A mixed-methods evaluation using effectiveness perception surveys, social network analysis, and county-level health statistics: A pilot study of eight rural Indiana community health coalitions

Community health coalitions (CHCs) are a promising approach for addressing disparities in rural health statistics. However, their effectiveness has been variable, and evaluation methods have been insufficient and inconsistent. Thus, we propose a mixed-methods evaluation framework and discuss pilot study findings. CHCs in our pilot study partnered with Purdue Extension. Extension links communities and land grant universities, providing programming and support for community-engaged research. We conducted social network analysis and effectiveness perception surveys in CHCs in 8 rural Indiana counties during summer 2017 and accessed county-level health statistics from 2015-16. We compared calculated variables (i.e., effectiveness survey k-means clusters, network measures, health status/outcomes) using Pearson’s correlations. CHC members’ positive perceptions of their leadership and functioning correlated with interconnectedness in their partnership networks, while more centralized partnership networks correlated with CHC members reporting problems in their coalitions. CHCs with highly rated leadership and functioning developed in counties with poor infant/maternal health and opioid outcomes. Likewise, CHCs reporting fewer problems for participation developed in counties with poor infant/maternal health, poor opioid outcomes, and more people without healthcare coverage. This pilot study provides a framework for iterative CHC evaluation. As the evidence grows, we will make recommendations for best practices that optimize CHC partnerships to improve local health in rural areas

A Method for Evaluating Rural Health Coalition Function and Structure Related to Long-Term Health Outcomes

Rural Americans have higher rates of preventable chronic disease, poorer health behaviors and outcomes, and limited access to healthcare services, as compared to their urban/suburban counterparts. Interventions targeting individual behavior change and policy aimed at creating healthy environments have been only marginally successful at improving rural health. Thus, federal governing bodies and national public health organizations recognize community engagement as a viable strategy to mitigate health disparities. One such strategy is the development of community health coalitions (CHCs). Although CHCs have had isolated instances of success, evaluating CHC effectiveness is methodologically challenging. Traditional CHC assessments are subjective, with no standard for validation. Thus, this dissertation describes the development and implementation of a novel mixed-methods, multi-level evaluation framework, comparing CHC partnership networks using social network analysis, CHC perceived effectiveness using the Coalition Self-Assessment Survey, local policy, system, and environment change interventions through a qualitative assessment of program reports, and county-level health statistics. In Indiana there is a robust network of CHCs partnering with Purdue Extension Educators (Ext) and Nutrition Education Program Community Wellness Coordinators (CWC). Ext receive broad training, address general health topics, and serve CHCs in an advisory capacity, taking on leadership roles as needed. In contrast, CWC receive focused leadership and research training, address nutrition-related health topics, and adopt a central leadership position in their partnerships. In year 1 partnership network interconnectedness positively correlated to perceived effectiveness for Ext-CHCs; however, for CWC-CHCs, network interconnectedness negatively correlated to perceived effectiveness. Additionally, CWC-CHCs reported more highly rated leadership and functioning, fewer problems for participation in their CHC, and had greater eigenvector centralization (indicating the presence of a network broker, i.e., a position of power), as compared to Ext-CHCs. At follow-up, increased collaboration centralization positively correlated to increased perceived effectiveness for Ext-CHCs, while increased communication centralization positively correlated to increased perceived effectiveness for CWC-CHCs. For both Ext-CHCs and CWC-CHCs, increased interconnectedness for good-high trust and formal ties positively correlated to increased perceived effectiveness. Findings are interpreted in the context of salient county-level health statistics and qualitative reports of CHC outcomes. This dissertation begins with (1) a systematic literature review on the impact of federal policy change on student dietary behaviors, then (2) present findings from a statewide survey examining differences in perceptions between school foodservice directors and CHC members regarding challenges related to implementing federal policy change and opportunities for school-based community engagement, then (3) explore rural CHC effectiveness across the public health logic model in a second systematic literature review, then (4) describe the development and pilot of a statewide CHC evaluation system, then present my findings from (5) year 1 and (6) follow-up, and finally (7) discuss conclusions and future directions

Exploring humanistic burden of fatigue in adults with multiple sclerosis: an analysis of US National Health and Wellness Survey data

Abstract Background This retrospective study examined the humanistic burden of fatigue in patients with relapsing-remitting multiple sclerosis (RRMS), compared with adults without MS, using data from the 2017 and 2019 US National Health and Wellness Survey. Methods The 5-item Modified Fatigue Impact Scale (MFIS-5) was used to assess level of fatigue (MFIS-5 score <15: low fatigue [LF]; MFIS-5 score ≥15: high fatigue [HF]) in patients with RRMS. Health-related quality of life (HRQoL) measures (Short Form 36-Item Health Survey version 2, Euroqol-5 Dimensions-5 Levels [EQ-5D-5L], Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7], Perceived Deficits Questionnaire-5) and treatment-related characteristics were assessed. Results In total, 498 respondents were identified as RRMS (n=375 RRMS+LF, n=123 RRMS+HF) and compared with 1,494 matched non-MS controls. RRMS+LF and RRMS+HF had significantly lower Short Form 6 Dimensions health utility, Mental and Physical Component Summary, and EQ-5D-5L scores and higher PHQ-9 and GAD-7 scores, compared with matched non-MS controls (all p<0.001); scores were worse for RRMS+HF than RRMS+LF across all measures (all p<0.001). A higher proportion of RRMS+HF reported moderate-to-severe depression and moderate-to-severe anxiety, compared with RRMS+LF and matched non-MS controls (both p<0.001). Fatigue was a significant predictor of poor HRQoL across all measures (all p<0.001). Conclusions Patients with RRMS experienced lower HRQoL with higher levels of fatigue, highlighting an unmet need. Results may help to inform physician-patient communication and shared decision-making to address fatigue and its associated impact on patients’ HRQoL

