NAU publications by CHER
Faculty & staff publications
NAU faculty and staff have the opportunity to publish their findings and knowledge as authors. CHER has many researchers that have been cited multiple times in major publications for their great work. The Center for Health Equity Research has accumulated all faculty publications into one, easy to navigate database.
Please type in a key word or author LAST name to search
Green, Shana M; Turner, DeAnne; Baldwin, Julie A; Walsh-Buhi, Eric R; Vamos, Cheryl A; Dagne, Getachew; Marhefka, Stephanie L AIDS and Behavior, 2018. @article{Green2018, title = {Towards an Information Motivation and Behavioral Skills Model for New Sex Partners: Results of a Study of Condom Use as an HIV Prevention Method for Emerging Adults Who Met Partners on Dating and Sex-Seeking Platforms or Offline}, author = {Shana M Green and DeAnne Turner and Julie A Baldwin and Eric R Walsh-Buhi and Cheryl A Vamos and Getachew Dagne and Stephanie L Marhefka}, url = {https://link.springer.com/article/10.1007/s10461-018-2349-1#citeas}, year = {2018}, date = {2018-12-01}, journal = {AIDS and Behavior}, abstract = {The information, motivation, behavioral Skills (IMB) model was used to identify factors that affect condom use with new sex partners that were met offline or online. Mixed methods data were collected from adults between the ages of 18 and 29 years who reported a new sex partner. A model was composed of participants’ IMB scale scores to determine the effect of these variables on condom use. A subset of 20 survey participants completed interviews exploring how IMB model elements may have influenced their condom use. Mixed methods results showed condom use skills were influential for condom use during the first sexual encounter between new partners. Qualitative findings suggest the information and motivation may also influence condom use with new sex partners. The IMB model for new partners may be relevant model for the development of interventions that encourage emerging adults to use condoms at first sex with new sex partners.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The information, motivation, behavioral Skills (IMB) model was used to identify factors that affect condom use with new sex partners that were met offline or online. Mixed methods data were collected from adults between the ages of 18 and 29 years who reported a new sex partner. A model was composed of participants’ IMB scale scores to determine the effect of these variables on condom use. A subset of 20 survey participants completed interviews exploring how IMB model elements may have influenced their condom use. Mixed methods results showed condom use skills were influential for condom use during the first sexual encounter between new partners. Qualitative findings suggest the information and motivation may also influence condom use with new sex partners. The IMB model for new partners may be relevant model for the development of interventions that encourage emerging adults to use condoms at first sex with new sex partners. |
Boucher, Nathan; Bull, Janet; Cross, S H; Kirby, Christine; David, Kelly J; Taylor, D H Acceptability of Innovative Palliative Care Model: Healthcare Consumer and Federal Taxpayer Views Journal Article Innovation in Aging, 2 (S1), pp. 1, 2018. @article{Boucher2018d, title = {Acceptability of Innovative Palliative Care Model: Healthcare Consumer and Federal Taxpayer Views}, author = {Nathan Boucher and Janet Bull and S H Cross and Christine Kirby and J Kelly David and D H Taylor}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230062/}, doi = {10.1093/geroni/igy023.767}, year = {2018}, date = {2018-11-11}, journal = {Innovation in Aging}, volume = {2}, number = {S1}, pages = {1}, abstract = {Semi-structured interviews with palliative care users were conducted along with federal taxpayers focus groups to assess palliative care knowledge. Interviewers also queried acceptability of a new model of community-based palliative care. Gaps in interview participants’ knowledge related to knowing services available in palliative care, how palliative care is paid for, and how to initiate palliative care. Similar concerns were shared by focus groups with the addition of their noting improved knowledge of palliative care from the focus group itself. Interview participants’ feedback on the new model of care included not having palliative care explained adequately and palliative care providers seen as consultants rather than providing full-time attention to care. Focus groups indicated the model sounded promising, but likely difficult to enact in our current system. Additional feedback from interviews/focus groups included perceptions that clinicians spent more time and provided more support for patients/families, and the broader application of palliative care.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Semi-structured interviews with palliative care users were conducted along with federal taxpayers focus groups to assess palliative care knowledge. Interviewers also queried acceptability of a new model of community-based palliative care. Gaps in interview participants’ knowledge related to knowing services available in palliative care, how palliative care is paid for, and how to initiate palliative care. Similar concerns were shared by focus groups with the addition of their noting improved knowledge of palliative care from the focus group itself. Interview participants’ feedback on the new model of care included not having palliative care explained adequately and palliative care providers seen as consultants rather than providing full-time attention to care. Focus groups indicated the model sounded promising, but likely difficult to enact in our current system. Additional feedback from interviews/focus groups included perceptions that clinicians spent more time and provided more support for patients/families, and the broader application of palliative care. |
II, Robert Trotter T; Lininger, Monica R; Camplain, Ricky; Fofanov, Viacheslav Y; Camplain, Carolyn; Baldwin, Julie A International Journal of Environmental Research and Public Health, 15 (11), 2018. @article{II2018b, title = {A Survey of Health Disparities, Social Determinants of Health, and Converging Morbidities in a County Jail: A Cultural-Ecological Assessment of Health Conditions in Jail Populations}, author = {Robert Trotter T II and Monica R Lininger and Ricky Camplain and Viacheslav Y Fofanov and Carolyn Camplain and Julie A Baldwin}, url = {https://www.mdpi.com/1660-4601/15/11/2500}, year = {2018}, date = {2018-11-08}, journal = {International Journal of Environmental Research and Public Health}, volume = {15}, number = {11}, abstract = {The environmental health status of jail populations in the United States constitutes a significant public health threat for prisoners and the general population. The ecology of jails creates a dynamic condition in relation to general population health due to the concentrated potential exposure to infectious diseases, difficult access to treatment for chronic health conditions, interruption in continuity of care for serious behavioral health conditions, as well as on-going issues for the prevention and treatment of substance abuse disorders. This paper reports on elements of a cross-sectional survey embedded in a parent project, “Health Disparities in Jail Populations.” The overall project includes a comprehensive secondary data analysis of the health status of county jail populations, along with primary data collection that includes a cross-sectional health and health care services survey of incarcerated individuals, coupled with collection of biological samples to investigate infectious disease characteristics of a county jail population. This paper reports on the primary results of the survey data collection that indicate that this is a population with complex and interacting co-morbidities, as well as significant health disparities compared to the general population.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The environmental health status of jail populations in the United States constitutes a significant public health threat for prisoners and the general population. The ecology of jails creates a dynamic condition in relation to general population health due to the concentrated potential exposure to infectious diseases, difficult access to treatment for chronic health conditions, interruption in continuity of care for serious behavioral health conditions, as well as on-going issues for the prevention and treatment of substance abuse disorders. This paper reports on elements of a cross-sectional survey embedded in a parent project, “Health Disparities in Jail Populations.” The overall project includes a comprehensive secondary data analysis of the health status of county jail populations, along with primary data collection that includes a cross-sectional health and health care services survey of incarcerated individuals, coupled with collection of biological samples to investigate infectious disease characteristics of a county jail population. This paper reports on the primary results of the survey data collection that indicate that this is a population with complex and interacting co-morbidities, as well as significant health disparities compared to the general population. |
