Community Input on an Enhanced Care Planning Tool Addressing Health Behaviors, Mental Health Needs, and Social Risks

Background: Many patients with multiple chronic conditions (MCC) have social risks, mental health needs, and/or unhealthy behaviors. These interfere with their ability to manage their MCC. A care planning tool was created to help address these needs; this study solicited feedback from stakeholder groups and incorporated it into improving the tool. Methods: Instrument: The Enhanced Care Planning (ECP) tool screens patients for social risks, mental health needs, and unhealthy behaviors. They are shown where their responses revealed risk, then select 1-2 to improve upon. Next, patients set personal goals and select strategies to support them. Patients are supported by the clinical care team and a community health worker to connect them to community resources. Procedures: Four stakeholder groups provided feedback on the ECP tool: community members, community service professionals (CSPs), researchers, and patients. A community review board of community members reviewed the ECP process. Researchers and CSPs then reviewed ECP content. Feedback was incorporated into revisions of the ECP content and process, then patients provided final feedback. Results: All stakeholder groups provided unique feedback. Community members desired visuals, the ability to individualize and receive support throughout the process. Researchers and CSPs recommended removing jargon. While researchers were interested in specific evidence-based strategies, CSPs suggested strategies with anecdotal support. Patients expressed positive overall impressions of the tool, interest in using it, and increased awareness of domains that influence their health. Conclusion: Feedback from all groups significantly altered the ECP tool’s design, and is likely to improve its usability and impact.https://scholarscompass.vcu.edu/gradposters/1109/thumbnail.jp

Is osteoporosis screening in postmenopausal women effective?

No single study evaluates the effectiveness of osteoporosis screening. However, screening women over the age of 65 years -- or those between 60-64 years with certain risk factors -- is recommended based on available evidence. First, osteoporosis is common, and its prevalence increases with age (strength of recommendation [SOR]: A - prospective cohort studies). Second, low bone mineral density predicts fracture risk (SOR: A - prospective cohort studies). Finally, the likelihood of osteoporotic fracture is reduced with therapy, such as alendronate 10 mg/day or risedronate 5 mg/day plus adequate daily calcium and vitamin D (SOR: A - meta-analysis of randomized clinical trials). Women under 60 years should not be screened (SOR: B--clinical decision rule). There is no evidence to guide decisions about screening interval or at what age to stop screening. The long-term risks of newer medications used for osteoporosis are unknown

Identifying Attrition Phases in Survey Data: Applicability and Assessment Study

Background: Although Web-based questionnaires are an efficient, increasingly popular mode of data collection, their utility is often challenged by high participant dropout. Researchers can gain insight into potential causes of high participant dropout by analyzing the dropout patterns. Objective: This study proposed the application of and assessed the use of user-specified and existing hypothesis testing methods in a novel setting—survey dropout data—to identify phases of higher or lower survey dropout. Methods: First, we proposed the application of user-specified thresholds to identify abrupt differences in the dropout rate. Second, we proposed the application of 2 existing hypothesis testing methods to detect significant differences in participant dropout. We assessed these methods through a simulation study and through application to a case study, featuring a questionnaire addressing decision-making surrounding cancer screening. Results: The user-specified method set to a low threshold performed best at accurately detecting phases of high attrition in both the simulation study and test case application, although all proposed methods were too sensitive. Conclusions: The user-specified method set to a low threshold correctly identified the attrition phases. Hypothesis testing methods, although sensitive at times, were unable to accurately identify the attrition phases. These results strengthen the case for further development of and research surrounding the science of attrition

