290 results on '"Stephens, Kari A"'
Search Results
2. The association between prolonged SARS-CoV-2 symptoms and work outcomes.
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Venkatesh, Arjun, Yu, Huihui, Malicki, Caitlin, Gottlieb, Michael, Elmore, Joann, Hill, Mandy, Idris, Ahamed, Montoy, Juan Carlos, OLaughlin, Kelli, Rising, Kristin, Stephens, Kari, Spatz, Erica, and Weinstein, Robert
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Humans ,COVID-19 ,Female ,Male ,Adult ,Middle Aged ,SARS-CoV-2 ,Prospective Studies ,Return to Work ,United States ,Employment ,Self Report ,Pandemics ,Absenteeism ,Young Adult - Abstract
While the early effects of the COVID-19 pandemic on the United States labor market are well-established, less is known about the long-term impact of SARS-CoV-2 infection and Long COVID on employment. To address this gap, we analyzed self-reported data from a prospective, national cohort study to estimate the effects of SARS-CoV-2 symptoms at three months post-infection on missed workdays and return to work. The analysis included 2,939 adults in the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) study who tested positive for their initial SARS-CoV-2 infection at the time of enrollment, were employed before the pandemic, and completed a baseline and three-month electronic survey. At three months post-infection, 40.8% of participants reported at least one SARS-CoV-2 symptom and 9.6% of participants reported five or more SARS-CoV-2 symptoms. When asked about missed work due to their SARS-CoV-2 infection at three months, 7.2% of participants reported missing ≥10 workdays and 13.9% of participants reported not returning to work since their infection. At three months, participants with ≥5 symptoms had a higher adjusted odds ratio of missing ≥10 workdays (2.96, 95% CI 1.81-4.83) and not returning to work (2.44, 95% CI 1.58-3.76) compared to those with no symptoms. Prolonged SARS-CoV-2 symptoms were common, affecting 4-in-10 participants at three-months post-infection, and were associated with increased odds of work loss, most pronounced among adults with ≥5 symptoms at three months. Despite the end of the federal Public Health Emergency for COVID-19 and efforts to return to normal, policymakers must consider the clinical and economic implications of the COVID-19 pandemic on peoples employment status and work absenteeism, particularly as data characterizing the numerous health and well-being impacts of Long COVID continue to emerge. Improved understanding of risk factors for lost work time may guide efforts to support people in returning to work.
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- 2024
3. Prescription Opioid Dose Reductions and Potential Adverse Events: a Multi-site Observational Cohort Study in Diverse US Health Systems
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Metz, Verena E., Ray, G. Thomas, Palzes, Vanessa, Binswanger, Ingrid, Altschuler, Andrea, Karmali, Ruchir N., Ahmedani, Brian K., Andrade, Susan E., Boscarino, Joseph A., Clark, Robin E., Haller, Irina V., Hechter, Rulin C., Roblin, Douglas W., Sanchez, Katherine, Bailey, Steffani R., McCarty, Dennis, Stephens, Kari A., Rosa, Carmen L., Rubinstein, Andrea L., and Campbell, Cynthia I.
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- 2024
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4. Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID-19 Testing Status Among Adults - United States, December 2020-March 2023.
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Ford, James, Yu, Huihui, Gottlieb, Michael, Morse, Dana, Santangelo, Michelle, OLaughlin, Kelli, Schaeffer, Kevin, Logan, Pamela, Rising, Kristin, Hill, Mandy, Wisk, Lauren, Salah, Wafah, Idris, Ahamed, Huebinger, Ryan, Spatz, Erica, Klabbers, Robin, Gatling, Kristyn, Wang, Ralph, Elmore, Joann, McDonald, Samuel, Stephens, Kari, Weinstein, Robert, Venkatesh, Arjun, Saydah, Sharon, Rodriguez, Robert, and Montoy, Juan Carlos
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Adult ,Humans ,Acute Disease ,Cohort Studies ,COVID-19 ,COVID-19 Testing ,Post-Acute COVID-19 Syndrome ,Prevalence ,Prospective Studies ,SARS-CoV-2 ,United States - Abstract
To further the understanding of post-COVID conditions, and provide a more nuanced description of symptom progression, resolution, emergence, and reemergence after SARS-CoV-2 infection or COVID-like illness, analysts examined data from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a prospective multicenter cohort study. This report includes analysis of data on self-reported symptoms collected from 1,296 adults with COVID-like illness who were tested for SARS-CoV-2 using a Food and Drug Administration-approved polymerase chain reaction or antigen test at the time of enrollment and reported symptoms at 3-month intervals for 12 months. Prevalence of any symptom decreased substantially between baseline and the 3-month follow-up, from 98.4% to 48.2% for persons who received a positive SARS-CoV-2 test results (COVID test-positive participants) and from 88.2% to 36.6% for persons who received negative SARS-CoV-2 test results (COVID test-negative participants). Persistent symptoms decreased through 12 months; no difference between the groups was observed at 12 months (prevalence among COVID test-positive and COVID test-negative participants = 18.3% and 16.1%, respectively; p>0.05). Both groups reported symptoms that emerged or reemerged at 6, 9, and 12 months. Thus, these symptoms are not unique to COVID-19 or to post-COVID conditions. Awareness that symptoms might persist for up to 12 months, and that many symptoms might emerge or reemerge in the year after COVID-like illness, can assist health care providers in understanding the clinical signs and symptoms associated with post-COVID-like conditions.
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- 2023
5. Association Between SARS-CoV-2 Variants and Frequency of Acute Symptoms: Analysis of a Multi-institutional Prospective Cohort Study-December 20, 2020-June 20, 2022.
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Wang, Ralph C, Gottlieb, Michael, Montoy, Juan Carlos C, Rodriguez, Robert M, Yu, Huihui, Spatz, Erica S, Chandler, Christopher W, Elmore, Joann G, Hannikainen, Paavali A, Chang, Anna Marie, Hill, Mandy, Huebinger, Ryan M, Idris, Ahamed H, Koo, Katherine, Li, Shu-Xia, McDonald, Samuel, Nichol, Graham, O'Laughlin, Kelli N, Plumb, Ian D, Santangelo, Michelle, Saydah, Sharon, Stephens, Kari A, Venkatesh, Arjun K, Weinstein, Robert A, and Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) Group
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Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) Group ,COVID-19 ,COVID-19 symptoms ,SARS-COV-2 ,variants of concern ,Neurosciences ,Emerging Infectious Diseases ,Clinical Research ,Prevention ,Lung ,Clinical Trials and Supportive Activities ,Good Health and Well Being - Abstract
BackgroundWhile prior work examining severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern focused on hospitalization and death, less is known about differences in clinical presentation. We compared the prevalence of acute symptoms across pre-Delta, Delta, and Omicron.MethodsWe conducted an analysis of the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a cohort study enrolling symptomatic SARS-CoV-2-positive participants. We determined the association between the pre-Delta, Delta, and Omicron time periods and the prevalence of 21 coronavirus disease 2019 (COVID-19) acute symptoms.ResultsWe enrolled 4113 participants from December 2020 to June 2022. Pre-Delta vs Delta vs Omicron participants had increasing sore throat (40.9%, 54.6%, 70.6%; P < .001), cough (50.9%, 63.3%, 66.7%; P < .001), and runny noses (48.9%, 71.3%, 72.9%; P < .001). We observed reductions during Omicron in chest pain (31.1%, 24.2%, 20.9%; P < .001), shortness of breath (42.7%, 29.5%, 27.5%; P < .001), loss of taste (47.1%, 61.8%, 19.2%; P < .001), and loss of smell (47.5%, 55.6%, 20.0%; P < .001). After adjustment, those infected during Omicron had significantly higher odds of sore throat vs pre-Delta (odds ratio [OR], 2.76; 95% CI, 2.26-3.35) and Delta (OR, 1.96; 95% CI, 1.69-2.28).ConclusionsParticipants infected during Omicron were more likely to report symptoms of common respiratory viruses, such as sore throat, and less likely to report loss of smell and taste.Trial registrationNCT04610515.
