Medicine and Health Sciences Commons^™

Technology-Enabled Behavioral Health Integration Decreases Emergency Department Utilization, Adam Pardes, Rachelle Rene, Phansy Chun Chun, Mollie Cherson

Jefferson Hospital Staff Papers and Presentations

Background:

Behavioral health integration allows for patient-centered care, leads to higher levels of provider-patient engagement, and is key to improving patient outcomes. However, behavioral health integration is administratively burdensome and therefore is often not adopted. Technology presents opportunities to increase care team efficiency and improve patient outcomes. The goal of this study was to retrospectively compare clinical outcomes and emergency department utilization in patients using a technology platform compared to patients receiving treatment as usual.

Methods:

The technology platform, NeuroFlow, was deployed to deliver technology-enabled behavioral health integration in 30 clinics, and 598 electronic health records were analyzed.

Results:

In …

E-Cigarette Use Among Women Of Reproductive Age: Impulsivity, Cigarette Smoking Status, And Other Risk Factors., Laura L. Chivers, Dennis J. Hand, Jeff S. Priest, Stephen T. Higgins

Department of Pediatrics Faculty Papers

INTRODUCTION: The study aim was to examine impulsivity and other risk factors for e-cigarette use among women of reproductive age comparing current daily cigarette smokers to never cigarette smokers. Women of reproductive age are of special interest because of the additional risk that tobacco and nicotine use represents should they become pregnant.

METHOD: Survey data were collected anonymously online using Amazon Mechanical Turk in 2014. Participants were 800 women ages 24-44years from the US. Half (n=400) reported current, daily smoking and half (n=400) reported smokingsociodemographics, tobacco/nicotine use, and impulsivity (i.e., delay discounting & Barratt Impulsiveness Scale). Predictors of smoking and …

Depression And Risk Perceptions In Older African Americans With Diabetes, Barry W. Rovner, Md, Julia A. Haller, Md, Robin J. Casten, Phd, Ann P. Murchison, Md, Mph, Lisa A. Hark, Phd, Rd

Department of Psychiatry and Human Behavior Faculty Papers

Introduction: The purpose of this study is to describe the impact of depression on perceptions of risks to health, diabetes self-management practices, and glycemic control in older African Americans with type 2 diabetes.

Methods: The authors analyzed data on depression, risk perceptions, diabetes self-management, and hemoglobin A1C in African Americans with type 2 diabetes.T tests, chi square, and multivariate regression were used to analyze the data.

Results: The sample included 177 African Americans (68% women) whose average age was 72.8 years. Thirty four (19.2%) participants met criteria for depression. Compared to non-depressed participants, depressed participants scored significantly higher on Personal …

A Community-Integrated Home Based Depression Intervention For Older African Americans: Descripton Of The Beat The Blues Randomized Trial And Intervention Costs., Laura N Gitlin, Lynn Fields Harris, Megan Mccoy, Nancy L Chernett, Eric Jutkowitz, Laura T Pizzi

Center for Applied Research on Aging and Health Research Papers

ABSTRACT: BACKGROUND: Primary care is the principle setting for depression treatment; yet many older African Americans in the United States fail to report depressive symptoms or receive the recommended standard of care. Older African Americans are at high risk for depression due to elevated rates of chronic illness, disability and socioeconomic distress. There is an urgent need to develop and test new depression treatments that resonate with minority populations that are hard-to-reach and underserved and to evaluate their cost and cost-effectiveness. METHODS/DESIGN: Beat the Blues (BTB) is a single-blind parallel randomized trial to assess efficacy of a non-pharmacological intervention to …

Ask A Different Question, Get A Different Answer: Why Living Wills Are Poor Guides To Care Preferences At The End Of Life., Laraine Winter, Susan M Parks, James J Diamond

Center for Applied Research on Aging and Health Research Papers

CONTEXT: Living wills have a poor record of directing care at the end of life, as a copious literature attests. Some speculation centers on the questionable correspondence between the scenario described in living wills versus the real-life circumstances that typically arise at the end of life.

