Medicine and Health Sciences Commons^™

Factors Associated With Ordering Laboratory Monitoring Of High-Risk Medications, Shira Fischer, Jennifer Tjia, George Reed, Daniel Peterson, Jerry Gurwitz, Terry Field

Jennifer Tjia

BACKGROUND: Knowledge about factors associated with provider ordering of appropriate testing is limited.

OBJECTIVE: To determine physician factors associated with ordering recommended laboratory monitoring tests for high-risk medications.

METHODS: Retrospective cohort study of patients prescribed a high-risk medication requiring laboratory monitoring in a large multispecialty group practice between 1 January 2008 and 31 December 2008. Analyses are based on administrative claims and electronic medical records. The outcome is a physician order for each recommended laboratory test for each prescribed medication. Key predictor variables are physician characteristics, including age, gender, specialty training, years since completing training, and prescribing volume. Additional variables …

An Electronic Health Record-Based Intervention To Increase Follow-Up Office Visits And Decrease Rehospitalization In Older Adults, Jerry Gurwitz, Terry Field, Jessica Ogarek, Jennifer Tjia, Sarah Cutrona, Leslie Harrold, Shawn Gagne, Peggy Preusse, Jennifer Donovan, Abir Kanaan, George Reed, Lawrence Garber

Jennifer Tjia

OBJECTIVES: To assess the effect of an electronic health record-based transitional care intervention involving automated alerts to primary care providers and staff when older adults were discharged from the hospital.

DESIGN: Randomized controlled trial.

SETTING: Large multispecialty group practice.

PARTICIPANTS: Individuals aged 65 and older discharged from hospital to home.

INTERVENTION: In addition to notifying primary care providers about the individual's recent discharge, the system provided information about new drugs added during the inpatient stay, warnings about drug-drug interactions, recommendations for dose changes and laboratory monitoring of high-risk medications, and alerts to the primary care provider's support staff to schedule …

Understanding The Role Of Promotora In A Latino Diabetes Education Program, Lynn Deitrick, Hannah Paxton, Alicia Rivera, Eric Gertner, Nyann Biery, Abby Letcher, Lissette Lahoz, Edgar Maldonado, Debbie Salas-Lopez

Debbie Salas-Lopez MD, MPH

No abstract provided.

Hypertension Management In A Student-Run Free Clinic: Meeting National Standards?, Jason Zucker, Jennifer Gillen, Jason Ackrivo, Robin Schroeder, Steven Keller

Robin S. Schroeder MD

PURPOSE: Affecting one in three adults, hypertension is one of the most prevalent disorders in the United States. The purpose of this analysis was to evaluate, using national care guidelines and quality standards, the quality of care provided at the Student Family Health Care Center (SFHCC) of the University of Medicine and Dentistry of New Jersey (Newark).

METHOD: The authors performed a chart review of all patients seen from June 2008 to June 2009, collecting the following data: age, gender, ethnicity, body mass index, most recent blood pressure measurement, comorbid conditions, number of visits, free medications dispensed, and smoking status. …

In Reply: Instrusive Inquiry Threatens The Privacy Of Physicians' Personal Health Information, Robin Schroeder, Chantal Brazeau, Sue Rovi

Robin S. Schroeder MD

No abstract provided.

Do State Medical Board Applications Violate The Americans With Disabilities Act?, Robin Schroeder, Chantal Brazeau, Freda Zackin, Sue Rovi, John Dickey, Mark Johnson, Steven Keller

Robin S. Schroeder MD

PURPOSE: To determine whether medical licensing board application questions about the mental or physical health or substance use history of the applicant violate the Americans with Disabilities Act (ADA) of 1990. METHOD: Content analysis of 51 allopathic licensing applications (50 states and District of Columbia) was performed at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in 2005. Questions referencing physical or mental health or substance use were identified by a team of physicians and reviewed and categorized based on the ADA and appropriate case law by legal counsel. RESULTS: Of the 51 applications reviewed, 49 …

Relationships Between Medical Student Burnout, Empathy, And Professionalism Climate, Chantal Brazeau, Robin Schroeder, Sue Rovi, Linda Boyd

Robin S. Schroeder MD

BACKGROUND: Medical student burnout is prevalent, and there has been much discussion about burnout and professionalism in medical education and the clinical learning environment. Yet, few studies have attempted to explore relationships between those issues using validated instruments. METHOD: Medical students were surveyed at the beginning of their fourth year using the Maslach Burnout Inventory, the Jefferson Scale of Physician Empathy-Student Version, and the Professionalism Climate Instrument. The data were analyzed using Statistical Package for the Social Sciences, and Spearman correlation analysis was performed. RESULTS: Scores indicative of higher medical student burnout were associated with lower medical student empathy scores …

Relationship Between Medical Student Service And Empathy, Chantal Brazeau, Robin Schroeder, Sue Rovi, Linda Boyd

Robin S. Schroeder MD

BACKGROUND: Student participation in service activities during medical school is believed to enhance student professionalism and empathy. Yet, there are no studies that measure medical student empathy levels in relation to service activities.

