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6. Assessing an electronic self-report method for improving quality of ethnicity and race data in the Veterans Health Administration.

Author

Almklov, Erin, Cohen, Alicia J, Russell, Lauren E, Mor, Maria K, Fine, Michael J, Hausmann, Leslie RM, Moy, Ernest, Washington, Donna L, Jones, Kenneth T, Long, Judith A, and Pittman, James

Subjects
Health Services and Systems, Health Sciences, Clinical Research, Good Health and Well Being, electronic screening, Veterans, health equity, racial and ethnic disparities, Health services and systems
Abstract

ObjectiveEvaluate self-reported electronic screening (eScreening) in a VA Transition Care Management Program (TCM) to improve the accuracy and completeness of administrative ethnicity and race data.Materials and methodsWe compared missing, declined, and complete (neither missing nor declined) rates between (1) TCM-eScreening (ethnicity and race entered into electronic tablet directly by patient using eScreening), (2) TCM-EHR (Veteran-completed paper form plus interview, data entered by staff), and (3) Standard-EHR (multiple processes, data entered by staff). The TCM-eScreening (n = 7113) and TCM-EHR groups (n = 7113) included post-9/11 Veterans. Standard-EHR Veterans included all non-TCM Gulf War and post-9/11 Veterans at VA San Diego (n = 92 921).ResultsEthnicity: TCM-eScreening had lower rates of missingness than TCM-EHR and Standard-EHR (3.0% vs 5.3% and 8.6%, respectively, P  .05) or data completeness (89.9% vs 91%, P > .05). Both had better data completeness than Standard-EHR (P

Published
2023

7. Aggression Towards Caregivers in Parkinsons Disease and Related Disorders: A Mixed Methods Study.

Author

Macchi, Zachary, Seshadri, Sandhya, Ayele, Roman, Bock, Meredith, Long, Judith, Coats, Heather, Miyasaki, Janis, Katz, Maya, Santos, Elizabeth, Sillau, Stefan, Lum, Hillary, Kluger, Benzi, and Pantilat, Steven

Subjects
Parkinsons disease, aggression, behavioral disturbances, caregivers, psychosocial issues
Abstract

BACKGROUND: Aggression is one manifestation of behavioral disturbances in neurodegenerative disease with emerging literature suggesting a high prevalence in Parkinsons disease and related disorders (PDRD). OBJECTIVES: Our aim was to describe characteristics, associated factors, and consequences of aggression towards caregivers in PDRD. METHODS: This is a convergent mixed methods study, leveraging data from 296 PDRD patient-caregiver dyads in a clinical trial of palliative care and semi-structured interviews with a subgroup of 14 caregivers who reported aggression. The primary outcome was baseline caregiver-reported aggression. Using multivariate linear regression, baseline dyad characteristics (eg, measures of disease, psychosocial issues, caregiver strain) were examined to identify factors associated with aggression. Thematic analysis of interviews was used to augment these findings. RESULTS: Associated variables included disease duration (r = 0.15, P

Published
2022

9. Development and Dissemination of a Neurology Palliative Care Curriculum: Education in Palliative and End-of-Life Care Neurology.

Author

Kluger, Benzi, Kramer, Neha, Katz, Maya, Galifianakis, Nicholas, Pantilat, Steven, Long, Judith, Vaughan, Christina, Foster, Laura, Creutzfeldt, Claire, Holloway, Robert, Sillau, Stefan, and Hauser, Joshua

Abstract

Despite increasing awareness of the importance of a palliative care approach to meet the needs of persons living with neurologic illness, residency and fellowship programs report meeting this educational need due to a limited pool of neuropalliative care educators and a lack of adequate educational resources. To meet this need, a group of experts in neuropalliative care and palliative medicine leveraged resources from the Education in Palliative and End-of-life Care (EPEC) program and the National Institutes of Nursing Research to create a library of modules addressing topics relevant for neurology trainees, palliative medicine fellows, and clinicians in practice. In this article, we describe the development and dissemination plan of the EPEC Neurology program, initial evidence of efficacy, and opportunities for neurology educators and health services researchers to use these resources.