OBJECTIVE: To assess the strength of association between responses to a standard living will question and preferences for treatments in six end-of-life scenarios.

DESIGN: Cross-sectional.

SETTING: Telephone interviews.

PARTICIPANTS: Two hundred two community-dwelling men and women 70 years of age or older in the greater Philadelphia area.

MAIN OUTCOME MEASURES: Strength of preferences for …

New Directions In Dementia Care At Home, Tracey Vause-Earland, E. Adel Herge, Catherine Verrier Piersol, Laura N. Gitlin, Janice Burke

Center for Applied Research on Aging and Health Research Papers

No abstract provided.

A Non-Pharmacological Intervention To Manage Behavioral And Psychological Symptoms Of Dementia And Reduce Caregiver Distress: Design And Methods Of Project Act3., Laura N Gitlin, Laraine Winter, Marie P Dennis, Walter W Hauck

Center for Applied Research on Aging and Health Research Papers

Project ACT is a randomized controlled trial designed to test the effectiveness of a non-pharmacological home-based intervention to reduce behavioral and psychological symptoms of dementia (BPSD) and caregiver distress. The study targets 272 stressed racially diverse family caregivers providing in-home care to persons with moderate stage dementia with one or more behavioral disturbances. All participants are interviewed at baseline, 4-months (main trial endpoint), and 6-months (maintenance). The four-month intervention involves up to 13 visits from an occupational therapist who works with families to problem-solve potential triggers (communication style, environmental clutter) contributing to behaviors, and instruct in strategies to reduce caregiver …

Evaluation Of A Telephone-Based Support Group Intervention For Female Caregivers Of Community-Dwelling Individuals With Dementia, Laraine Winter, Laura N. Gitlin

Center for Applied Research on Aging and Health Research Papers

Family caregivers, the "second victims" or hidden patients in dementia care, are at risk for social isolation, stress, depression, and mortality. Telephone-based support (telesupport groups) represents a practical, low-burden, low-cost source of emotional support. The present study evaluated the feasibility and effectiveness of professionally led telephone-based support groups for female family caregivers of community-dwelling dementia patients. Recruited through various community sources, 103 female caregivers were randomized to the telesupport group treatment or a control condition. Effects on caregiver burden, depression, and personal gains were evaluated at 6 months, the main end point. Older caregivers (≥65) in telesupport reported lower depression …

Mild Cognitive Impairment, Activity Participation, Functional Difficulty, & Adaptations , Laraine Winter, Laura N. Gitlin

Center for Applied Research on Aging and Health Research Papers

No abstract provided.

Current Health And Preferences For Life-Prolonging Treatments: An Application Of Prospect Theory To End-Of-Life Decision Making, Laraine Winter, Barbara Parker

Center for Applied Research on Aging and Health Research Papers

No abstract provided.

Mild Cognitive Impairment, Activity Participation, Functional Difficulty, And Adaptations In Functionally Vulnerable Elderly People: A Closer Look, Laraine Winter, Laura N. Gitlin

Center for Applied Research on Aging and Health Research Papers

No abstract provided.

A Randomized Trial Of A Multicomponent Home Intervention To Reduce Functional Difficulties In Older Adults, Laura N. Gitlin, Laraine Winter, Marie P. Dennis, Mary Corcoran, Walter W. Hauck

Center for Applied Research on Aging and Health Research Papers

OBJECTIVES: To test the efficacy of a multicomponent intervention to reduce functional difficulties, fear of falling, and home hazards and enhance self-efficacy and adaptive coping in older adults with chronic conditions.

DESIGN: A prospective, two-group, randomized trial. Participants were randomized to a treatment group or no-treatment group.

SETTING: Urban community-living older people.

PARTICIPANTS: Three hundred nineteen community-living adults aged 70 and older who reported difficulty with one or more activities of daily living.

