Woman talking to doctor

Barriers to seeking care for accidental bowel leakage: a qualitative study

Barriers to seeking care for accidental bowel leakage: a qualitative study

Dr. Heidi Brown et al. conducted focus groups and cognitive interviews with 39 women aged 46-85 to identify and describe the barriers to seeking care for accidental bowel leakage, a condition for which less than 30% of women who have it seek care. The investigators found 12 barriers to seeking care for accidental bowel leakage, such as lack of knowledge about the condition, lack of knowledge about treatment, fear of testing/treatment, and others, that fit into three overarching themes of (1) internalized self in relation to ABL: (2) perceptions about ABL and its treatments; and (3) interaction with the healthcare system. These barriers are similar to those described for urinary incontinence treatment, with the addition of lack of knowledge that ABL is a condition experienced by others.

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Parents talking to doctor in hospital

Strategies to reduce hospitalizations of children with medical complexity through complex care

Strategies to reduce hospitalizations of children with medical complexity through complex care

In this article, Dr. Ryan Coller et al. describe the process used by a complex care medical home program to develop intervention strategies aiming to reduce hospitalizations within their population. They used (a) semi-structured interviews of caregivers of children with medical complexity that were experienceing acute, unscheduled hospitalizations, and (b) conducted a literature review on preventing hospitalizations among children with medical complexity to link intervention strategies to key drivers for lowering hospital utilization. An expert panel then rated each model for effectiveness in ultimately reducing hospitalizations, and the complex care program applied those findings in their selection of a final set of feasible intervention strategies to implement.

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Patient in hospital

Apples and oranges: 4 definitions of multiple chronic conditions and their relationship to 30-day rehospitalization

Apples and oranges: 4 definitions of multiple chronic conditions and their relationship to 30-day rehospitalization

In this study, Melissa Dattalo et al. used HIP's Chronic Conditions Warehouse data to examine the extent of agreement of 4 commonly used definitions of multiple chronic conditions (MCC) and compare each definition's ability to predict 30-day hospital readmissions. They found that MCC definitions should not be used interchangeably. The two definitions with the greatest agreement (Charlson Comorbidity Index and Chronic Condition Special Needs Plan) were also the best predictors of readmissions. 

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foot wrapped up with medical tape

Diabetic foot ulcer severity predicts mortality in veterans with diabetes

Diabetic foot ulcer severity predicts mortality in veterans with diabetes

Dr. Meghan Brennan et al. recently conducted a study of a national cohort of veterans with type 2 diabetes who developed incident diabetic foot ulcers, and found that compared to early-stage ulcers, gangrene was increased with an increased risk of mortality over the next 1, 2, and 5 years. The authors also found that initial diabetic foot ulcer severity was a more significant predictor of subsequent death than diagnosed vascular disease, such as stroke, coronary artery disease, or peripheral arterial disease.

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Surgeons operating on patient

Endovascular vs. open revascularization for peripheral arterial disease

Endovascular vs. open revascularization for peripheral arterial disease

The aim of this study by Dr. Jason Wiseman et al. was to determine whether endovascular or open revascularization provides an advantageous long-term approach to symptomatic peripheral artery disease. The authors used Chronic Conditions Warehouse Medicare data and found that an endovascular approach is associated with improved amputation-free survival over the long term with only a modest relative increased risk of subsequent intervention.

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Diabetic foot ulcer

The association between geographic density of infectious disease physicians and limb preservation in patients with diabetic foot ulcers

The association between geographic density of infectious disease physicians and limb preservation in patients with diabetic foot ulcers

Dr. Meghan Brennan et al. studied geographic density of infectious disease physicians to capture the effects of access to these providers on major amputation. Using Chronic Conditions Warehouse data for Medicare enrollees with diabetic foot ulcers, they found living in hospital referral regions with high geographic density of infectious disease physicians was associated with a reduced risk in major amputation after controlling for other factors. 

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blood pressure measurement

"They're younger… it's harder." Primary providers' perspectives on hypertension management in young adults

"They're younger… it's harder." Primary providers' perspectives on hypertension management in young adults

Dr. Heather Johnson and team conducted a multicenter qualitative study to explore PCP perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care. They found altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were barriers to hypertension control.

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MyHEART: A non-randomized feasibility study of a young adult hypertension intervention

MyHEART: A non-randomized feasibility study of a young adult hypertension intervention

This study led by Dr. Heather Johnson sought to examine the feasibility of the MyHEART program, a telephone-based health coach self-management intervention for young adults with high blood pressure. The study team found MyHEART to be feasible and acceptable to young adults with uncontrolled hypertension. More patients reported blood pressure monitoring after the study, all coach-patient encounters were documented in the EHR for PCP review, and surveys indicate that patients had a positive experience with the intervention.

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Nurse and boy in a wheelchair

Medical complexity among children with special health care needs

Medical complexity among children with special health care needs

In this article, Dr. Ryan Coller et al. sought to identify subgroups of U.S. children with special health care needs and characterize key health outcomes by subgroup. They used a latent class analysis to identify 4 unique subgroups: (1) broad functional impairment with extensive health care, (2) broad functional impairment alone, (3) predominant physical impairment requiring family-delivered care, and (4) physical impairment alone. Children from class 1 had the highest ED visit rates and hospitalization odds, and the lowest odds of having a medical home. Despite having more shared decision making and medical home attributes, children in class 3 had more ED visits and missed school than children in class 2. However, children in class 2 experienced more cost-related difficulties, care delays, and parents needing to stop work.

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Doctors office

Does first-contact access to primary care differentially benefit those with certain personalities to receive preventive services?

Does first-contact access to primary care differentially benefit those with certain personalities to receive preventive services?

Dr. Nancy Pandhi and team used Wisconsin Longitudinal Study data to examine utilization of preventive care services in patients with certain personality characteristics. They found that certain personality characteristics, such as lower conscientiousness, lower agreeableness, and lower openness to new experience predicted receiving fewer of one or more preventive care services. For those with less agreeableness, improved first-contact access mitigated this effect. 

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