Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic
Identification of barriers, facilitators and system-based implementation strategies to increase teleophthalmology use for diabetic eye screening in a rural US primary care clinic
Teleophthalmology for diabetic eye screening is an evidence-based intervention substantially underused in US multipayer primary care clinics, even when equipment and trained personnel are readily available. HIP Investigator, Dr. Yao Liu et al. sought to identify patient and primary care provider (PCP) barriers, facilitators, as well as strategies to increase teleophthalmology use. The team of authors conducted standardised open-ended, individual interviews and analysed the transcripts using both inductive and directed content analysis to identify barriers and facilitators to teleophthalmology use.
Factors influencing patient adherence with diabetic eye screening in rural communities: A qualitative study
Factors influencing patient adherence with diabetic eye screening in rural communities: A qualitative study
Diabetic retinopathy remains the leading cause of blindness among working-age U.S. adults largely due to low screening rates. Rural populations face particularly greater challenges to screening because they are older, poorer, less insured, and less likely to receive guideline-concordant care than those in urban areas. Current patient education efforts may not fully address multiple barriers to screening faced by rural patients. HIP Investigator, Dr. Yao Liu et al. sought to characterize contextual factors affecting rural patient adherence with diabetic eye screening guidelines.
Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers.
Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers.
Excessive SBP variability may offer a potential new target for mitigating end-organ damage associated with microvascular and macrovascular disease, such as diabetic foot ulcers. Targeting SBP variability in addition to the absolute value, may help reduce the high risk of vascular complications faced by patients with diabetes. The goal of this study by HIP Investigator, Dr. Meghan Brennan et al. is to determine whether the risk of incident diabetic foot ulceration increases as SBP variability increases.
If We Don't Ask, They Won't Tell: Screening for Urinary and Fecal Incontinence by Primary Care Providers.
If We Don't Ask, They Won't Tell: Screening for Urinary and Fecal Incontinence by Primary Care Providers.
More than half of older adults experience urinary (UI) or fecal incontinence (FI), but the majority have never discussed symptoms with health care providers. Little is known about primary care providers' (PCPs') screening for UI and FI. Given the prevalence and significant negative impact of UI and FI, availability of effective treatment options, and the limited rates of spontaneous care seeking for these conditions, HIP Investigator, Dr. Heidi Brown et al. sought to quantify screening rates, attitudes, beliefs, and behaviors for these conditions among PCPs in our health care system.
Longitudinal trends and predictors of statin use among patients with diabetes.
Longitudinal trends and predictors of statin use among patients with diabetes.
Patients with diabetes have a well-established elevated risk of cardiovascular disease. Statins reduce morbidity and mortality among patients with diabetes, but their use remains suboptimal. In this study, HIP Investigator Dr. Meghan Brennan et al. sought to understand trends in statin use to inform strategies for improvement. They found that Statin use is slowly increasing among patients with diabetes, and at varying rates within subgroups of this population. Policies that prioritize these subgroups for statin promotion may help guide future, intervention-based research to increase compliance with current guidelines.
Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics.
Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics.
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Although smoking is a risk factor for cardiovascular and rheumatic disease severity, only 10% of rheumatology visits document cessation counseling. HIP Investigator, Dr. Christie Bartels et al. identified themes and categories of patient and health system-level facilitators/barriers to smoking cessation. Participant-reported barriers and facilitators to cessation involved psychological, health, and social and economic factors, and healthcare messaging, and resources.
The importance of health insurance claims data in creating learning health systems: evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet)
The importance of health insurance claims data in creating learning health systems: evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet)
Case management programs for high-need high-cost patients are spreading rapidly among health systems. PCORNet has substantial potential to support learning health systems in rapidly evaluating these programs, but access to complete patient data on health care utilization is limited as PCORNet is based on electronic health records not health insurance claims data. Because matching cases to comparison patients on baseline utilization is often a critical component of high-quality observational comparative effectiveness research for high-need high-cost patients, limited access to claims may negatively affect the quality of the matching process. HIP Investigator, Dr. Maureen Smith and team (including HIP Investigator, Dr. Menggang Yu) sought to determine whether the evaluation of programs for high-need high-cost patients required claims data to match cases to comparison patients.
Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA
Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA
Teleophthalmology is an evidence-based form of diabetic eye screening. This technology has been proven to substantially increase diabetic eye screening rates and decrease blindness. However, teleophthalmology implementation remains limited among U.S. health systems. In this paper, HIP Investigator Dr. Yao Liu et al. discuss opportunities to address key barriers to widespread implementation of teleophthalmology programs for diabetic eye screening in the United States (U.S.).
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.