Publications by authors named "Elizabeth Joy"

80 Publications

Implementation of Diabetes Prevention in Health Care Organizations: Best Practice Recommendations.

Popul Health Manag 2021 Jun 23. Epub 2021 Jun 23.

Diabetes Prevention Program, Community Health & Well-Being, Trinity Health, Livonia, Michigan, USA.

Approximately 1 in 3 American adults has prediabetes, a condition characterized by blood glucose levels that are above normal, not in the type 2 diabetes ranges, and that increases the risk of developing type 2 diabetes. Evidence-based treatments can be used to prevent or delay type 2 diabetes in adults with prediabetes. The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. Recommendations for each maturity phase are classified into 6 categories: (1) organizational support; (2) workforce and funding; (3) promotion and dissemination; (4) clinical integration and support; (5) evaluation and outcomes; (6) and program. As the burden of chronic disease grows, prevention must be prioritized and integrated into health care. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. Further research is suggested to assess the impact and adoption of diabetes prevention best practices.
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http://dx.doi.org/10.1089/pop.2021.0044DOI Listing
June 2021

The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part II: Diagnosis, Treatment, and Return-To-Play.

Clin J Sport Med 2021 Jul;31(4):349-366

Department of Family Medicine, University of California, Los Angeles, Los Angeles, California.

Abstract: The Male Athlete Triad is a medical syndrome most common in adolescent and young adult male athletes in sports that emphasize a lean physique, especially endurance and weight-class athletes. The 3 interrelated conditions of the Male Athlete Triad occur on spectrums of energy deficiency/low energy availability (EA), suppression of the hypothalamic-pituitary-gonadal axis, and impaired bone health, ranging from optimal health to clinically relevant outcomes of energy deficiency/low EA with or without disordered eating or eating disorder, functional hypogonadotropic hypogonadism, and osteoporosis or low bone mineral density with or without bone stress injury (BSI). Because of the importance of bone mass acquisition and health concerns in adolescence, screening is recommended during this time period in the at-risk male athlete. Diagnosis of the Male Athlete Triad is best accomplished by a multidisciplinary medical team. Clearance and return-to-play guidelines are recommended to optimize prevention and treatment. Evidence-based risk assessment protocols for the male athlete at risk for the Male Athlete Triad have been shown to be predictive for BSI and impaired bone health and should be encouraged. Improving energetic status through optimal fueling is the mainstay of treatment. A Roundtable on the Male Athlete Triad was convened by the Female and Male Athlete Triad Coalition in conjunction with the 64th Annual Meeting of the American College of Sports Medicine in Denver, Colorado, in May of 2017. In this second article, the latest clinical research to support current models of screening, diagnosis, and management for at-risk male athlete is reviewed with evidence-based recommendations.
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http://dx.doi.org/10.1097/JSM.0000000000000948DOI Listing
July 2021

The Male Athlete Triad-A Consensus Statement From the Female and Male Athlete Triad Coalition Part 1: Definition and Scientific Basis.

Clin J Sport Med 2021 Jul;31(4):335-348

Department of Orthopaedic Surgery, Stanford University, Stanford, California.

Abstract: The Male Athlete Triad is a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The causal role of low EA in the modulation of reproductive function and skeletal health in the male athlete reinforces the notion that skeletal health and reproductive outcomes are the primary clinical concerns. At present, the specific intermediate subclinical outcomes are less clearly defined in male athletes than those in female athletes and are represented as subtle alterations in the hypothalamic-pituitary-gonadal axis and increased risk for BSI. The degree of energy deficiency/low EA associated with such alterations remains unclear. However, available data suggest a more severe energy deficiency/low EA state is needed to affect reproductive and skeletal health in the Male Athlete Triad than in the Female Athlete Triad. Additional research is needed to further clarify and quantify this association. The Female and Male Athlete Triad Coalition Consensus Statements include evidence statements developed after a roundtable of experts held in conjunction with the American College of Sports Medicine 64th Annual Meeting in Denver, Colorado, in 2017 and are in 2 parts-Part I: Definition and Scientific Basis and Part 2: The Male Athlete Triad: Diagnosis, Treatment, and Return-to-Play. In this first article, we discuss the scientific evidence to support the Male Athlete Triad model.
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http://dx.doi.org/10.1097/JSM.0000000000000946DOI Listing
July 2021

COVID-19 outcomes in UK centre within highest health and wealth band: a prospective cohort study.

