A Randomized Controlled Trial of Community Health Workers Using Patient Stories to Support Hypertension Management: Preliminary Results

Background: Uncontrolled hypertension is a significant public health problem in the U.S. with about one half of people able to keep blood pressure under control. Furthermore, the social and economic costs of poor hypertension control are staggering. Community Health Worker (CHW) interventions are a low-cost, culturally tailored approach to improve chronic disease outcomes. Methods: This randomized trial conducted at two Community Health Centers (CHCs) in Massachusetts assessed the effect of CHWs assisting patients with hypertension. CHWs, trained in motivational interviewing, used video narratives from patients who have worked to control their BP through diet, exercise, and better medication adherence. Participants enrolled in the study were randomly assigned to immediate intervention or a delayed intervention (DI) (4 to 6 months later). Each participant received a DVD and met with a CHW 5 times (twice in person and three times telephonically) over six months. Results: One hundred seventy-one patients were randomly assigned to one of two treatment conditions. Participants ranged in age from 25 to 79 years old (mean = 56 years old). Seventy-three percent of participants were Hispanic and reported speaking Spanish at home. The intervention group experienced a significant reduction in BP over the 6 month period of time they were receiving the intervention. At 6 months, the average systolic BP declined from 141 at baseline to 136 (p Discussion: Having culturally appropriate tools, such as narrative videos and CHWs trained in motivational interviewing, can be an important, cost effective aid to educate, support, and encourage people to manage hypertension

Testing a Planned Missing Design to Reduce Respondent Burden in Web and SMS Administrations of the CAHPS Clinician and Group Survey (CG-CAHPS)

We test a planned missing design to reduce respondent burden in Web and SMS administrations of the CAHPS Clinician and Group Survey (CG-CAHPS), a survey of patient experiences widely used by health care providers. Members of an online nonprobability panel were randomly assigned to one of three invitation and data collection mode protocols: email invitation to a Web survey, SMS invitation to a Web survey, or SMS invitation to an SMS survey. Within these three mode protocols, respondents were randomly assigned to a planned missing design, which shortened the survey by about 40%, or to a control group that received the survey in its entirety. We compare survey duration, breakoff and completion rates, and five key patient experience measures across conditions to assess the effect of the planned missing design across the three modes. We found that a planned missing design worked well with our Web survey, reducing survey duration and breakoff without changing estimates relative to the full-survey control condition. However, mixed findings in the SMS survey suggest that even shortened, 15-item surveys may be too long to substantially reduce respondent burden. We conclude with recommendations for future research

Psychometric properties of the Impact Index in patients with chronic conditions

The purpose of this paper was to extend the generalizability of the patient-reported Impact Index by assessing convergent validity in patients with common chronic conditions. We conducted a cross-sectional survey of 1,000 English-speaking patients aged 21 and older who visited their provider in the past 6 months and were included in one or more of a hospital’s chronic condition registries. Patients completed a survey that included the Impact Index (4-item measure of how impacted a patient is by their health condition: range 0-12, higher score indicating greater negative impact on quality of life), overall health, and self-report of diagnosis of 8 chronic conditions. Patients were categorized as having symptomatic conditions (one or more symptomatic conditions) or asymptomatic conditions. We hypothesized that Impact Index scores would be negatively correlated with overall health, positively correlated with the number of chronic conditions (using Pearson correlations) and would be higher for symptomatic than asymptomatic conditions (using an independent t-test). Of the 492 respondents (50% response rate), 381/392 eligible respondents completed all Impact Index items. Impact Index scores ranged from 0 to 12 (M=6, SD=4). As reports of overall health increased (i.e., from poor to excellent), Impact Index scores decreased (r=-0.59, p\u3c.001). As the number of chronic conditions increased, so did Impact Index scores (r=0.33, p\u3c.001). Patients with symptomatic conditions reported higher Impact Index scores (M=6.6, SD=3.5) than those with asymptomatic conditions (M=4.1, SD=3.5, p\u3c.001, d=.70). These findings support the validity of the Impact Index for patients with a range of chronic conditions. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Acute Care Surgery Patterns in the Current Era: Results of a Qualitative Study

Introduction: Since Acute Care Surgery (ACS) was first conceptualized as a specialty a decade ago, ACS teams have been widely adopted. Little is known about the structure and function of these teams. Methods: We conducted 18 open-ended interviews with ACS leaders (1 interview/center representing geographic [New England, Northeast, Mid-Atlantic, South, West, Midwest] and practice [Public/Charity, Community, University] variations). Two independent reviewers analyzed transcribed interviews using an inductive approach to determine major themes in practice variation (NVivo qualitative analysis software). Results: All respondents described ACS as a specialty treating time sensitive surgical disease including trauma, emergency general surgery (EGS), and surgical critical care (SCC). 11/18 combined trauma and EGS into a single clinical team; 6/18 included elective general surgery. Emergency orthopedics, neurosurgery, and triage for all surgical services were rare (1/18 each). 11/18 had blocked OR time. All had a core group of trauma and SCC surgeons; 8/18 shared EGS due to volume, manpower, or competition for EGS call. Many (12/18) had formal morning signout rounds; few (2/18) had prospective EGS data registries. Streamlined access to EGS, evidence-based EGS protocols, and improved communication were considered strengths of ACS. ACS was described as the last great surgical service reinvigorated to provide timely, cost-effective EGS by experts in resuscitation and critical care and to attract young, talented, eager surgeons to trauma and SCC; however, there was concern that it might become the waste basket for everything that happens at inconvenient times. Conclusion: Despite rapid adoption of ACS, its implementation varies widely. Standardization of scope of practice, continuity of care, and registry development may improve EGS outcomes and allow the specialty to thrive