Published
2022

10. Early Ultrasound Surveillance of Newly-Created Hemodialysis Arteriovenous Fistula

Author

Sidders, Anna, Hudson, Cara, Foley, Claire, Hopkins, Valerie, Laing, Emma, Fitzpatrick-Creamer, Chloe, Thomas, Helen, Deary, Alison, Pettigrew, Gavin J., Richards, James, Hossain, Mohammed, Summers, Dominic, Slater, Matthew, Scott, Laura, Lagaac, Regin, Surendrakumar, Veena, Ayorinde, Tobi, Chipurovski, Igor, Kathirvel, Manikandan, Thialli, Manoj, Paul, Subhankar, Norton, Andrew, Knight, Simon, Bond, Klaus, Hardy, Elizabeth, Widdup, Joanne, Potter, Rachael, Pugh, Elisabeth, Parsons, Karen, Lafferty, Kathryn, Gavrila, Madita, Sutherland, Sheera, Rabara, Ria, Sivaprakasam, Rajesh, Crawford, Kate, Bolsworth, Amy, Ngwa-Ndifor, Naavalah, Clementoni, Laura, Motallebzadeh, Reza, Hossain, Mohammad Ayaz, Bartlett, Matthew, Badhan, Rani, Yuenchang, Fernando, Gardiner, Phil, Irani, Natasha, Moinuddin, Zia, Edlin, Helena, Jerram, Anna, Lai, Jessica, Banda, Joyce, Bendle, Janet, Turner, Sam, Morgan, Maria, Owen, William, Dawson, Sue, Daniel, Simon, Allsop, Karen, Tambyraja, Andrew, Carmichael, Sarah-Jane, Eadie, Tom, Lochiel, Rona, Lena, Midel, Gallagher, Karen, Barnett, Nicholas, Padayachee, Soundrie, Eldridge, Philip, Rabuya, May, Hare, Naomi, Somalanka, Subash, Patel, Jashree, Ghazanfar, Abbas, van Selm, Judy, Bodneck, Caroline, Augustin, Martia, Ansu, Kwame, Khosla, Nalin, Burney, Kashif, Dear, Karen, Basnayake, Duminda, Benny, Laijee, Hunter, James, Tiivas, Carl, Hyndman, Samantha, Truslove, Maria, Evans, Gail, Read, Kerry, Dutta, Sam, Beech, Andrew, Brand, Sarah, MacCormick-Swanson, Tara, Lawman, Sarah, Cheal, Darren, Smith, Mel, Trivedi, Kate, Toska, Valentina, Shah-Goodwin, Lorraine, Salter, Tracey, Bajwa, Adnan, Kerr, John, Fleet, Ana, Chapman, Lianne, Gee, Sarah, Weerasinghe, Thanuja, Kavanagh, Lisa, Rowe-Leete, Louise, Smith, George, Cai, Paris, Long, Judith, Rowe, Tracey, Aslam, Mohammed, Crane, Jeremy, Bagul, Atul, Quashie-Akponeware, Mary, Waters, Kate, Howson, Alexandra, Hoye, Neil, Walker, Alycon, Allen, Elisa, Hossain, Mohammed Ayaz, and Parsons, Joseph

Published
2024
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16. The Supporting Emerging Adults With Diabetes (SEAD) Program: An Adult-Based Real-World Clinical Model That Improves Hospitalizations, Diabetes Technology Uptake, and Glycemic Outcomes in Underserved Young Adults With Type 1 Diabetes.

Author

Agarwal, Shivani, Mathias, Priyanka, Schechter, Clyde, Finnan, Molly, Greenberg, Michael, Leung, Stephanie L., Movsas, Sharon, and Long, Judith A.

