Primary care colorectal cancer screening correlates with breast cancer screening
Primary care colorectal cancer screening correlates with breast cancer screening
In a retrospective cohort study, Dr. Jennifer Weiss et al. examined 90 primary care providers (PCPs) and over 33,000 patients eligible for colorectal cancer (CRC) screening to determine whether PCP colorectal cancer screening practices correlate with other preventive and chronic care needs. The investigators looked at CRC screening rates in comparison to five other PCP quality metrics—breast cancer screening, cervical cancer screening, HgbA1c and LDL testing, and blood pressure control—and found that PCP CRC screening rates have a strong correlation with breast cancer screening rates and a weak correlation with the other metrics. These results indicate that efforts to increase PCPs' CRC screening rates could be bundled with breast cancer screening improvement interventions to increase their impact.
Hypertension control after an initial cardiac event among Medicare patients with diabetes
Hypertension control after an initial cardiac event among Medicare patients with diabetes
In this study co-authored by Drs. Heather Johnson and Maureen Smith, investigators used EHR and Chronic Conditions Warehouse Medicare data to determine rates & predictors of achieving hypertension control among patients with diabetes and hypertension after they were discharged from the hospital for an initial cardiac event. They found that Medicare patients with diabetes were more likely to achieve hypertension control when prescribed beta-blockers at discharge, or if they had a history of more specialty visits., and adults who were 80 years or older were more likely to achieve control with diuretics.
Hospitalizations for ambulatory care-sensitive conditions among children with chronic and complex diseases
Hospitalizations for ambulatory care-sensitive conditions among children with chronic and complex diseases
Ambulatory-care sensitive (ACS) hospitalizations are those in which high quality outpatient care could have potentially prevented the need for hospitalization. In this study, Dr. Ryan Coller et al. evaluated ACS hospitalizations for children with non-complex chronic diseases and children with medical complexity, and sought to identify ambulatory care predictors of ACS hospitalizations. The authors found that among children with non-complex chronic diseases, 14.6% of hospitalizations were ACS hospitalizations and ACS hospitalizations were more likely with no outpatient visits in the prior year and less likely with timely well checks and phone encounters in the month before the admission. Among children with medical complexity, 5.3% of hospitalizations were ACS hospitalizations, and provider continuity was associated with fewer ACS hospitalizations.
Stratifying patients with diabetes into clinically relevant groups by combination of chronic conditions
Stratifying patients with diabetes into clinically relevant groups by combination of chronic conditions
Dr. Elizabeth Magnan et al. looked at combinations of chronic conditions among patients with diabetes to examine their relationships with diabetes quality metrics. They analyzed 12 conditions concordant with diabetes care to define classes based on co-occurrence: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. Patients had distinct quality metric achievement by condition class, and patients in less sever chronic condition classes were less likely to achieve diabetes metrics.
Implementing a mobile health system to integrate the treatment of addiction into primary care
Implementing a mobile health system to integrate the treatment of addiction into primary care
Dr. Andrew Quanbeck et al. implemented a mobile health (mHealth) system to help treat patients with substance use disorders. The investigators evaluated the effect of the system on patients and clinicians using the RE-AIM framework and found that the system improved care among primary care patients with substance use disorders and that patients using the system supported one another in their recovery. However, among clinicians, use of the technology was less robust than the use by patients, and ongoing funding and lack of availibility of the data in the electronic health record were challenges.
The importance of frequent return visits and hypertension control among young adults
The importance of frequent return visits and hypertension control among young adults
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This study by Cecile King and several HIP investigators evaluated the relationship between ambulatory blood pressure encounter intervals and hypertension control rates among young adults. A retrospective analysis showed that shorter encounter intervals were associated with higher hypertension control. Young adults with more frequent visits also had lower medication initiation, supporting the effectiveness of lifestyle modifications.
Risk prediction for heterogeneous populations with application to hospital admission prediction
Risk prediction for heterogeneous populations with application to hospital admission prediction
There is an increasing need to model risk for large hospital and health care systems that provide services to diverse and complex patients. In this paper co-authored by Drs. Menggang Yu and Maureen Smith, the investigators imposed structural constraints on the importance of variables in predicting outomes such as hospital admission, and demonstrated that their method performs well upon application in hospital admission prediction and validation for the Medicare population of a large helath care provider.
Validation of an instrument to assess barriers to care-seeking for accidental bowel leakage
Validation of an instrument to assess barriers to care-seeking for accidental bowel leakage
Despite the existence of effective, minimally invasive therapies for accidental bowel leakage, fewer than 30% of women with the condition seek care for it. To begin to understand the barriers to seeking care for ABL, Dr. Heidi Brown et al. developed a survey instrument and tested its vailidity by having adult women with ABL complete the survey electronically. Test-retest reliability for the instrument was excellent for all items, and factor extraction via oblique rotation resulted in a final instrument that contained 16 items in six domains.
MyHEART: Development & dissemination of a patient-centered website for young adults with hypertension
MyHEART: Development & dissemination of a patient-centered website for young adults with hypertension
In this article, Dr. Heather Johnson and team discuss the development of the MyHEART website and toolkit for young adults with hypertension. The website and toolkit were implemented successfully with input from community and healthcare stakeholders to provide evidence-based education to a hard-to-reach population.
Diabetic eye screening: knowledge and perspectives from providers and patients
Diabetic eye screening: knowledge and perspectives from providers and patients
In this review, Dr. Yao Liu and Rebecca Swearingen summarize current knowledge and perspectives on screening for diabetic retinopahty to better understand why diabetic eye screening rates remain low, given that diabetic retinopahty remains the leading cause of blindness among working-age US adults and timely screening and treatment prevent 90% of blindness. Despite the advancements in care in the last 10 years, including primary care and patient-oriented interventions and the use of teleophthalmology, patient-level barriers still exist, as well as workflow and systems-level barriers that affect providers and issues with sustaining the impact of interventions.