Research Publications

How Primary Care Provider Communication With Team Relates To Patients’ Disease Management

Ingrid Nembhard, PhD, MS, Associate Professor at the University of Pennsylvania's Wharton School
Jul. 1, 2020

 Yuna S.H. Lee, Marissa D. King, Daren Anderson, Paul D. Cleary, Ingrid M. Nembhard

Abstract [from journal]

Background: Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management.

Objective: To assess how PCP communication with their care team relates to patients’ health.

Research Design: Longitudinal study of how 3


Low Health Literacy Is Associated With Frailty And Reduced Likelihood Of Liver Transplant Listing: A Prospective Cohort Study

Jun. 21, 2020

Therese Bittermann, Kristen Dwinnells, Sakshum Chadha, Michael S. Wolf, Kim M. Olthoff, Marina Serper

Abstract [from journal]

The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplant (LT) evaluation. From 2014-2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Literacy was measured with the Newest Vital Sign (NVS), a brief validated assessment. Multivariable


Association of Homelessness with Hospital Readmissions—An Analysis of Three Large States

Jun. 17, 2020

Sameed Ahmed M. Khatana, Rishi K. Wadhera, Eunhee Choi, Peter W. Groeneveld, Dennis P. Culhane, Margot Kushel, Dhruv S. Kazi, Robert W. Yeh, Changyu Shen

Abstract [from journal]

Background: Individuals experiencing homelessness have higher hospitalization and mortality rates compared with the housed. Whether they also experience higher readmission rates, and if readmissions vary by region or cause of hospitalization is unknown.

Objective: Evaluate the association of homelessness with readmission rates across multiple US states.


Development Of Persistent Opioid Use After Cardiac Surgery

Nimesh Desai, MD, PhD
Jun. 17, 2020

Chase R. Brown, Zehang Chen, Fabliha Khurshan, Peter W. Groeneveld, Nimesh D. Desai

Abstract [from journal]

Importance  The overuse of opioids for acute pain management has led to an epidemic of persistent opioid use.

Objective  To determine the proportion of opioid-naive patients who develop persistent opioid use after cardiac surgery and investigate the association between the initial amount of opioids prescribed at discharge and the likelihood of developing new persistent opioid use.

Design, Setting, and Participants  This retrospective cohort study used data from a national...

A Targeted Program In An Academic Rheumatology Practice To Improve Compliance With Opioid Prescribing Guidelines For The Treatment Of Chronic Pain

Michael Ashburn, MD, MPH, MBA
Jun. 17, 2020

Eric J. Wang, Rebecca Helgesen, Chadwick R. Johr, Hannah S. Lacko, Michael A. Ashburn, Peter A. Merkel

Abstract [from journal]

Objective: The Centers for Disease Control and Prevention (CDC) and many state governments have issued guidelines for opioid prescribing for the treatment of chronic non-cancer-associated pain. We sought to decrease practice variation and increase adherence to these guidelines in a tertiary academic Rheumatology practice by developing an interdisciplinary Opioid Working Group and using Electronic Health Record (EHR)-integrated data feedback.

Methods: Division leadership and providers


Intravitreal Anti-Vascular Endothelial Growth Factor Cost Savings Achievable With Increased Bevacizumab Reimbursement and Utilization

Jun. 13, 2020

David B. Glasser, Ravi Parikh, Flora Lum, George A. Williams

Abstract [from journal]

Purpose: To model Medicare Part B and patient savings associated with increased bevacizumab payment and utilization for intravitreal anti-vascular endothelial growth factor (VEGF) therapy.

Design: Cost analysis.

Methods: Medicare claims and IRIS® Registry data were used to calculate Medicare Part B expenditures and patient co-pays for anti-VEGF agents with increasing reimbursement and utilization of bevacizumab relative to ranibizumab and aflibercept.



Association Among Surgeon Experience, Patient Risk, And Outcomes In Coronary Artery Bypass Grafting

Jun. 13, 2020

Jason J. Han, Markian M. Bojko, Matthew M. Duda, Amit Iyengar, John J. Kelly, William L. Patrick, Mark R. Helmers, Pavan Atluri

Abstract [from journal]

Background: There is an association between surgeon experience and outcomes following cardiac surgery. However, this association is not well studied in the context of patient risk. The purpose of this single-center, retrospective, observational study was to describe how surgeon experience relates to patient risk in isolated coronary artery bypass graft (CABG) surgery and how this impacts patient outcomes.

Methods: Surgeon experience was defined as time between the surgeon finishing fellowship


Preferences For Predictive Model Characteristics Among People Living With Chronic Lung Disease: A Discrete Choice Experiment

Jun. 12, 2020

Gary E. Weissman, Kuldeep N. Yadav, Trishya Srinivasan, Stephanie Szymanski, Florylene Capulong, Vanessa Madden, Katherine R. Courtright, Joanna L. Hart, David A. Asch, Sarah J. Ratcliffe, Marilyn M....

