Publications by authors named "Christine Baker"

87 Publications

Efficacy of a novel topical combination of esafoxolaner, eprinomectin and praziquantel for the prevention of heartworm disease in cats.

Parasite 2021 2;28:30. Epub 2021 Apr 2.

College of Veterinary Medicine, Cornell University, Ithaca, 14850 NY, USA.

NexGard Combo is a novel topical endectoparasiticide formulation for cats combining the insecticide/acaricide esafoxolaner, the nematodicide eprinomectin and the cestodicide praziquantel. The efficacy of this novel formulation for the prevention of heartworm disease in cats was tested in two experimental studies using an induced infection model and a randomized, blinded, placebo-controlled study design, and two USA isolates of Dirofilaria immitis. In each study, 20 naïve cats were each inoculated sub-cutaneously with 100 third-stage larvae of D. immitis 30 days before treatment. Following randomization to two treatment groups of ten cats, each cat was treated topically once, either with the minimum recommended dose of the novel formulation, or with an identical volume of placebo. Five months after treatment (6 months after infections), the cats were humanely euthanized for parasite recovery and count. Efficacy was calculated by comparison of the numbers of adult D. immitis recovered in the control and in the novel formulation groups. In the control groups of each study, D. immitis were recovered in seven and nine cats (respective worm counts ranges 1-7 and 1-16, respective geometric means 1.6 and 5.1). In both studies, none of the treated cats harbored any D. immitis at necropsy and the calculated efficacy of the novel formulation was 100%. There were no adverse reactions related to treatment with the novel formulation. The results of these two studies demonstrate that a topical NexGard Combo application at the minimum label dose is well-tolerated and efficacious in preventing heartworm disease in cats.
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http://dx.doi.org/10.1051/parasite/2021026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019556PMC
April 2021

Efficacy of a novel topical combination of esafoxolaner, eprinomectin and praziquantel in cats against Toxocara cati and Dipylidium caninum.

Parasite 2021 2;28:28. Epub 2021 Apr 2.

Boehringer-Ingelheim Animal Health, 3239 Satellite Blvd, Duluth, GA 30096, USA.

NexGard Combo, a novel topical antiparasitic product for cats, combines the insecticide/acaricide esafoxolaner with the nematocide eprinomectin and cestodicide praziquantel. The efficacy of this combination product was evaluated against two common endoparasites of global occurrence in cats, the nematode Toxocara cati and the cestode Dipylidium caninum, in five controlled studies using naturally or experimentally infected cats with parasites of North American, South African or European origin. Cats evaluated in these studies harbored patent infection of the target parasite confirmed through a pre-treatment fecal examination. In each study, cats were allocated randomly to two groups of equal size (8 or 10 cats per group per study), one group treated with a placebo (mineral oil) and the other with NexGard Combo. Both treatments were administered once as a spot-on at 0.12 mL per kg body weight to deliver the minimum label dosage (1.44 mg/kg esafoxolaner, 0.48 mg/kg eprinomectin, and 10.0 mg/kg praziquantel) to the NexGard Combo-treated cats. To determine efficacy, geometric mean parasite counts seven to 12 days after treatment of placebo-treated (control) cats and NexGard Combo-treated cats were compared. The efficacy of NexGard Combo was 98.8% and 100% against adult T. cati in two studies; and 98.0%, 98.3% and 93.2% against D. caninum in three studies. No adverse events related to treatment were observed throughout the studies. These studies demonstrate high efficacy against these major feline endoparasites and excellent acceptability of the novel topical antiparasitic combination of esafoxolaner, eprinomectin and praziquantel.
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http://dx.doi.org/10.1051/parasite/2021024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019557PMC
April 2021

Efficacy of a novel topical combination of esafoxolaner, eprinomectin and praziquantel against Amblyomma americanum in cats.

Parasite 2021 2;28:25. Epub 2021 Apr 2.

Boehringer-Ingelheim Animal Health, 29 avenue Tony Garnier, 69007 Lyon, France.

Esafoxolaner, a purified enantiomer of afoxolaner with insecticidal and acaricidal properties, is combined with eprinomectin and praziquantel in NexGard Combo, a novel topical endectoparasiticide product for cats. The efficacy of this novel formulation was assessed in two experimental studies against induced infestations with Amblyomma americanum, a tick species of major importance, highly prevalent in a large southeastern quarter of the United States. In each study, 10 cats were randomly allocated to a placebo control group and 10 cats to a novel formulation treated group. Infested cats were treated topically once at the minimum recommended dose. Both studies were designed to test curative efficacy on existing infestation, 72 h after treatment, and to test preventive efficacy, 72 h after subsequent weekly (Study #1) or fortnightly (Study #2) infestations for one month. For each infestation, all cats were infested with 50 unfed adult A. americanum. At each tick count, in both studies, at least 8 in 10 placebo control cats were infested with 13 (26%) or more live ticks, demonstrating adequate infestation throughout the studies. Curative efficacy of the novel formulation was 99% in both studies; preventive efficacy was 92% and 100% for at least one month.
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http://dx.doi.org/10.1051/parasite/2021021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019551PMC
April 2021

Target animal safety evaluation of a novel topical combination of esafoxolaner, eprinomectin and praziquantel for cats.

Parasite 2021 2;28:18. Epub 2021 Apr 2.

Boehringer-Ingelheim Animal Health, 29 Avenue Tony Garnier, 69007 Lyon, France.

The safety profile of NexGard Combo, a novel topical product for cats combining esafoxolaner, eprinomectin and praziquantel, for the treatment and prevention of internal and external parasites, was evaluated in kittens, in two margin-of-safety studies (Studies #1 and #2), and in an oral tolerance study (Study #3). In the margin of safety studies, kittens were dosed several times topically with multiples of the maximum exposure dose (1×): in Study #1, 3× and 5× doses four times at 2-week intervals; in Study #2, 1×, 3× and 5× doses six times at 4-week intervals. In Study #3, kittens were dosed orally once with a 1× dose. Furthermore, in Study #1, another group of kittens was dosed topically twice at a 4-week interval with a formulation of esafoxolaner as the sole active ingredient dosed at 23×. Physical examinations and clinical pathology analyses were performed throughout the studies, followed by necropsy and detailed histopathological evaluation in Studies #1 and #2. No significant treatment related effects were observed in the three studies, except for one occurrence of reversible neurological signs attributed to eprinomectin in one cat after the third 5× dose in Study #2, with clinical signs observed nine hours after dosing, pronounced for a few hours, significantly improved the next day, and absent 2 days after dosing. In conclusion, NexGard Combo was demonstrated safe in kittens following repeated topical administrations and following oral ingestion, and very high topical doses of esafoxolaner were well tolerated.
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http://dx.doi.org/10.1051/parasite/2021015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019570PMC
April 2021

Weak evidence of country- and institution-related status bias in the peer review of abstracts.