METHOD: Medical students from four classes (2007-2010) were surveyed at graduation using the Jefferson Scale of Physician Empathy-Student Version and questions about service activity during medical school. For two classes, empathy scores were also obtained at orientation. The data were analyzed using Statistical Package for the Social Sciences. Means comparison tests were performed.

RESULTS: Mean empathy scores at graduation were higher for students who participated in service …

Measuring And Assessing Preventive Medicine Services In A Student-Run Free Clinic, Jason Zucker, Janet Lee, Mamoona Khokhar, Robin Schroeder, Steven Keller

Robin S. Schroeder MD

No abstract provided.

Treatment Of Adult Obesity With Bariatric Surgery, Robin Schroeder, Jordan Garrison, Mark Johnson

Robin S. Schroeder MD

Bariatric surgery procedures, including laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass, result in an average weight loss of 50 percent of excess body weight. Remission of diabetes mellitus occurs in approximately 80 percent of patients after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Obesity Surgery Mortality Risk Score can help identify patients with increased mortality risk from bariatric surgery. Complications and adverse effects are lowest with laparoscopic surgery, and vary by procedure and presurgical risk. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can …

Knowledge Of And Perceived Need For Evidence-Based Education About Antipsychotic Medications Among Nursing Home Leadership And Staff, Celeste Lemay, Kathleen Mazor, Terry Field, Jennifer Donovan, Abir Kanaan, Becky Briesacher, Sarah Foy, Leslie Harrold, Jerry Gurwitz, Jennifer Tjia

Jennifer Tjia

BACKGROUND/OBJECTIVES: Antipsychotic use is common in US nursing homes, despite evidence of increased risk of morbidity and mortality, and limited efficacy in older adults with dementia. Knowledge, attitudes, and beliefs regarding antipsychotic use among nursing home staff are unclear. The study aim was to describe nursing home leadership and direct care staff members' knowledge of antipsychotic risks, beliefs and attitudes about the effectiveness of antipsychotics and nonpharmacologic management of dementia-related behaviors, and perceived need for evidence-based training about antipsychotic medication safety. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Survey of leadership and direct care staff of nursing homes in Connecticut was conducted …

Tobacco Screening Multicomponent Quality Improvement Network Program: Beyond Education, Sharon Kimmel, Suzanne Smith, Judith Sabino, Eric Gertner, Julie Dostal, Marna Greenberg

Marna R Greenberg DO, MPH, FACEP

No abstract provided.

Too Much Medicine; Too Little Care, Paul Glasziou, Ray Moynihan, Tessa Richards, Fiona Godlee

Ray Moynihan

Extract: A growing frustration in clinical medicine is that we are now so busy managing the proliferation of risk factors, “incidentalomas,” and the worried well that we lack the time to care properly for those who are seriously ill. As the definitions of common conditions such as diabetes and kidney disease have expanded and the categories and boundaries of mental disorders have grown, our time and attention for the most worryingly ill, disturbed, and vulnerable patients has shrunk. Too much medicine is harming both the sick and well.

Do You Think It's A Disease? A Survey Of Medical Students, Chrissy Erueti, Paul Glasziou, Chris Del Mar, Mieke Van Driel

Chrissy Erueti

Background: The management of medical conditions is influenced by whether clinicians regard them as "disease" or "not a disease". The aim of the survey was to determine how medical students classify a range of conditions they might encounter in their professional lives and whether a different name for a condition would influence their decision in the categorisation of the condition as a 'disease' or 'not a disease'. Methods: We surveyed 3 concurrent years of medical students to classify 36 candidate conditions into "disease" and "non-disease". The conditions were given a 'medical' label and a (lay) label and positioned where possible …

Studies To Reduce Unnecessary Medication Use In Frail Older Adults: A Systematic Review, Jennifer Tjia, Sarah Velten, Carole Parsons, Sruthi Valluri, Becky Briesacher

Jennifer Tjia

BACKGROUND: Overuse of unnecessary medications in frail older adults with limited life expectancy remains an understudied challenge.

