Publications by authors named "Aastha Chandak"

29 Publications

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Clinical and Economic Burden of Multiple Double-Stranded DNA Viral Infections after Allogeneic Hematopoietic Cell Transplantation.

Transplant Cell Ther 2022 Jun 25. Epub 2022 Jun 25.

Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.

Conditioning regimens for allogeneic hematopoietic cell transplantation (allo-HCT) are immunosuppressive and increase the risk for reactivation of and infection with double-stranded DNA (dsDNA) viruses, which contribute to morbidity and mortality after allo-HCT. This retrospective observational study evaluated the association of dsDNA viral infections with clinical outcomes, health resource utilization (HRU), and health care reimbursement after allo-HCT. Patients who underwent allo-HCT between 2012 and 2017 were identified from a US open-source claims database (Decision Resource Group Real-World Evidence Data Repository; n = 13,363) and categorized according to the presence or absence of dsDNA viral infection, defined as having ≥1 diagnosis code for cytomegalovirus (CMV), adenovirus (AdV), human herpesvirus 6 (HHV-6), or BK virus (BKV)/Epstein-Barr virus (EBV)/John Cunningham virus (JCV) (grouped together given a lack of specific diagnoses codes) within 1 year after allo-HCT. Only first allo-HCT data were used in patients who underwent multiple procedures. Study outcomes included clinical outcomes (eg, time to all-cause mortality, new diagnosis of renal impairment), HRU (hospital and intensive care unit length of stay [LOS], readmission rates), and health care reimbursement (total, inpatient, and outpatient costs as reported reimbursements from insurance claims). For all outcomes, patients were stratified by the presence/absence of any dsDNA viral infection and number (none, 1, 2, or ≥3) and type(s) of infection. The effect of graft-versus-host disease (GVHD) was assessed as well. Twenty-nine percent of patients were diagnosed with CMV, 13% with BKV/EBV/JCV, 5% with AdV, and 4% with HHV-6 in the year following their first allo-HCT. A single dsDNA viral infection was documented in 30% of individuals, 2 in 8%, and ≥3 in 2%. Patients with no viral infections had an overall hospital LOS (index hospitalization plus readmissions) of 41.3 days and a total health care reimbursement of $266,345. These numbers increased for every additional viral infection, regardless of the presence or absence of GVHD; the overall hospital LOS was 61.4 days and total healthcare reimbursement was $431,614 in patients with 1 viral infection, 77.0 days and $639,097 in patients with 2 viral infections, and 103.3 days and $964,378 in patients with ≥3 viral infections. An increase in the number of dsDNA viral infections was associated with a significantly higher adjusted hazard of all-cause mortality (1 versus 0 dsDNA viral infections: hazard ratio [HR], 1.5; [95% confidence interval (CI), 1.3 to 1.6]; 2 versus 0: HR, 2.0 [95% CI, 1.7 to 2.3]; ≥3 versus 0: HR, 2.4 [95% CI, 1.8 to 3.3]) and a significantly higher incidence of new diagnosis of renal impairment, regardless of the presence of GVHD (35% of patients with ≥3 infections, 31% of patients with 2 infections, 26% of patients with 1 infection, and 19% of patients with no infection). These results indicate that more directed prevention and treatment strategies for dsDNA viral infections could substantially improve clinical outcomes and reduce HRU.
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http://dx.doi.org/10.1016/j.jtct.2022.06.016DOI Listing
June 2022

Economic and clinical burden associated with respiratory viral infections after allogeneic hematopoietic cell transplant in the United States.

Transpl Infect Dis 2022 Aug 1;24(4):e13866. Epub 2022 Jun 1.

Certara, New York, New York, USA.

Background: Allogeneic hematopoietic cell transplant (allo-HCT) recipients are at increased risk for respiratory viral infections (RVIs), which invoke substantial morbidity and mortality. Limited effective antiviral options and drug resistance often hamper successful RVI treatment, creating additional burden for patients and the health care system.

Methods: Using an open-source health care claims database, we examined differences in clinical outcomes, health resource utilization, and total reimbursements during the 1-year period following allo-HCT in patients with and without any RVI infection (respiratory syncytial virus, influenza, parainfluenza virus, and human metapneumovirus). RVIs were diagnosed at any time ≤1 year after allo-HCT and identified by International Classification of Disease codes. Analyses were stratified by the presence or absence of acute or chronic graft-versus-host disease (GVHD).

Results: The study included 13 363 allo-HCT patients, 1368 (10.2%) of whom had a diagnostic code for any RVI. A higher proportion of patients with any RVI had pneumonia ≤1 year after allo-HCT compared to patients without any RVI, with or without GVHD. Patients with any RVI had higher all-cause mortality risk, longer length of post-allo-HCT hospital stay, higher readmission rate, and higher number of hospital days after allo-HCT compared to patients without the infection (all p < .05). Total unadjusted median reimbursements were higher for those with any RVI and each specific RVI assessed than those without the specific infection, with or without GVHD.

Conclusion: Allo-HCT patients with RVIs had significantly worse clinical outcomes and increased health resource utilization and reimbursements during the year following allo-HCT, with or without GVHD.
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http://dx.doi.org/10.1111/tid.13866DOI Listing
August 2022

Clinical Management of Hospitalized Coronavirus Disease 2019 Patients in the United States.

Open Forum Infect Dis 2022 Jan 28;9(1):ofab498. Epub 2021 Sep 28.

Gilead Sciences, Foster City, California, USA.

Background: The objective of this study was to characterize hospitalized coronavirus disease 2019 (COVID-19) patients and describe their real-world treatment patterns and outcomes over time.

Methods: Adult patients hospitalized on May 1, 2020-December 31, 2020 with a discharge diagnosis of COVID-19 were identified from the Premier Healthcare Database. Patient and hospital characteristics, treatments, baseline severity based on oxygen support, length of stay (LOS), intensive care unit (ICU) utilization, and mortality were examined.