INTERVENTION: Occupational and physical therapy sessions involving home modifications and training in their use; instruction in strategies of problem-solving, energy conservation, safe performance, and fall recovery techniques; …

Data And Safety Monitoring In Social Behavioral Intervention Trials: The Reach Ii Experience, Sara J. Czaja, Richard Schulz, Steven H. Belle, Louis D. Burgio, Nell Armstrong, Laura N. Gitlin, David W. Coon, Jennifer Martindale-Adams, Julie Klinger, Sidney M. Stahl

Center for Applied Research on Aging and Health Research Papers

Background Psychosocial and behavioral interventions trials targeting a broad range of complex social and behavioral problems such as smoking, obesity and family caregiving have proliferated in the past 30 years. At the same time the use of Data and Safety Monitoring Boards (DSMBs) to monitor the progress and quality of intervention trials and the safety of study participants has increased substantially. Most of the existing literature and guidelines for safety monitoring and reporting of adverse events focuses on medical interventions. Consequently, there is little guidance for investigators conducting social and behavior trials.

Purpose This paper summarizes how issues associated with …

The Role Of Spiritual Well-Being In Moderating Frail Elders' Affective Response To Functional Difficulty, Marie P. Dennis, Laura N. Gitlin, Laraine Winter, Yeon K. Chee

Center for Applied Research on Aging and Health Research Papers

Anxiety and depression have been well documented as affective consequences of functional impairment. Little research, however, has examined factors that moderate these associations. The present cross-sectional study examined the role of spiritual well-being in buffering the impact of functional difficulty on the anxiety and depressive symptoms of 319 functionally vulnerable community-dwelling elders, aged 70 or older, participating in a 6-month randomized controlled trial designed to enhance function. As demonstrated in recent research on spirituality and health, we expected that spiritual well-being would moderate the association between functional difficulty and anxiety as well as the relationship between functional difficulty and depression. …

The Tension Of Loss In Old Age, Christa Caruso, Helen K. Black

Center for Applied Research on Aging and Health Research Papers

Our poster is based on a larger qualitative study that explores the personal meaning of suffering to 122 community-dwelling elders. Because loss in old age emerges as a significant aspect of suffering in elders' narratives, we focus on suffering as loss. We are recruiting community dwelling elders aged 80 and above, stratified by ethnicity, gender and self-reported health for extended qualitative interviews. Respondents tell their life story and story of suffering along with personal definitions of suffering. Through narrative analysis we examine responses to the many losses experienced during a long life and the suffering that results from loss. By …

Religious Locus Of Control, Laraine Winter

Center for Applied Research on Aging and Health Research Papers

No abstract provided.

What Is Valuation Of Life For Frail Community-Dwelling Older Adults: Factor Structure And Criterion Validity Of The Vol, Marie P. Dennis, Laraine Winter, Helen K. Black, Laura N. Gitlin

Center for Applied Research on Aging and Health Research Papers

Lawton et al. (1999) defined valuation of life (VOL) as a cognitive-affective schema consisting of complex judgments, emotions and projections influenced by demographic and QOL factors. However, little is known about what constitutes VOL for frail elders. The present study evaluated the psychometric properties of a 13-item version of Lawton et al's. (2001) VOL Scale and examined correlational evidence in support of its construct validity with 319 elders enrolled in the Project ABLE study. Responses of half the sample (N=159) were submitted to principal axis factoring, yielding two factors (spiritual well-being, a = .88 and goal-related self-efficacy, a = .84), …

Provider-Caregiver Interactions: Evaluation And Use Of The Therapeutic Relationship Index For Caregiver Interventions, Yeon Kyung Chee, Marie P. Dennis, Laura N. Gitlin

Center for Applied Research on Aging and Health Research Papers

No abstract provided.

Caregiver Strategy Use To Contend With Cognitive And Functional Decline In Persons With Dementia , Laura N. Gitlin, Marie P. Dennis, Walter W. Hauck, Laraine Winter, Sandy Schinfeld

Center for Applied Research on Aging and Health Research Papers

No abstract provided.

Innovation In Occupational Therapy Practice: Evidence In Working With Families Caring For Persons With Dementia, Laura N. Gitlin

Center for Applied Research on Aging and Health Research Papers

No abstract provided.