Publications

Effect Of Peer Mentors In Diabetes Self-management vs Usual Care On Outcomes In US Veterans With Type 2 Diabetes

Judith Long, MD, Penn Internal General Medicine
Sep. 11, 2020

Judith A. Long, Valerie S. Ganetsky, Anne Canamucio, Tanisha N. Dicks, Michele Heisler, Steven C. Marcus

Abstract [from journal]

Importance:  Diabetes is a substantial public health issue. Peer mentoring is a low-cost intervention for improving glycemic control in patients with diabetes. However, long-term effects of peer mentoring and creation of sustainable models are not well studied.

Objective:  Assess the effects of a peer support intervention for improving glycemic control in patients with diabetes and evaluate a model in which former mentees serve as mentors.

Design, Setting, and Participants:  A...

Impact Of Medicaid Expansion On Women With Gynecologic Cancer: A Difference-In-Difference Analysis

Sep. 7, 2020

Benjamin B. Albright, Dimitrios Nasioudis, Stuart Craig, Haley A. Moss, Nawar A. Latif, Emily M. Ko, Ashley F. Haggerty

Abstract [from journal]

Background: Women with gynecologic cancer face socioeconomic disparities in care that impact survival outcomes. The Affordable Care Act offered states the option to expand Medicaid enrollment eligibility criteria as a means of improving timely and affordable access to care for the most vulnerable. Variable uptake of expansion by states created a natural experiment, allowing for quasi-experimental methods, which offer more unbiased estimates of treatment effects from retrospective data than traditional regression

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Know Your Epidemic, Know Your Response: Early perceptions of COVID-19 And Self-Reported Social Distancing In The United States

Hans-Peter Kohler, PhD
Sep. 4, 2020

Alberto Ciancio, Fabrice Kämpfen, Iliana V. Kohler, Daniel Bennett, Wändi Bruine de Bruin, Jill Darling, Arie Kapteyn, Jürgen Maurer, Hans-Peter Kohler 

Abstract [from journal]

As COVID-19 is rapidly unfolding in the United States, it is important to understand how individuals perceive the health and economic risks of the pandemic. In the absence of a readily available medical treatment, any strategy to contain the virus in the US will depend on the behavioral response of US residents. In this paper, we study individual's perceptions on COVID-19 and social distancing during the week of March 10-16, 2020, a week when COVID-19 was officially declared to be a pandemic by WHO and when new infections in the US

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Wearable Devices To Monitor And Reduce The Risk Of Cardiovascular Disease: Evidence And Opportunities

Sep. 4, 2020

Atsushi Mizuno, Sujatha Changolkar, Mitesh S. Patel

Abstract [from journal]

There is a growing interest in using wearable devices to improve cardiovascular risk factors and care. This review evaluates how wearable devices are used for cardiovascular disease monitoring and risk reduction. Wearables have been evaluated for detecting arrhythmias (e.g., atrial fibrillation) as well as monitoring physical activity, sleep, and blood pressure. Thus far, most interventions for risk reduction have focused on increasing physical activity. Interventions have been more successful if the use of wearable devices is

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Association Between 90-Minute Door-To-Balloon Time, Selective Exclusion Of Myocardial Infarction Cases, And Access Site Choice: Insights From The Cardiac Care Outcomes Assessment Program (COAP) In Washington State

Sep. 4, 2020

Ashwin S. Nathan, Swathi Raman, Nancy Yang, Ian Painter, Sameed Ahmed M. Khatana, Elias J. Dayoub, Howard C. Herrmann, Robert W. Yeh, Peter W. Groeneveld, Jacob A. Doll, James M. McCabe, Ravi S. Hira, Jay Giri...

Abstract [from journal]

Background: For patients presenting with ST-segment-elevation myocardial infarction, national quality initiatives monitor hospitals' proportion of cases with door-to-balloon (D2B) time under 90 minutes. Hospitals are allowed to exclude patients from reporting and may modify behavior to improve performance. We sought to identify whether there is a discontinuity in the number of cases included in the D2B time metric at 90 minutes and whether operators were increasingly likely to pursue femoral access in patients with

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Self-Efficacy Of Family Caregivers Of Older Adults With Cognitive Impairment: A Concept Analysis

Sep. 4, 2020

Tarik S. Khan, Karen B. Hirschman, Matthew D. McHugh, Mary D. Naylor

Abstract [from journal]

Background: Research demonstrates that increased self-efficacy can help family caregivers of older adults with Alzheimer's and other types of cognitive impairment experience lower burden and depressive symptom severity.

Aims: The purpose of this concept analysis is to address fundamental gaps in the understanding of self-efficacy in family caregivers of older adults with cognitive impairment, including updating the 26-year-old concept analysis with a contemporary definition.

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Assessment Of Receipt Of The First Home Health Care Visit After Hospital Discharge Among Older Adults

Sep. 1, 2020

Jun Li, Mingyu Qi, Rachel M. Werner

Abstract [from journal]

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it.

Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities.