Results: The study included 295657 patients (847 hospitals), with median age of 66 (interquartile range, 54-77) years. Among each set of demographic comparators, the majority were male, white, and over 65. Approximately 85% had no supplemental oxygen charges (NSOc) or low-flow oxygen (LFO) at baseline, whereas 75% received no more than NSOc or LFO as maximal oxygen support at any time during hospitalization. Remdesivir (RDV) and corticosteroid treatment utilization increased over time. By December, 50% were receiving RDV and 80% were receiving corticosteroids. A higher proportion initiated COVID-19 treatments within 2 days of hospitalization in December versus May (RDV, 87% vs 40%; corticosteroids, 93% vs 62%; convalescent plasma, 68% vs 26%). There was a shift toward initiating RDV in patients on NSOc or LFO (68.0% [May] vs 83.1% [December]). Median LOS decreased over time. Overall mortality was 13.5% and it was highest for severe patients (invasive mechanical ventilation/extracorporeal membrane oxygenation [IMV/ECMO], 53.7%; high-flow oxygen/noninvasive ventilation [HFO/NIV], 32.2%; LFO, 11.7%; NSOc, 7.3%). The ICU use decreased, whereas mortality decreased for NSOc and LFO.

Conclusions: Clinical management of COVID-19 is rapidly evolving. This large observational study found that use of evidence-based treatments increased from May to December 2020, whereas improvement in outcomes occurred over this time-period.
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http://dx.doi.org/10.1093/ofid/ofab498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522394PMC
January 2022

Remdesivir treatment in hospitalized patients with COVID-19: a comparative analysis of in-hospital all-cause mortality in a large multi-center observational cohort.

Clin Infect Dis 2021 Oct 1. Epub 2021 Oct 1.

Gilead Sciences, 333 Lakeside Drive, Foster City, CA, USA.

Background: Remdesivir (RDV) improved clinical outcomes among hospitalized COVID-19 patients in randomized trials, but data from clinical practice are limited.

Methods: We examined survival outcomes for US patients hospitalized with COVID-19 between Aug-Nov 2020 and treated with RDV within two-days of hospitalization vs. those not receiving RDV during their hospitalization using the Premier Healthcare Database. Preferential within-hospital propensity score matching with replacement was used. Additionally, patients were also matched on baseline oxygenation level (no supplemental oxygen charges (NSO), low-flow oxygen (LFO), high-flow oxygen/non-invasive ventilation (HFO/NIV) and invasive mechanical ventilation/ECMO (IMV/ECMO) and two-month admission window and excluded if discharged within 3-days of admission (to exclude anticipated discharges/transfers within 72-hrs consistent with ACTT-1 study). Cox Proportional Hazards models were used to assess time to 14-/28-day mortality overall and for patients on NSO, LFO, HFO/NIV and IMV/ECMO.

Results: 28,855 RDV patients were matched to 16,687 unique non-RDV patients. Overall, 10.6% and 15.4% RDV patients died within 14- and 28-days, respectively compared with 15.4% and 19.1% non-RDV patients. Overall, RDV was associated with a reduction in mortality at 14-days (HR[95% CI]: 0.76[0.70-0.83]) and 28-days (0.89[0.82-0.96]). This mortality benefit was also seen for NSO, LFO and IMV/ECMO at 14-days (NSO:0.69[0.57-0.83], LFO:0.68[0.80-0.77], IMV/ECMO:0.70[0.58-0.84]) and 28-days (NSO:0.80[0.68-0.94], LFO:0.77[0.68-0.86], IMV/ECMO:0.81[0.69-0.94]). Additionally, HFO/NIV RDV group had a lower risk of mortality at 14-days (0.81[0.70-0.93]) but no statistical significance at 28-days.

Conclusions: RDV initiated upon hospital admission was associated with improved survival among COVID-19 patients. Our findings complement ACTT-1 and support RDV as a foundational treatment for hospitalized COVID-19 patients.
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http://dx.doi.org/10.1093/cid/ciab875DOI Listing
October 2021

Economic and Clinical Burden of Virus-Associated Hemorrhagic Cystitis in Patients Following Allogeneic Hematopoietic Stem Cell Transplantation in the United States.

Transplant Cell Ther 2021 06 26;27(6):505.e1-505.e9. Epub 2021 Feb 26.

Memorial Sloan Kettering Cancer Center, New York, New York.

Hemorrhagic cystitis (HC) caused by viral infections such as BK virus, cytomegalovirus, and/or adenovirus after allogeneic hematopoietic stem cell transplantation (allo-HCT) causes morbidity and mortality, affects quality of life, and poses a substantial burden to the health care system. At present, HC management is purely supportive, as there are no approved or recommended antivirals for virus-associated HC. The objective of this retrospective observational study was to compare the economic burden, health resource utilization (HRU), and clinical outcomes among allo-HCT recipients with virus-associated HC to those without virus-associated HC using a large US claims database. Claims data obtained from the Decision Resources Group Real-World Evidence Data Repository were used to identify patients with first (index) allo-HCT procedure from January 1, 2012, through December 31, 2017. Outcomes were examined 1 year after allo-HCT and included total health care reimbursements, HRU, and clinical outcomes for allo-HCT patients with virus-associated HC versus those without. Further, a generalized linear model was used to determine adjusted reimbursements stratified by the presence or absence of any acute or chronic graft-versus-host disease (GVHD) after adjusting for age, health plan, underlying disease, stem cell source, number of comorbidities, baseline reimbursements, and follow-up time. Of 13,363 allo-HCT recipients, 759 (5.7%) patients met the prespecified criteria for virus-associated HC. Total unadjusted mean reimbursement was $632,870 for patients with virus-associated HC and $340,469 for patients without virus-associated HC. In a multivariable model, after adjusting for confounders, the adjusted reimbursements were significantly higher for virus-associated HC patients with and without GVHD compared to patients without virus-associated HC (P < .0001). Patients with virus-associated HC stayed 7.9 additional days in the hospital (P < .0001) and 6.1 additional days (P = .0009) in the intensive care unit (ICU) for the index hospitalization, as compared to patients without virus-associated HC. The hospital readmission rate was higher for allo-HCT patients with versus without virus-associated HC (P < .0001), resulting in 12.9 more days in the hospital (P < .0001) and 7.3 more days in the ICU (P < .0001) after the index hospitalization. Among patients with GVHD, those with virus-associated HC had significantly higher all-cause mortality as compared to those without virus-associated HC (23.2% versus 18.4%; P = .0035). In an adjusted analysis, patients with virus-associated HC had a significantly higher risk of mortality, regardless of the presence of GVHD. When stratified by GVHD, there were no significant differences in the baseline risk for renal impairment; virus-associated HC was associated with increased risk for renal impairment in the follow-up period in patients with or without GVHD (P < .0001 for both). After allo-HCT, patients with virus-associated HC have significantly higher health care reimbursements and HRU, with worse clinical outcomes, including renal impairment, irrespective of the presence of GVHD and significantly higher all-cause mortality in the presence of GVHD. Our results highlight the unmet clinical need for effective strategies to prevent and treat virus-associated HC in HCT recipients that may also reduce costs among these patients.
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http://dx.doi.org/10.1016/j.jtct.2021.02.021DOI Listing
June 2021

Practice patterns and incidence of adenovirus infection in allogeneic hematopoietic cell transplant recipients: Multicenter survey of transplant centers in the United States.

