Medical Decision Making

How health professionals and patients make treatment decisions, and the barriers to, and facilitators of, effective decision making.

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


Implementing Couple's Human Immunodeficiency Virus Testing And Counseling In The Antenatal Care Setting

Florence Marie Momplaisir, MD, MSHP, FACP
Aug. 6, 2020

Florence Momplaisir, Emily Finley, Sandra Wolf, Erika Aaron, Itoro Inoyo, David Bennett, Sara Seyedroudbari, Allison Groves

Abstract [from journal]

Objective: To describe a pilot implementation of couple's human immunodeficiency virus (HIV) testing and counseling in an antenatal care clinic in the United States.

Methods: We used a cross-sectional study design. Couples were recruited from an antenatal care clinic of a large, urban, tertiary medical center, and were eligible if both partners agreed to receive HIV test results together and reported no coercion to participate in testing and counseling and no intimate partner violence. We


Informal and Formal Home Care For Older Adults With Disabilities Increased, 2004-16

Aug. 1, 2020

Courtney H. Van Houtven, R. Tamara Konetzka, Elizabeth Taggert, Norma B. Coe

Abstract [from journal]

Rates of informal home care use among older adults with disabilities increased from 2004 to 2016, such that in 2016 almost three-quarters of these adults received informal home care. Informal care remains the most common source of home care, even though formal home care use grew at almost twice the rate, with a 6-percentage-point increase to 36.9 percent in 2016.

Efficacy Of An Enhanced Recovery After Surgery (ERAS) Pathway In Elderly Patients Undergoing Spine And Peripheral Nerve Surgery

Jul. 31, 2020

Joseph Ifrach, Rohan Basu, Disha S. Joshi, Tracy M. Flanders, Ali K. Ozturk, Neil R. Malhotra, Rachel Pessoa, Michael J. Kallan, Eileen Maloney, William C. Welch, Zarina S. Ali 

Abstract [from journal]

Objective: Elderly patients are a vulnerable patient population in elective spinal surgery. Older patients have more medical comorbidities and are also more sensitive to opiate medications. Despite this, spine and peripheral nerve surgery is still feasible in these patients, and an Enhanced Recovery After Surgery (ERAS) regimen can further enhance the safety profile.

Methods: This is a before and after cohort study at a single institution on elderly patients who underwent elective spine and


Concordance Of Confirmatory Prostate Biopsy In Active Surveillance With National Guidelines: An Analysis From The Multi-Institutional PURC Cohort

Jul. 29, 2020

Ruchika Talwar, Brian Friel, Sameer Mittal, Leilei Xia, Claudette Fonshell, John Danella, Bruce Jacobs, Thomas Lanchoney, Jay Raman, Jeffrey Tomaszewski, Edouard Trabulsi, Adam Reese, Eric Singer, Serge Ginzburg, Marc Smaldone, Robert Uzzo, Phillip Mucksavage, Thomas J. Guzzo, ...

Abstract [from journal]

Purpose: National Comprehensive Cancer Network (NCCN) guidelines recommend confirmatory biopsy within 12 months of active surveillance (AS) enrollment. With <10 cores on initial biopsy, re-biopsy should occur within 6 months. Our objective was to determine if patients on AS within practices in the Pennsylvania Urologic Regional Collaborative (PURC) receive guideline concordant confirmatory biopsies.

Materials and methods: Within PURC, a prospective collaborative of diverse urology practices


Ethics And Informatics In The Age Of COVID-19: Challenges And Recommendations For Public Health Organization And Public Policy

Ross Koppel, PhD
Jul. 28, 2020

Vignesh Subbian, Anthony Solomonides, Melissa Clarkson, Vasiliki Nataly Rahimzadeh, Carolyn Petersen, Richard Schreiber, Paul R. DeMuro, Prerna Dua, Kenneth W. Goodman, Bonnie Kaplan, Ross Koppel, Christoph U. Lehmann, Eric Pan, Yalini Senathirajah

Abstract [from journal]

The COVID-19 pandemic response in the United States has exposed significant gaps in information systems and processes to enable timely clinical and public health decision-making. Specifically, the use of informatics to mitigate the spread of SARS-CoV-2, support COVID-19 care delivery, and accelerate knowledge discovery bring to the forefront issues of privacy, surveillance, limits of state powers, and interoperability between public health and clinical information systems. Using a consensus building process, we critically analyze


Reducing Paediatric Overweight And Obesity Through Motivational Interviewing: Study Protocol For A Randomised Controlled Trial In The AAP PROS Research Network

Alexander G. Fiks, MD, MSCE
Jul. 28, 2020

Margaret E. Wright, Emerson Delacroix, Kendrin R. Sonneville, Shannon Considine, Tim Proctor, Jennifer Steffes, Donna Harris, Laura P. Shone, Heide Woo, Roger Vaughan, Robert W. Grundmeier, Alexander G. Fiks, Melissa S. Stockwell, Ken Resnicow

Abstract [from journal]

Introduction: Primary care remains an underused venue for prevention and management of paediatric overweight and obesity. A prior trial demonstrated a significant impact of paediatrician/nurse practitioner (Ped/NP)-and registered dietitian (RD)-delivered motivational interviewing (MI) on child body mass index (BMI). The study described here will test the effectiveness of an enhanced version of this primary care-based MI counselling intervention on child BMI.