Chinese and white Canadian satisfaction and compliance with physicians

BACKGROUND: Patient satisfaction has become an important indicator of primary care and healthcare system performance. Ethnic disparities in patient satisfaction and compliance with physician care have been studied in several countries. However, this issue has not received significant attention in Canada. The unique characteristics of the Canadian healthcare system and ethnic population make it worthwhile to examine this issue in this population. Therefore, we conducted a survey among Chinese and Whites in a Canadian city to determine their reported satisfaction, and perceptions of physicians. METHODS: The survey was conducted in English, Mandarin and Cantonese in 2005 among Chinese and White Canadians, 18 years of age or older, who had visited at least one physician in Canada. RESULTS: We analyzed 746 Chinese and 711 Whites in the general practitioner (GP) visit group and 485 Chinese and 637 Whites in the specialist visit group. A lower proportion of Chinese compared to Whites reported that they were very satisfied or satisfied with GP (73.7% vs. 92.8%) and specialist care (75.5% vs. 85.6%) and the differences between the two groups remained after adjustment for demographic variables and chronic conditions (risk adjusted OR: 0.70, 95%CI: 0.42–1.18 for the GP visit group and OR: 0.77, 95%CI: 0.48–1.23 for the specialist visit group). A similar proportion of Chinese and Whites reported that they always followed a physician's advice (59.4% vs. 59.6% for the GP visit group and 67.2% vs. 62.8% for the specialist visit group). Non-English speaking Chinese and recent arrivals in Canada were less likely to be satisfied with GPs than Chinese born in Canada [risk adjusted OR: 0.5, 95%CI: 0.3–0.9, 0.2 and 0.1–0.7, respectively]. CONCLUSION: Chinese Canadians reported lower satisfaction with physicians and perceived physicians slightly more negatively than White Canadians. Particularly, Chinese with limited English and short length of stay in Canada were less satisfied than Canadian born Chinese

English Language Proficiency and Geographical Proximity to a Safety Net Clinic as a Predictor of Health Care Access

Studies suggest that proximity to a safety net clinic (SNC) promotes access to care among the uninsured. Distance-based barriers to care may be greater for people with limited English proficiency (LEP), compared to those who are English proficient (EP), but this has not been explored. We assessed the relationship between distance to the nearest SNC and access in non-rural uninsured adults in California, and examined whether this relationship differs by language proficiency. Using the 2005 California Health Interview Survey and a list we compiled of California’s SNCs, we calculated distance between uninsured interviewee residence and the exact address of the nearest SNC. Using multivariate regression to adjust for other relevant characteristics, we examined associations between this distance and interviewee’s probability of having a usual source of health care (USOC) and having visited a physician in the prior 12 months. To examine differences by language proficiency, we included interactions between distance and language proficiency. Uninsured LEP adults living within 2 miles of a SNC were 9.3% less likely than their EP counterparts to have a USOC (P = 0.046). Further, distance to the nearest SNC was inversely associated with the probability of having a USOC among LEP, but not among EP; consequently, the difference between LEP and EP in the probability of having a USOC widened with increasing distance to the nearest SNC. There was no difference between LEP and EP adults living within 2 miles of a SNC in likelihood of having a physician visit; however, as with USOC, distance to the nearest SNC was inversely associated with the probability of having a physician visit among LEP but not EP. The effect sizes diminished, but remained significant, when we included county fixed effects in the models. Having LEP is a barrier to health care access, which compounds when combined with increased distance to the nearest SNC, among uninsured adults. Future studies should explore potential mechanisms so that appropriate interventions can be implemented

Impact ionization mass spectra of anorthite cosmic dust analogue particles

Anorthite, the Ca-rich end-member of plagioclase feldspar, is a dominant mineral component of the Lunar highlands. Plagioclase feldspar is also found in comets, meteorites and stony asteroids. It is therefore expected to contribute to the population of interplanetary (and circumplanetary) dust grains within the solar system. After coating micron- and submicron-sized grains of Anorthite with a conductive layer of Platinum, the mineral was successfully accelerated to hypervelocity speeds in the Max Planck Institut für Kernphysik’s Van de Graaff accelerator. We present impact ionization mass spectra generated following the impacts of anorthite grains with a prototype mass spectrometer (the Large Area Mass Analyser, LAMA) designed for use in space, and discuss the behavior of the spectra with increasing impact energy. Correlation analysis is used to identify the compositions and sources of cations present in the spectra, enabling the identification of several molecular cations (e.g., CaAlO2, CaSiO2, Ca2AlO3/CaAlSi2O2) which identify anorthite as the progenitor bulk grain material