Transpl Infect Dis 2020 Aug 20;22(4):e13283. Epub 2020 Apr 20.

Certara, Montreal, QC, USA.

Background: Adenovirus (AdV) is increasingly recognized as a threat to successful outcomes after allogeneic hematopoietic cell transplantation (allo-HCT). Guidelines have been developed to inform AdV screening and treatment practices, but the extent to which they are followed in clinical practice in the United States is still unknown. The incidence of AdV in the United States is also not well documented. The main objectives of the AdVance US study were thus to characterize current AdV screening and treatment practices in the United States and to estimate the incidence of AdV infection in allo-HCT recipients across multiple pediatric and adult transplant centers.

Methods: Fifteen pediatric centers and 6 adult centers completed a practice patterns survey, and 15 pediatric centers and four adult centers completed an incidence survey.

Results: The practice patterns survey results confirm that pediatric transplant centers are more likely than adult centers to routinely screen for AdV, and are also more likely to have a preemptive AdV treatment approach compared to adult centers. Perceived risk of AdV infection is a determining factor for whether routine screening and preemptive treatment are implemented. Most pediatric centers screen higher-risk patients for AdV weekly, in blood, and have a preemptive AdV treatment approach. The incidence survey results show that from 2015 to 2017, a total of 1230 patients underwent an allo-HCT at the 15 pediatric transplant centers, and 1815 patients underwent an allo-HCT at the 4 adult transplant centers. The incidences of AdV infection, AdV viremia, and AdV viremia ≥ 1000 copies/mL within 6 months after the first allo-HCT were 23%, 16%, and 9%, respectively, for patients at pediatric centers, and 5%, 3%, and 2%, respectively, for patients at adult centers.

Conclusions: These findings provide a more recent estimate of the incidence of AdV infection in the United States, as well as a multicenter view of practice patterns around AdV infection screening and intervention criteria, in pediatric and adult allo-HCT recipients.
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http://dx.doi.org/10.1111/tid.13283DOI Listing
August 2020

New oral anti-coagulants versus vitamin K antagonists in high thromboembolic risk patients.

PLoS One 2019 7;14(10):e0222762. Epub 2019 Oct 7.

LHU 3 Serenissima, Venezia, Italia.

Background: Oral anticoagulant therapy (VKA) is nowadays the mainstay of treatment in primary and secondary stroke prevention in patients with atrial fibrillation. Given the limited risk-benefit ratio of vitamin K antagonists, pharmacological research has been directed towards the development of products that could overcome these limits, new oral anticoagulants were recently introduced: dabigatran, rivaroxaban, apixaban, and edoxaban.

Aim: Scope of the present study was to examine patterns of use, effectiveness, safety and mean annual cost per patient of anticoagulant treatment for non-valvular AF in real clinical practice.

Methods: A retrospective observational cohort study, by using administrative databases (drugs, hospitalizations, clinical visits, lab tests, population registry), was conducted in the Local Health Unit (LHU) of Treviso, Italy, from January 1, 2012 to December 31, 2016.

Results: 5597 subjects were selected, 2171 of which satisfied all inclusion criteria. In particular 1355 patients were treated with VKA, 577 patients were treated with NOAC, and 239 patients were treated initially with VKA and subsequently switched to NOAC (switch group). NOAC treatment showed to be superior to VKA and this superiority was statistically significant on both end-points: patients in the NOAC group reported less cardiovascular events (9,9%) and less bleeding episodes (5,5%) versus VKA patients (14,6% and 11,4%; p<,0001 and p = 0,0049, respectively). The mean cost per patient per year was respectively € 1323,9 for patients treated with NOAC versus € 1003,3 for patients treated with VKA. Cost difference appears to be largely driven by drug cost (€ 767,9 for NOAC versus € 17,7 for VKA patients) and by specialist visits and laboratory tests (€ 318,4 for NOAC versus € 733,4 for VKA patients).

Conclusion: In this retrospective real-world study treatment with NOAC showed to be associated with significant reductions of CV events and bleeding events compared to VKA use, albeit at a higher NHS' direct cost per patient/year, mainly due to higher drug therapy cost.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0222762PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779249PMC
March 2020

Association between adenovirus viral load and mortality in pediatric allo-HCT recipients: the multinational AdVance study.

Bone Marrow Transplant 2019 10 25;54(10):1632-1642. Epub 2019 Feb 25.

Department of Pediatric Hematology/Oncology, IRCCS, Ospedale Pediatrico Bambino Gesù, University La Sapienza, Rome, Italy.

This multivariable analysis from the AdVance multicenter observational study assessed adenovirus (AdV) viremia peak, duration, and overall AdV viral burden-measured as time-averaged area under the viremia curve over 16 weeks (AAUC)-as predictors of all-cause mortality in pediatric allo-HCT recipients with AdV viremia. In the 6 months following allo-HCT, 241 patients had AdV viremia ≥ 1000 copies/ml. Among these, 18% (43/241) died within 6 months of first AdV ≥ 1000 copies/ml. Measures of AdV viral peak, duration, and overall burden of infection consistently correlate with all-cause mortality. In multivariable analyses, controlling for lymphocyte recovery, patients with AdV AAUC in the highest quartile had a hazard ratio of 11.1 versus the lowest quartile (confidence interval 5.3-23.6); for peak AdV viremia, the hazard ratio was 2.2 for the highest versus lowest quartile. Both the peak level and duration of AdV viremia were correlated with short-term mortality, independent of other known risk factors for AdV-related mortality, such as lymphocyte recovery. AdV AAUC, which assesses both peak and duration of AdV viremia, is highly correlated with mortality under the current standard of care. New therapeutic agents that decrease AdV AAUC have the potential of reducing mortality in this at-risk patient population.
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http://dx.doi.org/10.1038/s41409-019-0483-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957460PMC
October 2019

Incidence of Adenovirus Infection in Hematopoietic Stem Cell Transplantation Recipients: Findings from the AdVance Study.

Biol Blood Marrow Transplant 2019 04 20;25(4):810-818. Epub 2018 Dec 20.

