Publications by authors named "Arnav Shah"

9 Publications

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Underserved population acceptance of combination influenza-COVID-19 booster vaccines.

Vaccine 2022 01 7;40(4):562-567. Epub 2021 Dec 7.

Senior Research Associate, Policy and Research, The Commonwealth Fund, 1 East 75th Street, New York, NY 10021, USA. Electronic address:

Recent data indicates increasing hesitancy towards both COVID-19 and influenza vaccination. We studied attitudes towards COVID-19 booster, influenza, and combination influenza-COVID-19 booster vaccines in a nationally representative sample of US adults between May and June 2021 (n = 12,887). We used pre-qualification quotes to ensure adequate sample sizes for minority populations. Overall vaccine acceptance was 45% for a COVID-19 booster alone, 58% for an influenza vaccine alone, and 50% for a combination vaccine. Logistic regression showed lower acceptance among female, Black/African American, Native American/American Indian, and rural respondents. Higher acceptance was found among those with college and post-graduate degrees. Despite these differences, our results suggest that a combination vaccine may provide a convenient method of dual vaccination that may increase COVID-19 vaccination coverage.
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http://dx.doi.org/10.1016/j.vaccine.2021.11.097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8650809PMC
January 2022

Some characteristics of hyperglycaemic crisis differ between patients with and without COVID-19 at a safety-net hospital in a cross-sectional study.

Ann Med 2021 12;53(1):1642-1645

Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.

Objective: To compare patients with DKA, hyperglycaemic hyperosmolar syndrome (HHS), or mixed DKA-HHS and COVID-19 [COVID (+)] to COVID-19-negative (-) [COVID (-)] patients with DKA/HHS from a low-income, racially/ethnically diverse catchment area.

Methods: A cross-sectional study was conducted with patients admitted to an urban academic medical center between 1 March and 30 July 2020. Eligible patients met lab criteria for either DKA or HHS. Mixed DKA-HHS was defined as meeting all criteria for either DKA or HHS with at least 1 criterion for the other diagnosis.

Results: A total of 82 participants were stratified by COVID-19 status and type of hyperglycaemic crisis [26 COVID (+) and 56 COVID (-)]. A majority were either Black or Hispanic. Compared with COVID (-) patients, COVID (+) patients were older, more Hispanic and more likely to have type 2 diabetes (T2D, 73% vs 48%,  < .01). COVID(+) patients had a higher mean pH (7.25 ± 0.10 vs 7.16 ± 0.16,  < .01) and lower anion gap (18.7 ± 5.7 vs 22.7 ± 6.9,  = .01) than COVID (-) patients. COVID (+) patients were given less intravenous fluids in the first 24 h (2.8 ± 1.9 vs 4.2 ± 2.4 L,  = .01) and were more likely to receive glucocorticoids (95% vs. 11%,  < .01). COVID (+) patients may have taken longer to resolve their hyperglycaemic crisis (53.3 ± 64.8 vs 28.8 ± 27.5 h,  = .09) and may have experienced more hypoglycaemia <3.9 mmol/L (35% vs 19%,  = .09). COVID (+) patients had a higher length of hospital stay (LOS, 14.8 ± 14.9 vs 6.5 ± 6.0 days,  = .01) and in-hospital mortality (27% vs 7%,  = .02).

Discussion: Compared with COVID (-) patients, COVID (+) patients with DKA/HHS are more likely to have T2D. Despite less severe metabolic acidosis, COVID (+) patients may require more time to resolve the hyperglycaemic crisis and experience more hypoglycaemia while suffering greater LOS and risk of mortality. Larger studies are needed to examine whether differences in management between COVID (+) and (-) patients affect outcomes with DKA/HHS.
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http://dx.doi.org/10.1080/07853890.2021.1975042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8439248PMC
December 2021

Predicting and Preventing Acute Care Re-Utilization by Patients with Diabetes.

Curr Diab Rep 2021 09 4;21(9):34. Epub 2021 Sep 4.

Lewis Katz School of Medicine at Temple University, 3500 N Broad Street, Philadelphia, PA, 19140, USA.

Purpose Of Review: Acute care re-utilization, i.e., hospital readmission and post-discharge Emergency Department (ED) use, is a significant driver of healthcare costs and a marker for healthcare quality. Diabetes is a major contributor to acute care re-utilization and associated costs. The goals of this paper are to (1) review the epidemiology of readmissions among patients with diabetes, (2) describe models that predict readmission risk, and (3) address various strategies for reducing the risk of acute care re-utilization.

