5 research outputs found
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Hispanic Patients' Role Preferences in Primary Care Treatment Decision Making
Shared decision making is considered to be a crucial component of high quality and safe patient-centered primary care treatment. Hispanics are the fastest growing minority group in the United States and they experience substantial health disparities. The aim of this study was to examine the factors that correlate with Hispanics' decision role preferences for participation in treatment decision making with their primary care clinician. Hispanic patients (n=772) were recruited from five zip codes in the Washington Heights/Inwood community of New York City and survey data were collected via interview by bilingual community health workers in four New York-Presbyterian Ambulatory Care Network clinics. Data were analyzed using multinomial logistic regression to investigate the association between sociodemographic and health factors and role preference in primary care treatment decision making (passive, shared, active); passive role as the reference range.
Most survey respondents preferred to participate in medical treatment decisions in a shared or active role (90%) and also had inadequate health literacy (95%). The odds of wanting to participate in decision making in a shared role with a primary care provider significantly increased with younger age (OR=0.98, 95% CI [0.96- 0.99], p =0.01), less than 21 years living in the United States (OR=0.48, 95% CI [0.27- 0.88], p =0.02), more adequate health literacy (Newest Vital Sign) (OR=.46, 95% CI [0.25- 0.83], p =0.01), better ability to understand health instructions, pamphlets or written health materials (OR=0.55, 95% CI [0.31- 0.99], p =0.05), and higher social role performance (OR=0.97, 95% CI [0.94- 0.99], p =0.04). Statistically significant odds for preference for an active role were higher education (OR=3.11, 95% CI [1.20- 8.04], p =.02), less than 21 years living in the United States (OR=0.37, 95% CI [0.19- 0.73], p =0.004), and younger age (OR=0.98, 95% CI [0.95- 0.99], p =0.02). However, the overall models demonstrated poor fit with study data explaining 10% -14% of the variation of the dependent variable. Understanding the factors that influence Hispanic patients' role preference in primary care treatment decisions is crucial to providing higher quality patient-centered care and to possibly reducing Hispanics' health disparities. Our analysis suggested a number of patient specific factors that should be used to inform future informatics, clinical and public health primary care interventions for Hispanic patients. In addition, our analysis also underscores the need for more theoretical and analytical research to further characterize the factors that contribute to Hispanic patients' role preference in primary care treatment decision making
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The Jonas Scholars Program—Evaluation of a decade-long program to advance doctoral-prepared nurses
Background: The Jonas Scholars Program of Jonas Nursing & Veterans Healthcare aims to advance the pipeline of doctoral-prepared, research-focused, and practice-focused faculty via student financial support and leadership training.
Purpose: Program evaluation of the Jonas Scholars Program. We describe the reach of the program over time, scholar characteristics, and report on graduated scholars that are currently employed in faculty and clinical positions.
Method: Retrospective analysis of administrative records from the Jonas Scholars Program spanning 2008 to 2016.
Findings: The Jonas Scholars Program has grown substantially since its inception. From 2008 to 2016, a total of 1,032 doctoral students at 174 universities across the United States have received financial support through the program. Scholars have a mean age of 38 and nearly two-thirds are enrolled in a research-focused PhD program. Most graduated scholars for which data are available are primarily faculty in nursing schools 185 (30.7%), providing direct patient care 171 (28.4%), or conducting research 118 (19.8%).