Abstract [from journal]

Background. Patients may find clinical prediction models more useful if those models accounted for preferences for false-positive and false-negative predictive errors and for other model characteristics. Methods. We conducted a discrete choice experiment to compare preferences for characteristics of a hypothetical mortality prediction model among community-dwelling patients with chronic lung disease recruited from 3 clinics in Philadelphia. This design was chosen to allow us to quantify "exchange


Association Of A Novel Index Of Hospital Capacity Strain With Admission To Intensive Care Units

Jun. 10, 2020

George L. Anesi, Marzana Chowdhury, Dylan S Small, M. Kit Delgado, Rachel Kohn, Brian Bayes, Wei Wang, Erich Dress, Gabriel J. Escobar, Scott D. Halpern, Vincent X Liu

Abstract [from journal]

Rationale: Prior approaches to measuring healthcare capacity strain have been constrained by using individual care units, limited metrics of strain, or general, rather than disease-specific, populations.

Objectives: We sought to develop a novel composite strain index and measure its association with ICU admission decisions and hospital outcomes.

Methods: Using more than 9.2 million acute care encounters from 27 Kaiser Permanente Northern California and Penn Medicine


Pathways To Help-Seeking Among Black Male Trauma Survivors: A Fuzzy Set Qualitative Comparative Analysis

Jun. 9, 2020

John A. Rich, Theodore J. Corbin, Sara F. Jacoby, Jessica L. Webster, Therese S. Richmond

Abstract [from journal]

Many Black men suffer symptoms of traumatic stress in the aftermath of traumatic injury, and they also often carry social concerns, including experiences of discrimination and stigma, and a lack of financial resources. The objective of the present study was to understand how traumatic symptoms and social factors combine in complex ways toward the outcome of psychological help-seeking. We analyzed qualitative and quantitative data from 32 injured Black men admitted to a Level 1 trauma center. Qualitative interviews explored their


Suprapubic Versus Urethral Catheter For Urinary Drainage After Robot-Assisted Radical Prostatectomy

Leilei Xia
Jun. 6, 2020

Leilei Xia, Thomas J Guzzo, Phillip Mucksavage, Daniel J. Lee 

Abstract [from journal]

Purpose of review: To review the evidence regarding the usage of suprapubic tube (SPT) versus indwelling urethral catheter (IUC) after robot-assisted radical prostatectomy (RARP).

Recent findings: Available data on the use of SPT for urinary drainage after RARP is somewhat limited mostly because of the variations of study designs and non-standardized outcomes. Although it may provide some mild benefit in terms of catheter-related pain and discomfort, the benefit seems not to be clinically


Determinants Of Stigma Among Patients With Hepatitis C Virus (HCV) Infection

Jun. 5, 2020

M. Elle Saine, Julia E. Szymczak, Tyler M. Moore, Laura P. Bamford, Frances K. Barg, Jason SchnittkerJohn H. HolmesNandita Mitra, Vincent Lo Re

Abstract [from journal]

Stigma around hepatitis C virus (HCV) infection is an important and understudied barrier to HCV treatment and elimination. The determinants of HCV-related stigma, including the impacts of stage of HCV treatment (i.e., spontaneously-cleared; diagnosed, untreated; previously treated, not cured; currently being treated; treated, cured) and coinfection with human immunodeficiency virus (HIV), remain unknown. To address these gaps, we conducted a cross-sectional study among patients with a history of HCV infection (n=270) at outpatient


Evaluating The Impact Of Oncology Care Model Reporting Requirements On Biomarker Testing And Treatment

Jun. 4, 2020

Emily H Castellanos, Abigail Orlando, Xinran Ma, Ravi B Parikh, Gillian O'Connell, Neal J Meropol, James Hamrick, Blythe J S Adamson

Abstract [from journal]

Purpose: The Oncology Care Model (OCM) is Medicare's first alternative payment model program for patients with cancer. As of October 2017, participating practices were required to report biomarker testing of patients with advanced non-small-cell lung cancer (aNSCLC). Our objective was to evaluate the effect of this OCM reporting requirement on quality of care.

Methods: We selected patients with aNSCLC receiving care in practices in a nationwide de-identified electronic health record-derived


A Qualitative Assessment Of Factors That Children, Parents, And Clinicians Prioritize In The Setting Of Elective Anesthesia And Surgery

Jun. 3, 2020

Wallis T Muhly, Brittany Wohler, Maria N Nelson, Jonathan M Tan, Frances K Barg, William England, Carolyn Fazzini, Luis Sequera-Ramos, Paul A Stricker

Abstract [from journal]

Background: Assessing the postoperative recovery of pediatric patients is challenging as there is no validated comprehensive patient-centered recovery assessment tool for this population. A qualitative investigative approach with in-depth stakeholder interviews can provide insight into the recovery process and inform the development of a comprehensive patient-centered postoperative assessment tool for children.

Methods: We conducted open-ended, semistructured interviews with children 6-12 years


Universal Background Checks For Handgun Purchases Can Reduce Homicide Rates Of African Americans

Elinore Kaufman, U of Penn
Jun. 1, 2020

Elinore J. Kaufman, Christopher N. Morrison, Erik J. Olson, David K. Humphreys, Douglas J. Wiebe, Niels D. Martin, Carrie A. Sims, Mark H. Hoofnagle, C. William Schwab, Patrick M. Reilly, Mark J. Seamon

Abstract [from journal]

Background: Federal law requires background checks for firearms purchased from licensed dealers, but states can extend requirements to private sales of handguns and purchases at gun shows (universal background checks for handguns [UBC-HG]). Although firearm homicide disproportionately affects African Americans, little is known about how UBG-HG impacts African Americans. We hypothesized that implementation of UBC-HG would reduce rates of firearm homicide of African Americans.

Methods: We