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- 2023
6. Long COVID Clinical Phenotypes up to 6 Months After Infection Identified by Latent Class Analysis of Self-Reported Symptoms.
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Gottlieb, Michael, Spatz, Erica S, Yu, Huihui, Wisk, Lauren E, Elmore, Joann G, Gentile, Nicole L, Hill, Mandy, Huebinger, Ryan M, Idris, Ahamed H, Kean, Efrat R, Koo, Katherine, Li, Shu-Xia, McDonald, Samuel, Montoy, Juan Carlos C, Nichol, Graham, O'Laughlin, Kelli N, Plumb, Ian D, Rising, Kristin L, Santangelo, Michelle, Saydah, Sharon, Wang, Ralph C, Venkatesh, Arjun, Stephens, Kari A, Weinstein, Robert A, and INSPIRE Group
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INSPIRE Group ,COVID-19 ,Long COVID ,SARS-CoV-2 ,cluster ,phenotype ,Lung ,Infectious Diseases ,Clinical Research - Abstract
BackgroundThe prevalence, incidence, and interrelationships of persistent symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection vary. There are limited data on specific phenotypes of persistent symptoms. Using latent class analysis (LCA) modeling, we sought to identify whether specific phenotypes of COVID-19 were present 3 months and 6 months post-infection.MethodsThis was a multicenter study of symptomatic adults tested for SARS-CoV-2 with prospectively collected data on general symptoms and fatigue-related symptoms up to 6 months postdiagnosis. Using LCA, we identified symptomatically homogenous groups among COVID-positive and COVID-negative participants at each time period for both general and fatigue-related symptoms.ResultsAmong 5963 baseline participants (4504 COVID-positive and 1459 COVID-negative), 4056 had 3-month and 2856 had 6-month data at the time of analysis. We identified 4 distinct phenotypes of post-COVID conditions (PCCs) at 3 and 6 months for both general and fatigue-related symptoms; minimal-symptom groups represented 70% of participants at 3 and 6 months. When compared with the COVID-negative cohort, COVID-positive participants had higher occurrence of loss of taste/smell and cognition problems. There was substantial class-switching over time; those in 1 symptom class at 3 months were equally likely to remain or enter a new phenotype at 6 months.ConclusionsWe identified distinct classes of PCC phenotypes for general and fatigue-related symptoms. Most participants had minimal or no symptoms at 3 and 6 months of follow-up. Significant proportions of participants changed symptom groups over time, suggesting that symptoms present during the acute illness may differ from prolonged symptoms and that PCCs may have a more dynamic nature than previously recognized. Clinical Trials Registration. NCT04610515.
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- 2023
7. The Role of Primary Care in the Social Isolation and Loneliness Epidemic
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Mullen, Rebecca A., Tong, Sebastian T., Lum, Hillary D., Stephens, Kari A., and Krist, Alex H.
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Social isolation -- Forecasts and trends -- Control -- Health aspects ,Loneliness -- Forecasts and trends -- Control -- Health aspects ,Primary health care -- Influence -- Psychological aspects -- Social aspects ,Market trend/market analysis ,Health ,Science and technology - Abstract
The United States is facing a social isolation and loneliness crisis. In response, the US Surgeon General issued an advisory in May 2023 recommending actions that health care, community programs, and social services can take to collaboratively improve social connection. Primary care has a critical role to play in implementing the Surgeon General's recommendations. We present social isolation and loneliness as medical issues and highlight next steps for the primary care sector to combat this epidemic. https://doi.org/10.1370/afm.3102, Annals Early Access article INTRODUCTION The Social Isolation and Loneliness Epidemic Social isolation and loneliness have gained significant attention in recent years and are increasingly recognized as urgent health issues [...]
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- 2024
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8. Severe Fatigue and Persistent Symptoms at 3 Months Following Severe Acute Respiratory Syndrome Coronavirus 2 Infections During the Pre-Delta, Delta, and Omicron Time Periods: A Multicenter Prospective Cohort Study.
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Gottlieb, Michael, Wang, Ralph C, Yu, Huihui, Spatz, Erica S, Montoy, Juan Carlos C, Rodriguez, Robert M, Chang, Anna Marie, Elmore, Joann G, Hannikainen, Paavali A, Hill, Mandy, Huebinger, Ryan M, Idris, Ahamed H, Lin, Zhenqiu, Koo, Katherine, McDonald, Samuel, O'Laughlin, Kelli N, Plumb, Ian D, Santangelo, Michelle, Saydah, Sharon, Willis, Michael, Wisk, Lauren E, Venkatesh, Arjun, Stephens, Kari A, Weinstein, Robert A, and Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) Group
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Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) Group ,Humans ,Fatigue ,Prospective Studies ,Adult ,COVID-19 ,SARS-CoV-2 ,COVID-19 Testing ,Delta ,Long COVID ,Omicron ,Pneumonia ,Pneumonia & Influenza ,Infectious Diseases ,Lung ,Prevention ,Clinical Research ,Emerging Infectious Diseases ,Biodefense ,Vaccine Related ,Immunization ,Infection ,Good Health and Well Being ,Biological Sciences ,Medical and Health Sciences ,Microbiology - Abstract
BackgroundMost research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants focuses on initial symptomatology with limited longer-term data. We characterized prevalences of prolonged symptoms 3 months post-SARS-CoV-2 infection across 3 variant time-periods (pre-Delta, Delta, and Omicron).MethodsThis multicenter prospective cohort study of adults with acute illness tested for SARS-CoV-2 compared fatigue severity, fatigue symptoms, organ system-based symptoms, and ≥3 symptoms across variants among participants with a positive ("COVID-positive") or negative SARS-CoV-2 test ("COVID-negative") at 3 months after SARS-CoV-2 testing. Variant periods were defined by dates with ≥50% dominant strain. We performed multivariable logistic regression modeling to estimate independent effects of variants adjusting for sociodemographics, baseline health, and vaccine status.ResultsThe study included 2402 COVID-positive and 821 COVID-negative participants. Among COVID-positives, 463 (19.3%) were pre-Delta, 1198 (49.9%) Delta, and 741 (30.8%) Omicron. The pre-Delta COVID-positive cohort exhibited more prolonged severe fatigue (16.7% vs 11.5% vs 12.3%; P = .017) and presence of ≥3 prolonged symptoms (28.4% vs 21.7% vs 16.0%; P < .001) compared with the Delta and Omicron cohorts. No differences were seen in the COVID-negatives across time-periods. In multivariable models adjusted for vaccination, severe fatigue and odds of having ≥3 symptoms were no longer significant across variants.ConclusionsProlonged symptoms following SARS-CoV-2 infection were more common among participants infected during pre-Delta than with Delta and Omicron; however, these differences were no longer significant after adjusting for vaccination status, suggesting a beneficial effect of vaccination on risk of long-term symptoms. Clinical Trials Registration. NCT04610515.
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- 2023
9. Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection.