Design, setting, and participants: This cross-sectional study used

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The Beneficial Effects Of Medicare Advantage Special Needs Plans For Patients With End-Stage Renal Disease

Amole Navathe19-head
Sep. 1, 2020

Brian W. Powers, Jiali Yan, Jingsan Zhu, Kristin A. Linn, Sachin H. Jain, Jennifer Kowalski, Amol S. Navathe

Abstract [from journal]

Patients with end-stage renal disease (ESRD) are a vulnerable population with high rates of morbidity, mortality, and acute care use. Medicare Advantage Special Needs Plans (SNPs) are an alternative financing and delivery model designed to improve care and reduce costs for patients with ESRD, but little is known about their impact. We used detailed clinical, demographic, and claims data to identify fee-for-service Medicare beneficiaries who switched to ESRD SNPs offered by a single health plan (SNP enrollees) and similar

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Long-Term Care, Residential Facilities, And COVID-19: An Overview Of Federal And State Policy Responses

Angela Chen, MA
Sep. 1, 2020

Angela T. ChenKira L. Ryskina, Hye-Young Jung

Abstract [from journal]

The COVID-19 pandemic has disproportionately affected residents and staff at long-term care (LTC) and other residential facilities in the United States. The high morbidity and mortality at these facilities has been attributed to a combination of a particularly vulnerable population and a lack of resources to mitigate the risk. During the first wave of the pandemic, the federal and state governments received urgent calls for help from LTC and residential care facilities; between March and early June of 2020, policymakers responded

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Health Care Costs Of Alzheimer's And Related Dementias Within A Medicare Managed Care Provider

Norma Coe, PhD, PARC Co-Director
Sep. 1, 2020

Paul A. Fishman, Lindsay White, Bailey Ingraham, Sungchul Park, Eric B. Larson, Paul Crane, Norma B. Coe 

Abstract [from journal]

Background: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings.

Objective: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan.

Research design: A retrospective cohort design was used to estimate direct total, outpatient, inpatient

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Supportive Clinical Practice Environments Associated With Patient-Centered Care

Sep. 1, 2020

J. Margo Brooks CarthonHeather Brom, Lusine Poghosyan, Marguerite Daus, Barbara Todd, Linda Aiken

Abstract [from journal]

A lack of organizational supports in clinical settings may prevent nurse practitioners from providing patient centered care. Using a cross sectional survey design, data were collected from NPs in 1,571 practices across four states to investigate clinical practice environments and the extent to which they are associated with NP integration of patient preferences. Three-quarters of NPs reported frequent integration of patient preferences into clinical care. Overall, 371 practices (23.6%) were classified as good practice environments;

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Impact Of Hospitalization And Medication Switching On Post-Discharge Adherence To Oral Anticoagulants In Atrial Fibrillation Patients

Allison Willis, MD
Sep. 1, 2020

Thanh Phuong Pham Nguyen, Yong Chen, Dylan Thibault, Charles E. Leonard, Sean Hennessy, Allison Willis

Abstract [from journal

Background: Adherence to chronic medications remains poor in practice. There is limited evidence on how hospitalization affects post-discharge adherence to oral anticoagulants (OACs) in individuals with atrial fibrillation (AF). The aim of this study is to examine the impact of hospitalization and medication switching on post-discharge adherence to OACs in the AF population.

Methods: A quasi-experimental pre-post observational study was conducted using United States commercial insurance

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Implementing Inclusive Strategies To Deliver High Quality LGBTQ+ Care In Health Care Systems

Sep. 1, 2020

Dane Menkin, Dawn Tice, Dalmacio Flores

Abstract [from journal]

Aim: There is a growing recognition of the need to provide inclusive care for LGBTQ+ individuals. Our aim is to provide guidance for nurse managers contemplating similar inclusive changes in their workplace. The role of nurse managers as change agents is discussed based on our experience transforming a traditional suburban healthcare system to one that is now more LGBTQ+ inclusive.

Background: LGBTQ+ individuals require and deserve high-quality care. Nurse managers can serve as patient

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Evaluating The Costs And Outcomes Of Hospital Nursing Resources: A Matched Cohort Study Of Patients With Common Medical Conditions

Aug. 31, 2020

Karen B. LasaterMatthew D. McHughPaul R. RosenbaumLinda H. Aiken, Herbert L. Smith, Joseph G. Reiter, Bijan A. Niknam, Alexander S. Hill, Lauren L. Hochman, Siddharth JainJeffrey H. Silber...

Abstract [from journal]

Background: Nursing resources, such as staffing ratios and skill mix, vary across hospitals. Better nursing resources have been linked to better patient outcomes but are assumed to increase costs. The value of investments in nursing resources, in terms of clinical benefits relative to costs, is unclear.

Objective: To determine whether there are differential clinical outcomes, costs, and value among medical patients at hospitals characterized by better or worse nursing resources.

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Effects Of Leader Tactics On The Creativity, Implementation, And Evolution Of Ideas To Improve Healthcare Delivery

Ingrid Nembhard, PhD
Aug. 31, 2020

Yuna S. H. Lee, Paul D. Cleary, Ingrid M. Nembhard

Abstract [from journal]

Background: Slow progress in quality improvement (QI) has prompted calls to identify new QI ideas. Leaders guiding these efforts are advised to use evidence-based tactics, or specific approaches to address a goal, to promote clinician and staff engagement in the generation and implementation of QI ideas, but little evidence about effective tactics exists.

Objective: Examine the association between leader tactics and the creativity, implementation outcome, and evolution of

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