Walters, Karina L; Johnson-Jennings, Michelle; Stroud, Sandra; Rasmus, Stacy; Charles, Billy; John, Simeon; Allen, James; Kaholokula, Joseph Keawe‘aimoku; Look, Mele A; de Silva, Māpuana; Lowe, John; Baldwin, Julie A; Lawrence, Gary; Brooks, Jada; Noonan, Curtis W; Belcourt, Annie; Quintana, Eugenia; Semmens, Erin O; Boulafentis, Johna Prevention Science, pp. 1-11, 2018. @article{Walters2018, title = {Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian, Alaska Native, and Native Hawaiian Communities}, author = {Karina L Walters and Michelle Johnson-Jennings and Sandra Stroud and Stacy Rasmus and Billy Charles and Simeon John and James Allen and Joseph Keawe‘aimoku Kaholokula and Mele A Look and Māpuana de Silva and John Lowe and Julie A Baldwin and Gary Lawrence and Jada Brooks and Curtis W Noonan and Annie Belcourt and Eugenia Quintana and Erin O Semmens and Johna Boulafentis}, url = {https://link.springer.com/article/10.1007%2Fs11121-018-0952-z}, year = {2018}, date = {2018-11-06}, journal = {Prevention Science}, pages = {1-11}, abstract = {Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts “from the ground up.” Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts “from the ground up.” Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions. |
Walters, Karina L; Johnson-Jennings, Michelle; Stroud, Sandra; Rasmus, Stacy; Charles, Billy; John, Simeon; Allen, James; Kaholokula, Joseph Keawe‘aimoku; Look, Mele A; de Silva, Māpuana; Lowe, John; Baldwin, Julie A; Lawrence, Gary; Brooks, Jada; Noonan, Curtis W; Belcourt, Annie; Quintana, Eugenia; Semmens, Erin O; Boulafentis, Johna Prevention Science, pp. 1-11, 2018. @article{Walters2018b, title = {Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian, Alaska Native, and Native Hawaiian Communities.}, author = {Karina L. Walters and Michelle Johnson-Jennings and Sandra Stroud and Stacy Rasmus and Billy Charles and Simeon John and James Allen and Joseph Keawe‘aimoku Kaholokula and Mele A. Look and Māpuana de Silva and John Lowe and Julie A. Baldwin and Gary Lawrence and Jada Brooks and Curtis W. Noonan and Annie Belcourt and Eugenia Quintana and Erin O. Semmens and Johna Boulafentis}, url = {https://www.ncbi.nlm.nih.gov/pubmed/30397737}, doi = {10.1007/s11121-018-0952-z}, year = {2018}, date = {2018-11-06}, journal = {Prevention Science}, pages = {1-11}, abstract = {Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts "from the ground up." Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts "from the ground up." Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions. |
II, Robert Trotter T; Camplain, Ricky; Eaves, Emery R; Fofanov, Viacheslav Y; Dmitrieva, Natalia O; Hepp, Crystal M; Warren, Meghan; Barrios, Brianna A; Pagel, Nicole; Mayer, Alyssa; Baldwin, Julie A Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study Journal Article JMIR Res Protoc, 7 (10), 2018. @article{II2018b, title = {Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study}, author = {Robert Trotter T II and Ricky Camplain and Emery R Eaves and Viacheslav Y Fofanov and Natalia O Dmitrieva and Crystal M Hepp and Meghan Warren and Brianna A Barrios and Nicole Pagel and Alyssa Mayer and Julie A Baldwin}, editor = {Gunther Eysenbach and Nicola Kuter}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231773/}, year = {2018}, date = {2018-10-24}, journal = {JMIR Res Protoc}, volume = {7}, number = {10}, abstract = {Background Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. Objective This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. Methods The project has two processes—a secondary data analysis and primary data collection—which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the “honest broker” system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. Results To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. Conclusions This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. International Registered Report Identifier (IRRID) RR1-10.2196/10337}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Incarcerated populations have increased in the last 20 years and >12 million individuals cycle in and out of jails each year. Previous research has predominately focused on the prison population. However, a substantial gap exists in understanding the health, well-being, and health care utilization patterns in jail populations. Objective This pilot study has 5 main objectives: (1) define recidivists of the jail system, individuals characterized by high incarceration rates; (2) describe and compare the demographic and clinical characteristics of incarcerated individuals; (3) identify jail-associated health disparities; (4) estimate associations between incarceration and health; and (5) describe model patterns in health care and jail utilization. Methods The project has two processes—a secondary data analysis and primary data collection—which includes a cross-sectional health survey and biological sample collection to investigate infectious disease characteristics of the jail population. This protocol contains pilot elements in four areas: (1) instrument validity and reliability; (2) individual item assessment; (3) proof of concept of content and database accessibility; and (4) pilot test of the “honest broker” system. Secondary data analysis includes the analysis of 6 distinct databases, each covered by a formal memorandum of agreement between Northern Arizona University and the designated institution: (1) the Superior Court of Arizona Public Case Finder database; (2) North Country Health Care; (3) Health Choice Integrated Care; (4) Criminal Justice Information Services; (5) Correctional Electronic Medical Records; and (6) iLEADS. We will perform data integration processes using an automated honest broker design. We will administer a cross-sectional health survey, which includes questions about health status, health history, health care utilization, substance use practices, physical activity, adverse childhood events, and behavioral health, among 200 Coconino County Detention Facility inmates. Concurrent with the survey administration, we will collect Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus (samples from the nose) and dental microbiome (Streptococcus sobrinus and Streptococcus mutans samples from the mouth) from consenting participants. Results To date, we have permission to link data across acquired databases. We have initiated data transfer, protection, and initial assessment of the 6 secondary databases. Of 199 inmates consented and enrolled, we have permission from 97.0% (193/199) to access and link electronic medical and incarceration records to their survey responses, and 95.0% (189/199) of interviewed inmates have given nasal and buccal swabs for analysis of S. aureus and the dental microbiome. Conclusions This study is designed to increase the understanding of health needs and health care utilization patterns among jail populations, with a special emphasis on frequently incarcerated individuals. Our findings will help identify intervention points throughout the criminal justice and health care systems to improve health and reduce health disparities among jail inmates. International Registered Report Identifier (IRRID) RR1-10.2196/10337 |
