Evidence Development & Decision Science

The systematic production and application of medical knowledge to clinical practice. LDI Senior Fellows analyze the process by which data affect coverage and clinical decisions, and conducts comparative effectiveness and cost effectiveness studies.

Lessons Learned From the Implementation of a Video Health Coaching Technology Intervention to Improve Self-Care of Family Caregivers of Adults With Heart Failure

Dec. 20, 2020

Karen B. Hirschman, Kathryn H. Bowles, Lydia Garcia-Gonzalez, Brooke Shepard, Tracie J. Walser, Gladys L. Thomas, Michael A. StawnychyBarbara Riegel

Abstract [from journal]

Individuals with heart failure (HF) typically live in the community and are cared for at home by family caregivers. These caregivers often lack supportive services and the time to access those services when available. Technology can play a role in conveniently bringing needed support to these caregivers. The purpose of this article is to describe the implementation of a virtual health coaching intervention with caregivers of HF patients ("Virtual Caregiver Coach for You"-ViCCY). A randomized controlled trial is currently in progress


The Changing Landscape of Community Mental Health Care: Availability of Treatment Services in National Data, 2010-2017

Dec. 18, 2020

Janet R. Cummings, Joseph L. Smith, Sara W. Cullen, Steven C. Marcus

Abstract [from journal]

Objective: The authors sought to describe changes in availability of crisis and substance use treatment services in U.S. mental health facilities (including outpatient and inpatient facilities) from 2010 to 2017.

Methods: Using National Mental Health Services Survey data, the authors of this descriptive study examined changes in the proportion of facilities providing crisis and substance use treatment services during the 2010-2017 period.



Patient and Staff Perceptions of Universal Severe Acute Respiratory Syndrome Coronavirus 2 Screening Prior to Cardiac Catheterization and Electrophysiology Laboratory Procedures

Dec. 4, 2020

Naga Venkata K. Pothineni, Samantha Starkey, Kristine Conn, Christina Evans, Ronak Shah, Matthew C. Hyman, David S. Frankel, Rim Halaby, Hillary A. Johnston-Cox, Katherine Kunkel, Ashwin S. Nathan, Matthew E. Seigerman, Howard C. Herrmann, Jay Giri, Francis E....

Abstract [from journal]

In response to the coronavirus disease 2019 (COVID-19) pandemic many cardiac catheterization and electrophysiology laboratories canceled elective procedures to limit the burden on hospital resources. A major challenge in resuming elective procedures is the risk of exposing patients and health care personnel (HCP) to carriers of the virus. To facilitate procedure resumption, the Hospital of the University of Pennsylvania began testing all patients scheduled for elective and urgent catheterization and electrophysiology procedures for severe acute...

Mobile Health (mHealth) Technology: Assessment of Availability, Acceptability, and Use in CKD

Dec. 3, 2020

Sarah J. Schrauben, Lawrence Appel, Eleanor Rivera, Claudia M. Lora, James P. Lash, Jing Chen, L. Lee Hamm, Jeffrey C. Fink, Alan S. Go, Raymond R. Townsend, Rajat Deo, Laura M. Dember, Harold I. Feldman, Clarissa J. Diamantidis, CRIC Study...

Abstract [from journal]

Rationale & objective: Digital and mobile health (mHealth) technologies improve patient-provider communication and increase information accessibility. We assessed technology use, attitudes toward using mHealth technologies, and the proficiency in using mHealth technologies among individuals with chronic kidney disease (CKD).

Study design: Cross-sectional survey with open text responses SETTING & PARTICIPANTS: Chronic Renal Insufficiency Cohort Study participants who completed current


Trends in Oral Anticoagulant Co-Prescription With Antiepileptic Drugs Among Adults With Epilepsy, 2010–2018

Allison Willis, MD
Dec. 1, 2020

Emily K. Acton, Michael A. Gelfand, Sean Hennessy, Sharon X. Xie, John R. Pollard, Scott E. Kasner, Allison W. Willis

Abstract [from journal]

Treatment considerations for epilepsy patients requiring anticoagulation are changing, and actual prescribing practices have not been characterized. We used the 2010-2018 Optum Clinformatics® Data Mart Database to estimate the annual prevalence and distinguish the patterns of oral anticoagulants (OACs) co-dispensed with antiepileptic drugs (AEDs) among adults with epilepsy. Monotonic trends were assessed using the Spearman rank correlation coefficient (ρ). Multivariable logistic regression models were built to evaluate the


Greater Self-Reported Preference for Fat Taste and Lower Fat Restraint Are Associated With More Frequent Intake of High-Fat Food

Douglas Wiebe, PhD, University of Pennsylvania
Nov. 25, 2020

Agata Chmurzynska, Monika A. Mlodzik-Czyzewska, Anna M. Malinowska, Anna Radziejewska, Joanna Mikołajczyk-Stecyna, Ewa Bulczak, Douglas J. Wiebe

Abstract [from journal]

The determinants of the intake of high-fat products are not well recognized, but fat preference may be one of them. The aim of this study was thus to determine whether intake of different types of high-fat food is associated with fat preference in people with normal and increased body weight. Participants aged 20-40 years [n = 421] were enrolled in Poznań, Poland in 2016-2018. Fat preference was measured using the Fat Preference Questionnaire. Self-reported preference for fat taste (TASTE) and fat restraint (DIFF) scores were


Use of an Internet-of-Things Smart Home System for Healthy Aging in Older Adults in Residential Settings: Pilot Feasibility Study

George Demiris, Penn Nursing School
Nov. 10, 2020

Yong K. Choi, Hilaire J. Thompson, George Demiris

Abstract [from journal]

Background: The Internet-of-Things (IoT) technologies can create smart residences that integrate technology within the home to enhance residents' safety as well as monitor their health and wellness. However, there has been little research on real-world testing of IoT smart home devices with older adults, and the feasibility and acceptance of such tools have not been systematically examined.