Elife 2021 03 18;10. Epub 2021 Mar 18.

Danish Centre for Studies in Research and Research Policy, Department of Political Science, Aarhus University, Aarhus, Denmark.

Research suggests that scientists based at prestigious institutions receive more credit for their work than scientists based at less prestigious institutions, as do scientists working in certain countries. We examined the extent to which country- and institution-related status signals drive such differences in scientific recognition. In a preregistered survey experiment, we asked 4,147 scientists from six disciplines (astronomy, cardiology, materials science, political science, psychology and public health) to rate abstracts that varied on two factors: (i) author country (high status vs lower status in science); (ii) author institution (high status vs lower status university). We found only weak evidence of country- or institution-related status bias, and mixed regression models with discipline as random-effect parameter indicated that any plausible bias not detected by our study must be small in size.
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http://dx.doi.org/10.7554/eLife.64561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009675PMC
March 2021

Validity of The Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS): a daily activity criterion checklist for infants and toddlers.

Pediatr Res 2021 Feb 9. Epub 2021 Feb 9.

Department of Pediatrics and Kennedy Research Center on Neurodevelopmental and Intellectual Disabilities, University of Chicago Comer Children's Hospital, Chicago, IL, USA.

Background: The Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA-FS) is a 50-item, criterion-specified questionnaire that assesses a child's adaptive skills in everyday context and can be used in high-risk follow-up settings to identify risk for adverse neurodevelopmental outcome. Our aim was to validate the WIDEA-FS by comparing a sample of typically developing children to children with special health needs and to compare results to the Capute Scales, which include domains of including both the Cognitive Adaptive Test (CAT) and the Clinical Linguistic and Auditory Milestone Scale (CLAMS).

Methods: Six hundred and sixty children (typically developing and having special healthcare needs) aged 0-36 months completed the WIDEA-FS, the CAT, and the CLAMS assessments.

Results: Children with special health needs scored significantly lower on the WIDEA than those with typical development. WIDEA-FS subscales were significantly associated with the CAT (WIDEA-FS self-care 0.87, social cognition 0.89) and the CLAMS (WIDEA-FS communication 0.96, social cognition 0.92) tests.

Conclusions: The WIDEA-FS has concurrent validity with the CAT and CLAMS and construct validity in that children with special health needs have significantly poorer performance on the WIDEA-FS than children with typical development.

Impact: The WIDEA-FS demonstrated both construct validity and concurrent validity with the Capute Scales, including the Cognitive Adaptive Test (CAT) and the Clinical Linguistic and Auditory Milestone Scale (CLAMS). This is the first study to validate the use of the WIDEA-FS in children with typical development and children with special healthcare needs. The WIDEA-FS is a quick and valid checklist that can be used to assess neurodevelopmental functioning during daily activities in typically developing children and those at risk for neurodevelopmental differences.
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http://dx.doi.org/10.1038/s41390-020-01342-0DOI Listing
February 2021

Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development.

Minim Invasive Surg 2020 19;2020:5124952. Epub 2020 Aug 19.

Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.

Improvements in surgical and rehabilitation care are critical to lessen the burden of cerebral palsy (CP), the most common cause of severe physical disability in childhood. The selective percutaneous myofascial lengthening (SPML) surgical procedure is a minimally invasive method designed to improve ambulation by lengthening contracted musculoskeletal tissues. Information on surgical procedures, efficacy, and safety of SPML for children with CP is lacking. Phase 1 of our research is a "proof-of-principle" study for multisite SPML to improve functional mobility of children with CP, and Phase 2 assesses safety, reoperation rates, and efficacy over time in subsequent patient series. Phase 1 was a repeated measurement case series study of 17 children (mean age 7.6 years). One physical therapist, blinded to the surgeon's measurements, measured bilateral knee and ankle motion before and after SPML procedures, using video recordings of a standardized gait path. Functional Mobility Scale (FMS) 5, 50, and 500 outcomes were taken pre- and postoperatively and via telephone follow-up. In Phase 2, multisite SPLM surgeries were implemented in larger successive cohorts from 2006 to 2017. Complications, reoperation rates, and efficacy were retrospectively analyzed. Phase 1 results showed improvement in the children's knee and ankle motion while ambulating and improved FMS 5, 50, and 500 outcomes postoperatively (mean, 6.3 months). At second follow-up (mean 33.3 months), FMS 500 scores continued improvement, while FMS 5 and FMS 50 scores maintained. During Phase 2, the complication rate was 2.4%, and reoperation rates (including reoperations due to maturation) were between 8% and 13%. Improvements to correct ankle equinus were recorded in 498 cases. In conclusion, in a specialized center, single-event, multilevel SPML surgeries of children with CP safely improved ambulatory knee and ankle angle motion and daily mobility outcomes. Future educational studies of training needs for surgeons new to the approach are needed.
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http://dx.doi.org/10.1155/2020/5124952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453246PMC
August 2020

Comparison of readmissions among hospitalized nonvalvular atrial fibrillation patients treated with oral anticoagulants in the United States.

J Drug Assess 2020 24;9(1):87-96. Epub 2020 Apr 24.

Novosys Health, Green Brook, NJ, USA.

To compare the risks of 1-month all-cause, major bleeding (MB)-related and stroke-related readmissions and the associated hospital resource use and costs among patients previously hospitalized for nonvalvular atrial fibrillation (NVAF) and treated with warfarin, rivaroxaban, and dabigatran vs apixaban. Adult patients hospitalized with NVAF (any discharge diagnosis position) who received apixaban, warfarin, rivaroxaban, or dabigatran during hospitalization were identified from the Premier database (1 January 2013-30 June 2017) and grouped into respective cohorts. Propensity score matching was used to generate cohorts with similar characteristics. In regression analyses the risk of readmissions that occurred within 1 month of discharge were evaluated and the associated length of stay (LOS) and costs compared. NVAF patients treated with warfarin vs apixaban had significantly greater risk of all-cause (odds ratio [OR] = 1.05; confidence interval [CI] = 1.02-1.08;  < .001), MB-related (OR: 1.28; CI: 1.16-1.42;  < .001), and stroke-related (OR: 1.33; CI: 1.11-1.58;  = .002) readmissions; for all readmission categories, average LOS was significantly longer and costs significantly higher for warfarin treated patients. NVAF patients treated with rivaroxaban versus apixaban had significantly greater risk of all-cause (OR: 1.06; CI: 1.02-1.09;  = .001) and MB-related (OR = 1.62; CI = 1.44-1.83;  < .001) readmissions, but not stroke-related readmission; for MB-related readmissions average LOS and costs were higher for rivaroxaban treated patients. Significant differences in risks of all-cause, MB-related, and stroke-related readmissions were not observed between the apixaban and dabigatran cohorts. In this retrospective real-world analysis of NVAF patients, apixaban treatment was associated with better clinical outcomes than warfarin or rivaroxaban and lower hospital resource burden.
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http://dx.doi.org/10.1080/21556660.2020.1750418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241468PMC
April 2020

Exploring the acceptability of implantable defibrillators in patients with cardiac dystrophinopathy and carers.