Trotter, Robert ; Camplain, Ricky ; Eaves, Emery ; Fofanov, Viacheslav Y; Dmitrieva, Natalia ; Hepp, Crystal ; Warren, Meghan ; Barrios, Brianna ; Mayer, Alyssa ; Baldwin, Julie Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study Journal Article Journal of Medical Internet Research, 7 (10), 2018. @article{Trotter2018, title = {Health Disparities and Converging Epidemics in Jail Populations: Protocol for a Mixed-Methods Study}, author = {Trotter, Robert and Camplain, Ricky and Eaves, Emery and Fofanov, Viacheslav Y and Dmitrieva, Natalia and Hepp, Crystal and Warren, Meghan and Barrios, Brianna and Mayer, Alyssa and Baldwin, Julie}, doi = {10.2196/10337}, year = {2018}, date = {2018-10-01}, journal = {Journal of Medical Internet Research}, volume = {7}, number = {10}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
Boucher, Nathan A; Bull, Janet H; Cross, Sarah H; Kirby, Christine; Davis, Kelly J; Jr., Donald Taylor H Patient, caregiver and taxpayer knowledge of palliative care and views on a model of community-based palliative care Journal Article Journal of Pain and Symptom Management, 2018. @article{Boucher2018, title = {Patient, caregiver and taxpayer knowledge of palliative care and views on a model of community-based palliative care}, author = {Nathan A Boucher and Janet H Bull and Sarah H Cross and Christine Kirby and Kelly J Davis and Donald Taylor H Jr.}, url = {https://www.sciencedirect.com/science/article/pii/S0885392418304378}, year = {2018}, date = {2018-08-25}, journal = {Journal of Pain and Symptom Management}, abstract = {Context Palliative care (PC) model delivered by two large hospices and PC providers. Objectives To understand study participants' knowledge of PC and acceptability of a new community-based PC model. Methods Semistructured interview with patients and caregivers; focus groups with taxpayers. Descriptive content analysis with an inductive approach. Results Across 10 interviews and four focus groups (n = 4–10 per group), there was varying knowledge of PC. Gaps in interview and focus group participants' knowledge related to knowing the services available in PC, how PC is paid for, how to initiate PC, and how PC affects the patient's relationship with existing providers. Regarding the model, negative feedback from interview participants included not having PC explained adequately and PC providers seen as consultants and not as full-time providers. Focus group participants indicated that the model sounded promising but noted the likely difficulty in enacting it in our current health care system. Positive feedback from interview participants included the perception that clinicians spent more time and provided more support for patients and families and the developing ability of PC services to provide care more broadly than at the very end of life. Focus group participants had similar observations related to perceived attention to care and broader application of PC. Perceptions of time-constrained care delivery and suboptimal provider-patient communication persist for some patients getting PC services. Conclusion Education for patients, caregivers, and community members about the roles and benefits of PC will be needed to successfully expand community-based PC.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Context Palliative care (PC) model delivered by two large hospices and PC providers. Objectives To understand study participants' knowledge of PC and acceptability of a new community-based PC model. Methods Semistructured interview with patients and caregivers; focus groups with taxpayers. Descriptive content analysis with an inductive approach. Results Across 10 interviews and four focus groups (n = 4–10 per group), there was varying knowledge of PC. Gaps in interview and focus group participants' knowledge related to knowing the services available in PC, how PC is paid for, how to initiate PC, and how PC affects the patient's relationship with existing providers. Regarding the model, negative feedback from interview participants included not having PC explained adequately and PC providers seen as consultants and not as full-time providers. Focus group participants indicated that the model sounded promising but noted the likely difficulty in enacting it in our current health care system. Positive feedback from interview participants included the perception that clinicians spent more time and provided more support for patients and families and the developing ability of PC services to provide care more broadly than at the very end of life. Focus group participants had similar observations related to perceived attention to care and broader application of PC. Perceptions of time-constrained care delivery and suboptimal provider-patient communication persist for some patients getting PC services. Conclusion Education for patients, caregivers, and community members about the roles and benefits of PC will be needed to successfully expand community-based PC. |
Boucher, Nathan A; Bull, Janet H; Cross, Sarah H; Kirby, Christine; Davis, Kelly J; Taylor, Jr. Donald H Patient, Caregiver, and Taxpayer Knowledge of Palliative Care and Views on a Model of Community-Based Palliative Care Journal Article Journal of pain and Symptom Management, 56 (6), pp. 951-956, 2018. @article{Boucher2018b, title = {Patient, Caregiver, and Taxpayer Knowledge of Palliative Care and Views on a Model of Community-Based Palliative Care}, author = {Nathan A Boucher and Janet H Bull and Sarah H Cross and Christine Kirby and Kelly J Davis and Jr. Donald H. Taylor}, url = {https://www.sciencedirect.com/science/article/pii/S0885392418304378?dgcid=coauthor}, doi = {https://doi.org/10.1016/j.jpainsymman.2018.08.007}, year = {2018}, date = {2018-08-25}, journal = {Journal of pain and Symptom Management}, volume = {56}, number = {6}, pages = {951-956}, abstract = {Abstract Context Palliative care (PC) model delivered by two large hospices and PC providers. Objectives To understand study participants' knowledge of PC and acceptability of a new community-based PC model. Methods Semistructured interview with patients and caregivers; focus groups with taxpayers. Descriptive content analysis with an inductive approach. Results Across 10 interviews and four focus groups (n = 4–10 per group), there was varying knowledge of PC. Gaps in interview and focus group participants' knowledge related to knowing the services available in PC, how PC is paid for, how to initiate PC, and how PC affects the patient's relationship with existing providers. Regarding the model, negative feedback from interview participants included not having PC explained adequately and PC providers seen as consultants and not as full-time providers. Focus group participants indicated that the model sounded promising but noted the likely difficulty in enacting it in our current health care system. Positive feedback from interview participants included the perception that clinicians spent more time and provided more support for patients and families and the developing ability of PC services to provide care more broadly than at the very end of life. Focus group participants had similar observations related to perceived attention to care and broader application of PC. Perceptions of time-constrained care delivery and suboptimal provider-patient communication persist for some patients getting PC services. Conclusion Education for patients, caregivers, and community members about the roles and benefits of PC will be needed to successfully expand community-based PC.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Abstract Context Palliative care (PC) model delivered by two large hospices and PC providers. Objectives To understand study participants' knowledge of PC and acceptability of a new community-based PC model. Methods Semistructured interview with patients and caregivers; focus groups with taxpayers. Descriptive content analysis with an inductive approach. Results Across 10 interviews and four focus groups (n = 4–10 per group), there was varying knowledge of PC. Gaps in interview and focus group participants' knowledge related to knowing the services available in PC, how PC is paid for, how to initiate PC, and how PC affects the patient's relationship with existing providers. Regarding the model, negative feedback from interview participants included not having PC explained adequately and PC providers seen as consultants and not as full-time providers. Focus group participants indicated that the model sounded promising but noted the likely difficulty in enacting it in our current health care system. Positive feedback from interview participants included the perception that clinicians spent more time and provided more support for patients and families and the developing ability of PC services to provide care more broadly than at the very end of life. Focus group participants had similar observations related to perceived attention to care and broader application of PC. Perceptions of time-constrained care delivery and suboptimal provider-patient communication persist for some patients getting PC services. Conclusion Education for patients, caregivers, and community members about the roles and benefits of PC will be needed to successfully expand community-based PC. |