OBJECTIVE: To identify intervention studies that reduced use of unnecessary medications in frail older adults. A secondary goal was to identify and review studies focusing on patients approaching end of life. We examined criteria for identifying unnecessary medications, intervention processes for medication reduction, and intervention effectiveness.

METHODS: A systematic review of English articles using MEDLINE, EMBASE, and International Pharmaceutical Abstracts from January 1966 to September 2012. Additional studies were identified by searching bibliographies. Search terms included prescription drugs, drug utilization, hospice or palliative …

Short- And Long-Term Risk Of Colorectal Adenoma Recurrence Among Whites And Blacks, Adeyinka Laiyemo, Chyke Doubeni, Hassan Brim, Hassan Ashktorab, Robert Schoen, Samir Gupta, Aline Charabaty, Elaine Lanza, Duane Smoot, Elizabeth Platz, Amanda Cross

Chyke A. Doubeni

BACKGROUND: It is unclear whether the higher burden from colorectal cancer among blacks is due to an increased biological susceptibility. OBJECTIVE: To determine whether non-Hispanic blacks (blacks) have a higher risk of adenoma recurrence than non-Hispanic whites (whites) after removal of colorectal adenoma. DESIGN: Secondary analysis of the Polyp Prevention Trial (PPT) data. SETTING: United States. PATIENTS: Patients were 1668 self-identified whites and 153 blacks who completed the 4-year trial. Of these, 688 whites and 55 blacks enrolled in a posttrial, passive Polyp Prevention Trial Continued Follow-up Study (PPT-CFS) and underwent another colonoscopy. MAIN OUTCOME MEASUREMENTS: Recurrence and location of …

Perceptions Of Evidence-Based Programs Among Community-Based Organizations Tackling Health Disparities: A Qualitative Study, Shoba Ramanadhan, Josephine Crisostomo, Jaclyn Alexander-Molloy, Ediss Gandelman, Milagro Grullon, Vilma Lora, Chrasandra Reeves, Clara Savage, Kasisomayajula Viswanatha, Chyke Doubeni

Chyke A. Doubeni

Dissemination of prevention-focused evidence-based programs (EBPs) from research to community settings may improve population health and reduce health disparities, but such flow has been limited. Academic-community partnerships using community-based participatory research (CBPR) principles may support increased dissemination of EBPs to community-based organizations (CBOs). This qualitative study examined the EBP-related perceptions and needs of CBOs targeting underserved populations. As part of PLANET MassCONECT, a CBPR study, we conducted six key informant interviews with community leaders and four focus groups with CBO staff members in Boston, Worcester and Lawrence, Massachusetts, in 2008. Working definitions of EBPs among CBO staff members varied greatly …

Fpin's Clinical Inquiries. Leukotriene Receptor Antagonists For The Treatment Of Allergic Skin Disorders., Brian Stello, Linda Schwartz, David Fiore

Linda Matula Schwartz MDE, AHIP, CM

No abstract provided.

Factors Associated With Inadequate Colorectal Cancer Screening With Flexible Sigmoidoscopy, Adeyinka Laiyemo, Chyke Doubeni, Paul Pinsky, V. Paul Doria-Rose, Andrew Sanderson, Robert Bresalier, Joel Weissfeld, Robert Schoen, Pamela Marcus, Phillip Prorok, Christine Berg

Chyke A. Doubeni

BACKGROUND AND STUDY AIM: Inadequate colorectal cancer screening wastes limited endoscopic resources. We examined patients factors associated with inadequate flexible sigmoidoscopy (FSG) screening at baseline screening and repeat screening 3-5 years later in 10 geographically-dispersed screening centers participating in the ongoing Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

METHODS: A total of 64,554 participants (aged 55-74) completed baseline questionnaires and underwent FSG at baseline. Of these, 39,385 participants returned for repeat screening. We used logistic regression models to assess factors that are associated with inadequate FSG (defined as a study in which the depth of insertion of FSG was …

Contribution Of Behavioral Risk Factors And Obesity To Socioeconomic Differences In Colorectal Cancer Incidence, Chyke Doubeni, Jacqueline Major, Adeyinka Laiyemo, Mario Schootman, Ann Zauber, Albert Hollenbeck, Rashmi Sinha, Jeroan Allison

Chyke A. Doubeni

BACKGROUND:Health behaviors are known risk factors for colorectal cancer and are more common in low socioeconomic status (SES) populations. We evaluated the extent to which behavioral risk factors and body mass index (BMI) explain SES disparities in colorectal cancer incidence, overall and by tumor location.

