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4 results on '"Margaret Schwarze"'

1. Best Case/Worst Case-ICU: protocol for a multisite, stepped-wedge, randomised clinical trial of scenario planning to improve communication in the ICU in US trauma centres for older adults with serious injury

Author

Deborah M Stein, Karen Brasel, Jan Jansen, Rachel Morris, Rosemary A Kozar, Kathleen M O'Connell, Stephanie Lueckel, Anne Buffington, Christine S Cocanour, Amy Zelenski, Bret M Hanlon, Lily Stalter, Kristine L Kwekkeboom, Margaret Schwarze, Mark D Cipolle, Anamaria J Robles, Rondi B Gelbard, Kyle J Bushaw, Melanie Fritz, and Patricia Ayoung-Chee

Subjects
Medicine
Abstract

Introduction Poor communication about serious injury in older adults can lead to treatment that is inconsistent with patient preferences, create conflict and strain healthcare resources. We developed a communication intervention called Best Case/Worst Case-intensive care unit (ICU) that uses daily scenario planning, that is, a narrative description of plausible futures, to support prognostication and facilitate dialogue among patients, their families and the trauma ICU team. This article describes a protocol for a multisite, randomised, stepped-wedge study to test the effectiveness of the intervention on the quality of communication (QOC) in the ICU.Methods and analysis We will follow all patients aged 50 and older admitted to the trauma ICU for 3 or more days after a serious injury at eight high-volume level 1 trauma centres. We aim to survey one family or ‘like family’ member per eligible patient 5–7 days following their loved ones’ admission and clinicians providing care in the trauma ICU. Using a stepped-wedge design, we will use permuted block randomisation to assign the timing for each site to begin implementation of the intervention and routine use of the Best Case/Worst Case-ICU tool. We will use a linear mixed-effects model to test the effect of the tool on family-reported QOC (using the QOC scale) as compared with usual care. Secondary outcomes include the effect of the tool on reducing clinician moral distress (using the Measure of Moral Distress for Healthcare Professionals scale) and patients’ length of stay in the ICU.Ethics and dissemination Institutional review board (IRB) approval was granted at the University of Wisconsin, and all study sites ceded review to the primary IRB. We plan to report results in peer-reviewed publications and national meetings.Trial registration number NCT05780918.

Published
2024
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2. Best Case/Worst Case: protocol for a multisite randomised clinical trial of a scenario planning intervention for patients with kidney failure

Author

Anne Buffington, Daniel Lam, Amar D Bansal, Karlie Haug, Amy Zelenski, Bret M Hanlon, Lily Stalter, Kristine L Kwekkeboom, Paul Rathouz, Katharine Cheung, Deidra Crews, Rebecca Frazier, Holly Koncicki, Alvin Moss, Maya Rao, Dawn F Wolfgram, Jeniann Yi, Carrie Brill, Rachael Kendrick, Toby C Campbell, Roy Jhagroo, and Margaret Schwarze

Subjects
Medicine
Abstract

Introduction Given the burdens of treatment and poor prognosis, older adults with kidney failure would benefit from improved decision making and palliative care to clarify goals, address symptoms, and reduce unwanted procedures. Best Case/Worst Case (BC/WC) is a communication tool that uses scenario planning to support patients’ decision making. This article describes the protocol for a multisite, cluster randomised trial to test the effect of training nephrologists to use the BC/WC communication tool on patient receipt of palliative care, and quality of life and communication.Methods and analysis We are enrolling attending nephrologists, at 10 study sites in the USA, who see outpatients with advanced chronic kidney disease considering dialysis. We aim to enrol 320 patients with an estimated glomerular filtration rate of ≤24 mL/min/1.73 m2 who are age 60 and older and have a predicted survival of 18 months or less. Nephrologists will be randomised in a 1:1 ratio to receive training to use the communication tool (intervention) at study initiation or after study completion (wait-list control). Patients in the intervention group will receive care from a nephrologist trained to use the BC/WC communication tool. Patients in the control group will receive usual care. Using chart review and surveys of patients and caregivers, we will test the efficacy of the BC/WC intervention with receipt of palliative care as the primary outcome. Secondary outcomes include intensity of treatment at the end of life, the effect of the intervention on quality of communication (QOC) between nephrologists and patients (using the QOC scale), the change in quality of life (using the Functional Assessment of Chronic Illness Therapy-Palliative Care scale) and receipt of dialysis.Ethics and dissemination Approvals have been granted by the Institutional Review Board at the University of Wisconsin (ID: 2022-0193), with each study site ceding review to the primary IRB. All nephrologists will be consented and given a copy of the consent form. No patients or caregivers will be recruited or consented until their nephrology provider has chosen to participate in the study. Results will be disseminated via submission for publication in a peer-reviewed journal and at national meetings.Trial registration number NCT04466865.