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OLaughlin, Kelli, Klabbers, Robin, Ebna Mannan, Imtiaz, Gentile, Nicole, Geyer, Rachel, Zheng, Zihan, Yu, Huihui, Li, Shu-Xia, Chan, Kwun, Spatz, Erica, Wang, Ralph, LHommedieu, Michelle, Weinstein, Robert, Plumb, Ian, Gottlieb, Michael, Huebinger, Ryan, Hagen, Melissa, Elmore, Joann, Hill, Mandy, Kelly, Morgan, McDonald, Samuel, Rising, Kristin, Rodriguez, Robert, Venkatesh, Arjun, Idris, Ahamed, Santangelo, Michelle, Koo, Katherine, Saydah, Sharon, Nichol, Graham, and Stephens, Kari
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COVID-19 ,SARS-CoV-2 ,cohort ,disparities ,ethnicity ,race ,survey ,Adult ,Humans ,COVID-19 ,Self Report ,Race Factors ,COVID-19 Vaccines ,Prospective Studies ,SARS-CoV-2 ,Health Status ,White - Abstract
INTRODUCTION: Data on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection. METHODS: Participants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (N = 3,161; 2,402 SARS-CoV-2-positive, 759 SARS-CoV-2-negative). Marginal odds ratios were estimated using GEE logistic regression for individual symptoms, health status, activity level, and missed work 3 and 6 months after COVID-19 illness, comparing each ethnicity or race to the referent group (non-Hispanic or white), adjusting for demographic factors, social determinants of health, substance use, pre-existing health conditions, SARS-CoV-2 infection status, COVID-19 vaccination status, and survey time point, with interactions between ethnicity or race and time point, ethnicity or race and SARS-CoV-2 infection status, and SARS-CoV-2 infection status and time point. RESULTS: Following SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At 3 months, Hispanic participants were more likely than non-Hispanic participants to report fair/poor health (OR: 1.94; 95%CI: 1.36-2.78) and reduced activity (somewhat less, OR: 1.47; 95%CI: 1.06-2.02; much less, OR: 2.23; 95%CI: 1.38-3.61). At 6 months, differences by ethnicity were not present. At 3 months, Other/Multiple race participants were more likely than white participants to report fair/poor health (OR: 1.90; 95% CI: 1.25-2.88), reduced activity (somewhat less, OR: 1.72; 95%CI: 1.21-2.46; much less, OR: 2.08; 95%CI: 1.18-3.65). At 6 months, Asian participants were more likely than white participants to report fair/poor health (OR: 1.88; 95%CI: 1.13-3.12); Black participants reported more missed work (OR, 2.83; 95%CI: 1.60-5.00); and Other/Multiple race participants reported more fair/poor health (OR: 1.83; 95%CI: 1.10-3.05), reduced activity (somewhat less, OR: 1.60; 95%CI: 1.02-2.51; much less, OR: 2.49; 95%CI: 1.40-4.44), and more missed work (OR: 2.25; 95%CI: 1.27-3.98). DISCUSSION: Awareness of ethnic and racial differences in outcomes following SARS-CoV-2 infection may inform clinical and public health efforts to advance health equity in long-term outcomes.
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- 2023
10. The opioid use disorder core outcomes set (OUD-COS) for treatment research: findings from a Delphi consensus study.
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Karnik, Niranjan, Marsden, John, McCluskey, Connor, Boley, Randy, Bradley, Katharine, Campbell, Cynthia, Curtis, Megan, Fiellin, David, Ghitza, Udi, Hefner, Kathryn, Hser, Yih-Ing, McHugh, R, McPherson, Sterling, Mooney, Larissa, Moran, Landhing, Murphy, Sean, Schwartz, Robert, Shmueli-Blumberg, Dikla, Shulman, Matisyahu, Stephens, Kari, Watkins, Katherine, Weiss, Roger, and Wu, Li-Tzy
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Core outcomes set ,Delphi consensus ,US National Institute on Drug Abuse ,efficacy and effectiveness research ,opioid treatment cascade ,opioid use disorder ,Analgesics ,Opioid ,Consensus ,Delphi Technique ,Humans ,Opioid-Related Disorders ,Outcome Assessment ,Health Care ,Research Design ,United States - Abstract
BACKGROUND AND AIM: There is no gold-standard and considerable heterogeneity in outcome measures used to evaluate treatments for opioid use disorder (OUD) along the opioid treatment cascade. The aim of this study was to develop the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN) opioid use disorder core outcomes set (OUD-COS). DESIGN: Four-round, e-Delphi expert panel consensus study and plenary research group discussion and targeted consultation. SETTING: United States. PARTICIPANTS: A panel of 25 members including clinical practitioners, clinical researchers and administrative staff from the CTN, the networks affiliated clinical and community sites and the NIDA Centre for the CTN. MEASUREMENTS: From a pool of 24 candidate items in four domains (biomedical/disease status; behaviors, symptoms and functioning; opioid treatment cascade; and morbidity and mortality), the panel completed an on-line questionnaire to rank items with defined specification on a 9-point scale for importance, with a standard 70% consensus criterion. FINDINGS: After the fourth round of the questionnaire and subsequent discussion, consensus was reached for five outcomes: two patient-reported (global impression of improvement and incident non-fatal overdose); one clinician-reported (illicit/non-medical drug toxicology); and two from administrative records (duration of treatment and fatal opioid poisoning). CONCLUSIONS: An e-Delphi consensus study has produced the US National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network opioid use disorder core outcomes set (version 1) for opioid use disorder treatment efficacy and effectiveness research.
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- 2022
11. Study protocol for the Innovative Support for Patients with SARS-COV-2 Infections Registry (INSPIRE): A longitudinal study of the medium and long-term sequelae of SARS-CoV-2 infection
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O’Laughlin, Kelli N, Thompson, Matthew, Hota, Bala, Gottlieb, Michael, Plumb, Ian D, Chang, Anna Marie, Wisk, Lauren E, Hall, Aron J, Wang, Ralph C, Spatz, Erica S, Stephens, Kari A, Huebinger, Ryan M, McDonald, Samuel A, Venkatesh, Arjun, Gentile, Nikki, Slovis, Benjamin H, Hill, Mandy, Saydah, Sharon, Idris, Ahamed H, Rodriguez, Robert, Krumholz, Harlan M, Elmore, Joann G, Weinstein, Robert A, and Nichol, Graham
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Patient Safety ,HIV/AIDS ,Clinical Trials and Supportive Activities ,Prevention ,Emerging Infectious Diseases ,Vaccine Related ,Biodefense ,Infectious Diseases ,Clinical Research ,Lung ,Pneumonia ,Cancer ,Infection ,Good Health and Well Being ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,COVID-19 ,Case-Control Studies ,Cohort Studies ,Female ,Humans ,Longitudinal Studies ,Male ,Middle Aged ,Palliative Care ,Patient Reported Outcome Measures ,Prognosis ,Registries ,SARS-CoV-2 ,Social Determinants of Health ,Therapies ,Investigational ,Time Factors ,Young Adult ,INSPIRE Investigators ,General Science & Technology - Abstract
BackgroundReports on medium and long-term sequelae of SARS-CoV-2 infections largely lack quantification of incidence and relative risk. We describe the rationale and methods of the Innovative Support for Patients with SARS-CoV-2 Registry (INSPIRE) that combines patient-reported outcomes with data from digital health records to understand predictors and impacts of SARS-CoV-2 infection.MethodsINSPIRE is a prospective, multicenter, longitudinal study of individuals with symptoms of SARS-CoV-2 infection in eight regions across the US. Adults are eligible for enrollment if they are fluent in English or Spanish, reported symptoms suggestive of acute SARS-CoV-2 infection, and if they are within 42 days of having a SARS-CoV-2 viral test (i.e., nucleic acid amplification test or antigen test), regardless of test results. Recruitment occurs in-person, by phone or email, and through online advertisement. A secure online platform is used to facilitate the collation of consent-related materials, digital health records, and responses to self-administered surveys. Participants are followed for up to 18 months, with patient-reported outcomes collected every three months via survey and linked to concurrent digital health data; follow-up includes no in-person involvement. Our planned enrollment is 4,800 participants, including 2,400 SARS-CoV-2 positive and 2,400 SARS-CoV-2 negative participants (as a concurrent comparison group). These data will allow assessment of longitudinal outcomes from SARS-CoV-2 infection and comparison of the relative risk of outcomes in individuals with and without infection. Patient-reported outcomes include self-reported health function and status, as well as clinical outcomes including health system encounters and new diagnoses.ResultsParticipating sites obtained institutional review board approval. Enrollment and follow-up are ongoing.ConclusionsThis study will characterize medium and long-term sequelae of SARS-CoV-2 infection among a diverse population, predictors of sequelae, and their relative risk compared to persons with similar symptomatology but without SARS-CoV-2 infection. These data may inform clinical interventions for individuals with sequelae of SARS-CoV-2 infection.