Williamson, Heather J; Perkins, Elizabeth A; Massey, Oliver T; Baldwin, Julie A; Lulinski, Amie; Armstrong, Mary I; Levins, Bruce L Family Caregivers as Needed Partners: Recognizing Their Role in Medicaid Managed Long‐Term Services and Supports Journal Article Journal of Policy and Practice in Intellectual Disabilities, 15 (3), pp. 214-225, 2018. @article{Williamson2018, title = {Family Caregivers as Needed Partners: Recognizing Their Role in Medicaid Managed Long‐Term Services and Supports}, author = {Heather J Williamson and Elizabeth A Perkins and Oliver T Massey and Julie A Baldwin and Amie Lulinski and Mary I Armstrong and Bruce L Levins}, url = {https://onlinelibrary.wiley.com/doi/full/10.1111/jppi.12258}, year = {2018}, date = {2018-08-24}, journal = {Journal of Policy and Practice in Intellectual Disabilities}, volume = {15}, number = {3}, pages = {214-225}, abstract = {Adults with intellectual and/or developmental disabilities (IDD) in the United States are supported by both formal Medicaid‐funded long‐term services and supports and family caregivers. Lack of alternative housing options and wait lists for long‐term services and supports means the role of the family caregiver is and will continue be critical. Rising long‐term services and supports costs combined with goals to improve care coordination and access to services are driving more states to change the design of their long‐term services and supports systems to a Medicaid‐Managed Long‐Term Services and Supports (MLTSS) approach. Best practices for implementing MLTSS for individuals with IDD include acknowledging the family caregiver role. The current study's aim is to understand how family caregivers and their roles are recognized in MLTSS for adults with IDD in Kansas. Kansas was selected given their unique approach to MLTSS for adults with IDD, referred to as KanCare. In‐depth semi‐structured telephone interviews were completed with 31 stakeholders in Kansas, including statewide/regional representatives (N = 13), service coordination providers (N = 7), and family caregivers (N = 11). Additional family support services were available in KanCare, but families had difficulty accessing them. No formal processes were reported for assessing the needs of family caregivers in KanCare and families found communications with managed care entities challenging. Families reported difficulties with taking on responsibility of managing in‐home supports and there were concerns about being paid to provide care as a guardian. Family caregivers play a critical role in MLTSS, including assisting with care coordination and access to services. However, their role was not formally acknowledged in KanCare. Future research, practice, and policy efforts should focus on promoting family caregiver assessments and identifying best practices for supporting family caregivers in MLTSS.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Adults with intellectual and/or developmental disabilities (IDD) in the United States are supported by both formal Medicaid‐funded long‐term services and supports and family caregivers. Lack of alternative housing options and wait lists for long‐term services and supports means the role of the family caregiver is and will continue be critical. Rising long‐term services and supports costs combined with goals to improve care coordination and access to services are driving more states to change the design of their long‐term services and supports systems to a Medicaid‐Managed Long‐Term Services and Supports (MLTSS) approach. Best practices for implementing MLTSS for individuals with IDD include acknowledging the family caregiver role. The current study's aim is to understand how family caregivers and their roles are recognized in MLTSS for adults with IDD in Kansas. Kansas was selected given their unique approach to MLTSS for adults with IDD, referred to as KanCare. In‐depth semi‐structured telephone interviews were completed with 31 stakeholders in Kansas, including statewide/regional representatives (N = 13), service coordination providers (N = 7), and family caregivers (N = 11). Additional family support services were available in KanCare, but families had difficulty accessing them. No formal processes were reported for assessing the needs of family caregivers in KanCare and families found communications with managed care entities challenging. Families reported difficulties with taking on responsibility of managing in‐home supports and there were concerns about being paid to provide care as a guardian. Family caregivers play a critical role in MLTSS, including assisting with care coordination and access to services. However, their role was not formally acknowledged in KanCare. Future research, practice, and policy efforts should focus on promoting family caregiver assessments and identifying best practices for supporting family caregivers in MLTSS. |
King, Caroline; Atwood, Sidney; Lozada, Mia; Nelson, Adrianne Katrina; Brown, Chris; Sabo, Samantha; Curley, Cameron; Muskett, Olivia; Orav, Endel John; Shin, Sonya PLoS ONE, 13 (8), 2018. @article{King2018b, title = {Identifying risk factors for 30-day readmission events among American Indian patients with diabetes in the Four Corners region of the southwest from 2009 to 2016.}, author = {Caroline King and Sidney Atwood and Mia Lozada and Adrianne Katrina Nelson and Chris Brown and Samantha Sabo and Cameron Curley and Olivia Muskett and Endel John Orav and Sonya Shin}, editor = {Prabath W. B. Nanayakkara}, url = {https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195476}, doi = {10.1371/journal.pone.0195476}, year = {2018}, date = {2018-08-02}, journal = {PLoS ONE}, volume = {13}, number = {8}, abstract = {OBJECTIVE: The objective of this study was to identify risk factors for 30-day readmission events for American Indian patients with diabetes in the southwest. RESEARCH DESIGN AND METHODS: Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using logistic regression analyses. RESULTS: Of 2,660 patients, 394 (14.8%) patients had at least one readmission within 30 days of discharge. Older age (OR (95% CI) = 1.26, (1.17, 1.36)), longer length of stay (OR (95% CI) = 1.01, (1.0001, 1.0342)), and a history of substance use disorder (OR (95% CI) = 1.80, (1.25, 2.60)) were risk factors for 30-day readmission. An American Indian language preference was protective against readmission. CONCLUSIONS: Readmission events are complex and may reflect broad and interwoven disparities in community systems. Future research should work to support community-defined interventions to address both in hospital and external factors that impact risk factors for readmission.}, keywords = {}, pubstate = {published}, tppubtype = {article} } OBJECTIVE: The objective of this study was to identify risk factors for 30-day readmission events for American Indian patients with diabetes in the southwest. RESEARCH DESIGN AND METHODS: Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using logistic regression analyses. RESULTS: Of 2,660 patients, 394 (14.8%) patients had at least one readmission within 30 days of discharge. Older age (OR (95% CI) = 1.26, (1.17, 1.36)), longer length of stay (OR (95% CI) = 1.01, (1.0001, 1.0342)), and a history of substance use disorder (OR (95% CI) = 1.80, (1.25, 2.60)) were risk factors for 30-day readmission. An American Indian language preference was protective against readmission. CONCLUSIONS: Readmission events are complex and may reflect broad and interwoven disparities in community systems. Future research should work to support community-defined interventions to address both in hospital and external factors that impact risk factors for readmission. |