Supplementary tables: Clinical and economic outcomes associated with use of anti-arrhythmic drugs versus ablation in atrial fibrillation

These are peer-reviewed supplementary data for the article 'Clinical and economic outcomes associated with use of anti-arrhythmic drugs versus ablation in atrial fibrillation' published in the Journal of Comparative Effectiveness Research.Supplementary table 1: Risk of occurrence of LTCO in direct comparison of individual drugs scenarioSupplementary table 2: LTCO risk of treatments (non-temporal scenarios)Supplementary table 3: LTCO risk of treatments (temporal scenarios)Aim: To evaluate the clinical and economic impact of antiarrhythmic drugs (AADs) compared with ablation both as individual treatments and as combination therapy without/with considering the order of treatment among patients with atrial fibrillation (AFib). Materials & methods: A budget impact model over a one-year time horizon was developed to assess the economic impact of AADs (amiodarone, dofetilide, dronedarone, flecainide, propafenone, sotalol, and as a group) versus ablation across three scenarios: direct comparisons of individual treatments, non-temporal combinations, and temporal combinations. The economic analysis was conducted in accordance with CHEERS guidance as per current model objectives. Results are reported as costs per patient per year (PPPY). The impact of individual parameters was evaluated using one-way sensitivity analysis (OWSA). Results: In direct comparisons, ablation had the highest annualmedication/procedure cost ($29,432), followed by dofetilide ($7661), dronedarone ($6451), sotalol ($4552), propafenone ($3044), flecainide ($2563), and amiodarone ($2538). lecainide had the highest costs for long-term clinical outcomes ($22,964), followed by dofetilide ($17,462), sotalol ($15,030), amiodarone ($12,450), dronedarone ($10,424), propafenone ($7678) and ablation ($9948). In the non-temporal scenario, total costs incurred for AADs (group) + ablation ($17,278) were lower compared with ablation alone ($39,380). In the temporal scenario, AADs (group) before ablation resulted in PPPY cost savings of ($22,858) compared with AADs (group) after ablation ($19,958). Key factors in OWSA were ablation costs, the proportion of patients having reablation, and withdrawal due to adverse events. Conclusion: Utilization of AADs as individual treatment or in combination with</p

A value-based budget impact model for dronedarone compared with other rhythm control strategies

Aim: The budgetary consequences of increasing dronedarone utilization for treatment of atrial fibrillation were evaluated from a US payer perspective. Materials & methods: A budget impact model over a 5-year time horizon was developed, including drug-related costs and risks for long-term clinical outcomes (LTCOs). Treatments included antiarrhythmic drugs (AADs; dronedarone, amiodarone, sotalol, propafenone, dofetilide, flecainide), rate control medications, and ablation. Direct comparisons and temporal and non-temporal combination scenarios investigating treatment order were analyzed as costs per patient per month (PPPM). Results: By projected year 5, costs PPPM for dronedarone versus other AADs decreased by $37.69 due to fewer LTCOs, treatment with dronedarone versus ablation or rate control medications + ablation resulted in cost savings ($359.94 and $370.54, respectively), and AADs placed before ablation decreased PPPM costs by$242 compared with ablation before AADs. Conclusion Increased dronedarone utilization demonstrated incremental cost reductions over time

Supplementary data: A value-based budget impact model for dronedarone compared with other rhythm control strategies

Supplementary Table 1: Annual Rate control costs associated with AADs and Annual ablation cost associated with AADsSupplementary Table 2: Risk of LTCOs for AADsSupplementary Table 3: Event Risks Associated with Dronedarone vs. Rate Control + AblationSupplementary Table 4: Event Risks Associated with Dronedarone vs. AblationSupplementary Table 5: Event Risks Associated with Dronedarone + Rate Control vs. AADs + Rate ControlSupplementary Table 6: Event Risks Associated with Dronedarone vs. Rate ControlSupplementary Table 7: Event Risks Associated with Dronedarone + Ablation vs. other AADs + AblationSupplementary Table 8: Event Risks Associated with Dronedarone + Rate Control + Ablation vs. AADs + Rate Control + AblationSupplementary Table 9: Event Risks Associated with Dronedarone vs. Rate Control vs. AblationSupplementary Table 10: Event Risks for Temporal ScenariosAim: The budgetary consequences of increasing dronedarone utilization for treatment of atrial fibrillation were evaluated from a US payer perspective. Materials & methods: A budget impact model over a 5-year time horizon was developed, including drug-related costs and risks for long-term clinical outcomes (LTCOs). Treatments included antiarrhythmic drugs (AADs; dronedarone, amiodarone, sotalol, propafenone, dofetilide, flecainide), rate control medications, and ablation. Direct comparisons and temporal and non-temporal combination scenarios investigating treatment order were analyzed as costs per patient per month (PPPM). Results: By projected year 5, costs PPPM for dronedarone versus other AADs decreased by $37.69 due to fewer LTCOs, treatment with dronedarone versus ablation or rate control medications + ablation resulted in cost savings ($359.94 and $370.54, respectively), and AADs placed before ablation decreased PPPM costs by$242 compared with ablation before AADs. Conclusion: Increased dronedarone utilization demonstrated incremental cost reductions over time.</p