Department of Pediatric Oncology/Hematology/Stem Cell Transplantation, Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address:

Adenovirus (AdV) is an increasingly recognized threat to recipients of allogeneic hematopoietic stem cell transplantation (allo-HCT), particularly when infection is prolonged and unresolved. AdVance is the first multinational, multicenter study to evaluate the incidence of AdV infection in both pediatric and adult allo-HCT recipients across European transplantation centers. Medical records for patients undergoing first allo-HCT between January 2013 and September 2015 at 50 participating centers were reviewed. The cumulative incidence of AdV infection (in any sample using any assay) during the 6 months after allo-HCT was 32% (95% confidence interval [CI], 30.9% to 33.4%) among pediatric allo-HCT recipients (n = 1736) and 6% (95% CI, 4.7% to 6.4%) among adult allo-HCT recipients (n = 2540). The incidence of AdV viremia ≥1000copies/mL (a common threshold for initiation of preemptive treatment) was 14% (95% CI, 13.0% to 14.8%) in pediatric recipients and 1.5% (95% CI, 1.1% to 2.0%) in adult recipients. Baseline risk factors for developing AdV viremia ≥1000copies/mL included younger age, use of T cell depletion, and donor type other than matched related. Baseline demographic factors were broadly comparable across patients of all ages and identified by multivariate analyses. Notably, the incidence of AdV infection decreased stepwise with increasing age; younger adults (age 18 to 34 years) had a similar incidence as older pediatric patients (<18 years). This study provides a contemporary multicenter understanding of the incidence and risk factors for AdV infection following allo-HCT. Our findings may help optimize infection screening and intervention criteria, particularly for younger at-risk adults.
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http://dx.doi.org/10.1016/j.bbmt.2018.12.753DOI Listing
April 2019

Current practices in the management of adenovirus infection in allogeneic hematopoietic stem cell transplant recipients in Europe: The AdVance study.

Eur J Haematol 2019 Mar 11;102(3):210-217. Epub 2019 Jan 11.

Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.

Objective: Adenovirus (AdV) infections are potentially life-threatening for allogeneic hematopoietic stem cell transplant (allo-HCT) recipients. The AdVance study aimed to evaluate the incidence, management, and outcomes of AdV infections in European allo-HCT recipients.

Methods: As part of the study, physician surveys were conducted to determine current AdV screening and treatment practices at their center.

Results: All of the 28 respondents who treat pediatric patients reported routine AdV screening practices, with 93% screening all allo-HCT recipients and others screening those with transplant-related risk factors. Nearly all centers take a pre-emptive approach to AdV treatment in both high- (89%) and low-risk patients (75%). Among the 14 respondents who treat adult patients, 5 (36%) reported routine screening practices and few (21%) screen all allo-HCT recipients unless risk factors are present. In adults, pre-emptive AdV treatment is uncommon and quantitative AdV thresholds are rare. Typical treatment for all patients with symptomatic AdV infection is off-label intravenous cidofovir.

Conclusions: Our findings confirm that screening for AdV is more common in pediatric patients. Antiviral treatment is employed in both pediatric and adult patients, although adults are generally treated when AdV disease is diagnosed. The approach to AdV screening and treatment is risk-based and consistent with clinical guidelines.
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http://dx.doi.org/10.1111/ejh.13194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850370PMC
March 2019

The Role of Gender in Cost-Related Medication Nonadherence Among Patients with Diabetes.

J Am Board Fam Med 2018 Sep-Oct;31(5):743-751

From School of Public Health, The University of Memphis, Memphis, TN (SSB, OOI, SK); School of Pharmacy, University of Wisconsin, Madison, WI (OS); Department of Nursing, University of South Dakota, Sioux Falls, SD (PD); Analytica Laser, New York, NY (AC); Department of Health Systems Administration, Georgetown University, Washington D.C. (SH); Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, WI (YW); Health Research and Educational Trust, Chicago, IL (JB); Department of Health Administration, Governor State University, IL (LN); Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, TN (WJL); Jack C. Massey College of Business, Belmont University, TN (DW); Fogelman College of Business and Economics, The University of Memphis, Memphis, TN (CFC).

Objective: Under 50% of type 2 diabetic patients achieve the recommended glycemic control. One barrier to glycemic control is patients' cost-related nonadherence to medications. We hypothesize gender differences in medication nonadherence due to costs among diabetic patients.

Methods: US National Health Interview Survey (2011 to 2014) data yielded 5260 males and 6188 females with diabetes for over a year. We applied 2 analytic methods (A and B below) across multiple outcome measures (1 to 4) of medication nonadherence due to cost. The key independent variable was participant's gender.

Results: Across methods and measure, females consistently report significantly higher rates of medication nonadherence due to costs. Pearson's χ showed that female patients were more likely to (1) skip medication (13.5%-10.2%; < .001), take less than prescribed medication (13.9%-10.5%; < .001), delay filling prescriptions (16.8%-12.5%; < .001), and ask doctors to prescribe lower-cost alternative medications (31.8%-28.0%; < .001). Controlling for covariates, logistic regression models found females more likely to skip medication (OR, 1.30; 95% CI, 1.09-1.55), take less than prescribed medication (OR, 1.26; 95%, CI, 1.06-1.50), delay filling prescriptions, (OR, 1.29; 95% CI, 1.11-1.50), and request lower-cost medication (OR, 1.17; 95% CI, 1.04-1.32). Our results report other factors that influence medication adherence, including socioeconomic and health status variables.

Conclusions: A significant gender-based disparity exists on cost-related nonadherence of medication among diabetic patients. Health care providers and policy-makers should pay close attention to find ways to address cost-related nonadherence of medication among patients with chronic illness, especially among female patients.
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http://dx.doi.org/10.3122/jabfm.2018.05.180039DOI Listing
October 2019

Rural-Urban Disparities in Access to Breast Cancer Screening: A Spatial Clustering Analysis.

J Rural Health 2019 03 10;35(2):229-235. Epub 2018 Jun 10.

Department of Environmental and Occupational Health, School of Community Health Sciences, University of Nevada, Las Vegas, Nevada.

Purpose: The purpose of this study was to examine rural-urban differences in access to breast cancer screening in a predominantly rural Midwestern state in the United States.

Methods: The study is a retrospective analysis of pooled cross-sectional data for the years 2008 to 2012. We conducted hot spot analyses of the rate of late-stage diagnosis of breast cancer at the census tract level in Nebraska for cases diagnosed between 2008 and 2012, using cancer registry data. We also conducted hot spot analyses of access to mammography facilities (distance to the nearest center) using data on mammography facilities from the US Food and Drug Administration and rates of screening using the National Private Insurance Claims data for year 2013.