Open Heart 2020 21;7(1):e001230. Epub 2020 Apr 21.

Department of Cardiology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.

Objective: Unlike for patients with other forms of cardiomyopathies, those with severe ventricular dysfunction due to Duchenne muscular dystrophy (DMD) are not offered implantable cardioverter-defibrillator (ICD) therapy routinely. This prospective study aimed to determine the views of DMD-patients and their carers about discussing sudden death risk and their acceptance of ICDs.

Design And Setting: Adults with DMD (n=9) and parents/carers (n=9) participated in audio-recorded, 60-90 min focus group sessions (patients 2; parents/carers 2) conducted through either a face-to-face session at a neutral venue or a videoconference. Sessions were facilitated by a clinical psychologist, experienced in conducting focus group research. All participants understood the rationale for the study and the nature of ICD therapy. The same predefined themes were explored with each group. Recordings were transcribed, analysed thematically by two researchers, working independently and then agreed. Differences in responses between patient and carer groups were also studied and compared. Participants all provided informed written consent and the study had ethical approval.

Results: Three main themes emerged: (1) access to/quality of information provided by professionals and patient engagement with them; (2) decision-making about ICDs; (3) individuals' own 'lived experience' of DMD.

Conclusions: The main findings were: (1) patients with DMD want to have their risk of sudden arrhythmic death discussed, when relevant and (2) if ICD therapy were established as beneficial, they would welcome an individualised discussion about its appropriateness for them.
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http://dx.doi.org/10.1136/openhrt-2019-001230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204554PMC
December 2020

Classification of Opioid Usage Through Semi-Supervised Learning for Total Joint Replacement Patients.

IEEE J Biomed Health Inform 2021 01 5;25(1):189-200. Epub 2021 Jan 5.

Opioid misuse and overdose have become a public health hazard and caused drug addiction and death in the United States due to rapid increase in prescribed and non-prescribed opioid usage. The misuse and overdose are highly related to opioid over-prescription for chronic and acute pain treatment, where a one-size-fits-all prescription plan is often adopted but can lead to substantial leftovers for patients who only consume a few. To reduce over-prescription and opioid overdose, each patient's opioid usage pattern should be taken into account. As opioids are often prescribed for patients after total joint replacement surgeries, this study introduces a machine learning model to predict each patient's opioid usage level in the first 2 weeks after discharge. Specifically, the electronic health records, patient prescription history, and consumption survey data are collected to investigate the level of short-term opioid usage after joint replacement surgeries. However, there are a considerable number of answers missing in the surveys, which degrades data quality. To overcome this difficulty, a semi-supervised learning model that assigns pseudo labels via Bayesian regression is proposed. Using this model, the missing survey answers of opioids amount taken by the patients are predicted first. Then, based on the prediction, pseudo labels are assigned to those patients to improve classification performance. Extensive experiments indicate that such a semi-supervised learning model has shown a better performance in the resulting patients classification. It is expected that by using such a model the providers can adjust the amount of prescribed opioids to meet each patient's actual need, which can benefit the management of opioid prescription and pain intervention.
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http://dx.doi.org/10.1109/JBHI.2020.2992973DOI Listing
January 2021

Lean body mass and risk of type 2 diabetes - a Danish cohort study.

J Diabetes Metab Disord 2019 Dec 14;18(2):445-451. Epub 2019 Sep 14.

1Department of Public Health, Aarhus University, Bartholins Allé 2 - Building 1260, DK-8000 Aarhus C, Denmark.

Purpose: Excess body fat is a commonly known risk factor for type 2 diabetes. However, whether lean body mass, or fat free mass, could have a protective effect against type 2 diabetes, remains unclear. The aim of this study was to explore the association between lean body mass, fat mass and type 2 diabetes.

Methods: This study used data from the Danish Diet, Cancer and Health cohort of 37,053 men and women, aged 50-64 years at baseline (1993-1997). The exposure was measurements of body composition using bioelectrical impedance analysis. Incident diabetes during follow-up was determined through linkage to the Danish National Diabetes Register. Cox proportional hazards regression analysis was used to estimate HR and 95%CI for the association between lean body mass and incident type 2 diabetes, with and without adjustment for fat mass. A sensitivity analysis was performed, excluding cases of incident type 2 diabetes within the first 2 years of follow-up.

Results: When adjusted for fat mass, the main analysis showed non-linear inverse association between lean body mass and risk of diabetes for men, but not for women. However, the sensitivity analysis found no association for either men or women.

Conclusions: Lean body mass was not associated with incident type 2 diabetes when excluding cases that may have been subclinical at baseline. The results imply that public health should focus on reduction of fat mass for diabetes prevention.
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http://dx.doi.org/10.1007/s40200-019-00438-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915175PMC
December 2019

Validation of obesity coding among newly treated nonvalvular atrial fibrillation patients using an integrated electronic medical record and claims database.

Curr Med Res Opin 2020 02 28;36(2):189-197. Epub 2019 Sep 28.

BHE, Boston, MA, USA.