Subjects
TYPE 1 diabetes, TRANSITION to adulthood, PROPORTIONAL hazards models, YOUNG adults, LIFE spans
Abstract

OBJECTIVE: Underserved young adults (YA) with type 1 diabetes (T1D) experience the worst outcomes across the life span. We developed and integrated the Supporting Emerging Adults with Diabetes (SEAD) program into routine endocrinology care to address unmet social and medical challenges. RESEARCH DESIGN AND METHODS: This study was designed as a longitudinal cohort study, with prospective data collection over 4 years on YA in SEAD compared with usual endocrine care. We used propensity-weighted analysis to account for differences in baseline characteristics, and multivariate regression and Cox proportional hazard models to evaluate change in outcomes over time. Primary outcomes included incidence of hospitalizations, diabetes technology uptake, and annual change in HbA1c levels. RESULTS: We included 497 YA with T1D in SEAD (n = 332) and usual endocrine care (n = 165); mean age 25 years, 27% non-Hispanic Black, 46% Hispanic, 49% public insurance, mean HbA1c 9.2%. Comparing YA in SEAD versus usual care, 1) incidence of hospitalizations was reduced by 64% for baseline HbA1c >9% (HR 0.36 [0.13, 0.98]) and 74% for publicly insured (HR 0.26 [0.07, 0.90]); 2) automated insulin delivery uptake was 1.5-times higher (HR 1.51 [0.83, 2.77]); and 3) HbA1c improvement was greater (SEAD, −0.37% per year [−0.59, −0.15]; usual care, −0.26% per year [−0.58, 0.05]). CONCLUSIONS: SEAD meaningfully improves clinical outcomes in underserved YA with T1D, especially for publicly insured and high baseline HbA1c levels. Early intervention for at-risk YA with T1D as they enter adult care could reduce inequity in short and long-term outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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23. Early Ultrasound Surveillance of Newly-Created Hemodialysis Arteriovenous Fistula

Author

Richards, James, primary, Summers, Dominic, additional, Sidders, Anna, additional, Allen, Elisa, additional, Thomas, Helen, additional, Hossain, Mohammed Ayaz, additional, Paul, Subhankar, additional, Slater, Matthew, additional, Bartlett, Matthew, additional, Lagaac, Regin, additional, Laing, Emma, additional, Hopkins, Valerie, additional, Fitzpatrick-Creamer, Chloe, additional, Hudson, Cara, additional, Parsons, Joseph, additional, Turner, Sam, additional, Tambyraja, Andrew, additional, Somalanka, Subash, additional, Hunter, James, additional, Dutta, Sam, additional, Hoye, Neil, additional, Lawman, Sarah, additional, Salter, Tracey, additional, Aslam, Mohammed, additional, Bagul, Atul, additional, Sivaprakasam, Rajesh, additional, Smith, George, additional, Moinuddin, Zia, additional, Knight, Simon, additional, Barnett, Nicholas, additional, Motallebzadeh, Reza, additional, Pettigrew, Gavin J., additional, Foley, Claire, additional, Deary, Alison, additional, Richards, James, additional, Hossain, Mohammed, additional, Scott, Laura, additional, Surendrakumar, Veena, additional, Ayorinde, Tobi, additional, Chipurovski, Igor, additional, Kathirvel, Manikandan, additional, Thialli, Manoj, additional, Norton, Andrew, additional, Bond, Klaus, additional, Hardy, Elizabeth, additional, Widdup, Joanne, additional, Potter, Rachael, additional, Pugh, Elisabeth, additional, Parsons, Karen, additional, Lafferty, Kathryn, additional, Gavrila, Madita, additional, Sutherland, Sheera, additional, Rabara, Ria, additional, Crawford, Kate, additional, Bolsworth, Amy, additional, Ngwa-Ndifor, Naavalah, additional, Clementoni, Laura, additional, Hossain, Mohammad Ayaz, additional, Badhan, Rani, additional, Yuenchang, Fernando, additional, Gardiner, Phil, additional, Irani, Natasha, additional, Edlin, Helena, additional, Jerram, Anna, additional, Lai, Jessica, additional, Banda, Joyce, additional, Bendle, Janet, additional, Morgan, Maria, additional, Owen, William, additional, Dawson, Sue, additional, Daniel, Simon, additional, Allsop, Karen, additional, Carmichael, Sarah-Jane, additional, Eadie, Tom, additional, Lochiel, Rona, additional, Lena, Midel, additional, Gallagher, Karen, additional, Padayachee, Soundrie, additional, Eldridge, Philip, additional, Rabuya, May, additional, Hare, Naomi, additional, Patel, Jashree, additional, Ghazanfar, Abbas, additional, van Selm, Judy, additional, Bodneck, Caroline, additional, Augustin, Martia, additional, Ansu, Kwame, additional, Khosla, Nalin, additional, Burney, Kashif, additional, Dear, Karen, additional, Basnayake, Duminda, additional, Benny, Laijee, additional, Tiivas, Carl, additional, Hyndman, Samantha, additional, Truslove, Maria, additional, Evans, Gail, additional, Read, Kerry, additional, Beech, Andrew, additional, Brand, Sarah, additional, MacCormick-Swanson, Tara, additional, Cheal, Darren, additional, Smith, Mel, additional, Trivedi, Kate, additional, Toska, Valentina, additional, Shah-Goodwin, Lorraine, additional, Bajwa, Adnan, additional, Kerr, John, additional, Fleet, Ana, additional, Chapman, Lianne, additional, Gee, Sarah, additional, Weerasinghe, Thanuja, additional, Kavanagh, Lisa, additional, Rowe-Leete, Louise, additional, Cai, Paris, additional, Long, Judith, additional, Rowe, Tracey, additional, Crane, Jeremy, additional, Quashie-Akponeware, Mary, additional, Waters, Kate, additional, Howson, Alexandra, additional, and Walker, Alycon, additional