Objective: This study aims to conduct a pilot study to investigate the feasibility of using IoT smart


Developing the TIC Grade: A Youth Self-Report Measure of Perceptions of Trauma-Informed Care

Laura Sinko
Nov. 9, 2020

Laura Sinko, Dana Beck, Julia Seng

Abstract [from journal]

Background: Service delivery organizations are advancing the provision of trauma-informed care (TIC) for youth to improve outcomes. However, currently there are no validated, reliable evaluation measures to capture the voices of adolescent clients and how well they perceive TIC implementation.

Aims: The purpose of this project was to create an evaluation measure with strong content validity for adolescent health and service users to give feedback to organizations about their implementation of


Predictors Of Mortality In Older Adults With Epilepsy: Implications For Learning Health Systems

Allison Willis, MD
Oct. 21, 2020

Leah J. Blank, Emily K. Acton, Allison W. Willis

Abstract [from journal]

Objective: To determine the incidence of epilepsy and subsequent 5-year mortality among older adults, as well as characteristics associated with mortality.

Methods: Retrospective cohort study of Medicare beneficiaries age 65 or above with at least 2 years enrollment before January 2009. Incident epilepsy cases were identified in 2009 using ICD-9-CM code-based algorithms; death was assessed through 2014. Cox regression models examined the association between 5-year mortality


Association Between Intensive Care Unit Utilization For Patients With Non-ST Segment Elevation Myocardial Infarction And Patient Experience

Oct. 9, 2020

Alexander C. Fanaroff, Anita Y. Chen, Sean van Diepen, Deirdre Mylod, Eric D. Peterson, Tracy Y. Wang

Abstract [from journal]

Routine intensive care unit (ICU) utilization for patients with initially stable non-ST segment elevation myocardial infarction is not associated with improved short- or long-term patient outcomes; however, the association with patient experience has not been reported. Using Hospital Consumer Assessment of Healthcare Providers and Systems patient survey data linked to ICU use data from the National Cardiovascular Data Registry, we found no association between hospital-level ICU utilization and metrics of patient experience, including


Evaluating the Quality of Research Ethics Review and Oversight

Oct. 7, 2020

Institutional Review Boards (IRBs)—or “Research Ethics Committees” (RECs) outside the United States—are charged with protecting human research subjects. However, the quality of IRB performance is rarely subject to the same scrutiny that the boards themselves apply to research projects. In AJOB Empirical Bioethics, we conducted the first systematic analysis of 10 IRB quality measurement tools.

Evaluating Spillover Of HIV Knowledge From Study Participants To Their Network Members In A Stepped-wedge Behavioural Intervention In Tanzania

Oct. 7, 2020

Jeffrey Rewley, Mary C. Smith Fawzi, Keith McAdam, Sylvia Kaaya, Yuanyuan Liu, Jim Todd, Irene Andrew, Jukka Pekka Onnela

Abstract [from journal]

Objectives: We aim to describe the social network members of participants of a behavioural intervention, and examine how the effects of the intervention may spillover among network members.

Design: Secondary analysis of a step-wedge randomised controlled trial.

Setting: Change agents (CAs) were recruited from waiting rooms of HIV treatment facilities in Dar es Salaam, Tanzania, and their network members (NMs) were recruited directly by CAs.



Effect Of Passive Choice and Active Choice Interventions in the Electronic Health Record to Cardiologists On Statin Prescribing: A Cluster Randomized Clinical Trial

Oct. 7, 2020

Srinath Adusumalli, Julie E. Westover, Douglas S. Jacoby, Dylan S. Small, Christine VanZandbergen, Jessica Chen, Ann M. Cavella, Rebecca Pepe, Charles A. L. Rareshide, Christopher K. Snider, Kevin G. VolppDavid A. Asch, ...

Abstract [from journal]

Importance: Statin therapy is underused for many patients who could benefit.

Objective: To evaluate the effect of passive choice and active choice interventions in the electronic health record (EHR) to promote guideline-directed statin therapy.

Design, setting, and participants: Three-arm randomized clinical trial with a 6-month preintervention period and 6-month intervention. Randomization conducted at the cardiologist level at 16 cardiology practices in Pennsylvania


Association Of Discharge To Home Vs Institutional Postacute Care With Outcomes After Lower Extremity Joint Replacement

Amole Navathe19-head
Oct. 1, 2020

Robert E. Burke, Anne Canamucio, Elina Medvedeva, Eric L. HumeAmol S. Navathe

Abstract [from journal]

Importance: Changes in financial incentives have led to more patients being discharged home than to institutional forms of postacute care, such as skilled nursing facilities (SNFs), after elective lower extremity total joint replacement (LEJR).

Objective: To evaluate the association of this change with hospital readmissions, surgical complications, and mortality.

Design, setting, and participants: This cohort study used cross-temporal propensity-matching to identify 104