To evaluate the validity of diagnosis codes for identifying obesity and morbid obesity among newly treated nonvalvular atrial fibrillation (NVAF) patients. An integrated electronic medical record (EMR) and claims database (1 January 2013-31 March 2018) was used. Adult patients with ≥1 claim for an oral anticoagulant (OAC) from 1 January 2014-30 September 2017 were identified (index date). Patients were required to have ≥1 atrial fibrillation diagnosis, no OAC use or valvular disease during the 12 months before index date, ≥12 months of continuous enrollment before and ≥6 months after index date, and ≥1 BMI measurement 6 months before or after index date. Patients with BMI ≥30 kg/m and BMI ≥40 kg/m were classified as obese and morbidly obese, respectively. Sensitivity, specificity and positive predictive value (PPV) were calculated to assess the validity of diagnosis codes for obesity and morbid obesity. A total of 7501 patients met all selection criteria. Forty-six percent of patients had BMI ≥ 30 kg/m, of whom about one-quarter had a BMI ≥ 40 kg/m. Twenty-five percent and 10% of patients had a diagnosis code for obesity or morbid obesity, respectively. Sensitivity, specificity and PPV for obesity diagnosis codes were 48.67% (95% CI: 47.00%-50.35%), 95.24% (94.54%-95.88%) and 89.78% (88.32%-91.12%), respectively, and 62.75% (59.30%-66.11%), 96.46% (95.99%-96.89%) and 67.93% (64.43%-71.29%) for morbid obesity diagnosis codes, respectively. Among newly treated NVAF patients, obesity diagnosis codes had high PPV, high specificity and modest sensitivity. Morbid obesity diagnosis codes also had high specificity, but modest PPV and sensitivity. These findings have implications for case selection and control for obesity as a confounder in studies using a claims database.
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http://dx.doi.org/10.1080/03007995.2019.1666448DOI Listing
February 2020

Switching to Another Oral Anticoagulant and Drug Discontinuation Among Elderly Patients With Nonvalvular Atrial Fibrillation Treated With Different Direct Oral Anticoagulants.

Clin Appl Thromb Hemost 2019 Jan-Dec;25:1076029619870249

3 Novosys Health, Green Brook, NJ, USA.

We compared the risks of switching to another oral anticoagulant (OAC) and discontinuation of direct oral anticoagulants (DOACs) among elderly patients with nonvalvular atrial fibrillation (NVAF) who were prescribed rivaroxaban or dabigatran versus apixaban. Patients (≥65 years of age) with NVAF prescribed DOACs (January 1, 2013 to September 30, 2017) were identified from the Humana research database and grouped into DOAC cohorts. Cox regression analyses were used to evaluate whether the risk for switching to another OAC or discontinuing index DOACs differed among cohorts. Of the study population (N = 38 250), 55.9% were prescribed apixaban (mean age: 78.6 years; 49.8% female), 37.3% rivaroxaban (mean age: 77.4 years; 46.7% female), and 6.8% dabigatran (mean age: 77.0 years; 44.0% female). Compared to patients prescribed apixaban, patients prescribed rivaroxaban (hazard ratio [HR]: 2.08; 95% confidence interval [CI], 1.92-2.25; < .001) or dabigatran (HR: 3.74; 95% CI, 3.35-4.18, < .001) had a significantly higher risk of switching to another OAC during the follow-up; compared to patients prescribed apixaban, the risks of discontinuation were also higher for patients treated with rivaroxaban (HR: 1.10; 95% CI, 1.07-1.13, < .001) or dabigatran (HR: 1.29; 95% CI, 1.23-1.35, < .001).
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http://dx.doi.org/10.1177/1076029619870249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829636PMC
January 2020

Continuation with apixaban treatment is associated with lower risk for hospitalization and medical costs among elderly patients.

Curr Med Res Opin 2019 10 5;35(10):1769-1776. Epub 2019 Jun 5.

Novosys Health , Green Brook , NJ , USA.

To compare the risk of hospitalization and costs associated with major bleeding (MB) or stroke/systemic embolism (SE) among elderly patients with nonvalvular atrial fibrillation (NVAF) who initiated apixaban then switched to another oral anticoagulant (OAC) vs. those who continued with apixaban treatment. NVAF patients (≥65 years) initiating apixaban were identified from the Humana database (1 January 2013-30 September 2017) and grouped into switcher and continuer cohorts. For switchers, the earliest switch from apixaban to another OAC was defined as the index event/date. A random date during apixaban treatment was selected as the index date for continuers. Patients were followed from index date to health plan disenrollment or 31 December 2017, whichever was earlier. Multivariable regression analyses were used to examine the association of switchers vs. continuers with risk of MB-related or stroke/SE-related hospitalization and healthcare costs during follow-up. Of 7858 elderly NVAF patients included in the study, 14% ( = 1110; mean age: 78 years) were switchers; 86% ( = 6748; mean age: 79 years) were continuers. Apixaban switchers vs. continuers had significantly greater risk of MB-related hospitalization (hazard ratio [HR]: 2.00; 95% CI: 1.52-2.64;  < .001) during follow-up; risk of stroke/SE hospitalization did not differ significantly (HR: 1.36, 95% CI: 0.89-2.06,  = .154). MB- and stroke/SE-related medical costs were higher for switchers vs. continuers, although total all-cause healthcare costs were similar. Elderly patients with NVAF in the US who continued with apixaban treatment had a lower risk of MB-related hospitalization and lower MB- and stroke/SE-related medical costs compared to patients who switched to another OAC.
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http://dx.doi.org/10.1080/03007995.2019.1623187DOI Listing
October 2019

Comparative clinical outcomes between direct oral anticoagulants and warfarin among elderly patients with non-valvular atrial fibrillation in the CMS medicare population.

J Thromb Thrombolysis 2019 Aug;48(2):240-249

Pfizer Inc., New York, NY, USA.

Atrial fibrillation (AF) prevalence increases with age; > 80% of US adults with AF are aged ≥ 65 years. Compare the risk of stroke/systemic embolism (SE), major bleeding (MB), net clinical outcome (NCO), and major adverse cardiac events (MACE) among elderly non-valvular AF (NVAF) Medicare patients prescribed direct oral anticoagulants (DOACs) VS warfarin. NVAF patients aged ≥ 65 years who initiated DOACs (apixaban, dabigatran, and rivaroxaban) or warfarin were selected from 01JAN2013-31DEC2015 in CMS Medicare data. Propensity score matching was used to balance DOAC and warfarin cohorts. Cox proportional hazards models estimated the risk of stroke/SE, MB, NCO, and MACE. 37,525 apixaban-warfarin, 18,131 dabigatran-warfarin, and 55,359 rivaroxaban-warfarin pairs were included. Compared to warfarin, apixaban (HR: 0.69; 95% CI 0.59-0.81) and rivaroxaban (HR: 0.82; 95% CI 0.73-0.91) had lower risk of stroke/SE, and dabigatran (HR: 0.88; 95% CI 0.72-1.07) had similar risk of stroke/SE. Apixaban (MB: HR: 0.61; 95% CI 0.57-0.67; NCO: HR: 0.64; 95% CI 0.60-0.69) and dabigatran (MB: HR: 0.79; 95% CI 0.71-0.89; NCO: HR: 0.84; 95% CI 0.76-0.93) had lower risk of MB and NCO, and rivaroxaban had higher risk of MB (HR: 1.08; 95% CI 1.02-1.14) and similar risk of NCO (HR: 1.04; 95% CI 0.99-1.09). Compared to warfarin, apixaban had a lower risk for stroke/SE, MB, and NCO; dabigatran had a lower risk of MB and NCO; and rivaroxaban had a lower risk of stroke/SE but higher risk of MB. All DOACs had lower risk of MACE compared to warfarin.
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http://dx.doi.org/10.1007/s11239-019-01838-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599494PMC
August 2019

An empirical tool for estimating the share of unmet need due to healthcare inefficiencies, suboptimal access, and lack of effective technologies.