Methods for Evaluating Respondent Attrition in Web-Based Surveys

Background: Electronic surveys are convenient, cost effective, and increasingly popular tools for collecting information. While the online platform allows researchers to recruit and enroll more participants, there is an increased risk of participant dropout in Web-based research. Often, these dropout trends are simply reported, adjusted for, or ignored altogether. Objective: To propose a conceptual framework that analyzes respondent attrition and demonstrates the utility of these methods with existing survey data. Methods: First, we suggest visualization of attrition trends using bar charts and survival curves. Next, we propose a generalized linear mixed model (GLMM) to detect or confirm significant attrition points. Finally, we suggest applications of existing statistical methods to investigate the effect of internal survey characteristics and patient characteristics on dropout. In order to apply this framework, we conducted a case study; a seventeen-item Informed Decision-Making (IDM) module addressing how and why patients make decisions about cancer screening. Results: Using the framework, we were able to find significant attrition points at Questions 4, 6, 7, and 9, and were also able to identify participant responses and characteristics associated with dropout at these points and overall. Conclusions: When these methods were applied to survey data, significant attrition trends were revealed, both visually and empirically, that can inspire researchers to investigate the factors associated with survey dropout, address whether survey completion is associated with health outcomes, and compare attrition patterns between groups. The framework can be used to extract information beyond simple responses, can be useful during survey development, and can help determine the external validity of survey results

A state-level study of opioid use disorder treatment access and neonatal abstinence syndrome

Background Adult opioid use and neonatal abstinence syndrome (NAS) are growing public health problems in the United States (U.S.). Our objective was to determine how opioid use disorder treatment access impacts the relationship between adult opioid use and NAS. Methods We conducted a cross-sectional state-level ecologic study using 36 states with available Healthcare Cost and Utilization Project State Inpatient Databases in 2014. Opioid use disorder treatment access was determined by the: 1) proportion of people needing but not receiving substance use treatment, 2) density of buprenorphine-waivered physicians, and 3) proportion of individuals in outpatient treatment programs (OTPs). The incidence of NAS was defined as ICD-9 code 779.5 (drug withdrawal syndrome in newborn) from any discharge diagnosis field per 1000 live births in that state. Results Unmet need for substance use disorder treatment correlated with NAS (r = 0.54, 95% CI: 0.26–0.73). The correlation between adult illicit drug use/dependence and NAS was higher in states with a lower density of buprenorphine-waivered physicians and individuals in OTPs. Conclusions Measures of opioid use disorder treatment access dampened the correlation between illicit drug use/dependence and NAS. Future studies using community- or individual-level data may be better poised to answer the question of whether or not opioid use disorder treatment access improves NAS relative to adult opioid use

Harnessing Information Technology to Inform Patients Facing Routine Decisions: Cancer Screening as a Test Case

PURPOSE Technology could transform routine decision making by anticipating patients’ information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use such a decision module and its impact on care, using 3 cancer screening decisions as test cases. METHODS Twelve practices with 55,453 patients using a patient portal participated in this prospective observational cohort study. Participation was open to patients who might face a cancer screening decision: women aged 40 to 49 who had not had a mammogram in 2 years, men aged 55 to 69 who had not had a prostate-specific antigen test in 2 years, and adults aged 50 to 74 overdue for colorectal cancer screening. Data sources included module responses, electronic health record data, and a postencounter survey. RESULTS In 1 year, one-fifth of the portal users (11,458 patients) faced a potential cancer screening decision. Among these patients, 20.6% started and 7.9% completed the decision module. Fully 47.2% of module completers shared responses with their clinician. After their next office visit, 57.8% of those surveyed thought their clinician had seen their responses, and many reported the module made their appointment more productive (40.7%), helped engage them in the decision (47.7%), broadened their knowledge (48.1%), and improved communication (37.5%). CONCLUSIONS Many patients face decisions that can be anticipated and proactively facilitated through technology. Although use of technology has the potential to make visits more efficient and effective, cultural, workflow, and technical changes are needed before it could be widely disseminated