METHODS: We analyzed prospective National Institutes of Health-AARP Diet and Health Study data on 506 488 participants who were recruited in 1995-1996 from six US states and two metropolitan areas and followed through 2006. Detailed baseline data on risk factors for colorectal cancer, including health behaviors, were obtained using questionnaires. SES was measured by self-reported …

Socioeconomic Status, Healthcare Density, And Risk Of Prostate Cancer Among African American And Caucasian Men In A Large Prospective Study, Jacqueline Major, M. Oliver, Chyke Doubeni, Albert Hollenbeck, Barry Graubard, Rashmi Sinha

Chyke A. Doubeni

OBJECTIVES: The purpose of this study was to separately examine the impact of neighborhood socioeconomic deprivation and availability of healthcare resources on prostate cancer risk among African American and Caucasian men. METHODS: In the large, prospective NIH-AARP Diet and Health Study, we analyzed baseline (1995-1996) data from adult men, aged 50-71 years. Incident prostate cancer cases (n = 22,523; 1,089 among African Americans) were identified through December 2006. Lifestyle and health risk information was ascertained by questionnaires administered at baseline. Area-level socioeconomic indicators were ascertained by linkage to the US Census and the Area Resource File. Multilevel Cox models were …

Variation Of Adenoma Prevalence By Age, Sex, Race, And Colon Location In A Large Population: Implications For Screening And Quality Programs, Douglas Corley, Christopher Jensen, Amy Marks, Wei Zhao, Jolanda De Boer, Theodore Levin, Chyke Doubeni, Bruce Fireman, Charles Quesenberry

Chyke A. Doubeni

BACKGROUND and AIMS: Reliable community-based colorectal adenoma prevalence estimates are needed to inform colonoscopy quality standards and to estimate patient colorectal cancer risks; however, minimal data exist from populations with large numbers of diverse patients and examiners. METHODS: We evaluated the prevalence of adenomas detected by sex, age, race/ethnicity, and colon location among 20,792 Kaiser Permanente Northern California members >/=50 years of age who received a screening colonoscopy exam (102 gastroenterologists, years 2006-2008). RESULTS: Prevalence of detected adenomas increased more rapidly with age in the proximal colon (adjusted odds ratio [OR], 2.39; 95% confidence interval [CI], 2.05-2.80; 70-74 vs 50-54 …

Self-Reported Colorectal Cancer Screening Of Medicare Beneficiaries In Family Medicine Vs. Internal Medicine Practices In The United States: A Cross-Sectional Study, Angela Higgins, Anna Doubeni, Karon Phillips, Adeyinka Laiyemo, Becky Briesacher, Jennifer Tjia, Chyke Doubeni

Chyke A. Doubeni

BACKGROUND: The benefit of screening for decreasing the risk of death from colorectal cancer (CRC) has been shown, yet many patients in primary care are still not undergoing screening according to guidelines. There are known variations in delivery of preventive health care services among primary care physicians. This study compared self-reported CRC screening rates and patient awareness of the need for CRC screening of patients receiving care from family medicine (FPs) vs. internal medicine (internists) physicians. METHODS: Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey). The main …

Neighborhood Socioeconomic Status And Use Of Colonoscopy In An Insured Population--A Retrospective Cohort Study, Chyke Doubeni, Guruprasad Jambaulikar, Hassan Fouayzi, Scott Robinson, Margaret Gunter, Terry Field, Douglas Roblin, Robert Fletcher

Chyke A. Doubeni

BACKGROUND: Low-socioeconomic status (SES) is associated with a higher colorectal cancer (CRC) incidence and mortality. Screening with colonoscopy, the most commonly used test in the US, has been shown to reduce the risk of death from CRC. This study examined if, among insured persons receiving care in integrated healthcare delivery systems, differences exist in colonoscopy use according to neighborhood SES. METHODS: We assembled a retrospective cohort of 100,566 men and women, 50-74 years old, who had been enrolled in one of three US health plans for >/=1 year on January 1, 2000. Subjects were followed until the date of first …

Verbal Autopsy Tool For Infant Mortality, Vijay Kumar Chattu

Vijay Kumar Chattu

Information on causes of death is extremely important for policy-making, planning, monitoring and evaluation of health programs as well as for field research, comparisons and epidemic awareness.The Millennium Development Goal for India is to reduce infant mortality rate to 35 per 1000 & under-five mortality to 45 per 1000 live births by 2015.The incorporation of Verbal Autopsy (VA) in the existing Registration Systems is necessary in order to fulfil its ultimate goal of improving the information on causes of infant deaths in areas where Civil Registration and Death Certification are weak. VA provides information for local action by health authorities …