BMC Health Serv Res 2019 Feb 11;19(1):113. Epub 2019 Feb 11.

Parexel International, 2520 Meridian Parkway, Durham, NC, 27713, USA.

Background: Although there has been growing attention to the measurement of unmet need, which is the overall epidemiological burden of disease, current measures ignore the burden that could be eliminated from technological advances or more effective use of current technologies.

Methods: We developed a conceptual framework and empirical tool that separates unmet need from met need and subcategorizes the causes of unmet need into suboptimal access to and ineffective use of current technologies and lack of current technologies. Statistical models were used to model the relationship between health-related quality of life (HR-QOL) and treatment utilization using data from the National Health and Wellness Survey (NHWS). Predicted HR-QOL was combined with prevalence data from the Global Burden of Disease Study (GBD) to estimate met need and the causes of unmet need due to morbidity in the US and EU5 for five diseases: rheumatoid arthritis, breast cancer, Parkinson's disease, hepatitis C, and chronic obstructive pulmonary disease (COPD).

Results: HR-QOL was positively correlated with adherence to medication and patient-perceived quality and negatively correlated with financial barriers. Met need was substantial across all disease and regions, although significant unmet need remains. While the majority of unmet need was driven by lack of technologies rather than ineffective use of current technologies, there was considerable variation across diseases and regions. Overall unmet need was largest for COPD, which had the highest prevalence of all diseases in this study.

Conclusion: We developed a methodology that can inform decisions about which diseases to invest in and whether those investments should focus on improving access to currently available technologies or inventing new technologies.
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http://dx.doi.org/10.1186/s12913-019-3914-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371562PMC
February 2019

Comparison of Drug Switching and Discontinuation Rates in Patients with Nonvalvular Atrial Fibrillation Treated with Direct Oral Anticoagulants in the United States.

Adv Ther 2019 01 29;36(1):162-174. Epub 2018 Nov 29.

Bristol-Myers Squibb, Lawrenceville, NJ, USA.

Introduction: Continuous usage of direct oral anticoagulants (DOACs) among nonvalvular atrial fibrillation (NVAF) patients is essential to maintain stroke prevention. We examined switching and discontinuation rates for the three most frequently initiated DOACs in NVAF patients in the USA.

Methods: Patients who initiated apixaban, rivaroxaban, or dabigatran (index event/date) were identified from the Pharmetrics Plus claims database (Jan 1, 2013-Sep 30, 2016, includes patients with commercial and Medicare coverage) and grouped into cohorts by index DOAC. Patients were required to have a diagnosis of NVAF and continuous health plan enrollment for 12 months prior to the index date (baseline period) and at least 3 months during the follow-up period. Drug switching rates to any other DOAC or warfarin and index DOAC discontinuation rate were evaluated separately with descriptive statistics, Kaplan-Meier analysis, and multivariable Cox regression analysis.

Results: Of the NVAF study population (n = 41,864), 37% initiated apixaban (n = 15,352; mean age 62 years), 51% initiated rivaroxaban (n = 21,250; mean age 61 years), and 13% initiated dabigatran (n = 5262; mean age 61 years). During the follow-up period, the unadjusted drug switching rates of patients treated with apixaban, rivaroxaban, and dabigatran were 3.6%, 6.3%, and 11.1%, respectively (p < 0.001 across the three cohorts); while the index DOAC discontinuation rates were 52.8%, 60.3%, and 62.9%, respectively (p < 0.001). After we controlled for differences in patient characteristics, patients treated with rivaroxaban (HR 1.8; 95% CI 1.6-2.0; p < 0.001) and dabigatran (HR 3.4; 95% CI 3.0-3.8, p < 0.001) had a significantly greater likelihood for drug switching than patients treated with apixaban. Also, both rivaroxaban (HR 1.1; 95% CI 1.1-1.2, p < 0.001) and dabigatran (HR 1.3; 95% CI 1.2-1.3, p < 0.001) treated patients were more likely to discontinue treatment.

Conclusion: In the real-world setting, patients with NVAF newly treated with apixaban were less likely to switch or discontinue treatment compared to patients treated with rivaroxaban or dabigatran.

Funding: Pfizer and Bristol-Myers Squibb.
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http://dx.doi.org/10.1007/s12325-018-0840-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6318235PMC
January 2019

Randomised controlled trial of cognitive behavioural therapy in COPD.

ERJ Open Res 2018 Oct 23;4(4). Epub 2018 Nov 23.

Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK.

Anxiety is an important comorbidity in chronic obstructive pulmonary disease (COPD). We investigated if cognitive behavioural therapy (CBT), delivered by respiratory nurses, reduced symptoms of anxiety and was cost-effective. Patients with COPD and anxiety were randomised to CBT or self-help leaflets. Anxiety, depression and quality of life were measured at baseline, 3, 6 and 12 months. A cost-effectiveness analysis was conducted from a National Health Service hospital perspective and quality-adjusted life-years estimated using the EuroQol-5D questionnaire. In total, 279 patients were recruited. Group mean change from baseline to 3 months in the Hospital Anxiety and Depression Anxiety Subscale was 3.4 (95% CI 2.62-4.17, p<0.001) for the CBT group and 1.88 (95% CI 1.19-2.55, p<0.001) in the leaflet group. The CBT group was superior to leaflets at 3 months (mean difference in the Hospital Anxiety and Depression Anxiety Subscale was 1.52, 95% CI 0.49-2.54, p=0.003). Importantly, the CBT intervention was more cost-effective than leaflets at 12 months, significantly lowering hospital admissions and attendance at emergency departments. CBT delivered by respiratory nurses is a clinically and cost-effective treatment for anxiety in patients with COPD relative to self-help leaflets.
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http://dx.doi.org/10.1183/23120541.00094-2018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250562PMC
October 2018

Whole-genome sequencing for methicillin-resistant Staphylococcus aureus (MRSA) outbreak investigation in a neonatal intensive care unit.

Infect Control Hosp Epidemiol 2018 12 4;39(12):1412-1418. Epub 2018 Oct 4.

1Division of Pediatric Infectious Diseases,Department of Pediatric and Adolescent Medicine,Mayo Clinic,Rochester,Minnesota.

Objective: To evaluate whole-genome sequencing (WGS) as a molecular typing tool for MRSA outbreak investigation.