Published
2024
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24. Identifying the most clinically effective exercise prescription for people with intermittent claudication (MAXIMISE): a component network meta-analysis with concurrent cost-effectiveness analysis

Author

Pymer, Sean, additional, Harwood, Amy Elizabeth, additional, Prosser, Jonathon, additional, Ravindhran, Bharadhwaj, additional, Fenton, Candida, additional, Hewitt, Catherine, additional, Huang, Chao, additional, Long, Judith, additional, Soares, Marta O, additional, Sayers, Robert, additional, Hatfield, Josie, additional, Gordon, Hayley, additional, Pittack, Sara, additional, Reeve, Joanne, additional, Duarte, Ana, additional, and Chetter, Ian, additional

Published
2024
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32. Effects of a standardized community health worker intervention on hospitalization among disadvantaged patients with multiple chronic conditions: A pooled analysis of three clinical trials

Author

Vasan, Aditi, Morgan, John W., Mitra, Nandita, Xu, Chang, Long, Judith A., Asch, David A., and Kangovi, Shreya

Subjects
Medically underserved populations -- Care and treatment, Chronic diseases -- Care and treatment -- Demographic aspects, Community health aides -- Services, Community health services -- Standards, Business, Health care industry
Abstract

Objective: To analyze the effects of a standardized community health worker (CHW) intervention on hospitalization. Data Sources/Study Setting: Pooled data from three randomized clinical trials (n = 1340) conducted between 2011 and 2016. Study Design: The trials in this pooled analysis were conducted across diseases and settings, with a common study design, intervention, and outcome measures. Participants were patients living in high-poverty regions of Philadelphia and were predominantly Medicaid insured. They were randomly assigned to receive usual care versus IMPaCT, an intervention in which CHWs provide tailored social support, health behavior coaching, connection with resources, and health system navigation. Trial one (n = 446) tested two weeks of IMPaCT among hospitalized general medical patients. Trial two (n = 302) tested six months of IMPaCT among outpatients at two academic primary care clinics. Trial three (n = 592) tested six months of IMPaCT among outpatients at academic, Veterans Affairs (VA), and Federally Qualified Health Center primary care practices. Data Collection/Extraction Methods: The primary outcome for this study was all-cause hospitalization, as measured by total number of hospital days per patient. Hospitalization data were collected from statewide or VA databases at 30 days postenrollment in Trial 1, twelve months postenrollment in Trial 2, and nine months postenrollment in Trial 3. Principal Findings: Over 9398 observed patient months, the total number of hospital days per patient in the intervention group was 66 percent of the total in the control group (849 days for 674 intervention patients vs 1258 days for 660 control patients, incidence rate ratio (IRR) 0.66, P < .0001). This reduction was driven by fewer hospitalizations per patient (0.27 vs 0.34, P < .0001) and shorter mean length of stay (4.72 vs 5.57 days, P = .03). The intervention also decreased rates of hospitalization outside patients' primary health system (18.8 percent vs 34.8 percent, P = .0023). Conclusions: Data from three randomized clinical trials across multiple settings show that a standardized CHW intervention reduced total hospital days and hospitalizations outside the primary health system. This is the largest analysis of randomized trials to demonstrate reductions in hospitalization with a health system-based social intervention. KEYWORDS access/demand/utilization of services, determinants of health/population health/socioeconomic causes of health, internal medicine, social determinants of health, 1 | INTRODUCTION In the United States, hospitalizations account for one third of all healthcare expenditures, amounting to more than 1.1 trillion dollars annually. (1) Hospital-based care is often both [...]