Published
2022
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3. Best Case/Worst Case: protocol for a multisite randomised clinical trial of a scenario planning intervention for patients with kidney failure

Author

Karlie Haug, Anne Buffington, Amy Zelenski, Bret M Hanlon, Lily Stalter, Kristine L Kwekkeboom, Paul Rathouz, Amar D Bansal, Katharine Cheung, Deidra Crews, Rebecca Frazier, Holly Koncicki, Daniel Lam, Alvin Moss, Maya Rao, Dawn F Wolfgram, Jeniann Yi, Carrie Brill, Rachael Kendrick, Toby C Campbell, Roy Jhagroo, and Margaret Schwarze

Subjects
Renal Dialysis, Communication, Palliative Care, Quality of Life, Humans, General Medicine, Renal Insufficiency, Middle Aged, Aged, Randomized Controlled Trials as Topic
Abstract

IntroductionGiven the burdens of treatment and poor prognosis, older adults with kidney failure would benefit from improved decision making and palliative care to clarify goals, address symptoms, and reduce unwanted procedures. Best Case/Worst Case (BC/WC) is a communication tool that uses scenario planning to support patients’ decision making. This article describes the protocol for a multisite, cluster randomised trial to test the effect of training nephrologists to use the BC/WC communication tool on patient receipt of palliative care, and quality of life and communication.Methods and analysisWe are enrolling attending nephrologists, at 10 study sites in the USA, who see outpatients with advanced chronic kidney disease considering dialysis. We aim to enrol 320 patients with an estimated glomerular filtration rate of ≤24 mL/min/1.73 m2who are age 60 and older and have a predicted survival of 18 months or less. Nephrologists will be randomised in a 1:1 ratio to receive training to use the communication tool (intervention) at study initiation or after study completion (wait-list control). Patients in the intervention group will receive care from a nephrologist trained to use the BC/WC communication tool. Patients in the control group will receive usual care. Using chart review and surveys of patients and caregivers, we will test the efficacy of the BC/WC intervention with receipt of palliative care as the primary outcome. Secondary outcomes include intensity of treatment at the end of life, the effect of the intervention on quality of communication (QOC) between nephrologists and patients (using the QOC scale), the change in quality of life (using the Functional Assessment of Chronic Illness Therapy-Palliative Care scale) and receipt of dialysis.Ethics and disseminationApprovals have been granted by the Institutional Review Board at the University of Wisconsin (ID: 2022-0193), with each study site ceding review to the primary IRB. All nephrologists will be consented and given a copy of the consent form. No patients or caregivers will be recruited or consented until their nephrology provider has chosen to participate in the study. Results will be disseminated via submission for publication in a peer-reviewed journal and at national meetings.Trial registration numberNCT04466865.