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- 2022
12. Association of initial opioid prescription duration and an opioid refill by pain diagnosis: Evidence from outpatient settings in ten US health systems
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Nguyen, Anh P., Palzes, Vanessa A., Binswanger, Ingrid A., Ahmedani, Brian K., Altschuler, Andrea, Andrade, Susan E., Bailey, Steffani R., Clark, Robin E., Haller, Irina V., Hechter, Rulin C., Karmali, Ruchir, Metz, Verena E., Poulsen, Melissa N., Roblin, Douglas W., Rosa, Carmen L., Rubinstein, Andrea L., Sanchez, Katherine, Stephens, Kari A., Yarborough, Bobbi Jo H., and Campbell, Cynthia I.
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- 2024
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13. Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial
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Crocker, Abigail M, Kessler, Rodger, van Eeghen, Constance, Bonnell, Levi N, Breshears, Ryan E, Callas, Peter, Clifton, Jessica, Elder, William, Fox, Chet, Frisbie, Sylvie, Hitt, Juvena, Jewiss, Jennifer, Kathol, Roger, Clark/Keefe, Kelly, O’Rourke-Lavoie, Jennifer, Leibowitz, George S, Macchi, CR, McGovern, Mark, Mollis, Brenda, Mullin, Daniel J, Nagykaldi, Zsolt, Natkin, Lisa Watts, Pace, Wilson, Pinckney, Richard G, Pomeroy, Douglas, Pond, Alexander, Postupack, Rachel, Reynolds, Paula, Rose, Gail L, Scholle, Sarah Hudson, Sieber, William J, Stancin, Terry, Stange, Kurt C, Stephens, Kari A, Teng, Kathryn, Waddell, Elizabeth Needham, and Littenberg, Benjamin
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Health Services and Systems ,Health Sciences ,Clinical Trials and Supportive Activities ,Comparative Effectiveness Research ,Health Services ,Behavioral and Social Science ,Mental Health ,Clinical Research ,Management of diseases and conditions ,7.3 Management and decision making ,7.1 Individual care needs ,Generic health relevance ,Good Health and Well Being ,Adult ,Health Care Costs ,Humans ,Outcome Assessment ,Health Care ,Patient-Centered Care ,Primary Health Care ,Randomized Controlled Trials as Topic ,Surveys and Questionnaires ,Behavioral health ,Primary care ,Multiple chronic conditions ,Pragmatic trials ,Randomized control trial ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Cardiovascular System & Hematology ,General & Internal Medicine ,Clinical sciences ,Epidemiology ,Health services and systems - Abstract
BackgroundChronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice's degree of behavioral health integration.MethodsForty-five primary care practices, with existing onsite behavioral health care, will be recruited for this study. Forty-three practices will be randomized to the intervention or usual care arm, while 2 practices will be considered "Vanguard" (pilot) practices for developing the intervention. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice's degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.DiscussionAs primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.Trial registrationClinicalTrials.gov NCT02868983 . Registered on August 16, 2016.
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- 2021
14. Characteristics of Family Physicians Practicing Collaboratively With Behavioral Health Professionals
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Tong, Sebastian T., Morgan, Zachary J., Stephens, Kari A., Bazemore, Andrew, and Peterson, Lars E.
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Integrated delivery networks -- Surveys -- Statistics ,Health care teams -- Surveys -- Statistics ,Psychiatric personnel -- Surveys ,Primary health care -- Surveys -- Management ,Physicians (General practice) -- Surveys ,Company business management ,Health ,Science and technology - Abstract
Integrating behavioral health into primary care can improve access to behavioral health and patient health outcomes. We used 2017-2021 American Board of Family Medicine continuing certificate examination registration questionnaire responses to determine the characteristics of family physicians who work collaboratively with behavioral health professionals. With a 100% response rate, 38.8% of 25,222 family physicians reported working collaboratively with behavioral health professionals, with those working in independently owned practices and in the South having substantially lower rates. Future research exploring these differences could help develop strategies to support family physicians implement integrated behavioral health to improve care for patients in these communities. Key words: behavioral medicine; integration of care; mental health services; primary health care https://doi.org/10.1370/afm.2947, INTRODUCTION The complexity of patients presenting in primary care continues to grow with an estimated 1 in 3 adults in the United States presenting with multiple chronic conditions. (1) The [...]
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- 2023
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15. Core outcomes set for research on the treatment of opioid use disorder (COS-OUD): the National Institute on Drug Abuse Clinical Trials Network protocol for an e-Delphi consensus study.
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Karnik, Niranjan, Campbell, Cynthia, Curtis, Megan, Fiellin, David, Ghitza, Udi, Hefner, Kathryn, Hser, Yih-Ing, McHugh, R, Murphy, Sean, McPherson, Sterling, Moran, Landhing, Mooney, Larissa, Wu, Li-Tzy, Shmueli-Blumberg, Dikla, Shulman, Matisyahu, Schwartz, Robert, Stephens, Kari, Watkins, Katherine, and Marsden, John
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Consensus ,Core outcome set ,E-Delphi survey ,Opioid use disorder ,Outcome reporting ,Patient-reported outcomes ,Adolescent ,Adult ,Aged ,Consensus ,Delphi Technique ,Endpoint Determination ,Female ,Humans ,Male ,Middle Aged ,National Institute on Drug Abuse (U.S.) ,Opioid-Related Disorders ,Research Design ,Treatment Outcome ,United States ,Young Adult - Abstract
BACKGROUND: A lack of consensus on the optimal outcome measures to assess the efficacy and effectiveness of interventions for the treatment of opioid use disorder (OUD) has hampered the pooling of research data for evidence synthesis and clinical guidelines. A core outcome set (COS) is a minimum set of outcome measures that are recommended for all studies of a particular condition. The National Drug Abuse Treatment Clinical Trials Network (CTN) Core Outcome Set for OUD (COS-OUD) is a development study to identify core constructs, meaningful outcomes, and their optimal measurement for all efficacy and effectiveness studies of OUD treatment and service delivery. METHODS/DESIGN: Overseen by an expert workgroup, a modified, stepwise, e-Delphi methodology will be used to gain consensus among a panel of clinical practitioners and researchers involved in the treatment of OUD, who are members of the CTN. Sequential rounds of anonymous, online questionnaires will be used to identify, rate the importance of, and refine a core outcome set. A consensus threshold will be achieved if at least 70% of the panel rate the measure as critical for inclusion in the COS-OUD. Where consensus is not reached or there are suggestions for new measures, these will be brought forward to a further round of review prior to a consensus meeting. Products from this study will be communicated via peer-reviewed scientific journals and conferences. DISCUSSION: This initiative will develop a COS for OUD intervention trials, treatment studies, and service delivery and will support the pooling of research and clinical practice data and efforts to develop measurement-based care within the OUD treatment cascade. TRIAL REGISTRATION: http://www.comet-initiative.org/Studies/Details/1579.
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- 2021
16. Integrated Primary Care Psychology Training Programs: Challenges and Strategies
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Ma, Kris Pui Kwan, Breedlove, Dominika, LePoire, Erin, Prado, Maria G., Ratzliff, Anna, and Stephens, Kari A.