Published
2020
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35. High-intensity interval training in patients with intermittent claudication

Author

Pymer, Sean, primary, Harwood, Amy E., additional, Prosser, Jonathon, additional, Waddell, Alexander, additional, Rhavindhran, Bharadhwaj, additional, Ibeggazene, Said, additional, McGregor, Gordon, additional, Huang, Chao, additional, Twiddy, Maureen, additional, Nicholls, Adam R., additional, Ingle, Lee, additional, Carroll, Sean, additional, He, Heije, additional, Long, Judith, additional, Rooms, Marjorie, additional, and Chetter, Ian C., additional

Published
2023
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41. High INtensity Interval Training in pATiEnts with Intermittent Claudication (INITIATE): A Feasibility Proof-of-concept Study

Author

Pymer, Sean, primary, Harwood, Amy, additional, Rhavindhran, Bharadhwaj, additional, Ibeggazene, Saïd, additional, McGregor, Gordon, additional, Huang, Chao, additional, Twiddy, Maureen, additional, Nicholls, Adam, additional, Ingle, Lee, additional, Carroll, Sean, additional, Long, Judith, additional, and Chetter, Ian, additional

Published
2023
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44. High-intensity interval training in patients with intermittent claudication: Presented at the 2022 Vascular Society of Great Britain and Ireland Annual Scientific Meeting, Brighton, United Kingdom, November 23-25, 2022; presented at the 2023 Surgical Research Society Meeting, Nottingham, United Kingdom, March 22-24, 2023; and presented at the 2023 Vascular Annual Meeting of the Society for Vascular Surgery, National Harbor, MD, June 14-17, 2023

Author

Pymer, Sean, Harwood, Amy E, Prosser, Jonathon, Waddell, Alexander, Rhavindhran, Bharadhwaj, Ibeggazene, Said, McGregor, Gordon, Huang, Chao, Twiddy, Maureen, Nicholls, Adam R, Ingle, Lee, Carroll, Sean, He, Heije, Long, Judith, Rooms, Marjorie, Chetter, Ian C, Pymer, Sean, Harwood, Amy E, Prosser, Jonathon, Waddell, Alexander, Rhavindhran, Bharadhwaj, Ibeggazene, Said, McGregor, Gordon, Huang, Chao, Twiddy, Maureen, Nicholls, Adam R, Ingle, Lee, Carroll, Sean, He, Heije, Long, Judith, Rooms, Marjorie, and Chetter, Ian C