Published
2022

4. Costs of repair of abdominal aortic aneurysm with different devices in a multicenter randomized trial

Author

Jon S. Matsumura, Kevin T. Stroupe, Frank A. Lederle, Tassos C. Kyriakides, Ling Ge, Julie A. Freischlag, Erika R. Ketteler, Darra D. Kingsley, John M. Marek, Richard J. Massen, Brian D. Matteson, J. David Pitcher, Mark Langsfeld, John D. Corson, James M. Goff, Karthnik Kasirajan, Christina Paap, Diane C. Robertson, Atef Salam, Ravi Veeraswamy, Ross Milner, Karthikeshwar Kasirajan, Jane Guidot, Brajesh K. Lal, Steven J. Busuttil, Michael P. Lilly, Melita Braganza, Kea Ellis, Mark A. Patterson, William D. Jordan, David Whitley, Steve Taylor, Marc Passman, Donna Kerns, Cindy Inman, Jennifer Poirier, James Ebaugh, Joseph Raffetto, David Chew, Subhash Lathi, Christopher Owens, Kathleen Hickson, Hasan H. Dosluoglu, Karen Eschberger, Melina R. Kibbe, Henry M. Baraniewski, Jon Matsumura, Michelle Endo, Anna Busman, Wendy Meadows, Mary Evans, Joseph S. Giglia, Hosam El Sayed, Amy B. Reed, Madeline Ruf, Stephanie Ross, Jessie M. Jean-Claude, Gilles Pinault, Preet Kang, Nadine White, Matthew Eiseman, Reba Jones, Carlos H. Timaran, J. Gregory Modrall, M. Burress Welborn, Jorge Lopez, Tammy Nguyen, John K.Y. Chacko, Kenneth Granke, Angela G. Vouyouka, Erin Olgren, Prakash Chand, Brenda Allende, Michael Ranella, Claudia Yales, Thomas A. Whitehill, William C. Krupski, Mark R. Nehler, Stephen P. Johnson, Darrell N. Jones, Pamela Strecker, Michelle A. Bhola, Cynthia K. Shortell, John L. Gray, Jeffrey H. Lawson, Richard McCann, Mark W. Sebastian, Jean Kistler Tetterton, Carla Blackwell, Patricia A. Prinzo, Nina Lee, Frank T. Padberg, Joaquim J. Cerveira, Robert W. Zickler, Karen A. Hauck, Scott A. Berceli, W. Anthony Lee, C. Keith Ozaki, Peter R. Nelson, Anne S. Irwin, Randy Baum, Bernadette Aulivola, Heron Rodriguez, Fred N. Littooy, Howard Greisler, Mary T. O'Sullivan, Panagiotis Kougias, Peter H. Lin, Ruth L. Bush, Gene Guinn, Catherine Cagiannos, Sherilyn Pillack, Barbara Guillory, Dolores Cikrit, Stephen G. Lalka, Gary Lemmon, Ryan Nachreiner, Mitzi Rusomaroff, Elaine O'Brien, Joseph J. Cullen, Jamal Hoballah, W. John Sharp, Jeanne L. McCandless, Vickie Beach, David Minion, Thomas H. Schwarcz, Joy Kimbrough, Laura Ashe, Anna Rockich, Jill Warner-Carpenter, Mohammed Moursi, John F. Eidt, Sandra Brock, Christian Bianchi, Vicki Bishop, Ian L. Gordon, Roy Fujitani, Stephen M. Kubaska, Mina Behdad, Reza Azadegan, Christine Ma Agas, Kathy Zalecki, John R. Hoch, Sandra C. Carr, Charles Acher, Margaret Schwarze, Girma Tefera, Matthew Mell, Beth Dunlap, Janice Rieder, John M. Stuart, Darryl S. Weiman, Omran Abul-Khoudoud, H. Edward Garrett, Sandra M. Walsh, Karen L. Wilson, Gary R. Seabrook, Robert A. Cambria, Kellie R. Brown, Brian D. Lewis, Susan Framberg, Christa Kallio, Roderick A. Barke, Steven M. Santilli, Alexandre C. d'Audiffret, Nancy Oberle, Catherine Proebstle, Lauri Lee Johnson, Glenn R. Jacobowitz, Neal Cayne, Caron Rockman, Mark Adelman, Paul Gagne, Matthew Nalbandian, Leah J. Caropolo, Iraklis I. Pipinos, Jason Johanning, Thomas Lynch, Holly DeSpiegelaere, Georgia Purviance, Wei Zhou, Ronald Dalman, Jason T. Lee, Bassem Safadi, Sheila M. Coogan, Sherry M. Wren, Doghdoo D. Bahmani, Deanna Maples, Shawna Thunen, Michael A. Golden, Marc E. Mitchell, Ronald Fairman, Sally Reinhardt, Mark A. Wilson, Edith Tzeng, Satish Muluk, Nina M. Peterson, Maria Foster, James Edwards, Gregory L. Moneta, Gregory Landry, Lloyd Taylor, Richard Yeager, Eleanor Cannady, Gerald Treiman, Stephanie Hatton-Ward, Barbara Salabsky, Nikhil Kansal, Erik Owens, Melanie Estes, Beth A. Forbes, Cinda Sobotta, Joseph H. Rapp, Linda M. Reilly, Sandra L. Perez, Kimberly Yan, Rajaabrata Sarkar, Shelley S. Dwyer, Ted R. Kohler, Thomas S. Hatsukami, David G. Glickerman, Michael Sobel, Thomas S. Burdick, Kimberly Pedersen, Patricia Cleary, Martin Back, Dennis Bandyk, Brad Johnson, Murray Shames, Rebecca L. Reinhard, Sandra C. Thomas, Glenn C. Hunter, Luis R. Leon, Alex Westerband, Robert J. Guerra, Macario Riveros, John L. Mills, John D. Hughes, Andrea M. Escalante, Shemuel B. Psalms, Nancy N. Day, Robyn Macsata, Anton Sidawy, Jonathan Weiswasser, Subodh Arora, Brenda J. Jasper, Alan Dardik, Vivian Gahtan, Bart E. Muhs, Bauer E. Sumpio, Richard J. Gusberg, Marcelo Spector, Jeffrey Pollak, John Aruny, E. Lynne Kelly, James Wong, Penny Vasilas, Carmelene Joncas, Hugh A. Gelabert, Christian DeVirgillio, David A. Rigberg, and Loretta Cole