Methods and analysis: This cluster


Use of Hydrocortisone, Ascorbic Acid, and Thiamine in Adults With Septic Shock

Jul. 24, 2020

Emily A. Vail, Hannah Wunsch, Ruxandra Pinto, Nicholas A. Bosch, Allan J. Walkey, Peter K. Lindenauer, and Hayley B. Gershengorn

Abstract [from journal]

Rationale: In December 2016, a single-center study describing significant improvements in mortality among a small group of patients with severe sepsis and septic shock treated with hydrocortisone, high-dose ascorbic acid, and thiamine (HAT therapy) was published online.

Objectives: This study aims to describe the administration of HAT therapy among U.S. adults with septic shock before and after study publication and to compare outcomes between patients who received and did not receive HAT


Resource Utilization In The First 2 Years Following Operative Correction For Tetralogy Of Fallot: Study Using Data From The Optum's De‐Identified Clinformatics Data Mart Insurance Claims Database

Jul. 21, 2020

Michael L. O'Byrne, Grace DeCost, Hannah Katcoff, Jill J. Savla, Joyce Chang, Elizabeth Goldmuntz, Peter W. Groeneveld, Joseph W. Rossano, Jennifer A. Faerber, and Laura Mercer‐Rosa

Abstract [from journal]

Background: Despite excellent operative survival, correction of tetralogy of Fallot frequently is accompanied by residual lesions that may affect health beyond the incident hospitalization. Measuring resource utilization, specifically cost and length of stay, provides an integrated measure of morbidity not appreciable in traditional outcomes.

Methods and Results: We conducted a retrospective cohort study, using de‐identified commercial insurance claims data, of 269 children who underwent


COVID-19 Has Increased the Demand for Advanced Care Planning

Jul. 20, 2020

The COVID-19 pandemic has claimed over half a million lives worldwide. In the U.S., it is estimated that one in five adults who develops symptomatic COVID-19 will wind up in a hospital, and one in 20 may develop respiratory failure requiring a mechanical ventilator.

The Effect Of Increased Cost-Sharing On Low-Value Service Use

Jul. 20, 2020

Jonathan Gruber, Johanna Catherine Maclean, Bill Wright, Eric Wilkinson, Kevin G Volpp

Abstract [from journal]

We examine the effect of a value-based insurance design (VBID) program implemented at a large public employer in the state of Oregon. The program substantially increased cost-sharing for several healthcare services likely to be of low value for most patients: diagnostic services (e.g., imaging services) and surgeries (e.g., spinal surgeries for pain). Using a difference-in-differences design coupled with granular, administrative health insurance claims data over the period 2008-2012, we estimate the change in low-value service use


Regulatory Flexibility For COVID-19 Research

Jul. 9, 2020

Holly Fernandez Lynch, Neal W. Dickert, Patricia J. Zettler, Steven JoffeEmily A. Largent

Abstract [from journal]

Clinical research is critical to combatting COVID-19, but regulatory requirements for human subjects protection may sometimes pose a challenge in pandemic circumstances. Although regulators have offered some helpful guidance for research during the pandemic, we identify further compliance challenges regarding institutional review board (IRB) review and approval, informed consent, emergency research, and research involving incarcerated people. Our proposals for regulatory flexibility in these areas seek to satisfy the goals of


Variation In Tonsillectomy Cost And Revisit Rates: Analysis Of Administrative And Billing Data From US Children's Hospitals

Ron Keren, MD, MPH
Jun. 30, 2020

Sanjay Mahant, Troy Richardson, Ron Keren, Rajendu Srivastava, Jeremy Meier, Pediatric Research in Inpatient Setting (PRIS) Network

Abstract [from journal]

Background: Tonsillectomy is one of the most common and cumulatively expensive surgical procedures in children. We determined if substantial variation in resource use, as measured by standardised costs, exists across hospitals for performing tonsillectomy and if higher resource use is associated with better quality of care, as measured by revisits to hospital.

Methods: We conducted a retrospective analysis of children undergoing routine outpatient tonsillectomy between 2011 to 2017 across US