Results: The spatial clustering analyses found that urban areas in Nebraska had lower distances to mammography centers, higher screening rates and lower rates of late-stage diagnosis of breast cancer. Rural areas had higher distance to the mammography centers and higher rates of late-stage at diagnosis for breast cancer.

Conclusions: The evidence from this study points to geographic disparities in access to screening for breast cancer. Mitigating the access issues that rural women face would require interventions specifically targeted to rural populations.
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http://dx.doi.org/10.1111/jrh.12308DOI Listing
March 2019

Mortality following pancreatectomy for elderly rural veterans with pancreatic cancer.

J Geriatr Oncol 2017 Jul 22;8(4):284-288. Epub 2017 May 22.

Division of Oncology-Hematology, VA-NWIHCS, University of Nebraska Medical Center, United States.

Purpose: The objective of this study was to examine rural/urban differences in post-operative mortality for elderly dually eligible Veteran patients with pancreatic cancer treated by surgery with or without adjuvant therapy.

Materials And Methods: In this retrospective observational study, Medicare claims data were used to identify elderly dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy with or without adjuvant therapy. Hierarchical logistic regression models adjusted for age, rurality of residence, post-operative complication rate, length of stay, blood transfusion during admission, and co-morbidity were examined to assess differences in mortality between rural and urban Veteran patients.

Results: Among 4,686 dually eligible Veteran patients with pancreatic cancer who underwent pancreatectomy between 1997 and 2011, those who lived in a small rural town focused area had significantly higher odds of one-year mortality (Odds Ratio [OR]= 1.50; p<0.01; Confidence Interval [CI]: 1.15-1.95), compared to those who lived in an urban focused area. Surgical or 90-day mortality was not significantly associated with the rurality of the Veterans' residence. Patients who were younger, had fewer comorbidities, and shorter length of stay had lower odds of dying at 90days and one year.

Conclusions: Using a nationally representative database we found that rural and older patients had worse long-term post-operative outcomes than their urban and younger counterparts, while there were no rural/urban differences in early post-operative outcomes. The study adds to evidence pointing to disparities in the quality of care of Veterans based on place of residence.
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http://dx.doi.org/10.1016/j.jgo.2017.05.001DOI Listing
July 2017

Postoperative mortality following multi-modality therapy for pancreatic cancer: Analysis of the SEER-Medicare data.

J Surg Oncol 2017 Feb;115(2):158-163

Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.

Background And Objectives: The objective of this study was to examine post-operative mortality for elderly pancreatic cancer patients treated with multi-modality therapy.

Methods: Surveillance Epidemiology and End Results (SEER) Medicare linked data were used to examine differences in mortality between patients who underwent pancreatectomy alone and those who had early (within 12 weeks) and late (after 12 weeks) adjuvant therapy (chemotherapy and/or radiotherapy).

Results: Among 4,105 patients who underwent pancreatectomy between 1991 and 2008, 1-year mortality (Odds Ratio [OR] = 0.71; P-value = 0.000; 95% Confidence Interval [CI]: 0.60-0.85) and 6-month mortality (OR = 0.44; P-value = 0.000; 95%CI: 0.35-0.53) following pancreatectomy were significantly lower in the group that underwent pancreatectomy with early adjuvant therapy. Late adjuvant therapy group also had lower 1 year (OR = 0.51; P-value = 0.000; 95%CI: 0.43-0.61) and 6 months (OR = 0.14; P-value = 0.000; 95%CI: 0.10-0.17) mortality, compared to surgery alone.

Conclusions: Post-operative outcomes were better for patients treated with surgery with adjuvant therapy, with the late adjuvant therapy group having the best outcomes (lowest odds of 6 month and 1-year mortality following surgery). J. Surg. Oncol. 2017;115:158-163. © 2017 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jso.24472DOI Listing
February 2017

Provision of Rehabilitation Services in Residential Care Facilities: Evidence From a National Survey.

Arch Phys Med Rehabil 2017 06 23;98(6):1203-1209. Epub 2016 Dec 23.

Methodist Le Bonheur Center for Healthcare Economics, Fogelman College of Business and Economics, The University of Memphis, Memphis, TN.

Objective: To examine the association between organizational factors and provision of rehabilitation services that include physical therapy (PT) and occupational therapy (OT) in residential care facilities (RCFs) in the United States.

Design: A cross-sectional, observational study conducted using a national sample from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics.

Settings: U.S. RCFs.

Participants: RCFs (N=2302; weighted sample, 31,134 RCFs).

Interventions: Not applicable.

Main Outcome Measures: The association between characteristics of the facilities, director and staff, and residents, and provision of PT and OT services was assessed using multivariate logistic regression analyses.

Results: Among all RCFs in the United States, 43.9% provided PT and 40.0% provided OT. Medicaid-certified RCFs, larger-sized RCFs, RCFs with a licensed director, RCFs that used volunteers, and RCFs with higher personal care aide hours per patient per day were more likely to provide both PT and OT, while private, for-profit RCFs were less likely to provide PT and OT. RCFs with a higher percentage of white residents were more likely to provide PT, while RCFs with chain affiliation were more likely to provide OT.

Conclusions: Less than half of the RCFs in the United States provide PT and OT, and this provision of therapy services is associated with organizational characteristics of the facilities. Future research should explore the effectiveness of rehabilitation services in RCFs on residents' health outcomes.
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http://dx.doi.org/10.1016/j.apmr.2016.11.021DOI Listing
June 2017

Does Cost-Related Medication Nonadherence among Cardiovascular Disease Patients Vary by Gender? Evidence from a Nationally Representative Sample.

Womens Health Issues 2017 Jan - Feb;27(1):108-115. Epub 2016 Nov 25.

Fogelman College of Business and Economics, The University of Memphis, Memphis, Tennessee.

Introduction: Cardiovascular disease (CVD) is a leading cause of death and disability as well as a major burden on the U.S. healthcare system. Cost-related medication nonadherence (CRN) to prescribed medications is common among patients with CVD. This study examines the gender differences in CRN among CVD patients.