Cordova-Marks, Felina M; Harris, Robin; Teufel-Shone, Nicolette; Norton, Beatrice; Mastergeorge, Ann M; Gerald, Lynn Characteristics of American Indian female caregivers on a Southwest American Indian reservation Journal Article Journal of Community Health, 2018. @article{Cordova-Marks2018, title = {Characteristics of American Indian female caregivers on a Southwest American Indian reservation}, author = {Felina M Cordova-Marks and Robin Harris and Nicolette Teufel-Shone and Beatrice Norton and Ann M Mastergeorge and Lynn Gerald}, url = {https://link.springer.com/article/10.1007%2Fs10900-018-0552-7}, year = {2018}, date = {2018-07-28}, journal = {Journal of Community Health}, abstract = {American Indian (AI) caregivers have been excluded from national survey efforts. Drawing from a 2012 survey administered on the Hopi Reservation in northern Arizona, 20% of adults are caregivers. More information is needed to guide program development tailored to Hopi needs. In a University-Community collaboration, a 58 question survey was administered to self-identified caregivers of a family member about amount and type of care provided, difficulties, caregiver health, and desired support services. Characteristics of caregivers and their experiences were described. Forty-four (44) female Hopi caregivers were interviewed from June–October 2017, mean age of 59 years (± 12.6) with mean 5.5 year (± 4.4) history of providing care. Over 84% provided care to either a parent or grandparent. Most caregivers provided transportation (93.2%), housework (93.2%), and medical related care (72.7%). Caregivers stated they had difficulties with not having enough time for family and or friends (88.6%), financial burdens (75.0%), and not having enough time for themselves (61.4%). The most frequently identified difficulty was stress (45.5%). Caregivers would like additional services, with 76.7% asking for training. Over 77% would not consider placing their relative in an assisted living facility. Compared to national data, Hopi female caregivers are older, provide more care hours/week, more caregiving duties, and for a longer number of years. Stress is the most reported difficulty, although lower than national levels. As caregivers are resistant to placing the recipient in assisted living, educational efforts should focus on training caregivers to assist the care recipient and decreasing caregiver stress.}, keywords = {}, pubstate = {published}, tppubtype = {article} } American Indian (AI) caregivers have been excluded from national survey efforts. Drawing from a 2012 survey administered on the Hopi Reservation in northern Arizona, 20% of adults are caregivers. More information is needed to guide program development tailored to Hopi needs. In a University-Community collaboration, a 58 question survey was administered to self-identified caregivers of a family member about amount and type of care provided, difficulties, caregiver health, and desired support services. Characteristics of caregivers and their experiences were described. Forty-four (44) female Hopi caregivers were interviewed from June–October 2017, mean age of 59 years (± 12.6) with mean 5.5 year (± 4.4) history of providing care. Over 84% provided care to either a parent or grandparent. Most caregivers provided transportation (93.2%), housework (93.2%), and medical related care (72.7%). Caregivers stated they had difficulties with not having enough time for family and or friends (88.6%), financial burdens (75.0%), and not having enough time for themselves (61.4%). The most frequently identified difficulty was stress (45.5%). Caregivers would like additional services, with 76.7% asking for training. Over 77% would not consider placing their relative in an assisted living facility. Compared to national data, Hopi female caregivers are older, provide more care hours/week, more caregiving duties, and for a longer number of years. Stress is the most reported difficulty, although lower than national levels. As caregivers are resistant to placing the recipient in assisted living, educational efforts should focus on training caregivers to assist the care recipient and decreasing caregiver stress. |
Tyson, Dinorah Martinez; Teran, Enrique; Dao, Lillie Uyen-Loan; Chee, Vanessa; Hernandez, Isabel; Flores, Mercedes; Ortiz, Miguel Reina; Izurieta, Ricardo; Baldwin, Julie A Cancer is in Style: Lifestyle change and the perceived impact of globalization on Andean indigenous communities in Ecuador Journal Article Ethnicity and Health, 2018. @article{Tyson2018, title = {Cancer is in Style: Lifestyle change and the perceived impact of globalization on Andean indigenous communities in Ecuador}, author = {Dinorah Martinez Tyson and Enrique Teran and Lillie Uyen-Loan Dao and Vanessa Chee and Isabel Hernandez and Mercedes Flores and Miguel Reina Ortiz and Ricardo Izurieta and Julie A Baldwin}, url = {https://www.tandfonline.com/doi/abs/10.1080/13557858.2018.1493437?journalCode=ceth20}, doi = {10.1080/13557858.2018.1493437}, year = {2018}, date = {2018-07-04}, journal = {Ethnicity and Health}, abstract = {Introduction: There is a paucity of information on cancer among Indigenous populations in Latin America. Methods: Guided by tenets of community engaged research and syndemic theory, we conducted eight focus groups (n = 59) with Kichwa men and women in the province of Imbabura, Ecuador. Data were analyzed using applied thematic analysis techniques. Results: Cancer emerged as an important health problem and was reported as a growing concern. Kichwa participants in this study attributed the rise in cancer to (1) exposure to chemicals and pesticides, (2) urbanization and development, and (3) the rise of innutritious, westernized diets. Conclusion: Our findings suggest that the Kichwa are attuned to the global phenomena in which traditional diet has been replaced by western, processed foods and fast food, which result in higher levels of chronic diseases such as cancer. More research is needed to understand the cancer burden among Indigenous peoples in Latin America.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Introduction: There is a paucity of information on cancer among Indigenous populations in Latin America. Methods: Guided by tenets of community engaged research and syndemic theory, we conducted eight focus groups (n = 59) with Kichwa men and women in the province of Imbabura, Ecuador. Data were analyzed using applied thematic analysis techniques. Results: Cancer emerged as an important health problem and was reported as a growing concern. Kichwa participants in this study attributed the rise in cancer to (1) exposure to chemicals and pesticides, (2) urbanization and development, and (3) the rise of innutritious, westernized diets. Conclusion: Our findings suggest that the Kichwa are attuned to the global phenomena in which traditional diet has been replaced by western, processed foods and fast food, which result in higher levels of chronic diseases such as cancer. More research is needed to understand the cancer burden among Indigenous peoples in Latin America. |