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Health care teams -- Training -- Evaluation ,Psychology -- Methods ,Behavioral health care -- Methods ,Primary health care -- Methods ,Medical care -- Quality management ,Company business management ,Family and marriage ,Health ,Psychology and mental health - Abstract
Introduction: Integrating behavioral health in primary care improves quality of care and outcomes for patients with comorbid conditions. Shortage of a trained behavioral health workforce limits adoption. Professional psychology training programs contribute to recruitment, retention, and development of skilled providers, who value and deliver behavioral health services in primary care. This study interviewed a cohort of established psychology training programs in real-world, state-wide clinical primary care settings and identified their strategies and challenges with teaching practices and program resources that impact the robust quality of training. Method: Between December 2020 and March 2021, we conducted semistructured interviews with 12 licensed psychologists who oversaw nine integrated primary care psychology training programs at the internship and postdoctoral levels across Washington State. Data were analyzed using a thematic approach. Results: Programs taught psychology trainees about integrated primary care via extensive onboarding, modeling and shadowing, structured learning environment, interprofessional education opportunities, flexible and cross-disciplinary supervision, and a psychologically safe space. Teaching challenges included balancing scheduled and curbside supervision, pivoting to telehealth, and aligning trainee expectations and program requirements. Training programs were funded through different and multiple sources, but most lacked a stable funding mechanism, compounded by barriers for psychology trainees to bill for services, a lack of control over organization's budgeting decisions, and instability in funding renewal. Conclusion: Synergistic support from program, organization, and system/policy levels are needed to align teaching activities with clinical practice environments and invest in the growth and sustainability of psychology training programs on integrated primary care. Keywords: behavioral health, integrated primary care, interprofessional education, psychology, workforce, Integrated primary care, in which teams of medical providers and their behavioral health counterparts work closely together to address population health needs, has emerged in response to calls for a [...]
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- 2022
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17. Adapting and Implementing a Nurse Care Management Model for Rural Primary Care Patients with Chronic Pain
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Tong, Sebastian, primary, Keiser, Brennan, additional, Hoffman, Elise, additional, Ang, Dennis, additional, Belza, Basia, additional, Baldwin, Laura-Mae, additional, Lober, Bill, additional, Ludden, Thomas, additional, Stephens, Kari A., additional, Tapp, Hazel, additional, and Patel, Kushang, additional
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- 2024
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18. Examining the Needs of Patient Stakeholders as Research Partners in Health Data Networks for Translational Research.
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Stephens, Kari A, Osterhage, Katie P, Fiore-Gartland, Brittany, Lovins, Terri L, Keppel, Gina A, and Kim, Katherine K
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Information and Computing Sciences ,Health Services and Systems ,Human-Centred Computing ,Health Sciences ,Clinical Research ,Prevention ,7.3 Management and decision making ,Management of diseases and conditions ,Generic health relevance ,Good Health and Well Being - Abstract
Patient stakeholders are getting increasingly involved in research health data networks, particularly as research partners. However, tools do not exist to help effectively orient, educate, and engage patient stakeholders as they take on these roles. Using a human centered design approach, we conducted a patient stakeholder needs assessment qualitative study to identify key user needs to drive design recommendations for development of an online education and engagement tool for research health data networks. We found three key needs related to multiple role identities, motivations and expectations for participation on research teams, and patient journeys. Design recommendations derived from the needs assessment are discussed that can support future tool design and testing.
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- 2019
19. Examining the Needs of Patient Stakeholders as Research Partners in Health Data Networks for Translational Research.
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Stephens, Kari, Osterhage, Katie, Fiore-Gartland, Brittany, Lovins, Terri, Keppel, Gina, and Kim, Katherine
- Abstract
Patient stakeholders are getting increasingly involved in research health data networks, particularly as research partners. However, tools do not exist to help effectively orient, educate, and engage patient stakeholders as they take on these roles. Using a human centered design approach, we conducted a patient stakeholder needs assessment qualitative study to identify key user needs to drive design recommendations for development of an online education and engagement tool for research health data networks. We found three key needs related to multiple role identities, motivations and expectations for participation on research teams, and patient journeys. Design recommendations derived from the needs assessment are discussed that can support future tool design and testing.
- Published
- 2019
20. Integrated Behavioral Health Implementation Patterns in Primary Care Using the Cross-Model Framework: A Latent Class Analysis
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Buchanan, Gretchen J. R., Piehler, Timothy, Berge, Jerica, Hansen, Audrey, and Stephens, Kari A.
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- 2022
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21. The Impact of the COVID-19 Pandemic on Patient Disparities in Long-Term Opioid Therapy
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Tong, Sebastian T., primary, Zheng, Zihan, additional, Prado, Maria G., additional, West, Imara I., additional, LeMaster, Joseph W., additional, Hatch, Mary A., additional, Szabo, Lili S., additional, Anastas, Tracy M., additional, Ma, Kris Pui Kwan, additional, and Stephens, Kari A., additional
- Published
- 2024
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22. Effects of intervention stage completion in an integrated behavioral health and primary care randomized pragmatic intervention trial
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Stephens, Kari A., primary, van Eeghen, Constance, additional, Zheng, Zihan, additional, Anastas, Tracy, additional, Ma, Kris Pui Kwan, additional, Prado, Maria G., additional, Clifton, Jessica, additional, Rose, Gail, additional, Mullin, Daniel, additional, Chan, Kwun C. G., additional, and Kessler, Rodger, additional
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- 2024
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23. Patient and provider perceptions supporting chronic pain digital therapeutics in primary care
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Stephens, Kari, Ma, Kris "Pui Kwan", Zhang, Ying, Prado, Maria, Au, Margaret, Geyer, Rachel, Mollis, Brenda, Zbikowski, Susan, Waters, Deanna, MA, and Masterson, Jo
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Chronic pain -- Surveys -- Care and treatment ,Telemedicine -- Surveys -- Usage ,Patients -- Surveys ,Primary health care -- Methods -- Technology application -- Surveys ,Medical personnel -- Surveys ,Technology application ,Health ,Science and technology - Abstract
Context: Digital therapeutics may be uniquely positioned to address challenges reported by providers in chronic pain (CP) management. Previous studies have shown patient-provider discordance in priorities for CP management, which can be addressed in digital therapeutics development to encourage implementation and use. Objective: To assess primary care providers' and patients' perceptions of CP treatment goals and motivators for use of a digital therapeutic delivering CP related behavioral interventions. Study Design: Quantitative surveys. Setting: Participants were recruited from four primary care clinics in Washington and Colorado, two patient support groups, and one research community stakeholder group. Population Studied: The sample included 31 patients and 39 providers. Most patients identified as male (61.3%), non-Hispanic White (96.8%) and had experienced pain for one year or longer (90.3%). A mix of provider roles were included: primary care providers (46.2%), behavioral health providers (41.0%), clinical pharmacists (5.1%), and nurses (5.1%). All providers had experience treating patients with CP. Outcomes: Participants rated 10 CP treatment goals (e.g., quality of life, self-management skills) and 11 motivators for use (e.g., coaching, insurance payment coverage) of digital therapeutics on a 5-point Likert-scale. Descriptive statistics and Chi- Square tests were computed. Results: Patients and providers differed in their perceptions of importance across all treatment goals. Patients' ratings of treatment goals ranged from least to very important, whereas providers uniformly rated all treatment goals as very or extremely important (p < .05), and provider ratings of importance were consistently higher than patients (p < .05). Patients and providers on average did not rate motivators for use very high and they differed in their perceptions across six specific motivators. Providers rated friend recommendations and coaching features as more likely to motivate use than patients did (p < .05). Providers tended to rate more uniformly than patients on motivators related to insurance covering most of the cost, it being recommended by a provider or friend, and if the program was personalized with coaching (p < .05). Conclusions: Incorporating digital therapeutics in routine primary care may help improve CP management by providing customizable features that address diverse treatment goals, and bridge differing perspectives between providers and patients., Presenters Kari Stephens, PhD, Kris (Pui Kwan) Ma, PhD, Ying Zhang, MD, MPH, Maria Prado, MPH, Margaret Au, Rachel Geyer, MPH, Brenda Mollis, MA, MPA, MPH, Susan Zbikowski, PhD, Deanna [...]