Predicting Nursing Home Adherence To A Clinical Trial Intervention: Lessons For The Conduct Of Cluster Randomized Trials, Jennifer Tjia, Kathleen Mazor, Terry Field, Peter Doherty, Ann Spenard, Jerry Gurwitz

Jennifer Tjia

OBJECTIVES: To describe factors predictive of nursing home (NH) adherence to a clinical trial intervention. DESIGN: Post hoc analysis of a cluster randomized trial (CRT) evaluating a structured communication intervention to improve nurse-physician telephone communication in NHs. SETTING: NH. PARTICIPANTS: All eligible licensed nursing staff in all participating NHs. MEASUREMENTS: Adherence was defined as active participation for at least 3 months of the 12-month trial. NH characteristics hypothesized to affect trial outcomes (profit status, bed size, nursing staff time, NH quality, and leadership turnover) were measured a priori. The association between intervention adherence, NH characteristics and preintervention questionnaire response rate …

Diagnostic E-Codes For Commonly Used, Narrow Therapeutic Index Medications Poorly Predict Adverse Drug Events, Charles Leonard, Kevin Haynes, A. Localio, Sean Hennessy, Jennifer Tjia, Abigail Cohen, Stephen Kimmel, Harold Feldman, Joshua Metlay

Jennifer Tjia

OBJECTIVE: We sought to examine the validity of specific hospital discharge codes in identifying drug toxicity precipitating hospitalization, among elderly users of high-risk medications. STUDY DESIGN AND SETTING: We conducted a cross-sectional evaluation assessing the diagnostic test characteristics of International Classification of Diseases-9 External-Cause-of-Injury codes (E-codes) compared with a reference standard of medical record review. This study was nested within a prospective cohort of elders using warfarin, digoxin, or phenytoin as identified in the Pharmaceutical Assistance Contract for the Elderly benefit program. RESULTS: We identified 4,803 subjects contributing 11,409 person-years of exposure to at least one of three drug groups. …

A Comparison Of Outcomes Resulting From Generalist Vs Specialist Care For A Single Discrete Medical Condition: A Systematic Review And Methodologic Critique, Gerald Smetana, Bruce Landon, Andrew Bindman, Helen Burstin, Roger Davis, Jennifer Tjia, Eugene Rich

Jennifer Tjia

BACKGROUND: Studies of clinical outcomes for generalist vs specialist care for diagnoses within a specialist's narrow domain have tended to favor specialty care. METHODS: A MEDLINE search from January 1, 1980, through April 1, 2005, and a hand search of retrieved bibliographies of English-language studies that compared generalist vs specialist care for individual patients with a single discrete medical condition were performed. Two reviewers determined eligibility for each study and abstracted data onto a standardized instrument. RESULTS: A total of 49 articles met our inclusion criteria: 24 studies favored specialty care, 13 found no difference in outcomes, 7 varied by …

A Systematic Review Of Validated Methods For Identifying Heart Failure Using Administrative Data, Jane Saczynski, Susan Andrade, Leslie Harrold, Jennifer Tjia, Sarah Cutrona, Katherine Dodd, Robert Goldberg, Jerry Gurwitz

Jennifer Tjia

PURPOSE: To identify and describe the validity of algorithms used to detect heart failure (HF) using administrative and claims data sources.

METHODS: A systematic review of PubMed and Iowa Drug Information Service searches of the English language was performed to identify studies published between 1990 and 2010 that evaluated the validity of algorithms for the identification of patients with HF using and claims data. Abstracts and articles were reviewed by two study investigators to determine their relevance on the basis of predetermined criteria.

RESULTS: The initial search strategy identified 887 abstracts. Of these, 499 full articles were reviewed and 35 …

Growth In Dementia-Associated Hospitalizations Among The Oldest Old In The United States: Implications For Ethical Health Services Planning, Marya Zilberberg, Jennifer Tjia

Jennifer Tjia

As the world population ages, an epidemic of neurologic diseases, such as Alzheimer-type dementia and Parkinson disease, is predicted. The most rapid population growth has been observed in the 85 years and older group ... Concurrent with this population growth, we have witnessed a vast expansion of health care utilization and expenditures, with the consequent close scrutiny and attempts to rein in this supply-driven juggernaut. ... We conducted this analysis to gain a better understanding of the current trends in dementia-associated hospitalizations among the 85 years and older population in the United States and its implications for future health care …