relationship with our target audience.Conclusions: Although recruiting older adults in research is challenging, our study shows that a high response rate can be achieved by developing the survey through expert input and by involving all important stakeholders, including older adults, throughout the entire process. [ABSTRACT FROM AUTHOR]

Published
2021
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187. The new landscape of medication adherence improvement: where population health science meets precision medicine

Author

Zullig,Leah L, Blalock,Dan, Dougherty,Samantha, Henderson,Rochelle, Ha,Carolyn C, Oakes,Megan, and Bosworth,Hayden B

Subjects
Patient Preference and Adherence
Abstract

Leah L Zullig,1,2 Dan V Blalock,1,3 Samantha Dougherty,4 Rochelle Henderson,5 Carolyn C Ha,4 Megan M Oakes,2 Hayden B Bosworth1–3,6 1Durham Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC, USA; 2Department of Population Health Sciences, Duke University, Durham, NC, USA; 3Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA; 4Pharmaceutical Research and Manufacturers of America, Washington, DC, USA; 5Express Scripts Holding Company, St Louis, MO, USA; 6School of Nursing, Duke University, Durham, NC, USA Abstract: Despite the known health and economic benefits of medications, nonadherence remains a significant, yet entirely preventable public health burden. Over decades, there have been numerous research studies evaluating health interventions and policy efforts aimed at improving adherence, yet no universal or consistently high impact solutions have been identified. At present, new challenges and opportunities in policy and the movement toward value-based care should foster an environment that appreciates adherence as a mechanism to improve health outcomes and control costs (eg, fewer hospitalizations, reduced health care utilization). Our objective was to provide a commentary on recent changes in the landscape of research and health policy directed toward improving adherence and an actionable agenda to achieve system level savings and improved health by harnessing the benefits of medications. Specifically, we address the complementary perspectives of precision medicine and population health management; integrating data sources to develop innovative measurement of adherence and target adherence interventions; and behavioral economics to determine appropriate incentives. Keywords: adherence, policy, precision medicine, population health

Published
2018

188. Additional file 1: of Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis

Author

Zullig, Leah, Goldstein, Karen, Bosworth, Hayden, Andrews, Sara, Danus, Susanne, Jackson, George, Provenzale, Dawn, Weinberger, Morris, Kelley, Michael, and Voils, Corrine

Subjects
cardiovascular diseases, neoplasms, digestive system diseases
Abstract

Figure S1. Association between CRC and CVD risk factors. This figure depicts individual and shared risk factors for CRC and CVD. (DOCX 266Â kb)

Published
2018
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189. Detecting geriatric needs in older patients with breast cancer through use of a brief geriatric screening tool

Author

Kikuchi, Robin, primary, Broadwater, Gloria, additional, Shelby, Rebecca, additional, Robertson, Jessica, additional, Zullig, Leah L., additional, Maloney, Bailey, additional, Meyer, Claudia, additional, Mungal, Daniel, additional, Marcom, Paul K., additional, Kanesvaran, Ravindran, additional, White, Heidi, additional, and Kimmick, Gretchen, additional

Published
2019
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192. Does antiretroviral therapy packaging matter? Perceptions and preferences of antiretroviral therapy packaging for people living with HIV in Northern Tanzania.

Author

Muiruri, Charles, primary, Jazowski, Shelley A., additional, Semvua, Seleman K., additional, Karia, Francis P., additional, Knettel, Brandon A., additional, Zullig, Leah L., additional, Ramadhani, Habib O, additional, Mmbaga, Blandina T., additional, Bartlett, John A., additional, and Bosworth, Hayden B., additional

Published
2019
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197. Awareness of Cancer Risk Factors and Its Signs and Symptoms in Northern Tanzania: a Cross-Sectional Survey in the General Population and in People Living with HIV

Author

Munishi, Oresto Michael, primary, McCormack, Valerie, additional, Mchome, Bariki, additional, Mangi, Glory, additional, Zullig, Leah L., additional, Bartlett, John, additional, Mapunda, Oscar, additional, Nyindo, Pilli, additional, Namwai, Theresia, additional, Muiruri, Charles, additional, Kimaro, Frank, additional, Karia, Francis, additional, and Mmbaga, Blandina T., additional

Published
2019
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