Subjects
medicine.medical_specialty, Time Factors, medicine.medical_treatment, Prosthesis Design, Endovascular aneurysm repair, law.invention, Blood Vessel Prosthesis Implantation, Aortic aneurysm, Randomized controlled trial, law, Blood vessel prosthesis, Health care, medicine, Humans, Hospital Costs, Veterans Affairs, health care economics and organizations, Health economics, business.industry, Endovascular Procedures, Health Care Costs, Length of Stay, medicine.disease, United States, Abdominal aortic aneurysm, Blood Vessel Prosthesis, Surgery, United States Department of Veterans Affairs, Treatment Outcome, Stents, Health Expenditures, Cardiology and Cardiovascular Medicine, business, Aortic Aneurysm, Abdominal
Abstract

Objective Prior analysis in the Open vs Endovascular Repair Veterans Affairs (VA) Cooperative Study (CSP #498) demonstrated that survival, quality of life, and total health care costs are not significantly different between the open and endovascular methods of repair of abdominal aortic aneurysm. The device is a major cost of this method of repair, and the objective of this study was to evaluate the costs of the device, abdominal aortic aneurysm repair, and total health care costs when different endograft systems are selected for the endovascular repair (EVR). Within each selected system, EVR costs are compared with open repair costs. Methods The study randomized 881 patients to open (n = 437) or EVR (n = 444). Device selection was recorded before randomization; therefore, open repair controls were matched to each device cohort. Data were excluded for two low-volume devices, implanted in only 13 individuals, leaving 423 control and 431 endovascular patients: 166 Zenith (Cook Medical, Bloomington, Ind), 177 Excluder (W. L. Gore & Associates, Flagstaff, Ariz), and 88 AneuRx (Medtronic, Minneapolis, Minn). Mean device, hospitalization, and total health care costs from randomization to 2 years were compared. Health care utilization data were obtained from patients and national VA and Medicare data sources. VA costs were determined using methods previously developed by the VA Health Economics Resource Center. Non-VA costs were obtained from Medicare claims data and billing data from the patient's health care providers. Results Implant costs were 38% of initial hospitalization costs. Mean device (range, $13,600-$14,400), initial hospitalization (range, $34,800-$38,900), and total health care costs at 2 years in the endovascular (range, $72,400-$78,200) and open repair groups (range, $75,600-$82,100) were not significantly different among device systems. Differences between endovascular and corresponding open repair cohorts showed lower mean costs for EVR (range, $3200-$8300), but these were not statistically different. Conclusions The implant costs of endovascular aneurysm repair are substantial. When evaluating total health care system expenditures, there is large individual variability in costs, and there is no significant difference at 2 years among systems or when an individual system is compared with open repair.

Published
2015
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