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- 2023
24. Provider challenges and strategies with treating chronic pain: Informing development of digital therapeutics for primary care
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Ma, Kris "Pui Kwan", Zhang, Ying, Prado, Maria, Geyer, Rachel, Mollis, Brenda, Zbikowski, Susan, Waters, Deanna, Masterson, Jo, and Stephens, Kari
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Chronic pain -- Care and treatment -- Surveys ,Telemedicine -- Usage -- Quality management -- Surveys ,Primary health care -- Methods -- Technology application -- Surveys ,Technology application ,Health ,Science and technology - Abstract
Context: Digital therapeutics are growing as a solution to improve access and quality of care. Increasing evidence has shown the efficacy of digital therapeutics in managing pain for patients, but they are underutilized by primary care providers who see over half of the patients with chronic pain. Engaging providers to develop and use digital therapeutics with patients in chronic pain management has become necessary. Objective: This study explored primary care providers' challenges and strategies in chronic pain management to identify needs and practice gaps that inform development of digital therapeutics for chronic pain. Study Design: Qualitative study, using a human-centered design approach. Setting: Eleven providers from four primary care clinics in Washington and Colorado participated in semi-structured interviews between July and October 2021. Population Studied: The sample (N=11) included seven primary care physicians, two behavioral health providers, one physician assistant and one nurse. Most providers worked in clinics affiliated with urban, academic health systems or in federally qualified health centers. Outcomes: Interviews focused on provider goals in chronic pain management, challenges and strategies used, and perceptions of digital therapeutics. Results: Four themes related to provider needs emerged: patient-provider alliance, team-based care, tracking and monitoring, and social determinants of health. Providers desired resources to streamline pain education, counseling, and goal setting with patients. Greater accessibility to multidisciplinary care team consultations and non-pharmacological pain treatments would be beneficial to providers and patients. Infrastructure and systems are needed for providers to systematically track and monitor patients' pain. Providers requested assistance with connecting underserved patients to wraparound social services and addressing healthcare access barriers. Conclusion: Digital therapeutics for chronic pain would benefit from incorporating multimodal features that strengthen patient-provider alliance, increase access to non-pharmacological treatment options, support population health tracking and management, and provide equitable solutions that require lower sophistication of device and Internet access. Leveraging digital therapeutics in healthcare settings requires meeting provider needs at individual care and system levels., Presenters Kris (Pui Kwan) Ma, PhD, Ying Zhang, MD, MPH, Maria Prado, MPH, Rachel Geyer, MPH, Brenda Mollis, MA, MPA, MPH, Susan Zbikowski, PhD, Deanna Waters, MA, Jo Masterson, MBA, [...]
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- 2023
25. Service utilization and chronic condition outcomes among primary care patients with substance use disorders and co-occurring chronic conditions
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Stephens, Kari A., West, Imara I., Hallgren, Kevin A., Mollis, Brenda, Ma, Kris, Donovan, Dennis M., Stuvek, Brenda, and Baldwin, Laura-Mae
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- 2020
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26. Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network
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Hallgren, Kevin A., Witwer, Elizabeth, West, Imara, Baldwin, Laura-Mae, Donovan, Dennis, Stuvek, Brenda, Keppel, Gina A., Mollis, Brenda, and Stephens, Kari A.
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- 2020
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27. Implementing partnership-driven clinical federated electronic health record data sharing networks
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Stephens, Kari A, Anderson, Nicholas, Lin, Ching-Ping, and Estiri, Hossein
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Information and Computing Sciences ,Health Services and Systems ,Health Sciences ,Clinical Research ,Generic health relevance ,Computer Communication Networks ,Cooperative Behavior ,Databases as Topic ,Electronic Health Records ,Humans ,Information Dissemination ,Information Storage and Retrieval ,Models ,Organizational ,Software ,United States ,User-Computer Interface ,Information systems ,Data sharing ,Federated networks ,Implementation ,Electronic health records ,Engineering ,Medical and Health Sciences ,Medical Informatics ,Biomedical and clinical sciences ,Health sciences ,Information and computing sciences - Abstract
ObjectiveBuilding federated data sharing architectures requires supporting a range of data owners, effective and validated semantic alignment between data resources, and consistent focus on end-users. Establishing these resources requires development methodologies that support internal validation of data extraction and translation processes, sustaining meaningful partnerships, and delivering clear and measurable system utility. We describe findings from two federated data sharing case examples that detail critical factors, shared outcomes, and production environment results.MethodsTwo federated data sharing pilot architectures developed to support network-based research associated with the University of Washington's Institute of Translational Health Sciences provided the basis for the findings. A spiral model for implementation and evaluation was used to structure iterations of development and support knowledge share between the two network development teams, which cross collaborated to support and manage common stages.ResultsWe found that using a spiral model of software development and multiple cycles of iteration was effective in achieving early network design goals. Both networks required time and resource intensive efforts to establish a trusted environment to create the data sharing architectures. Both networks were challenged by the need for adaptive use cases to define and test utility.ConclusionAn iterative cyclical model of development provided a process for developing trust with data partners and refining the design, and supported measureable success in the development of new federated data sharing architectures.
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- 2016
28. A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions
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Littenberg, Benjamin, primary, Clifton, Jessica, additional, Crocker, Abigail M., additional, Baldwin, Laura-Mae, additional, Bonnell, Levi N., additional, Breshears, Ryan E., additional, Callas, Peter, additional, Chakravarti, Prama, additional, Clark/Keefe, Kelly, additional, Cohen, Deborah J., additional, deGruy, Frank V., additional, Eidt-Pearson, Lauren, additional, Elder, William, additional, Fox, Chester, additional, Frisbie, Sylvie, additional, Hekman, Katie, additional, Hitt, Juvena, additional, Jewiss, Jennifer, additional, Kaelber, David C., additional, Kelley, Kairn Stetler, additional, Kessler, Rodger, additional, O’Rourke-Lavoie, Jennifer B., additional, Leibowitz, George S., additional, Macchi, C. R., additional, Martin, Matthew P., additional, McGovern, Mark, additional, Mollis, Brenda, additional, Mullin, Daniel, additional, Nagykaldi, Zsolt, additional, Natkin, Lisa W., additional, Pace, Wilson, additional, Pinckney, Richard G., additional, Pomeroy, Douglas, additional, Reynolds, Paula, additional, Rose, Gail L., additional, Scholle, Sarah Hudson, additional, Sieber, William J., additional, Soucie, Jeni, additional, Stancin, Terry, additional, Stange, Kurt C., additional, Stephens, Kari A., additional, Teng, Kathryn, additional, Waddell, Elizabeth Needham, additional, and van Eeghen, Constance, additional
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- 2023
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29. Women and ethnoracial minorities with poor cardiovascular health measures associated with a higher risk of developing mood disorder
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Guo, Aixia, Stephens, Kari A., Khan, Yosef M., Langabeer, James R., and Foraker, Randi E.