Siwon, Jang; Liller, Karen; Baldwin, Julie A; Zhu, Yiliang; VandeWeerd, Carla The relationship between high school coaches' injury beliefs and practices Journal Article Health Behavior and Policy Review, 5 (4), pp. 39-49, 2018. @article{Siwon2018, title = {The relationship between high school coaches' injury beliefs and practices}, author = {Jang Siwon and Karen Liller and Julie A Baldwin and Yiliang Zhu and Carla VandeWeerd }, url = {https://www.ingentaconnect.com/contentone/psp/hbpr/2018/00000005/00000004/art00005}, doi = {10.14485/HBPR.5.4.5}, year = {2018}, date = {2018-07-01}, journal = {Health Behavior and Policy Review}, volume = {5}, number = {4}, pages = {39-49}, abstract = {Objective In this paper, we describe high school coaches’ beliefs and knowledge pertaining to sports injury and their readiness for the practice of high school injury prevention. Methods A mixed-methods approach was used to assess 111 Florida high school coaches’ beliefs and knowledge related to sports injury, readiness for injury prevention practice, and the relationship between coaches’ beliefs, knowledge and readiness. Results Whereas only 22% of respondents exhibited high injury susceptibility beliefs, levels of self-efficacy were strongly related to particular injury prevention behaviors. Coaches who employed medical staff were 4 times more likely to implement prevention programs and have emergency plans. Conclusion This research supports coaches having access to evidence-based injury prevention programs and policies should be developed on the need for coaches to execute prevention programs.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective In this paper, we describe high school coaches’ beliefs and knowledge pertaining to sports injury and their readiness for the practice of high school injury prevention. Methods A mixed-methods approach was used to assess 111 Florida high school coaches’ beliefs and knowledge related to sports injury, readiness for injury prevention practice, and the relationship between coaches’ beliefs, knowledge and readiness. Results Whereas only 22% of respondents exhibited high injury susceptibility beliefs, levels of self-efficacy were strongly related to particular injury prevention behaviors. Coaches who employed medical staff were 4 times more likely to implement prevention programs and have emergency plans. Conclusion This research supports coaches having access to evidence-based injury prevention programs and policies should be developed on the need for coaches to execute prevention programs. |
Dickerson, Daniel; Baldwin, Julie A; Belcourt, Annie; Belone, Lorenda; Gittelsohn, Joel; Kaholokula, Joseph Keawe'aimoku; Lowe, John; Patten, Christi A; Wallerstein, Nina Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions Journal Article Prevention Science, 2018. @article{Dickerson2018, title = {Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions}, author = {Daniel Dickerson and Julie A Baldwin and Annie Belcourt and Lorenda Belone and Joel Gittelsohn and Joseph Keawe'aimoku Kaholokula and John Lowe and Christi A Patten and Nina Wallerstein}, url = {https://link.springer.com/article/10.1007%2Fs11121-018-0926-1}, doi = {10.1007/s11121-018-0926-1}, year = {2018}, date = {2018-06-29}, journal = {Prevention Science}, abstract = {American Indians/Alaska Natives/Native Hawaiians (AI/AN/NHs) disproportionately experience higher rates of various health conditions. Developing culturally centered interventions targeting health conditions is a strategy to decrease the burden of health conditions among this population. This study analyzes characteristics from 21 studies currently funded under the Interventions for Health Promotion and Disease Prevention in Native American (NA) Populations program among investigators currently funded under this grant mechanism. Four broad challenges were revealed as critical to address when scientifically establishing culturally centered interventions for Native populations. These challenges were (a) their ability to harness culture-centered knowledge and perspectives from communities; (b) their utilization of Indigenous-based theories and knowledge systems with Western-based intervention paradigms and theories; (c) their use of Western-based methodologies; and (d) their cultural adaptation, if based on an evidence-based treatment. Findings revealed that qualitative methodologies and community-based participatory research (CBPR) approaches were very commonly used to finalize the development of interventions. Various Indigenous-based theories and knowledge systems and Western-based theories were used in the methodologies employed. Cultural adaptations were made that often used formative mixed qualitative and quantitative methods. Illustrative examples of strategies used and suggestions for future research are provided. Findings underscored the importance of CBPR methods to improve the efficacy of interventions for AI/AN/NH communities by integrating Indigenous-based theories and knowledge systems with Western science approaches to improve health.}, keywords = {}, pubstate = {published}, tppubtype = {article} } American Indians/Alaska Natives/Native Hawaiians (AI/AN/NHs) disproportionately experience higher rates of various health conditions. Developing culturally centered interventions targeting health conditions is a strategy to decrease the burden of health conditions among this population. This study analyzes characteristics from 21 studies currently funded under the Interventions for Health Promotion and Disease Prevention in Native American (NA) Populations program among investigators currently funded under this grant mechanism. Four broad challenges were revealed as critical to address when scientifically establishing culturally centered interventions for Native populations. These challenges were (a) their ability to harness culture-centered knowledge and perspectives from communities; (b) their utilization of Indigenous-based theories and knowledge systems with Western-based intervention paradigms and theories; (c) their use of Western-based methodologies; and (d) their cultural adaptation, if based on an evidence-based treatment. Findings revealed that qualitative methodologies and community-based participatory research (CBPR) approaches were very commonly used to finalize the development of interventions. Various Indigenous-based theories and knowledge systems and Western-based theories were used in the methodologies employed. Cultural adaptations were made that often used formative mixed qualitative and quantitative methods. Illustrative examples of strategies used and suggestions for future research are provided. Findings underscored the importance of CBPR methods to improve the efficacy of interventions for AI/AN/NH communities by integrating Indigenous-based theories and knowledge systems with Western science approaches to improve health. |
Camplain, Ricky; Kucharska-Newton, Anna; Keyserling, Thomas C; Layton, Bradley J; Loehr, Laura; Heiss, Gerardo Incidence of Heart Failure Observed in Emergency Departments, Ambulatory Clinics, and Hospitals Journal Article The American Journal of Cardiology, 121 (1), pp. 1328-1335, 2018. @article{Camplain2018, title = {Incidence of Heart Failure Observed in Emergency Departments, Ambulatory Clinics, and Hospitals}, author = {Ricky Camplain and Anna Kucharska-Newton and Thomas C Keyserling and Bradley J Layton and Laura Loehr and Gerardo Heiss}, url = {https://www.sciencedirect.com/science/article/pii/S0002914918302509?via%3Dihub}, doi = {10.1016/j.amjcard.2018.02.014}, year = {2018}, date = {2018-06-01}, journal = {The American Journal of Cardiology}, volume = {121}, number = {1}, pages = {1328-1335}, abstract = {Reports on the burden of heart failure (HF) have largely omitted HF diagnosed in outpatient settings. We quantified annual incidence rates ([IR] per 1,000 person years) of HF identified in ambulatory clinics, emergency departments (EDs), and during hospital stays in a national probability sample of Medicare beneficiaries from 2008 to 2014, by age and race/ethnicity. A 20% random sample of Medicare beneficiaries ages ≥65 years with continuous Medicare Parts A, B, and D coverage was used to estimate annual IRs of HF identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Of the 681,487 beneficiaries with incident HF from 2008 to 2014, 283,451 (41%) presented in ambulatory clinics, 76,919 (11%) in EDs, and 321,117 (47%) in hospitals. Overall, incidence of HF in ambulatory clinics decreased from 2008 (IR 22.2, 95% confidence interval [CI] 22.0, 22.4) to 2014 (IR 15.0, 95% CI 14.8, 15.1). Similarly, incidence of HF-related ED visits without an admission to the hospital decreased somewhat from 2008 (IR 5.5, 95% CI 5.4, 5.6) to 2012 (IR 4.2, 95% CI 4.1, 4.3) and stabilized from 2013 to 2014. Similar to previous reports, HF hospitalizations, both International Classification of Diseases, Ninth Revision, Clinical Modification code 428.x in the primary and any position, decreased over the study period. More than half of all new cases of HF in Medicare beneficiaries presented in an ambulatory clinic or ED. The overall incidence of HF decreased from 2008 to 2014, regardless of health-care setting. In conclusion, consideration of outpatient HF is warranted to better understand the burden of HF and its temporal trends.