Design: Investigation of MRSA colonization/infection in a neonatal intensive care unit (NICU) over 3 years (2014-2017).

Setting: Single-center level IV NICU.PatientsNICU infants and healthcare workers (HCWs).

Methods: Infants were screened for MRSA using a swab of the anterior nares, axilla, and groin, initially by targeted (ring) screening, and later by universal weekly screening. Clinical cultures were collected as indicated. HCWs were screened once using swabs of the anterior nares. MRSA isolates were typed using WGS with core-genome multilocus sequence typing (cgMLST) analysis and by pulsed-field gel electrophoresis (PFGE). Colonized and infected infants and HCWs were decolonized. Control strategies included reinforcement of hand hygiene, use of contact precautions, cohorting, enhanced environmental cleaning, and remodeling of the NICU.

Results: We identified 64 MRSA-positive infants: 53 (83%) by screening and 11 (17%) by clinical cultures. Of 85 screened HCWs, 5 (6%) were MRSA positive. WGS of MRSA isolates identified 2 large clusters (WGS groups 1 and 2), 1 small cluster (WGS group 3), and 8 unrelated isolates. PFGE failed to distinguish WGS group 2 and 3 isolates. WGS groups 1 and 2 were codistributed over time. HCW MRSA isolates were primarily in WGS group 1. New infant MRSA cases declined after implementation of the control interventions.

Conclusion: We identified 2 contemporaneous MRSA outbreaks alongside sporadic cases in a NICU. WGS was used to determine strain relatedness at a higher resolution than PFGE and was useful in guiding efforts to control MRSA transmission.
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http://dx.doi.org/10.1017/ice.2018.239DOI Listing
December 2018

An Analytical Framework for TJR Readmission Prediction and Cost-Effective Intervention.

IEEE J Biomed Health Inform 2019 07 25;23(4):1760-1772. Epub 2018 Jul 25.

This paper introduces an analytical framework for assessing the cost-effectiveness of intervention strategies to reduce total joint replacement (TJR) readmissions. In such a framework, a machine learning-based readmission risk prediction model is developed to predict an individual TJR patient's risk of hospital readmission within 90 days post-discharge. Specifically, through data sampling and boosting techniques, we overcome the class imbalance problem by iteratively building an ensemble of models. Then, utilizing the results of the predictive model, and by taking into account the imbalanced misclassification costs between readmitted and nonreadmitted patients, a cost analysis framework is introduced to support decision making in selecting cost-effective intervention policies. Finally, using this framework, a case study at a community hospital is presented to demonstrate the applicability of the analysis.
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http://dx.doi.org/10.1109/JBHI.2018.2859581DOI Listing
July 2019

A cost-benefit analysis of smoking cessation prescription coverage from a US payer perspective.

Clinicoecon Outcomes Res 2018 16;10:359-370. Epub 2018 Jul 16.

Patient & Health Impact, Pfizer, Inc, New York, NY, USA.

Introduction: Smoking drives substantial direct health care spending, comprising 8.7% ($168 billion) of annual United States aggregated spending. Smoking cessation (SC) prescription use is an effective strategy to improve health outcomes, increase quit rates, and reduce economic burden. However, patient out-of-pocket costs may limit the use. Health care payers play a vital role in driving use through formulary decisions and copayment policies but must consider both the near-term financial investment as well as downstream effects of increased coverage on health care budgets. This study estimates the return on investment (ROI) of providing Affordable Care Act (ACA)-recommended prescription SC coverage.

Methods: A cost-benefit analysis (CBA) estimates the ROI of providing prescription SC coverage, based on pharmacy costs and savings from smoking-attributable medical expenditures among Medicare, Medicaid, and commercial plan enrollees over 10 years. The CBA incorporated national-level population demographics, smoking prevalence estimates, proportion of smokers attempting to quit, and the utilization of SC products. A five-state Markov chain model simulated patterns of quit attempts, relapse, and cessation assuming two quit attempts per year, no patient cost-sharing, and 25.4% utilization of prescription SC aids. Results include number of quitters, annual pharmacy and smoking-attributable medical costs, and ROI.

Results: After initial investment in SC treatment, smoking-attributable medical benefits accrue over time, generating a positive ROI by year 4 for commercial (11.3%) and Medicaid (78.4%) plans and by year 3 for Medicare (30.6%). Over 10 years, an average return of $1.18, $2.50, and $3.22 savings per dollar spent on SC prescriptions for commercial, Medicaid, and Medicare plans, respectively, may be realized.

Discussion: Given the proven efficacy of SC pharmacotherapy, near-term investments in supporting ACA-recommended SC coverage translate into a positive ROI. As smoking is a leading cause of morbidity and mortality, increased access to prescription SC medications may improve health outcomes and reduce smoking-attributable costs to payers over time.
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http://dx.doi.org/10.2147/CEOR.S165576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052927PMC
July 2018

Mobile App Usage Patterns of Patients Prescribed a Smoking Cessation Medicine: Prospective Observational Study.

JMIR Mhealth Uhealth 2018 Apr 17;6(4):e97. Epub 2018 Apr 17.

Express Scripts Inc, St Louis, MO, United States.

Background: Cigarette smoking is the leading preventable cause of death and is responsible for more than 480,000 deaths per year in the United States. Smoking cessation is challenging for many patients. Regardless of available treatment options, most quit attempts are unaided, and it takes multiple attempts before a patient is successful. With the ever-increasing use of smartphones, mobile apps hold promise in supporting cessation efforts. This study evaluates the ease of use and user satisfaction with the Pfizer Meds app to support smoking cessation among patients prescribed varenicline (Chantix).

Objective: Study participants included varenicline users who downloaded and used the app on their personal smartphone. The main objectives were to report mobile app download frequency and usage details and to describe the participant-reported satisfaction with and usefulness of the app over the 14-week follow-up study period.

Methods: Adults aged 18 years or older who had been prescribed varenicline were identified from the Express Scripts Incorporated pharmacy claims database. After meeting privacy restrictions, subjects were sent an invitation letter and second reminder letter with instructions on how to download the Pfizer Meds mobile app. Participants received a push notification to complete a smartphone-enabled survey regarding the utility of the app 12 weeks after downloading the app. Descriptive statistics summarized sociodemographics, use of varenicline, and details of use and satisfaction with the mobile app.

