Health Behavior & Communication

Incentives and communication strategies that influence behaviors affecting health. LDI Senior Fellows study financial and non-financial incentives that promote healthy behaviors, and how individuals and communities receive and exchange health information.

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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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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Mental Health, Social Influences, And HIV Pre-Exposure Prophylaxis (PrEP) Utilization Among Men And Transgender Individuals Screening For HIV Prevention Trials

Aug. 28, 2020

Sarah M. Wood, Knashawn H. Morales, David Metzger, Annet Davis, Danielle Fiore, Danielle Petsis, Kezia Barnett, Helen C. Koenig, Nadia DowshenRobert Gross, Ian Frank

Abstract [from journal]

The effects of mental health comorbidities and social support on the HIV pre-exposure prophylaxis (PrEP) care continuum are unknown. We conducted a cross-sectional study of men and transgender individuals, ≥ 18 years-old, with ≥ 2 male or transgender partners, or recent condomless anal intercourse. Surveys assessed demographics, mental health treatment, depressive symptomatology, social support, and PrEP-related social contacts. Logistic regression assessed associations between these factors and PrEP uptake and persistence.

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Prevalence Of Psychotropic And Opioid Prescription Fills Among Community-Dwelling Older Adults With Dementia In The U.S.

Aug. 18, 2020

Donovan T. Maust, Julie Strominger, Julie P. W. Bynum, Kenneth M. Langa, Lauren B. Gerlach, Kara Zivin, Steven C. Marcus

Abstract [from journal]

This pharmacoepidemiology study uses Medicare data to estimate US prescription fills for antidepressants, anxiolytics, antipsychotics, opioids, and antiepileptics among community-dwelling older adults with dementia in 2014-2015, and identifies the most commonly prescribed medications.

Harnessing Implementation Science To Optimize Harm Prevention In Critically Ill Children: A Pilot Study Of Bedside Nurse CLABSI Bundle Performance In The Pediatric Intensive Care Unit

Aug. 17, 2020

Charlotte Z. Woods-Hill, Kelly Papili, Eileen Nelson, Kathryn Lipinski, Judy SheaRinad BeidasMeghan Lane-Fall

Abstract [from journal]

Objectives: Central-line associated bloodstream infection (CLABSI) is associated with increased mortality, morbidity, and cost in hospitalized children. An evidence-based bundle of care can decrease CLABSI, but bundle compliance is imperfect. We explored factors impacting bundle performance in the pediatric intensive care unit (PICU) by bedside nurses.

Methods: Single-center cross sectional electronic survey of PICU bedside nurses in an academic tertiary care center; using the COM-B (

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Improving Child Behaviors And Parental Stress: A Randomized Trial Of Child Adult Relationship Enhancement In Primary Care

Joanne Wood, MD
Aug. 10, 2020

Joanne N. Wood, Devon Kratchman, Philip V. Scribano, Steven Berkowitz, Samantha Schilling

Abstract [from journal]

Background: Prior single site evaluations of PriCARE, a 6-session group parent training, demonstrated reductions in child behavioral problems and improvements in positive parenting attitudes.

Objective: To measure the impact of PriCARE on disruptive child behaviors, parenting stress, and parenting attitudes in a multisite study.

Methods: Caregivers of children 2- to 6-years-old with behavior concerns recruited from 4 pediatric primary care practices were randomized 2:1

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Short-Term Psychological Outcomes Of Disclosing Amyloid Imaging Results To Research Participants Who Do Not Have Cognitive Impairment

Jason Karlawish, MD of Penn Medicine
Aug. 10, 2020

Joshua D. Grill, Rema Raman, Karin Ernstrom, David L. Sultzer, Jeffrey M. Burns, Michael C. Donohue, Keith A. Johnson, Paul S. Aisen, Reisa A. Sperling, Jason Karlawish, A4 Study Team

Abstract [from journal]

Importance: The goal of preclinical Alzheimer disease (AD) clinical trials is to move diagnosis and treatment to presymptomatic stages, which will require biomarker testing and disclosure.

Objective: To assess the short-term psychological outcomes of disclosing amyloid positron emission tomography results to older adults who did not have cognitive impairment.

Design, setting, and participants: This observational study included participants who were screening for a

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Teaching Old Drugs New Tricks: Statins For COVID-19?

Aug. 4, 2020

David C. Fajgenbaum, Daniel J. Rader

Abstract [from journal]

The COVID-19 pandemic has driven unprecedented efforts to identify existing treatments that can be quickly and effectively repurposed to reduce morbidity and mortality. In this issue of Cell Metabolism, Zhang et al. (2020) report an association between statin use and improved outcomes in a large observational study of hospitalized COVID-19 patients. Given the widespread availability, low cost, and safety of statins, this promising result should be further investigated in randomized controlled trials.

"The More They Know, The Better Care They Can Give": Patient Perspectives On Measuring Functional Status In Primary Care

Rebecca Brown, MD, MPH
Aug. 4, 2020

Francesca M. Nicosia, Malena J. Spar, Alicia Neumann, Molly C. Silvestrini, Maureen Barrientos, Rebecca T. Brown

Abstract [from journal]

Background: Despite its importance to care and outcomes for older adults, functional status is seldom routinely measured in primary care. Understanding patient perspectives is necessary to develop effective, patient-centered approaches for measuring function, yet we know little about patient views on this topic.

Objective: To examine patient and caregiver perspectives on measuring activities of daily living (ADLs) and instrumental ADLs (IADLs).

Design: Qualitative study

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Wide Variation in The Percentage of Donation After Circulatory Death Donors Across Donor Service Areas: A Potential Target for Improvement

Aug. 1, 2020

Elizabeth M. SonnenbergJesse Y. HsuPeter P. ReeseDavid S. Goldberg, Peter L. Abt

Abstract [from journal]

Background: Substantial differences exist in the clinical characteristics of donors across the 58 donor service areas (DSAs). Organ procurement organization (OPO) performance metrics incorporate organs donated after circulatory determination of death (DCDD) donors but do not measure potential DCDD donors.

Methods: Using 2011-2016 United Network for Organ Sharing data, we examined the variability in DCDD donors/all deceased donors (%DCDD) across DSAs. We supplemented United Network for Organ

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Hepatitis C and The Layering of Disease-Related Stigma

Jul. 28, 2020
“That's exactly how I feel like they look at you. Like, ‘You on drugs, you dirty, you homeless, you don't got nowhere to take yourself, staying yourself and take yourself.’ Why should they try to help you and give you the best care possible? For what? They could save it for somebody else that's doing all the right things versus give it to the people that's doing all the wrong things.” – HIV/HCV-coinfected study participant

Visual Impairment Is More Common In Parkinson's Disease And Is A Risk Factor For Poor Health Outcomes

Maureen Maguire, PhD, ScM
Jul. 28, 2020

Ali G. Hamedani, Danielle S. Abraham, Maureen G. MaguireAllison W. Willis

Abstract [from journal]

Background: Visual impairment is associated with hip fracture, depression, anxiety, and dementia in the general population, and many causes of visual impairment are preventable or treatable with early detection. However, the prevalence, outcomes, and healthcare utilization patterns associated with visual impairment have not been examined in Parkinson's disease (PD).

Methods: We performed a cross-sectional analysis of all Medicare beneficiaries with complete data in 2014 and longitudinal

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