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Reports on the burden of heart failure (HF) have largely omitted HF diagnosed in outpatient settings. We quantified annual incidence rates ([IR] per 1,000 person years) of HF identified in ambulatory clinics, emergency departments (EDs), and during hospital stays in a national probability sample of Medicare beneficiaries from 2008 to 2014, by age and race/ethnicity. A 20% random sample of Medicare beneficiaries ages ≥65 years with continuous Medicare Parts A, B, and D coverage was used to estimate annual IRs of HF identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Of the 681,487 beneficiaries with incident HF from 2008 to 2014, 283,451 (41%) presented in ambulatory clinics, 76,919 (11%) in EDs, and 321,117 (47%) in hospitals. Overall, incidence of HF in ambulatory clinics decreased from 2008 (IR 22.2, 95% confidence interval [CI] 22.0, 22.4) to 2014 (IR 15.0, 95% CI 14.8, 15.1). Similarly, incidence of HF-related ED visits without an admission to the hospital decreased somewhat from 2008 (IR 5.5, 95% CI 5.4, 5.6) to 2012 (IR 4.2, 95% CI 4.1, 4.3) and stabilized from 2013 to 2014. Similar to previous reports, HF hospitalizations, both International Classification of Diseases, Ninth Revision, Clinical Modification code 428.x in the primary and any position, decreased over the study period. More than half of all new cases of HF in Medicare beneficiaries presented in an ambulatory clinic or ED. The overall incidence of HF decreased from 2008 to 2014, regardless of health-care setting. In conclusion, consideration of outpatient HF is warranted to better understand the burden of HF and its temporal trends. |
King, Caroline; Atwood, Sidney; Brown, Chris; Nelson, Adrianne Katrina; Lozada, Mia; Wei, Jennie; Merino, Maricruz; Curley, Cameron; Muskett, Olivia; Sabo, Samantha; Gampa, Vikas; Orav, John; Shin, Sonya Primary Care Diabetes, 12 (3), pp. 212-217, 2018. @article{King2018, title = {Primary care and survival among American Indian patients with diabetes in the Southwest United States: Evaluation of a cohort study at Gallup Indian Medical Center, 2009-2016}, author = {Caroline King and Sidney Atwood and Chris Brown and Adrianne Katrina Nelson and Mia Lozada and Jennie Wei and Maricruz Merino and Cameron Curley and Olivia Muskett and Samantha Sabo and Vikas Gampa and John Orav and Sonya Shin}, url = {https://www.primary-care-diabetes.com/article/S1751-9918(17)30184-5/fulltext}, year = {2018}, date = {2018-06-01}, journal = {Primary Care Diabetes}, volume = {12}, number = {3}, pages = {212-217}, abstract = {Objectives To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States. Methods Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses. Results Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI) = 0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p < 0.001). The median survival time for patients who had seen a primary care provider was 2322 days versus 2158 days for those who had not seen a primary care provider. Conclusions Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objectives To evaluate the role of primary care healthcare delivery on survival for American Indian patients with diabetes in the southwest United States. Methods Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using a log-rank test and Cox Proportional Hazards analyses. Results Of the 2661 patients included in analysis, 286 patients died during the study period. Having visited a primary care provider in the year prior to first admission of the study period was protective against all-cause mortality in unadjusted analysis (HR (95% CI) = 0.47 (0.31, 0.73)), and after adjustment. The log-rank test indicated there is a significant difference in overall survival by primary care engagement history prior to admission (p < 0.001). The median survival time for patients who had seen a primary care provider was 2322 days versus 2158 days for those who had not seen a primary care provider. Conclusions Compared with those who did not see a primary care provider in the year prior to admission, having seen a primary care provider was associated with improved survival after admission. |
Vassy, Jason L; Davis, Kelly J; Kirby, Christine; Richardson, Ian J; Green, Robert C; McGuire, Amy L; Ubel, Peter A How primary care providers talk to patients about genome sequencing results: Risk, rationale, and recommendation Journal Article Journal of General Internal Medicine, 33 (6), pp. 877-885, 2018. @article{Vassy2018, title = {How primary care providers talk to patients about genome sequencing results: Risk, rationale, and recommendation}, author = {Jason L Vassy and Kelly J Davis and Christine Kirby and Ian J Richardson and Robert C Green and Amy L McGuire and Peter A Ubel}, url = {https://link.springer.com/article/10.1007/s11606-017-4295-4}, year = {2018}, date = {2018-06-01}, journal = {Journal of General Internal Medicine}, volume = {33}, number = {6}, pages = {877-885}, abstract = {Background Genomics will play an increasingly prominent role in clinical medicine. Objective To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Design Qualitative analysis. Participants PCPs and their generally healthy patients undergoing genome sequencing. Approach Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients’ office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. Key Results For each genomic result discussed in 48 PCP–patient visits, we identified a “take-home” message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. Conclusions PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Genomics will play an increasingly prominent role in clinical medicine. Objective To describe how primary care physicians (PCPs) discuss and make clinical recommendations about genome sequencing results. Design Qualitative analysis. Participants PCPs and their generally healthy patients undergoing genome sequencing. Approach Patients received clinical genome reports that included four categories of results: monogenic disease risk variants (if present), carrier status, five pharmacogenetics results, and polygenic risk estimates for eight cardiometabolic traits. Patients’ office visits with their PCPs were audio-recorded, and summative content analysis was used to describe how PCPs discussed genomic results. Key Results For each genomic result discussed in 48 PCP–patient visits, we identified a “take-home” message (recommendation), categorized as continuing current management, further treatment, further evaluation, behavior change, remembering for future care, or sharing with family members. We analyzed how PCPs came to each recommendation by identifying 1) how they described the risk or importance of the given result and 2) the rationale they gave for translating that risk into a specific recommendation. Quantitative analysis showed that continuing current management was the most commonly coded recommendation across results overall (492/749, 66%) and for each individual result type except monogenic disease risk results. Pharmacogenetics was the most common result type to prompt a recommendation to remember for future care (94/119, 79%); carrier status was the most common type prompting a recommendation to share with family members (45/54, 83%); and polygenic results were the most common type prompting a behavior change recommendation (55/58, 95%). One-fifth of recommendation codes associated with monogenic results were for further evaluation (6/24, 25%). Rationales for these recommendations included patient context, family context, and scientific/clinical limitations of sequencing. Conclusions PCPs distinguish substantive differences among categories of genome sequencing results and use clinical judgment to justify continuing current management in generally healthy patients with genomic results. |