Recent Findings: Hospital readmissions and ED visits by diabetes patients are common and costly. Major risk factors for readmission include sociodemographics, comorbidities, insulin use, hospital length of stay (LOS), and history of readmissions, most of which are non-modifiable. Several models for predicting the risk of readmission among diabetes patients have been developed, two of which have reasonable accuracy in external validation. In retrospective studies and mostly small randomized controlled trials (RCTs), interventions such as inpatient diabetes education, inpatient diabetes management services, transition of care support, and outpatient follow-up are generally associated with a reduction in the risk of acute care re-utilization. Data on readmission risk and readmission risk reduction interventions are limited or lacking among patients with diabetes hospitalized for COVID-19. The evidence supporting post-discharge follow-up by telephone is equivocal and also limited. Acute care re-utilization of patients with diabetes presents an important opportunity to improve healthcare quality and reduce costs. Currently available predictive models are useful for identifying higher risk patients but could be improved. Machine learning models, which are becoming more common, have the potential to generate more accurate acute care re-utilization risk predictions. Tools embedded in electronic health record systems are needed to translate readmission risk prediction models into clinical practice. Several risk reduction interventions hold promise but require testing in multi-site RCTs to prove their generalizability, scalability, and effectiveness.
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http://dx.doi.org/10.1007/s11892-021-01402-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418292PMC
September 2021

How do health care experiences of the seriously ill differ by disease?

Healthc (Amst) 2020 Sep 4;8(3):100446. Epub 2020 Jul 4.

The Commonwealth Fund, New York, NY, USA.

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http://dx.doi.org/10.1016/j.hjdsi.2020.100446DOI Listing
September 2020

TGF-β is insufficient to induce adipocyte state loss without concurrent PPARγ downregulation.

Sci Rep 2020 08 21;10(1):14084. Epub 2020 Aug 21.

Department of Chemical and Systems Biology, Stanford University, Stanford, CA, USA.

Cell plasticity, the ability of differentiated cells to convert into other cell types, underlies the pathogenesis of many diseases including the transdifferentiation of adipocytes (fat cells) into myofibroblasts in the pathogenesis of dermal fibrosis. Loss of adipocyte identity is an early step in different types of adipocyte plasticity. In this study, we determine the dynamics of adipocyte state loss in response to the profibrotic cytokine TGF-β. We use two complementary approaches, lineage tracing and live fluorescent microscopy, which both allow for robust quantitative tracking of adipocyte identity loss at the single-cell level. We find that the intracellular TGF-β signaling in adipocytes is inhibited by the transcriptional factor PPARγ, specifically by its ubiquitously expressed isoform PPARγ1. However, TGF-β can lead to adipocyte state loss when it is present simultaneously with another stimulus. Our findings establish that an integration of stimuli occurring in a specific order is pivotal for adipocyte state loss which underlies adipocyte plasticity. Our results also suggest the possibility of a more general switch-like mechanism between adipogenic and profibrotic molecular states.
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http://dx.doi.org/10.1038/s41598-020-71100-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442643PMC
August 2020

Views From Patients With Cancer in the Setting of Unplanned Acute Care: Informing Approaches to Reduce Health Care Utilization.

JCO Oncol Pract 2020 11 23;16(11):e1291-e1303. Epub 2020 Jun 23.

Penn Center for Cancer Care Innovation at the Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Purpose: New oncology care delivery models that avoid preventable acute care are needed, yet it is unclear which interventions best meet the needs of patients and caregivers. Perspectives from patients who experienced unplanned acute care events may inform the successful development and implementation of care delivery models.

Methods: We performed a qualitative interview study of patients with solid tumors on active treatment who experienced the following 3 types of unplanned acute care events: emergency department visits, first hospitalizations, and multiple hospitalizations. Patients were prospectively recruited within a large academic health system from August 2018 to January 2019. Interviews followed a semi-structured guide developed from the Consolidated Framework for Implementation Research. The constant comparative approach was used to identify themes.

Results: Forty-nine patients were interviewed; 51% were men, 75% were non-Hispanic White, and the mean age was 57.4 years (standard deviation, 1.9 years). Fifty-five percent of patients had metastatic disease, and 33% had an Eastern Cooperative Oncology Group performance status of 3-4. We identified the following key themes: drivers of the decision to seek acute care, patients' emotional concerns that influence interactions with the oncology team, and strategies used to avoid acute care. Patients' recommendations for interventions included anticipatory guidance, peer support, improved triage methods, and enhanced symptom management. Patients preferred options for virtual and home-based outpatient care.