BMJ Open 2020 11 16;10(11):e042090. Epub 2020 Nov 16.

Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK

Objectives: To describe the characteristics and outcomes of hospitalised patients with COVID-19 from UK in the highest decile of health and gross regional products per capita.

Design: Prospective cohort study.

Setting: Recruited all adult inpatients with laboratory-confirmed COVID-19 symptoms admitted to a single Surrey centre between March and April 2020. Extensive demographic details were documented.

Outcome Measure: COVID-19 status of alive/dead and intensive care unit (ICU) status of yes/no.

Participants: Patients with COVID-19 from Surrey centre UK (n=429).

Results: 429 adult inpatients (mean age 70±18 years; men 56.4%) were included in this study, of whom, 19.1% required admission to ICU and 31.9% died. Adverse outcomes were associated with age (OR with each decade of years: 1.78, 95% CI 1.53 to 2.11, p<0.001 for mortality); male gender (OR=1.08, 95% CI 0.72 to 1.63, p=0.72, present in 70.7%, of admissions to ICU versus 53% of other cases, p=0.004); cardiac disease (OR=3.43, 95% CI 2.10 to 5.63, p<0.001), diabetes mellitus (OR=2.37, 95% CI 1.09 to 5.17, p=0.028) and dementia (OR=5.06, 95% CI 2.79 to 9.44, p<0.001). There was no significant impact of ethnicity or body mass index on disease outcome.

Conclusions: Despite reports of worse outcomes in deprived regions, we show similar complication and mortality rates due to COVID-19 in an affluent and high life expectancy region.
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http://dx.doi.org/10.1136/bmjopen-2020-042090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670555PMC
November 2020

Demonstrating the Clinical Impact of Continuous Glucose Monitoring Within an Integrated Healthcare Delivery System.

J Diabetes Sci Technol 2020 Sep 16:1932296820955228. Epub 2020 Sep 16.

Intermountain Healthcare, Salt Lake City, UT, USA.

Background: Approximately 30 million Americans currently suffer from diabetes, and nearly 55 million people will be impacted by 2030. Continuous glucose monitoring (CGM) systems help patients manage their care with real-time data. Although approximately 95% of those with diabetes suffer from type 2, few studies have measured CGM's clinical impact for this segment within an integrated healthcare system.

Methods: A parallel randomized, multisite prospective trial was conducted using a new CGM device (Dexcom G6) compared to a standard of care finger stick glucometer (FSG) (Contour Next One). All participants received usual care in primary care clinics for six consecutive months while using these devices. Data were collected via electronic medical records, device outputs, exit surveys, and insurance company (SelectHealth) claims in accordance with institutional review board approval.

Results: Ninety-nine patients were randomized for analysis ( = 50 CGM and  = 49 FSG). CGM patients significantly decreased hemoglobin A1c ( = .001), total visits ( = .009), emergency department encounters ( = .018), and labs ordered ( = .001). Among SelectHealth non-Medicare Advantage patients, per member per month savings were $417 for CGM compared to FSG, but $9 more for Medicare Advantage. Seventy percent of CGM users reported that the technology helped them better understand daily activity and diet compared to only 16% for FSG.

Discussion: Participants using CGM devices had meaningful improvements in clinical outcomes, costs, and self-reported measures compared to the FSG group. Although a larger study is necessary to confirm these results, CGM devices appear to improve patient outcomes while making treatment more affordable.
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http://dx.doi.org/10.1177/1932296820955228DOI Listing
September 2020

Exercise Is Medicine.