Methods: We used 2011 to 2014 data from the National Health Interview Survey, an annual, cross-sectional, nationally representative household survey of the noninstitutionalized U.S. civilian population (≥18 years of age). Based on Andersen's model of health services utilization, multivariate logistic regressions were estimated to examine the effect of gender on the primary composite outcome of CRN which was identified if any of the following types of CRN were reported: 1) skipped medication doses to save money, 2) took less medication to save money, and 3) delayed prescription filling to save money.

Results: Among CVD patients who had used a prescription medication in the last 12 months, 10.0% skipped medication doses, 10.6% took less medication, and 12.8% delayed filling their prescriptions. After adjusting for confounding factors, gender was found to be significantly associated with the composite outcome of CRN among CVD patients. Women were 1.54 times (95% confidence interval, 1.33-1.77) more likely to have any of the types of CRN compared with men.

Conclusion: There are significant gender disparities in CRN among CVD patients. More support for and closer monitoring of CRN is needed for disadvantaged groups, especially women with limited resources.
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http://dx.doi.org/10.1016/j.whi.2016.10.004DOI Listing
December 2017

Readiness for Teledentistry: Validation of a Tool for Oral Health Professionals.

J Med Syst 2017 Jan 7;41(1). Epub 2016 Nov 7.

Department of Health Services Research & Administration, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE, 68198-4350, USA.

We validated a survey tool to test the readiness of oral health professionals for teledentistry (TD). The survey tool, the University of Calgary Health Telematics Unit's Practitioner Readiness Assessment Tool (PRAT) gathered information about the participants' beliefs, attitudes and readiness for TD before and after a teledentistry training program developed for a rural state in the Mid-Western United States. Ninety-three dental students, oral health and other health professionals participated in the TD training program and responded to the survey. Wilcoxon signed rank test was used to assess statistical differences in the change in the readiness rating before and after the training. Principal Components Analysis identified a three factor structure for the PRAT tool: Attitudes/ Attributes of Personnel; Motivation to Change and Institutional Resources. Overall, the evaluation demonstrated a positive change in all trainees' attitudes following the training sessions, with the majority of trainees acknowledging a positive impact of the training on their readiness for teledentistry.
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http://dx.doi.org/10.1007/s10916-016-0654-7DOI Listing
January 2017

Risk Factors for In-Hospital Mortality in Heart Failure Patients: Does Rurality, Payer or Admission Source Matter?

J Rural Health 2018 Dec 8;34(1):103-108. Epub 2016 Jun 8.

Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia.

Purpose: Considering the high prevalence of heart failure and the economic burden of the disease, factors that influence in-hospital mortality are of importance in improving outcomes of care for this patient population. The purpose of this study was to examine the determinants of in-hospital mortality for adult heart failure patients.

Methods: The study design is a retrospective observational study design using the 2010 Nebraska Hospital Discharge data set including 4,319 hospitalizations for 3,521 heart failure patients admitted to 79 hospitals in Nebraska. Hierarchical logistic regression models including patient- and hospital-specific random intercepts were analyzed. Covariates included in the analysis were patient age in years, gender, comorbidity status, length of stay, primary payer, type and source of admission, transfers, and rurality of county of residence.

Results: Overall, 3.5% of heart failure patients died during their hospital stay. In logistic regression analysis that adjusted for age, sex, and comorbidities, the odds of dying in hospital for heart failure patients increased with age (OR = 1.03, 95% CI: 1.01-1.04), co-morbidity (OR = 1.15; 95% CI: 1.05-1.25) and length of stay (OR = 1.03, 95% CI: 1.01-1.05). The patient's gender, payer source, rurality of county of residence, source, and type of admission were not risk factors for in-hospital death.

Conclusion: Increasing age, comorbidity and length of stay were risk factors for in-hospital death for heart failure. An understanding of the risk factors for in-hospital death is critical to improving outcomes of care for heart failure patients.
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http://dx.doi.org/10.1111/jrh.12186DOI Listing
December 2018

Impact of Community-Based Dental Education on Attainment of ADEA Competencies: Students' Self-Ratings.

J Dent Educ 2016 Jun;80(6):670-6

Dr. McFarland is Professor and Chair, Community and Preventive Dentistry, College of Dentistry, Creighton University; Dr. Nayar is Associate Professor, Department of Health Services Research and Administration, College of Public Health and Adjunct Associate Professor, Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center; Dr. Ojha is Senior Manager, Office of Quality Assessment and Improvement Practice Institute, American Dental Association; Ms. Chandak is Graduate Assistant, Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center; Dr. Gupta is Graduate Assistant, Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center; and Dr. Lange is Professor, Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center.

Fourth-year dental students at the College of Dentistry, University of Nebraska Medical Center participate in a community-based dental education (CBDE) program that includes a four-week rotation in rural dental practices and community health clinics across Nebraska and nearby states. The aim of this study was to assess the impact of participation in the CBDE program on the self-rated competencies of these students. A retrospective survey was administered to students who participated in extramural rotations in two academic years. The survey collected demographic data and asked students to rate themselves on a scale from 1=not competent at all to 5=very competent on attainment of the American Dental Education Association (ADEA) Competencies for the New General Dentist for before and after the rotations. A total of 92 responses were obtained: 43 students for 2011-12 and 49 students for 2012-13 (95% response rate for each cohort). The results showed that the students' mean pre-program self-ratings ranged from 3.28 for the competency domain of Practice Management and Informatics to 3.93 for Professionalism. Their mean post-program self-ratings ranged from 3.76 for Practice Management and Informatics to 4.31 for Professionalism. The students showed a statistically significant increase in self-ratings for all six competency domains. The increase was greatest in the domain of Critical Thinking and least in Communication and Interpersonal Skills. Overall, these results suggest that the CBDE program was effective in improving the students' self-perceptions of competence in all six domains and support the idea that a competency-based evaluation of CBDE programs can provide valuable information to dental educators about program effectiveness.
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June 2016

Use of Mobile Health Applications for Health-Seeking Behavior Among US Adults.

J Med Syst 2016 Jun 4;40(6):153. Epub 2016 May 4.

Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, USA.

