Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers
Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers
Over 30 million people in the United States have diabetes, and up to 25% of them will develop a diabetic foot ulcer (DFU). Specific to DFUs, rural patients face 50% higher odds of major (above-ankle) amputation and 40% higher odds of death compared to their urban counterparts. A group of authors including HIP Investigators, Dr. Meghan Brennan and Dr. Christie Bartels sought to understand what health system factors contribute to the rural disparity in diabetic foot ulcer outcomes.
The authors concluded that future interventions focusing on mitigating the poor connections across rural and urban healthcare systems could reduce the rural disparity in major amputations.
Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Healthcare Factors Most Predictive
Predictors of Smoking Cessation in Patients With Rheumatoid Arthritis in Two Cohorts: Healthcare Factors Most Predictive
Smoking doubles the risk of developing rheumatoid arthritis (RA) and additionally contributes to cardiovascular, pulmonary, and oncologic diseases, the main causes of death in patients with RA. While patients are more likely to quit smoking after diagnosis of a smoking-related chronic disease, research shows most will continue to smoke.
HIP Investigator, Dr. Christie Bartels et al. identified predictors of smoking cessation in patients with RA in two health systems to guide future intervention implementation efforts. Authors found that emphasizing smoking cessation with new or seropositive RA patients and leveraging health system interventions could improve smoking cessation and outcomes in RA.
The Balanced Opioid Initiative
The Balanced Opioid Initiative
Rates of opioid prescribing tripled in the USA between 1999 and 2015 and were associated with significant increases in opioid misuse and overdose death. Roughly half of all opioids are prescribed in primary care. The challenge remains in implementing guidelines in a way that balances safety and effectiveness when following clinical guidelines recommending opioid prescribing practices.
HIP Investigator, Dr. Andy Quanbeck et al. designed a study to discover the most cost-effective sequence and combination of strategies for improving opioid prescribing practices in diverse primary care clinics. The results of the study promise to help understand how to cost effectively improve the implementation of evidence-based practices.
Growing Evidence for Successful Care Management in Children With Medical Complexity
Growing Evidence for Successful Care Management in Children With Medical Complexity
In this article, Dr. Mary Ehlenbach and HIP Investigator Dr. Ryan Coller reviewed the success of programs designed to better coordinate care for children with medical complexity. With respect to changes in acute care use, children likely respond to complex care models in different ways. Additionally, what complex care achieves and how it achieves it for any given child is likely not uniform in cross section or over time.
Telemedicine for Glaucoma: Guidelines and Recommendations
Telemedicine for Glaucoma: Guidelines and Recommendations
Glaucoma is the leading cause of irreversible blindness worldwide, estimated to affect >60 million people. Access to glaucoma specialists is challenging and likely to become more difficult as the population ages. Glaucoma care guidelines are not as standardized as those for diabetic retinopathy, which allow for significant regional and provider variability in glaucoma diagnosis and management.
In these guidelines, co-authored by HIP Investigator Dr. Yao Liu, authors reviewed considerations and practice recommendations for teleglaucoma programs.
Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition
Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition
The third edition of the Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy includes fundamental requirements to be followed when providing medical and other health care services using telecommunication technologies, and any other electronic communications between patients, practitioners, and other health care providers, as well as “best practice” recommendations. These guidelines were co-authored by HIP Investigator, Dr. Yao Liu and aim to assist providers in pursuing a sound course of action in providing safe and effective medical care using telehealth tools based on current scientific knowledge, technological requirements, and patient needs.
Health System Research Priorities for Children and Youth With Special Health Care Needs
Health System Research Priorities for Children and Youth With Special Health Care Needs
Children and youth with special health care needs (CYSHCN) have, or are at an increased risk for, chronic physical, developmental, behavioral, or emotional conditions and also require health and related services of a type or amount beyond that required by children generally.
HIP Investigator, Dr. Ryan Coller et al. synthesized the opinions of a national multidisciplinary group of CYSHCN experts, including family caregivers, to prioritize research topics facing CYSHCN. Authors sought to take a foundational step toward developing a national research agenda for CYSHCN systems of care.
Factors associated with health psychology use in pediatric type 1 diabetes
Factors associated with health psychology use in pediatric type 1 diabetes
For children with type 1 diabetes (T1D), self-management is complex and requires coordination between a child and his or her family multiple times every day to test blood sugars, determine and administer insulin doses, and adjust as needed. The consequences of suboptimal self-management are a combination of short- and long-term complications, some of which are life-threatening.
In this publication, HIP Investigator Dr. Elizabeth Cox et al. evaluated the prevalence of health psychology use in children with T1D and the association of this use with individual and contextual characteristics.
Better together: multidisciplinary approach improves adherence to pelvic floor physical therapy
Better together: multidisciplinary approach improves adherence to pelvic floor physical therapy
Pelvic floor muscle exercises are a mainstay in the treatment of pelvic floor disorders such as urinary incontinence, overactive bladder, pelvic organ prolapse, and fecal incontinence. Women are more likely to report improvement in incontinence symptoms when they participate in directly supervised pelvic floor physical therapy (PFPT) as opposed to performing recommended exercises without supervision. However, < 50% of women referred for PFPT complete their prescribed program. HIP Investigator, Dr. Heidi Brown et al. sought to determine whether consultation with PFPT at the time of initial urogynecologic evaluation increases adherence to PFPT and to identify factors associated with PFPT attendance and completion.
The authors were also interested in exploring the relationship between the rate of surgical management of patients seen in multidisciplinary clinic versus those seen in a traditional clinic and those who attended PFPT versus those who did not. They hypothesized that rates of PFPT adherence would be higher when the patient met with a physical therapist at her initial urogynecology consultation as opposed to meeting with the urogynecologist alone.
A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers
A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers
Nearly 2 million Americans develop a diabetic foot ulcer each year; within 5 years of ulceration, 5% will undergo major amputation and 50% to 70% will die. Experts have recommended a multidisciplinary team approach to optimally address certain comorbidities in a coordinated manner and to reduce major amputations. Authors including HIP Investigators Dr. Meghan Brennan and Dr. Christie Bartels described multidisciplinary team composition and function using a systems engineering conceptual model and summarized the impact of multidisciplinary teams on major amputations. They hypothesized that multidisciplinary teams are associated with a reduced risk of major amputation.
The group found that multidisciplinary team composition was variable but reduced major amputations in 94% of studies.