Results: Of the 38,129 varenicline users who were sent invitation letters, 1281 participants (3.35%) downloaded the Pfizer Meds app. Of the 1032 users with demographic and other data, 585 (56.68%) were females, and 446 (43.22%) were males; mean age was 46.4 years (SD 10.8). The mean number of app sessions per participant was 4.0 (SD 6.8). The end-of-study survey was completed by 131 survey respondents (10.23%, 131/1281); a large number of participants (117/131, 89.3%) reported being extremely, very, or moderately satisfied with the app. A total of 97 survey respondents (97/131, 74.0%) reported setting up a quit date in the app. Of those, 74 (74/97, 76%) reported quitting on their quit date.

Conclusions: Positive patient engagement was observed in this study based on app download and usage. This study quantified how the Pfizer Meds app performed in an observational real-world data setting. The findings demonstrate the willingness of participants to set a quit date and use the app for support in medication adherence, refill reminders, and information regarding how to take the medication. This study provides real-world evidence of the contribution apps can make to the continued encouragement of smokers to improve their health by smoking cessation.
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http://dx.doi.org/10.2196/mhealth.9115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5930175PMC
April 2018

Smoking Cessation Is Associated With Lower Indirect Costs.

J Occup Environ Med 2018 06;60(6):490-495

Pfizer Inc. (Ms Baker, Ms Bruno, and Dr Emir); Kantar Health (Ms Li and Dr Goren), New York, New York.

Objective: This study quantified differences in indirect costs due to decreased work productivity between current and former smokers. Former smokers were further categorized by number of years since quitting to assess corresponding differences.

Methods: Data on employed individuals were obtained from the 2013 US National Health and Wellness Survey (NHWS; N = 75,000). Indirect costs were calculated for current smokers and former smokers from weekly wages based on age and sex.

Results: The annual total indirect costs for current smokers were $1327.53, $1560.18, and $1839.87 higher than for those who quit 0 to 4 years, 5 to 10 years, and more than or equal to 11 years prior, respectively. There were no significant differences in mean total indirect costs between the former smoker groups.

Conclusions: Current smokers showed significantly higher total annual indirect costs compared with former smokers, independently of the number of years since quitting smoking.
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http://dx.doi.org/10.1097/JOM.0000000000001302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991186PMC
June 2018

A cost-effectiveness analysis of varenicline for smoking cessation using data from the EAGLES trial.

Clinicoecon Outcomes Res 2018 19;10:67-74. Epub 2018 Jan 19.

Data Pyxis Ltd., St Albans, UK.

Background: The cost-effectiveness of varenicline has been demonstrated in the US health care setting using the Benefits of Smoking Cessation on Outcomes (BENESCO) model to simulate the lifetime direct costs and consequences of a hypothetical cohort of US adult smokers who make a single attempt to quit. The aim of this study was to undertake an updated cost-effectiveness analysis, using current epidemiology inputs and recently published smoking cessation data from the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES), the largest clinical trial of smoking cessation pharmacotherapies conducted to date.

Methods: BENESCO is a Markov model simulating the effect of a single attempt to quit smoking on four smoking-related diseases: coronary heart disease, stroke, chronic obstructive lung disease, and lung cancer. Inputs were updated to include efficacy from EAGLES and newer data for the epidemiology of smoking in the US, the epidemiology and direct treatment costs of the four morbidities, and the costs of the interventions. Analyses compared varenicline, bupropion, nicotine replacement therapy (NRT) patch, and placebo with regard to the incidence of smoking-related morbidity, the incidence of smoking-related mortality, and cost-effectiveness at a time horizon from 2 years to lifetime.

Results: The study cohort comprised of 18,394,068 US adult smokers who made a single quit attempt during the first year of the model. For varenicline, there were an estimated 319,730 fewer smoking-related morbidities at the lifetime compared with placebo. Similarly, smoking-related mortality decreased by 198,240 subjects when varenicline was compared with placebo. For the same time horizon, varenicline was more effective and less costly, ie, dominant, compared with all comparators in the cost-effectiveness analysis.

Conclusion: Based on the BENESCO model, smoking cessation with varenicline results in reduced incidence of smoking-related morbidity and mortality compared with other smoking cessation interventions and remains a cost-effective strategy in the US population.
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http://dx.doi.org/10.2147/CEOR.S153897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783141PMC
January 2018

Estimating the public economic consequences of introducing varenicline smoking cessation therapy in South Korea using a fiscal analytic framework.

J Med Econ 2018 Jun 13;21(6):571-576. Epub 2018 Feb 13.

b Global Market Access Solutions , St-Prex , Switzerland.

Background And Aims: Smoking gives rise to many cross-sectorial public costs and benefits for government. Costs arise from increased healthcare spending and work-related social benefits, while smoking itself provides significant revenue for government from tobacco taxes. To better understand the public economic impact of smoking and smoking cessation therapies, this study developed a government perspective framework for assessing smoking-attributable morbidity and mortality and associated public costs. This framework includes changes in lifetime tax revenue and health costs, as well as changes in tobacco tax revenue, from fewer smokers.

Methods: A modified generational accounting framework was developed to assess relationships between smoking-attributable morbidity and mortality and public economic consequences of smoking, including lifetime tax revenue gains/losses, government social transfers, and health spending. Based on the current prevalence of smoking in South Korean males, a cohort model was developed for smokers, former-smokers, and never-smokers. The model simulated the lifetime discounted fiscal transfers for different age cohorts in 5 year age bands, and the return on investment (ROI) from smoking cessation therapy.

Results: Former smokers are estimated to generate higher lifetime earnings and direct tax revenues and lower lifetime healthcare costs due to the reduction of smoking-attributable mortality and morbidity compared to smokers, even after accounting for reduced tobacco taxes paid. Based on the costs of public investments in varenicline, this study estimated a ROI from 1.4-1.7, depending on treatment age, with higher ROI in younger cohorts, with an average ROI of 1.6 for those aged less than 65.

Conclusions: This analysis suggests that reductions in smoking can generate positive public economic benefits for government, even after accounting for lost tobacco tax revenues. The results described here are likely applicable to countries having similar underlying smoking prevalence, comparable taxation rates, and social benefit protection provided to individuals with smoking-related conditions.
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http://dx.doi.org/10.1080/13696998.2018.1434183DOI Listing
June 2018

Increasing the Connectivity and Autonomy of RNs with Low-Risk Obstetric Patients.

Am J Nurs 2018 Jan;118(1):48-55

Anne M. Baron is a connected care RN in the Department of Nursing at the Mayo Clinic in Rochester, MN, where Susan L. Stirn is a nurse administrator. Jennifer L. Ridgeway and Dawn M. Finnie are principal health services analysts, Megan A. Morris is an assistant professor of health services research, Megan E. Branda is a statistician, and Jonathan W. Inselman is a statistical programmer analyst at the Mayo Clinic's Robert D. and Patricia E. Kern Center for the Science of Health Care and Delivery. Christine A. Baker is nurse manager of the neonatal ICU at the Mayo Clinic. Contact author: Anne M. Baron, The authors have disclosed no potential conflicts of interest, financial or otherwise.