The Five Phases of Pandemic Care for Primary Care

During a pandemic, many more patients than usual are likely to have symptoms, and many of them will seek care. Nearly all will need primary care, and primary care will need to be there to help them. In 2014, the CDC issued a framework to address the influenza pandemia, describing six intervals, from investigation of cases of novel influenza through preparation for future pandemic waves. This is a great public health framework, but it does not address the specific needs of primary care practices. We propose a framework, in waves, that parallels the CDC's. All communities in the US will go through all waves, but to different degrees and at different times. There may be others that we do not anticipate, some will happen simultaneously, some will repeat themselves, and the cycle will happen again as COVID-19 changes and re-infects our communities. With each wave, primary care will need to continuously reinvent and transform itself. And throughout, primary care will need to provide usual care, including managing chronic conditions, addressing new acute problems, and promoting prevention. One thing is clear: if primary care does not do well in this crisis, the system will be completely overwhelmed. If primary care does everything perfectly, the system will just be overwhelmed. Either way, there is a tough road ahead, and there are thousands of natural experiments occurring across the nation. It is critical to learn from these experiences and to be prepared for next time. The transformations present an opportunity for our health system to evolve, build informatics infrastructure, expand digital health, support diverse multidisciplinary teams to care for patients across settings, fix payment to enable comprehensive, continuous care, and convert to a true community-based focus for patient-centered and population-focused care that helps all in need.https://deepblue.lib.umich.edu/bitstream/2027.42/154687/1/Krist_deepblue.pd

Screening for Gynecologic Conditions With Pelvic Examination US Preventive Services Task Force Recommendation Statement

IMPORTANCE Many conditions that can affect women\u27s health are often evaluated through pelvic examination. Although the pelvic examination is a common part of the physical examination, it is unclear whether performing screening pelvic examinations in asymptomatic women has a significant effect on disease morbidity and mortality. OBJECTIVE To issue a new US Preventive Services Task Force(USPSTF) recommendation on screening for gynecologic conditions with pelvic examination for conditions other than cervical cancer, gonorrhea, and chlamydia, for which the USPSTF has already made specific recommendations. EVIDENCE REVIEW The USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women 18 years and older who are not at increased risk for any specific gynecologic condition. FINDINGS Overall, the USPSTF found inadequate evidence on screening pelvic examinations for the early detection and treatment of a range of gynecologic conditions in asymptomatic, nonpregnant adult women. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic examinations in asymptomatic, nonpregnant adult women. (I statement) This statement does not apply to specific disorders for which the USPSTF already recommends screening (ie, screening for cervical cancer with a Papanicolaou smear, screening for gonorrhea and chlamydia)

Planetary embryos and planetesimals residing in thin debris disks

We consider constraints on the planetesimal population residing in the disks of AU Microscopii, Beta Pictoris and Fomalhaut taking into account their observed thicknesses and normal disk opacities. We estimate that bodies of radius 5, 180 and 70 km are responsible for initiating the collisional cascade accounting for the dust production for AU-Mic, Beta-Pic and Fomalhaut's disks, respectively, at break radii from the star where their surface brightness profiles change slope. Larger bodies, of radius 1000km and with surface density of order 0.01 g/cm^2, are required to explain the thickness of these disks assuming that they are heated by gravitational stirring. A comparison between the densities of the two sizes suggests the size distribution in the largest bodies is flatter than that observed in the Kuiper belt. AU Mic's disk requires the shallowest size distribution for bodies with radius greater than 10km suggesting that the disk contains planetary embryos experiencing a stage of runaway growth.Comment: submitted to MNRA

Screening for Impaired Visual Acuity in Older Adults: US Preventive Services Task Force Recommendation Statement

DESCRIPTION: Update of the US Preventive Services Task Force (USPSTF) recommendation on screening for impaired visual acuity in older adults. METHODS: The USPSTF reviewed the evidence on screening for visual acuity impairment associated with uncorrected refractive error, cataracts, and age-related macular degeneration among adults 65 years or older in the primary care setting; the benefits and harms of screening; the accuracy of screening; and the benefits and harms of treatment of early vision impairment due to uncorrected refractive error, cataracts, and age-related macular degeneration. POPULATION: This recommendation applies to asymptomatic adults 65 years or older who do not present to their primary care clinician with vision problems. RECOMMENDATION: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults. (I statement)