This study explores the use of mobile health applications (mHealth apps) on smartphones or tablets for health-seeking behavior among US adults. Data was obtained from cycle 4 of the 4th edition of the Health Information National Trends Survey (HINTS 4). Weighted multivariate logistic regression models examined predictors of 1) having mHealth apps, 2) usefulness of mHealth apps in achieving health behavior goals, 3) helpfulness in medical care decision-making, and 4) asking a physician new questions or seeking a second opinion. Using the Andersen Model of health services utilization, independent variables of interest were grouped under predisposing factors (age, gender, race, ethnicity, and marital status), enabling factors (education, employment, income, regular provider, health insurance, and rural/urban location of residence), and need factors (general health, confidence in their ability to take care of health, Body Mass Index, smoking status, and number of comorbidities). In a national sample of adults who had smartphones or tablets, 36 % had mHealth apps on their devices. Among those with apps, 60 % reported the usefulness of mHealth apps in achieving health behavior goals, 35 % reported their helpfulness for medical care decision-making, and 38 % reported their usefulness in asking their physicians new questions or seeking a second opinion. The multivariate models revealed that respondents were more likely to have mHealth apps if they had more education, health insurance, were confident in their ability to take good care of themselves, or had comorbidities, and were less likely to have them if they were older, had higher income, or lived in rural areas. In terms of usefulness of mHealth apps, those who were older and had higher income were less likely to report their usefulness in achieving health behavior goals. Those who were older, African American, and had confidence in their ability to take care of their health were more likely to respond that the mHealth apps were helpful in making a medical care decision and asking their physicians new questions or for a second opinion. Potentially, mHealth apps may reduce the burden on primary care, reduce costs, and improve the quality of care. However, several personal-level factors were associated with having mHealth apps and their perceived helpfulness among their users, indicating a multidimensional digital divide in the population of US adults.
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http://dx.doi.org/10.1007/s10916-016-0492-7DOI Listing
June 2016

Patient-Provider Communication About Prostate Cancer Screening and Treatment: New Evidence From the Health Information National Trends Survey.

Am J Mens Health 2017 Jan 7;11(1):134-146. Epub 2016 Jul 7.

1 The University of Memphis, Memphis, TN, USA.

The American Urological Association, American Cancer Society, and American College of Physicians recommend that patients and providers make a shared decision with respect to prostate-specific antigen (PSA) testing for prostate cancer (PCa). The goal of this study is to determine the extent of patient-provider communication for PSA testing and treatment of PCa and to examine the patient specific factors associated with this communication. Using recent data from the Health Information National Trends Survey, this study examined the association of patient characteristics with four domains of patient-provider communication regarding PSA test and PCa treatment: (1) expert opinion of PSA test, (2) accuracy of PSA test, (3) side effects of PCa treatment, and (4) treatment need of PCa. The current results suggested low level of communication for PSA testing and treatment of PCa across four domains. Less than 10% of the respondents report having communication about all four domains. Patient characteristics like recent medical check-up, regular healthcare provider, global health status, age group, marital status, race, annual household income, and already having undergone a PSA test are associated with patient-provider communication. There are few discussions about PSA testing and PCa treatment options between healthcare providers and their patients, which limits the shared decision-making process for PCa screening and treatment as recommended by the current best practice guidelines. This study helps identify implications for changes in physician practice to adhere with the PSA screening guidelines.
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http://dx.doi.org/10.1177/1557988315614082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675184PMC
January 2017

Integration of public health and primary care: A systematic review of the current literature in primary care physician mediated childhood obesity interventions.

Obes Res Clin Pract 2015 Nov-Dec;9(6):539-52. Epub 2015 Aug 7.

School of Public Health, The University of Memphis, Memphis, TN, United States.

Introduction: Childhood obesity, with its growing prevalence, detrimental effects on population health and economic burden, is an important public health issue in the United States and worldwide. There is need for expansion of the role of primary care physicians in obesity interventions. The primary aim of this review is to explore primary care physician (PCP) mediated interventions targeting childhood obesity and assess the roles played by physicians in the interventions.

Methods: A systematic review of the literature published between January 2007 and October 2014 was conducted using a combination of keywords like "childhood obesity", "paediatric obesity", "childhood overweight", "paediatric overweight", "primary care physician", "primary care settings", "healthcare teams", and "community resources" from MEDLINE and CINAHL during November 2014. Author name(s), publication year, sample size, patient's age, study and follow-up duration, intervention components, role of PCP, members of the healthcare team, and outcomes were extracted for this review.

Results: Nine studies were included in the review. PCP-mediated interventions were composed of behavioural, education and technological interventions or a combination of these. Most interventions led to positive changes in Body Mass Index (BMI), healthier lifestyles and increased satisfaction among parents. PCPs participated in screening and diagnosing, making referrals for intervention, providing nutrition counselling, and promoting physical activity. PCPs, Dietitians and nurses were often part of the healthcare team.

Conclusion: PCP-mediated interventions have the potential to effectively curb childhood obesity. However, there is a further need for training of PCPs, and explain new types of interventions such as the use of technology.
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http://dx.doi.org/10.1016/j.orcp.2015.07.005DOI Listing
September 2016

Use of information technology for medication management in residential care facilities: correlates of facility characteristics.

J Med Syst 2015 Jun 14;39(6):70. Epub 2015 May 14.

Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, 135 Robison Hall, Memphis, TN, 38152, USA,

The effectiveness of information technology in resolving medication problems has been well documented. Long-term care settings such as residential care facilities (RCFs) may see the benefits of using such technologies in addressing the problem of medication errors among their resident population, who are usually older and have numerous chronic conditions. The aim of this study was two-fold: to examine the extent of use of Electronic Medication Management (EMM) in RCFs and to analyze the organizational factors associated with the use of EMM functionalities in RCFs. Data on RCFs were obtained from the 2010 National Survey of Residential Care Facilities. The association between facility, director and staff, and resident characteristics of RCFs and adoption of four EMM functionalities was assessed through multivariate logistic regression. The four EMM functionalities included were maintaining lists of medications, ordering for prescriptions, maintaining active medication allergy lists, and warning of drug interactions or contraindications. About 12% of the RCFs adopted all four EMM functionalities. Additionally, maintaining lists of medications had the highest adoption rate (34.5%), followed by maintaining active medication allergy lists (31.6%), ordering for prescriptions (19.7%), and warning of drug interactions or contraindications (17.9%). Facility size and ownership status were significantly associated with adoption of all four EMM functionalities. Medicaid certification status, facility director's age, education and license status, and the use of personal care aides in the RCF were significantly associated with the adoption of some of the EMM functionalities. EMM is expected to improve the quality of care and patient safety in long-term care facilities including RCFs. The extent of adoption of the four EMM functionalities is relatively low in RCFs. Some RCFs may strategize to use these functionalities to cater to the increasing demands from the market and also to provide better quality of care.
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http://dx.doi.org/10.1007/s10916-015-0252-0DOI Listing
June 2015

Discovering Sexual Health Conversations between Adolescents and Youth Development Professionals.