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- 2021
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30. T105 - Prescription Opioid Dose Reductions and Potential Adverse Events: A Multi-Site Study in Eight U.S. Health Systems
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Metz, Verena, Ray, Thomas, Palzes, Vanessa, Binswanger, Ingrid, Altschuler, Andrea, Andrade, Susan, Clark, Robin, Haller, Irina, Hechter, Rulin, Roblin, Douglas, Bailey, Steffani, McCarty, Dennis, Stephens, Kari, Rubinstein, Andrea, Karmali, Ruchir, and Campbell, Cynthia
- Published
- 2024
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31. Integrated Behavioral Health in Primary Care Residency and Nonresidency Practices
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Ma, Kris Pui Kwan, primary, Mollis, Brenda L., additional, West, Imara I., additional, Rolfes, Jennifer, additional, Clifton, Jessica, additional, Kessler, Rodger, additional, Baldwin, Laura-Mae, additional, Chakravarti, Prama, additional, Dewane, Sarah, additional, Gerrish, Winslow, additional, Holmes, John, additional, Karlson, Katie, additional, Roberts, Verena, additional, and Stephens, Kari A., additional
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- 2023
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32. Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing
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Parchman, Michael L., Penfold, Robert B., Ike, Brooke, Tauben, David, Von Korff, Michael, Stephens, Mark, Stephens, Kari A., and Baldwin, Laura-Mae
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Opioid abuse -- Prevention ,Rural medicine -- Methods ,Pain management -- Methods ,Opioids -- Dosage and administration ,Prescriptions (Drugs) -- Methods ,Primary health care -- Methods ,Health ,Science and technology - Abstract
PURPOSE Six key elements of opioid medication management redesign in primary care have been previously identified. Here, we examine the effect of implementing these Six Building Blocks on opioid-prescribing practices. METHODS Six rural-serving organizations with 20 clinic locations received support for 15 months during the period October 2015 to May 2017 to implement the Six Building Blocks. Patients undergoing long-term opioid therapy (LtOT) at these study sites were compared with patients undergoing LtOT enrolled in a regional health plan who did not receive care at the study sites but who resided in the same primary care service areas (control group). Outcomes were monthly trend in the proportion of patients undergoing LtOT prescribed a >100 morphine equivalent dose (MED) of opioids daily and the total number of patients receiving an opioid prescription. An interrupted time series using difference- indifference analysis was used for tests of significance. RESULTS The proportion of patients prescribed a >100 MED of opioids daily decreased 2.2% (11.8% to 9.6%) among patients at the intervention clinics and 1.3% (14.0% to 12.7%) among patients in the control group. The rate of decrease was significantly greater among study patients than among patients in the control group (P = .018). The rate of decrease in the number of patients on LtOT at intervention clinics increased during the intervention period compared with the preintervention period (P CONCLUSIONS Efforts to redesign opioid medication management in primary care resulted in a significant decrease in opioid prescribing. Future research is needed to determine if these results are generalizable to other settings and to assess implications for patient-reported outcomes., INTRODUCTION Use of opioid medication long term for chronic pain has contributed to an epidemic of opioid overdose and addiction. (1) Although rates of opioid prescribing have moderated in recent [...]
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- 2019
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33. Symptoms and signs of lung cancer prior to diagnosis: case–control study using electronic health records from ambulatory care within a large US-based tertiary care centre
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Prado, Maria G, primary, Kessler, Larry G, additional, Au, Margaret A, additional, Burkhardt, Hannah A, additional, Zigman Suchsland, Monica, additional, Kowalski, Lesleigh, additional, Stephens, Kari A, additional, Yetisgen, Meliha, additional, Walter, Fiona M, additional, Neal, Richard D, additional, Lybarger, Kevin, additional, Thompson, Caroline A, additional, Al Achkar, Morhaf, additional, Sarma, Elizabeth A, additional, Turner, Grace, additional, Farjah, Farhood, additional, and Thompson, Matthew J, additional
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- 2023
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34. Prescription Opioid Taper Support for Outpatients With Chronic Pain: A Randomized Controlled Trial
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Sullivan, Mark D., Turner, Judith A., DiLodovico, Cory, D'Appollonio, Angela, Stephens, Kari, and Chan, Ya-Fen
- Published
- 2017
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35. Geospatial divide in real-world EHR data: Analytical workflow to assess regional biases and potential impact on health equity
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Xie, Serena Jinchen, Kapos, Flavia P., Mooney, Stephen J., Mooney, Sean, Stephens, Kari A., Chen, Cynthia, Hartzler, Andrea L., and Pratap, Abhishek
- Subjects
Articles - Abstract
Real-world data (RWD) like electronic health records (EHR) has great potential for secondary use by health systems and researchers. However, collected primarily for efficient health care, EHR data may not equitably represent local regions and populations, impacting the generalizability of insights learned from it. We assessed the geospatial representativeness of regions in a large health system EHR data using a spatial analysis workflow, which provides a data-driven way to quantify geospatial representation and identify adequately represented regions. We applied the workflow to investigate geospatial patterns of overweight/obesity and depression patients to find regional “hotspots” for potential targeted interventions. Our findings show the presence of geospatial bias in EHR and demonstrate the workflow to identify spatial clusters after adjusting for bias due to the geospatial representativeness. This work highlights the importance of evaluating geospatial representativeness in RWD to guide targeted deployment of limited healthcare resources and generate equitable real-world evidence.
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- 2023
36. Intersectionality of Systemic Disadvantage on Mortality and Care Following TBI
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Starosta, Amy J., primary, Mata-Greve, Felicia, additional, Humbert, Andrew, additional, Zheng, Zihan, additional, Prado, Maria G., additional, Au, Margaret A., additional, Mollis, Brenda, additional, Stephens, Kari A., additional, and Hoffman, Jeanne M., additional
- Published
- 2023
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37. Developing Digital Therapeutics for Chronic Pain in Primary Care: A Qualitative Human-Centered Design Study of Providers’ Motivations and Challenges
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Ma, Kris Pui Kwan, primary, Stephens, Kari A, additional, Geyer, Rachel E, additional, Prado, Maria G, additional, Mollis, Brenda L, additional, Zbikowski, Susan M, additional, Waters, Deanna, additional, Masterson, Jo, additional, and Zhang, Ying, additional
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- 2023
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38. Provider Challenges and Strategies with Treating Chronic Pain: Informing Development of Digital Therapeutics for Primary Care
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Ma, Kris (Pui Kwan), primary, Zhang, Ying, additional, Prado, Maria, additional, Geyer, Rachel, additional, Mollis, Brenda, additional, Zbikowski, Susan, additional, Waters, Deanna, additional, Masterson, Jo, additional, and Stephens, Kari, additional
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- 2023
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39. Patient and Provider Perceptions Supporting Chronic Pain Digital Therapeutics in Primary Care
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Stephens, Kari, primary, Ma, Kris (Pui Kwan), additional, Zhang, Ying, additional, Prado, Maria, additional, Au, Margaret, additional, Geyer, Rachel, additional, Mollis, Brenda, additional, Zbikowski, Susan, additional, Waters, Deanna, additional, and Masterson, Jo, additional
- Published
- 2023
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40. Characteristics of Family Physicians Who Work in Integrated Behavioral Health Practice Settings
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Tong, Sebastian, primary, Morgan, Zachary, additional, Stephens, Kari, additional, and Peterson, Lars, additional
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- 2023
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41. Implementing partnership-driven clinical federated electronic health record data sharing networks
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Stephens, Kari A., Anderson, Nicholas, Lin, Ching-Ping, and Estiri, Hossein
- Published
- 2016
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42. Integrated Behavioral Health in Primary Care Residency and Nonresidency Practices.
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Kwan Ma, Kris Pui, Mollis, Brenda L., West, Imara I., Rolfes, Jennifer, Clifton, Jessica, Kessler, Rodger, Baldwin, Laura-Mae, Chakravarti, Prama, Dewane, Sarah, Gerrish, Winslow, Holmes, John, Karlson, Katie, Roberts, Verena, and Stephens, Kari A.