Conclusion: Patient-centered care models should focus on early delivery of supportive interventions that help patients and caregivers navigate the unexpected issues that come with cancer treatment. Patients advocate for proactive, multidisciplinary supportive interventions that enable home-based care and are led by the primary oncology team.
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http://dx.doi.org/10.1200/OP.20.00013DOI Listing
November 2020

Primary Care Physicians' Role In Coordinating Medical And Health-Related Social Needs In Eleven Countries.

Health Aff (Millwood) 2020 01 10;39(1):115-123. Epub 2019 Dec 10.

Eric C. Schneider is senior vice president for policy and research at the Commonwealth Fund.

Primary care physicians in the US, like their colleagues in several other high-income countries, are increasingly tasked with coordinating services delivered not just by specialists and hospitals but also by home care professionals and social service agencies. To inform efforts to improve care coordination, the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians queried primary care physicians in eleven high-income countries about their ability to coordinate patients' medical care with specialists, across settings of care, and with social service providers. Compared to physicians in other countries, substantial proportions of US physicians did not routinely receive timely notification or the information needed for managing ongoing care from specialists, after-hours care centers, emergency departments, or hospitals. Primary care practices in a handful of countries, including the US, are not routinely exchanging information electronically outside the practice. Top-performing countries demonstrate the feasibility of improving two-way communication between primary care and other sites of care. The surveyed countries share the challenge of coordinating with social service providers, and the results call for solutions to support primary care physicians.
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http://dx.doi.org/10.1377/hlthaff.2019.01088DOI Listing
January 2020

An Assessment of Patient, Caregiver, and Clinician Perspectives on the Post-discharge Phase of Care.

Ann Surg 2021 04;273(4):719-724

Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Objective: We sought to elicit patients', caregivers', and health care providers' perceptions of home recovery to inform care personalization in the learning health system.

Summary Background Data: Postsurgical care has shifted from the hospital into the home. Daily care responsibilities fall to patients and their caregivers, yet stakeholder concerns in these heterogeneous environments, especially as they relate to racial inequities, are poorly understood.

Methods: Surgical oncology patients, caregivers, and clinicians participated in freelisting; an open-ended interviewing technique used to identify essential elements of a domain. Within 2 weeks after discharge, participants were queried on 5 domains: home independence, social support, pain control, immediate, and overall surgical impact. Salience indices, measures of the most important words of interest, were calculated using Anthropac by domain and group.

Results: Forty patients [20 whites and 20 African-Americans (AAs)], 30 caregivers (17 whites and 13 AAs), and 20 providers (8 residents, 4 nurses, 4 nurse practitioners, and 4 attending surgeons) were interviewed. Patients and caregivers attended to the personal recovery experience, whereas providers described activities and individuals associated with recovery. All groups defined surgery as life-changing, with providers and caregivers discussing financial and mortality concerns. Patients shared similar thoughts about social support and self-care ability by race, whereas AA patients described heterogeneous pain management and more hopeful recovery perceptions. AA caregivers expressed more positive responses than white caregivers.

Conclusions: Patients live the day-to-day of recovery, whereas caregivers and clinicians also contemplate more expansive concerns. Incorporating relevant perceptions into traditional clinical outcomes and concepts could enhance the surgical experience for all stakeholders.
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http://dx.doi.org/10.1097/SLA.0000000000003479DOI Listing
April 2021

Older Americans Were Sicker And Faced More Financial Barriers To Health Care Than Counterparts In Other Countries.

Health Aff (Millwood) 2017 12 15;36(12):2123-2132. Epub 2017 Nov 15.

Arnav Shah is a research associate for policy and research at the Commonwealth Fund.

High-income countries are grappling with the challenge of caring for aging populations, many of whose members have chronic illnesses and declining capacity to manage activities of daily living. The 2017 Commonwealth Fund International Health Policy Survey of Older Adults in eleven countries showed that US seniors were sicker than their counterparts in other countries and, despite universal coverage under Medicare, faced more financial barriers to health care. The survey's findings also highlight economic hardship and mental health problems that may affect older adults' health, use of care, and outcomes. They show that in some countries, one in five elderly people have unmet needs for social care services-a gap that can undermine health. New to the survey is a focus on the "high-need" elderly (those with multiple chronic conditions or functional limitations), who reported high rates of emergency department use and care coordination failures. Across all eleven countries, many high-need elderly people expressed dissatisfaction with the quality of health care they had received.
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http://dx.doi.org/10.1377/hlthaff.2017.1048DOI Listing
December 2017
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