Am J Sex Educ 2015 Jan 20;10(1):21-39. Epub 2015 Mar 20.

University of Nebraska Medical Center.

Youth development professionals (YDPs), working at community-based organizations are in a unique position to interact with the adolescents as they are neither parents/guardians nor teachers. The objectives of this study were to explore qualitatively what sexual health issues adolescents discuss with YDPs and to describe those issues using the framework of the Sexuality Information and Education Council of the United States (SIECUS) comprehensive sexuality education guidelines. YDPs reported conversations with adolescents that included topics related to the SIECUS key concepts of human development, relationships, personal skills, sexual behavior, and sexual health.
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http://dx.doi.org/10.1080/15546128.2015.1009596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829363PMC
January 2015

Self-management of hypertension using technology enabled interventions in primary care settings.

Technol Health Care 2015 ;23(2):119-28

City University of New York School of Public Health, New York, NY, USA.

Background: Self-management of hypertension by controlling Blood Pressure (BP) through technology-based interventions can effectively reduce the burden of high BP, which affects one out of every three adults in the United States.

Objective: The primary aim of this study is to explore the role of technology enabled interventions to improve or enhance self-management among individuals with hypertension.

Methods: We conducted a systematic review of the literature published between July 2008 and June 2013 on the MEDLINE database (via PubMed interface) during July 2013. The search words were "hypertension" and "primary care" in combination with each of the terms of "technology", "internet", "computer" and "cell phone". Our inclusion criteria consisted of: (a) Randomized Controlled Trials (RCTs) (b) conducted on human subjects; (c) technology-based interventions (d) to improve self-management (e) of hypertension and if the (f) final results of the study were published in the study. Our exclusion criteria included (a) management of other conditions and (b) literature reviews.

Results: The initial search resulted in 108 results. After applying the inclusion and exclusion criteria, a total of 12 studies were analyzed. Various technologies implemented in the studies included internet-based telemonitoring and education, telephone-based telemonitoring and education, internet-based education, telemedicine via videoconferencing, telehealth kiosks and automated modem device. Some studies also involved a physician intervention, in addition to patient intervention. The outcomes of proportion of subjects with BP control and change in mean SBP and DBP were better for the group of subjects who received combined physician and patient interventions.

Conclusion: Interventions to improve BP control for self-management of hypertension should be aimed at both physicians as well as the patients. More interventions should utilize the JNC-7 guidelines and cost-effectiveness of the intervention should also be assessed.
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http://dx.doi.org/10.3233/THC-140886DOI Listing
April 2016

Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities.

Int J Med Inform 2014 Dec 2;83(12):975-82. Epub 2014 Oct 2.

Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, United States.

Objective: Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs.

Methods: We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs.

Results: In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption.

Conclusions: Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients' records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in RCFs.
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http://dx.doi.org/10.1016/j.ijmedinf.2014.09.007DOI Listing
December 2014

Estimating the State-Level Supply of Cancer Care Providers: Preparing to Meet Workforce Needs in the Wake of Health Care Reform.

J Oncol Pract 2015 01 12;11(1):32-7. Epub 2014 Nov 12.

University of Nebraska Medical Center, Omaha, NE

Purpose: This study describes the supply of cancer care providers-physicians, nurse practitioners (NPs), and physician assistants (PAs)-in Nebraska and analyzes changes in the supply over a 5-year period.

Method: We used workforce survey data for the years 2008 to 2012 from the Health Professions Tracking Service to analyze the cancer care workforce supply in the state of Nebraska. The supply of cancer care providers was analyzed over the 5-year period on the basis of age, sex, specialty, and practice location; distribution of work hours for cancer care physicians was analyzed for 2012.

Results: From 2008 to 2012, there was a 3.3% increase in the number of cancer care physicians. Majority of the cancer care physicians (82.5%), NPs (81.1%), and PAs (80%) reported working in urban counties, whereas approximately half of the state's population resides in rural counties (47%). Compared with the national distribution, Nebraska has a lower proportion of medical oncologists, radiation oncologists, and pediatric hematologists/oncologists. The gap between the number of cancer care physicians age ≥ 64 years and the number younger than 40 years is slowly closing in Nebraska, with an increase in those age ≥ 64 years.

Conclusion: Increasing cancer incidence and improved access to cancer care through the Affordable Care Act could increase demand for cancer care workers. Policymakers and legislators should consider a range of policies based on the best available data on the supply of cancer care providers and the demand for cancer care.
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http://dx.doi.org/10.1200/JOP.2014.001565DOI Listing
January 2015

Supervising dentists' perspectives on the effectiveness of community-based dental education.

J Dent Educ 2014 Aug;78(8):1139-44

Dr. Nayar is Associate Professor, Department of Health Services Research and Administration, College of Public Health and Adjunct Associate Professor, Oral Biology, College of Dentistry, University of Nebraska Medical Center; Dr. McFarland is Associate Professor, College of Dentistry, University of Nebraska Medical Center; Dr. Lange is Professor, College of Dentistry, University of Nebraska Medical Center; Dr. Ojha is Senior Manager, Office of Quality Assessment and Improvement, American Dental Association; Ms. Chandak is Graduate Assistant, Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center.

The Commission on Dental Accreditation recently implemented new predoctoral standards that require dental schools in the United States to provide students with community-based dental education (CBDE) experiences. The objective of this study was to examine the perspectives of supervising dentists (also known as dental preceptors) at rural CBDE sites regarding the University of Nebraska Medical Center program's effectiveness in improving the competencies of dental students. Surveys were sent to all forty-three preceptors in two subsequent years: nineteen responded to all questions in 2012 and sixteen in 2013, for a total of thirty-five participants. These preceptors evaluated the effectiveness of the program based on the American Dental Education Association (ADEA) Competencies for the New General Dentist. Overall, these preceptors rated the CBDE program as effective (excellent or very good) in improving the students' competence in five of the six ADEA domains: Critical Thinking, Professionalism, Communication and Interpersonal Skills, Health Promotion, Patient Care: Assessment, Diagnosis, and Treatment Planning, and Patient Care: Establishment and Maintenance of Oral Health. Practice Management and Informatics was found to be the least effective domain of competence. CBDE provides a unique opportunity to develop a competent dental workforce with an appreciation for the value of community service. Applying a competency-based framework to program evaluation can provide valuable information on program effectiveness to program administrators, educators, and the dental preceptors.
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August 2014
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