: Objective: RNs are adopting an ever-larger role in health care models designed to reduce costs, increase patient satisfaction, and improve patient outcomes. Most research exploring such models has focused on those involving physicians or advanced practice nurses rather than RNs. This study explored the perspectives of patients, RNs, and other providers regarding a new prenatal connected care model for low-risk patients aimed at reducing in-office visits and creating virtual patient-RN connections.

Methods: This qualitative evaluation was performed as part of a larger randomized controlled trial of the new care model. Individual interviews and asynchronous online focus groups were conducted with a total of 41 patients, up to 10 unit and connected care RNs, and up to 17 other providers (up to eight physicians and nine certified nurse midwives [CNMs]).

Results: Thematic analysis indicated that patients in the new care model valued connectedness and relationships with the connected care RNs, including the ability to contact them as needed outside the office setting. Patients also valued their relationships with physicians and CNMs. Physicians appreciated having more time to care for higher-risk patients, and the connected care RNs appreciated being able to work to a fuller scope of practice, although participants in all provider groups suggested the increased use of protocols and other systems to ensure patient safety and improve communication among providers.

Conclusions: A prenatal connected care model for low-risk women allowed patients to decrease the number of scheduled in-person clinic visits with physicians or CNMs while building stronger nurse-patient relationships through virtual connected care visits with an RN. The results included increased patient satisfaction and greater autonomy for RNs, allowing them to work to a fuller scope of practice. Although the new model gave physicians more time in which to see higher-risk patients, CNM-patient relationships may have been limited.
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http://dx.doi.org/10.1097/01.NAJ.0000529715.93343.b0DOI Listing
January 2018

Reducing COPD readmissions through predictive modeling and incentive-based interventions.

Health Care Manag Sci 2019 Mar 25;22(1):121-139. Epub 2017 Nov 25.

Department of Industrial and Systems Engineering, University of Wisconsin, Madison, WI, USA.

This paper introduces a case study at a community hospital to develop a predictive model to quantify readmission risks for patients with chronic obstructive pulmonary disease (COPD), and use it to support decision making for appropriate incentive-based interventions. Data collected from the community hospital's database are analyzed to identify risk factors and a logistic regression model is developed to predict the readmission risk within 30 days post-discharge of an individual COPD patient. By targeting on the high-risk patients, we investigate the implementability of the incentive policy which encourages patients to take interventions and helps them to overcome the compliance barrier. Specifically, the conditions and scenarios are identified for either achieving the desired readmission rate while minimizing the total cost, or reaching the lowest readmission rate under incentive budget constraint. Currently, such models are under consideration for a pilot study at the community hospital.
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http://dx.doi.org/10.1007/s10729-017-9426-2DOI Listing
March 2019

Content Validity of a Willingness to Quit Tool for Use with Current Smokers in Clinical Practice.

Adv Ther 2017 10 22;34(10):2295-2306. Epub 2017 Sep 22.

Statistical Research and Data Science Center, Global Product Development, Pfizer Inc., New York, NY, USA.

Introduction: Despite reductions in rates of smoking in the past decade, smoking remains one of the most significant public health concerns. Quitting smoking can result in reductions in a number of serious health conditions. The brief Willingness to Quit (WTQ) tool can be used in routine clinical practice to assess current willingness to quit and engage a patient-physician dialogue regarding smoking cessation. The overall aim of this study was to validate the content of a WTQ tool for use with current smokers in clinical practice.

Methods: In-depth, qualitative interviews were conducted with 12 current smokers and five physicians. The interview was divided into two sections: concept elicitation (CE) followed by cognitive debriefing (CD). During CE, participants were asked questions exploring the different factors that can impact an individual's willingness to quit smoking. During CD, participants were given a copy of the WTQ tool and asked to comment on their level of understanding and interpretability of the items and the feasibility of completing the tool in clinical practice.

Results: All of the current smokers (n = 12) and physicians (n = 5) interviewed indicated that the items were understandable and relevant to assess willingness to quit. The tool was considered simple and suitable for use in clinical practice.

Conclusion: The WTQ tool is a brief tool to assess willingness to quit and to engage communication between patients and physicians. All smokers should be offered smoking cessation support and facilitating a discussion on willingness to quit further supports a personalized quit plan.

Funding: Pfizer Inc.
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http://dx.doi.org/10.1007/s12325-017-0611-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656735PMC
October 2017

The nature, characteristics and associations of care home staff stress and wellbeing: a national survey.

BMC Nurs 2017 8;16:22. Epub 2017 May 8.

Swansea University Medical School, Swansea University, Wales, UK.

Background: The majority of residents in care homes in the United Kingdom are living with dementia or significant memory problems. Caring in this setting can be difficult and stressful for care staff who work long hours, have little opportunity for training, are poorly paid and yet subject to high expectation. This may affect their mental and physical wellbeing, cause high rates of staff turnover and absenteeism, and affect the quality of care they provide. The main objective of this survey was to explore the nature, characteristics and associations of stress in care home staff.

Methods: Staff working in a stratified random sample of care homes within Wales completed measures covering: general health and wellbeing (SF-12); stress (Work Stress Inventory); job content (Karasek Job Content); approach to, and experience of, working with people living with dementia (Approaches to Dementia Questionnaire; and Experience of Working with Dementia Patients); and Productivity and Health Status (SPS-6). Multiple linear regressions explored the effects of home and staff characteristics on carers.

Results: 212 staff from 72 care homes completed questionnaires. Staff from nursing homes experienced more work stress than those from residential homes (difference 0.30; 95% confidence interval (CI) from 0.10 to 0.51;  < 0.01), and were more likely to report that their health reduced their ability to work (difference -4.77; CI -7.80 to -1.73;  < 0.01). Psychological demands on nurses were higher than on other staff (difference = 1.57; CI 0.03 to 3.10;  < 0.05). A positive approach to dementia was more evident in those trained in dementia care (difference 8.54; CI 2.31 to 14.76;  < 0.01), and in staff working in local authority homes than in the private sector (difference 7.75; CI 2.56 to 12.94;  < 0.01).

Conclusions: Our study highlights the importance of dementia training in care homes, with a particular need in the private sector. An effective intervention to reduce stress in health and social care staff is required, especially in nursing and larger care homes, and for nursing staff.

Trial Registration: ISRCTN registry: ISRCTN80487202. Registered 24 July 2013.
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http://dx.doi.org/10.1186/s12912-017-0216-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422906PMC
May 2017
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