Teufel-Shone, Nicolette; Jiang, Luohua; Rockwell, Jennifer; Chang, Jennifer; Beals, Janette; Bullock, Ann; Manson, Spero M Food choices and distress in reservation-based American Indians and Alaska Natives with type 2 diabetes Journal Article Public Health Nutrition, pp. 1-9, 2018. @article{Teufel-Shone2018, title = {Food choices and distress in reservation-based American Indians and Alaska Natives with type 2 diabetes}, author = {Nicolette Teufel-Shone and Luohua Jiang and Jennifer Rockwell and Jennifer Chang and Janette Beals and Ann Bullock and Spero M Manson}, url = {https://doi.org/10.1017/S1368980018000897}, doi = {10.1017/S1368980018000897}, year = {2018}, date = {2018-03-12}, journal = {Public Health Nutrition}, pages = {1-9}, abstract = {Objective: To examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives (AI/AN) with type 2 diabetes. Design: Participants completed a sociodemographic survey, an FFQ and the Kessler-6 Distress Scale. Foods were identified as ‘healthy’ or ‘unhealthy’ using a classification grounded in the health education provided by the programme case managers; healthy and unhealthy food scores were calculated using reported intake frequencies. Pearson’s correlation coefficients for distress and food scores were calculated for all participants and by gender. Multiple linear regression models stratified by gender assessed the association between distress and food scores, controlling for sociodemographics and duration of type 2 diabetes. Setting: Rural AI reservations and AN villages. Subjects: AI/AN (n 2484) with type 2 diabetes. Results: Both males (34·9 %) and females (65·1 %) had higher healthy food scores than unhealthy scores. In bivariate analysis, distress level had a significant negative correlation with healthy food scores among female participants, but the association was not significant among males. Significant positive correlations between distress and unhealthy food scores were found in both genders. In the final multivariate models, healthy food scores were not significantly related to distress; however, unhealthy food scores showed significant positive relationships with distress for both genders (females: β = 0·078}, keywords = {}, pubstate = {published}, tppubtype = {article} } Objective: To examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives (AI/AN) with type 2 diabetes. Design: Participants completed a sociodemographic survey, an FFQ and the Kessler-6 Distress Scale. Foods were identified as ‘healthy’ or ‘unhealthy’ using a classification grounded in the health education provided by the programme case managers; healthy and unhealthy food scores were calculated using reported intake frequencies. Pearson’s correlation coefficients for distress and food scores were calculated for all participants and by gender. Multiple linear regression models stratified by gender assessed the association between distress and food scores, controlling for sociodemographics and duration of type 2 diabetes. Setting: Rural AI reservations and AN villages. Subjects: AI/AN (n 2484) with type 2 diabetes. Results: Both males (34·9 %) and females (65·1 %) had higher healthy food scores than unhealthy scores. In bivariate analysis, distress level had a significant negative correlation with healthy food scores among female participants, but the association was not significant among males. Significant positive correlations between distress and unhealthy food scores were found in both genders. In the final multivariate models, healthy food scores were not significantly related to distress; however, unhealthy food scores showed significant positive relationships with distress for both genders (females: β = 0·078 |
Sabo, Samantha; Champion, Catalina Denman; Bell, Melanie L; Vucovich, Elsa Cornejo; Ingram, Maia; Valencia, Celina; del Vasquez, Maria Carmen Castro; Gonzalez-Fagoaga, Eduardo; de Zapien, Jill Geurnsey; Rosales, Cecilia B Meta Salud Diabetes study protocol: A cluster-randomized trial to reduce cardiovascular risk among a diabetic population of Mexico Journal Article BMJ Open, 8 (3), 2018. @article{Sabo2018, title = {Meta Salud Diabetes study protocol: A cluster-randomized trial to reduce cardiovascular risk among a diabetic population of Mexico}, author = {Samantha Sabo and Catalina Denman Champion and Melanie L Bell and Elsa Cornejo Vucovich and Maia Ingram and Celina Valencia and Maria Carmen Castro del Vasquez and Eduardo Gonzalez-Fagoaga and Jill Geurnsey de Zapien and Cecilia B Rosales}, url = {https://bmjopen.bmj.com/content/bmjopen/8/3/e020762.full.pdf}, doi = {10.1136/bmjopen-2017-020762}, year = {2018}, date = {2018-03-12}, journal = {BMJ Open}, volume = {8}, number = {3}, abstract = {Introduction Northern Mexico has among the highest rates of cardiovascular disease (CVD) and diabetes in the world. This research addresses core gaps in implementation science to develop, test and scale-up CVD risk-reduction interventions in diabetics through a national primary care health system. Methods and analysis The Meta Salud Diabetes (MSD) research project is a parallel two-arm cluster-randomized clinical behavioral trial based in 22 (n=22) health centers in Sonora, Mexico. MSD aims to evaluate the effectiveness of the MSD intervention for the secondary prevention of CVD risk factors among a diabetic population (n=320) compared with the study control of usual care. The MSD intervention consists of 2-hour class sessions delivered over a 13-week period providing educational information to encourage sustainable behavioral change to prevent disease complications including the adoption of physical activity. MSD is delivered within the context of Mexico’s national primary care health centre system by health professionals, including nurses, physicians and community health workers via existing social support groups for individuals diagnosed with chronic disease. Mixed models are used to estimate the effect of MSD by comparing cardiovascular risk, as measured by the Framingham Risk Score, between the trial arms. Secondary outcomes include hypertension, behavioral risk factors and psychosocial factors. Ethics and dissemination This work is supported by the National Institutes of Health, National Heart Lung and Blood Institute (1R01HL125996-01) and approved by the University of Arizona Research Institutional Review Board (Protocol 1508040144) and the Research Bioethics Committee at the University of Sonora. The first Internal Review Board approval date was 31 August 2015 with five subsequent approved amendments. This article refers to protocol V.0.2, dated 30 January 2017. Results will be disseminated via peer-reviewed publication and presentation at international conferences and will be shared through meetings with health systems officials.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Introduction Northern Mexico has among the highest rates of cardiovascular disease (CVD) and diabetes in the world. This research addresses core gaps in implementation science to develop, test and scale-up CVD risk-reduction interventions in diabetics through a national primary care health system. Methods and analysis The Meta Salud Diabetes (MSD) research project is a parallel two-arm cluster-randomized clinical behavioral trial based in 22 (n=22) health centers in Sonora, Mexico. MSD aims to evaluate the effectiveness of the MSD intervention for the secondary prevention of CVD risk factors among a diabetic population (n=320) compared with the study control of usual care. The MSD intervention consists of 2-hour class sessions delivered over a 13-week period providing educational information to encourage sustainable behavioral change to prevent disease complications including the adoption of physical activity. MSD is delivered within the context of Mexico’s national primary care health centre system by health professionals, including nurses, physicians and community health workers via existing social support groups for individuals diagnosed with chronic disease. Mixed models are used to estimate the effect of MSD by comparing cardiovascular risk, as measured by the Framingham Risk Score, between the trial arms. Secondary outcomes include hypertension, behavioral risk factors and psychosocial factors. Ethics and dissemination This work is supported by the National Institutes of Health, National Heart Lung and Blood Institute (1R01HL125996-01) and approved by the University of Arizona Research Institutional Review Board (Protocol 1508040144) and the Research Bioethics Committee at the University of Sonora. The first Internal Review Board approval date was 31 August 2015 with five subsequent approved amendments. This article refers to protocol V.0.2, dated 30 January 2017. Results will be disseminated via peer-reviewed publication and presentation at international conferences and will be shared through meetings with health systems officials. |
Sorry, no publications matched your criteria.