Abstract

Objective: Provision, uptake, adherence, and completion rates for supervised exercise programs (SEP) for intermittent claudication (IC) are low. A shorter, more time-efficient, 6-week, high-intensity interval training (HIIT) program may be an effective alternative that is more acceptable to patients and easier to deliver. The aim of this study was to determine the feasibility of HIIT for patients with IC. Methods: A single arm proof-of-concept study, performed in secondary care, recruiting patients with IC referred to usual-care SEPs. Supervised HIIT was performed three times per week for 6 weeks. The primary outcome was feasibility and tolerability. Potential efficacy and potential safety were considered, and an integrated qualitative study was undertaken to consider acceptability. Results: A total of 280 patients were screened: 165 (59%) were eligible, and 40 (25%) were recruited. The majority (n = 31; 78%) of participants completed the HIIT program. The remaining nine patients were withdrawn or chose to withdraw. Completers attended 99% of training sessions, completed 85% of sessions in full, and performed 84% of completed intervals at the required intensity. There were no related serious adverse events. Maximum walking distance (+94 m; 95% confidence interval, 66.6-120.8 m) and the SF-36 physical component summary (+2.2; 95% confidence interval, 0.3-4.1) were improved following completion of the program. Conclusions: Uptake to HIIT was comparable to SEPs in patients with IC, but completion rates were higher. HIIT appears feasible, tolerable, and potentially safe and beneficial for patients with IC. It may provide a more readily deliverable, acceptable form of SEP. Research comparing HIIT with usual-care SEPs appears warranted.

Published
2023

45. High-intensity interval training in patients with intermittent claudication

Author

Pymer, Sean, Harwood, Amy E, Prosser, Jonathon, Waddell, Alexander, Rhavindhran, Bharadhwaj, Ibeggazene, Said, McGregor, Gordon, Huang, Chao, Twiddy, Maureen, Nicholls, Adam R, Ingle, Lee, Carroll, Sean, He, Heije, Long, Judith, Rooms, Marjorie, Chetter, Ian C, Pymer, Sean, Harwood, Amy E, Prosser, Jonathon, Waddell, Alexander, Rhavindhran, Bharadhwaj, Ibeggazene, Said, McGregor, Gordon, Huang, Chao, Twiddy, Maureen, Nicholls, Adam R, Ingle, Lee, Carroll, Sean, He, Heije, Long, Judith, Rooms, Marjorie, and Chetter, Ian C

Abstract

Objective: Provision, uptake, adherence, and completion rates for supervised exercise programs (SEP) for intermittent claudication (IC) are low. A shorter, more time-efficient, 6-week, high-intensity interval training (HIIT) program may be an effective alternative that is more acceptable to patients and easier to deliver. The aim of this study was to determine the feasibility of HIIT for patients with IC. Methods: A single arm proof-of-concept study, performed in secondary care, recruiting patients with IC referred to usual-care SEPs. Supervised HIIT was performed three times per week for 6 weeks. The primary outcome was feasibility and tolerability. Potential efficacy and potential safety were considered, and an integrated qualitative study was undertaken to consider acceptability. Results: A total of 280 patients were screened: 165 (59%) were eligible, and 40 (25%) were recruited. The majority (n = 31; 78%) of participants completed the HIIT program. The remaining nine patients were withdrawn or chose to withdraw. Completers attended 99% of training sessions, completed 85% of sessions in full, and performed 84% of completed intervals at the required intensity. There were no related serious adverse events. Maximum walking distance (+94 m; 95% confidence interval, 66.6-120.8 m) and the SF-36 physical component summary (+2.2; 95% confidence interval, 0.3-4.1) were improved following completion of the program. Conclusions: Uptake to HIIT was comparable to SEPs in patients with IC, but completion rates were higher. HIIT appears feasible, tolerable, and potentially safe and beneficial for patients with IC. It may provide a more readily deliverable, acceptable form of SEP. Research comparing HIIT with usual-care SEPs appears warranted.

Published
2023

49. Additional file 1 of Study protocol: Type III hybrid effectiveness-implementation study implementing Age-Friendly evidence-based practices in the VA to improve outcomes in older adults

Author

Piazza, Kirstin Manges, Ashcraft, Laura Ellen, Rose, Liam, Hall, Daniel E., Brown, Rebecca T., Bowen, Mary Elizabeth (Libbey), Mavandadi, Shahrzad, Brecher, Alison C., Keddem, Shimrit, Kiosian, Bruce, Long, Judith A., Werner, Rachel M., and Burke, Robert E.

Abstract

Additional file 1: Figure S1. Study timeline.

Published
2023
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