Discussion: The Jonas Scholars Program supports the pipeline of a younger generation of doctoral-prepared nurses that are faculty in schools of nursing, providing direct patient care and conducting research
Nonelective coronary artery bypass graft outcomes are adversely impacted by Coronavirus disease 2019 infection, but not altered processes of care: A National COVID Cohort Collaborative and National Surgery Quality Improvement Program analysisCentral MessagePerspective
Objective: The effects of Coronavirus disease 2019 (COVID-19) infection and altered processes of care on nonelective coronary artery bypass grafting (CABG) outcomes remain unknown. We hypothesized that patients with COVID-19 infection would have longer hospital lengths of stay and greater mortality compared with COVID-negative patients, but that these outcomes would not differ between COVID-negative and pre-COVID controls. Methods: The National COVID Cohort Collaborative 2020-2022 was queried for adult patients undergoing CABG. Patients were divided into COVID-negative, COVID-active, and COVID-convalescent groups. Pre-COVID control patients were drawn from the National Surgical Quality Improvement Program database. Adjusted analysis of the 3 COVID groups was performed via generalized linear models. Results: A total of 17,293 patients underwent nonelective CABG, including 16,252 COVID-negative, 127 COVID-active, 367 COVID-convalescent, and 2254 pre-COVID patients. Compared to pre-COVID patients, COVID-negative patients had no difference in mortality, whereas COVID-active patients experienced increased mortality. Mortality and pneumonia were higher in COVID-active patients compared to COVID-negative and COVID-convalescent patients. Adjusted analysis demonstrated that COVID-active patients had higher in-hospital mortality, 30- and 90-day mortality, and pneumonia compared to COVID-negative patients. COVID-convalescent patients had a shorter length of stay but a higher rate of renal impairment. Conclusions: Traditional care processes were altered during the COVID-19 pandemic. Our data show that nonelective CABG in patients with active COVID-19 is associated with significantly increased rates of mortality and pneumonia. The equivalent mortality in COVID-negative and pre-COVID patients suggests that pandemic-associated changes in processes of care did not impact CABG outcomes. Additional research into optimal timing of CABG after COVID infection is warranted
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Chronic Lung Disease as a Risk Factor for Long COVID in Patients Diagnosed With Coronavirus Disease 2019: A Retrospective Cohort Study
Abstract Background Patients with coronavirus disease 2019 (COVID-19) often experience persistent symptoms, known as postacute sequelae of COVID-19 or long COVID, after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Chronic lung disease (CLD) has been identified in small-scale studies as a potential risk factor for long COVID. Methods This large-scale retrospective cohort study using the National COVID Cohort Collaborative data evaluated the link between CLD and long COVID over 6 months after acute SARS-CoV-2 infection. We included adults (aged ≥18 years) who tested positive for SARS-CoV-2 during any of 3 SARS-CoV-2 variant periods and used logistic regression to determine the association, considering a comprehensive list of potential confounding factors, including demographics, comorbidities, socioeconomic conditions, geographical influences, and medication. Results Of 1 206 021 patients, 1.2% were diagnosed with long COVID. A significant association was found between preexisting CLD and long COVID (adjusted odds ratio [aOR], 1.36). Preexisting obesity and depression were also associated with increased long COVID risk (aOR, 1.32 for obesity and 1.29 for depression) as well as demographic factors including female sex (aOR, 1.09) and older age (aOR, 1.79 for age group 40–65 [vs 18–39] years and 1.56 for >65 [vs 18–39] years). Conclusions CLD is associated with higher odds of developing long COVID within 6 months after acute SARS-CoV-2 infection. These data have implications for identifying high-risk patients and developing interventions for long COVID in patients with CLD
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The prevalence of postacute sequelae of coronavirus disease 2019 in solid organ transplant recipients: Evaluation of risk in the National COVID Cohort Collaborative
Postacute sequelae after the coronavirus disease (COVID) of 2019 (PASC) is increasingly recognized, although data on solid organ transplant (SOT) recipients (SOTRs) are limited. Using the National COVID Cohort Collaborative, we performed 1:1 propensity score matching (PSM) of all adult SOTR and nonimmunosuppressed/immunocompromised (ISC) patients with acute COVID infection (August 1, 2021 to January 13, 2023) for a subsequent PASC diagnosis using International Classification of Diseases, 10th Revision, Clinical Modification codes. Multivariable logistic regression was used to examine not only the association of SOT status with PASC, but also other patient factors after stratifying by SOT status. Prior to PSM, there were 8769 SOT and 1 576 769 non-ISC patients with acute COVID infection. After PSM, 8756 SOTR and 8756 non-ISC patients were included; 2.2% of SOTR (n = 192) and 1.4% (n = 122) of non-ISC patients developed PASC (P value < .001). In the overall matched cohort, SOT was independently associated with PASC (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.09-2.01). Among SOTR, COVID infection severity (aOR, 11.6; 95% CI, 3.93-30.0 for severe vs mild disease), older age (aOR, 1.02; 95% CI, 1.01-1.03 per year), and mycophenolate mofetil use (aOR, 2.04; 95% CI, 1.38-3.05) were each independently associated with PASC. In non-ISC patients, only depression (aOR, 1.96; 95% CI, 1.24-3.07) and COVID infection severity were. In conclusion, PASC occurs more commonly in SOTR than in non-ISC patients, with differences in risk profiles based on SOT status