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- 2023
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43. Three-Month Symptom Profiles Among Symptomatic Adults With Positive and Negative Severe Acute Respiratory Syndrome Coronavirus 2 Tests: A Prospective Cohort Study From the INSPIRE Group
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Spatz, Erica S, primary, Gottlieb, Michael, additional, Wisk, Lauren E, additional, Anderson, Jill, additional, Chang, Anna Marie, additional, Gentile, Nicole L, additional, Hill, Mandy J, additional, Huebinger, Ryan M, additional, Idris, Ahamed H, additional, Kinsman, Jeremiah, additional, Koo, Katherine, additional, Li, Shu-Xia, additional, McDonald, Samuel, additional, Plumb, Ian D, additional, Rodriguez, Robert M, additional, Saydah, Sharon, additional, Slovis, Benjamin, additional, Stephens, Kari A, additional, Unger, Elizabeth R, additional, Wang, Ralph C, additional, Yu, Huihui, additional, Hota, Bala, additional, Elmore, Joann G, additional, Weinstein, Robert A, additional, and Venkatesh, Arjun, additional
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- 2022
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44. How Timely Is Diagnosis of Lung Cancer? Cohort Study of Individuals with Lung Cancer Presenting in Ambulatory Care in the United States
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Zigman Suchsland, Monica, primary, Kowalski, Lesleigh, additional, Burkhardt, Hannah A., additional, Prado, Maria G., additional, Kessler, Larry G., additional, Yetisgen, Meliha, additional, Au, Maggie A., additional, Stephens, Kari A., additional, Farjah, Farhood, additional, Schleyer, Anneliese M., additional, Walter, Fiona M., additional, Neal, Richard D., additional, Lybarger, Kevin, additional, Thompson, Caroline A., additional, Achkar, Morhaf Al, additional, Sarma, Elizabeth A., additional, Turner, Grace, additional, and Thompson, Matthew, additional
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- 2022
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45. How Timely Is Diagnosis of Lung Cancer? Cohort Study of Individuals with Lung Cancer Presenting in Ambulatory Care in the United States
- Author
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Zigman Suchsland, Monica, Kowalski, Lesleigh, Burkhardt, Hannah A, Prado, Maria G, Kessler, Larry G, Yetisgen, Meliha, Au, Maggie A, Stephens, Kari A, Farjah, Farhood, Schleyer, Anneliese M, Walter, Fiona M, Neal, Richard D, Lybarger, Kevin, Thompson, Caroline A, Achkar, Morhaf Al, Sarma, Elizabeth A, Turner, Grace, Thompson, Matthew, Zigman Suchsland, Monica [0000-0001-7007-6973], Kowalski, Lesleigh [0000-0002-1742-6628], Burkhardt, Hannah A [0000-0002-9386-5569], Neal, Richard D [0000-0002-3544-2744], Lybarger, Kevin [0000-0001-5798-2664], Thompson, Caroline A [0000-0001-9990-9756], Achkar, Morhaf Al [0000-0002-4160-0550], and Apollo - University of Cambridge Repository
- Subjects
lung cancer ,diagnosis ,ambulatory care ,natural language processing ,diagnostic intervals ,Cancer Research ,Oncology ,Article - Abstract
Peer reviewed: True, Funder: Fred Hutchinson Cancer Research Center, The diagnosis of lung cancer in ambulatory settings is often challenging due to non-specific clinical presentation, but there are currently no clinical quality measures (CQMs) in the United States used to identify areas for practice improvement in diagnosis. We describe the pre-diagnostic time intervals among a retrospective cohort of 711 patients identified with primary lung cancer from 2012-2019 from ambulatory care clinics in Seattle, Washington USA. Electronic health record data were extracted for two years prior to diagnosis, and Natural Language Processing (NLP) applied to identify symptoms/signs from free text clinical fields. Time points were defined for initial symptomatic presentation, chest imaging, specialist consultation, diagnostic confirmation, and treatment initiation. Median and interquartile ranges (IQR) were calculated for intervals spanning these time points. The mean age of the cohort was 67.3 years, 54.1% had Stage III or IV disease and the majority were diagnosed after clinical presentation (94.5%) rather than screening (5.5%). Median intervals from first recorded symptoms/signs to diagnosis was 570 days (IQR 273-691), from chest CT or chest X-ray imaging to diagnosis 43 days (IQR 11-240), specialist consultation to diagnosis 72 days (IQR 13-456), and from diagnosis to treatment initiation 7 days (IQR 0-36). Symptoms/signs associated with lung cancer can be identified over a year prior to diagnosis using NLP, highlighting the need for CQMs to improve timeliness of diagnosis.
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- 2022
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46. Primary care challenges and strategies for treating chronic pain: Informing development of digital therapeutics (Preprint)
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Ma, Kris Pui Kwan, primary, Stephens, Kari A., additional, Geyer, Rachel, additional, Mollis, Brenda L., additional, Zbikowski, Susan M., additional, Waters, Deanna, additional, Masterson, Jo, additional, and Zhang, Ying, additional
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- 2022
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47. Payment strategies for behavioral health integration in hospital-affiliated and non-hospital-affiliated primary care practices
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Ma, Kris Pui Kwan, primary, Mollis, Brenda L, additional, Rolfes, Jennifer, additional, Au, Margaret, additional, Crocker, Abigail, additional, Scholle, Sarah H, additional, Kessler, Rodger, additional, Baldwin, Laura-Mae, additional, and Stephens, Kari A, additional
- Published
- 2022
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48. Exploring completeness in clinical data research networks with DQe-c
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Estiri, Hossein, Stephens, Kari A, Klann, Jeffrey G, and Murphy, Shawn N
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- 2018
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49. Three-Month Symptom Profiles Among Symptomatic Adults With Positive and Negative Severe Acute Respiratory Syndrome Coronavirus 2 Tests: A Prospective Cohort Study From the INSPIRE Group.
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Spatz, Erica S, Gottlieb, Michael, Wisk, Lauren E, Anderson, Jill, Chang, Anna Marie, Gentile, Nicole L, Hill, Mandy J, Huebinger, Ryan M, Idris, Ahamed H, Kinsman, Jeremiah, Koo, Katherine, Li, Shu-Xia, McDonald, Samuel, Plumb, Ian D, Rodriguez, Robert M, Saydah, Sharon, Slovis, Benjamin, Stephens, Kari A, Unger, Elizabeth R, and Wang, Ralph C
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EVALUATION of medical care ,COVID-19 ,SARS-CoV-2 ,MYALGIA ,MILD cognitive impairment ,COMPARATIVE studies ,SURVEYS ,SLEEP disorders ,RESEARCH funding ,FATIGUE (Physiology) ,HEADACHE ,POST-infectious disorders ,LONGITUDINAL method ,CLINICAL trial registries ,SYMPTOMS ,ADULTS - Abstract
Background Long-term symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are a major concern, yet their prevalence is poorly understood. Methods We conducted a prospective cohort study comparing adults with SARS-CoV-2 infection (coronavirus disease-positive [COVID+]) with adults who tested negative (COVID−), enrolled within 28 days of a Food and Drug Administration (FDA)-approved SARS-CoV-2 test result for active symptoms. Sociodemographic characteristics, symptoms of SARS-CoV-2 infection (assessed with the Centers for Disease Control and Prevention [CDC] Person Under Investigation Symptom List), and symptoms of post-infectious syndromes (ie, fatigue, sleep quality, muscle/joint pains, unrefreshing sleep, and dizziness/fainting, assessed with CDC Short Symptom Screener for myalgic encephalomyelitis/chronic fatigue syndrome) were assessed at baseline and 3 months via electronic surveys sent via text or email. Results Among the first 1000 participants, 722 were COVID+ and 278 were COVID−. Mean age was 41.5 (SD 15.2); 66.3% were female, 13.4% were Black, and 15.3% were Hispanic. At baseline, SARS-CoV-2 symptoms were more common in the COVID+ group than the COVID− group. At 3 months, SARS-CoV-2 symptoms declined in both groups, although were more prevalent in the COVID+ group: upper respiratory symptoms/head/eyes/ears/nose/throat (HEENT; 37.3% vs 20.9%), constitutional (28.8% vs 19.4%), musculoskeletal (19.5% vs 14.7%), pulmonary (17.6% vs 12.2%), cardiovascular (10.0% vs 7.2%), and gastrointestinal (8.7% vs 8.3%); only 50.2% and 73.3% reported no symptoms at all. Symptoms of post-infectious syndromes were similarly prevalent among the COVID+ and COVID− groups at 3 months. Conclusions Approximately half of COVID+ participants, as compared with one-quarter of COVID− participants, had at least 1 SARS-CoV-2 symptom at 3 months, highlighting the need for future work to distinguish long COVID. Clinical Trials Registration NCT04610515. [ABSTRACT FROM AUTHOR]
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- 2023
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50. The need for a measurement-based care professional practice guideline.
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Boswell, James F., primary, Hepner, Kimberly A., additional, Lysell, Kathleen, additional, Rothrock, Nan E., additional, Bott, Nick, additional, Childs, Amber W., additional, Douglas, Susan, additional, Owings-Fonner, Nicole, additional, Wright, C. Vaile, additional, Stephens, Kari A., additional, Bard, David E., additional, Aajmain, Syed, additional, and Bobbitt, Bruce L., additional
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- 2022
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