Am J Lifestyle Med 2020 Sep-Oct;14(5):511-523. Epub 2020 Apr 22.

Lifestyle Medicine Education University of South Carolina School of Medicine Greenville, Greenville, South Carolina.

There is overwhelming evidence in the scientific and medical literature that physical inactivity is a major public health problem with a wide array of harmful effects. Over 50% of health status can be attributed to unhealthy behaviors with smoking, diet, and physical inactivity as the main contributors. Exercise has been used in both the treatment and prevention of a variety of chronic conditions such as heart disease, pulmonary disease, diabetes, and obesity. While the negative effects of physical inactivity are widely known, there is a gap between what physicians tell their patients and exercise compliance. Exercise is Medicine was established in 2007 by the American College of Sports Medicine to inform and educate physicians and other health care providers about exercise as well as bridge the widening gap between health care and health fitness. Physicians have many competing demands at the point of care, which often translates into limited time spent counseling patients. The consistent message from all health care providers to their patients should be to start or to continue a regular exercise program. Exercise is Medicine is a solution that enables physicians to support their patients in implementing exercise as part of their disease prevention and treatment strategies.
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http://dx.doi.org/10.1177/1559827620912192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444006PMC
April 2020

Measuring Adherence to U.S. Preventive Services Task Force Diabetes Prevention Guidelines Within Two Healthcare Systems.

J Healthc Qual 2021 Mar-Apr 01;43(2):119-125

Abstract: Measuring adherence to the 2015 U.S. Preventive Services Task Force (USPSTF) diabetes prevention guidelines can inform implementation efforts to prevent or delay Type 2 diabetes. A retrospective cohort was used to study patients without a diagnosis of diabetes attributed to primary care clinics within two large healthcare systems in our state to study adherence to the following: (1) screening at-risk patients and (2) referring individuals with confirmed prediabetes to participate in an intensive behavioral counseling intervention, defined as a Center for Disease Control and Prevention (CDC)-recognized Diabetes Prevention Program (DPP). Among 461,866 adults attributed to 79 primary care clinics, 45.7% of patients were screened, yet variability at the level of the clinic ranged from 14.5% to 83.2%. Very few patients participated in a CDC-recognized DPP (0.52%; range 0%-3.53%). These findings support the importance of a systematic implementation strategy to specifically target barriers to diabetes prevention screening and referral to treatment.
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http://dx.doi.org/10.1097/JHQ.0000000000000281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878570PMC
August 2021

Sexual violence in sport: American Medical Society for Sports Medicine Position Statement.

Br J Sports Med 2021 Feb 18;55(3):132-134. Epub 2020 Jun 18.

Department of Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the Task Force used an iterative process and expert consensus to finalise the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
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http://dx.doi.org/10.1136/bjsports-2020-102226DOI Listing
February 2021

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

Clin J Sport Med 2020 07;30(4):291-292

Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
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http://dx.doi.org/10.1097/JSM.0000000000000855DOI Listing
July 2020

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

Curr Sports Med Rep 2020 Jun;19(6):232-234

Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
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http://dx.doi.org/10.1249/JSR.0000000000000722DOI Listing
June 2020

Sexual Violence in Sport: American Medical Society for Sports Medicine Position Statement.

Sports Health 2020 Jul/Aug;12(4):352-354. Epub 2020 Jun 8.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.
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http://dx.doi.org/10.1177/1941738120929946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787563PMC
July 2020

An Interpretive Description of Women's Experience in Coordinated, Multidisciplinary Treatment for an Eating Disorder.

Glob Qual Nurs Res 2020 Jan-Dec;7:2333393620913271. Epub 2020 May 4.

The University of Utah, Salt Lake City, Utah, USA.

Coordinated, multidisciplinary treatment for women with eating disorders is consistently recommended as maximally effective, but few studies have considered the patient experience. This qualitative study examined the experiences of women receiving such care in an outpatient setting. Using an interpretive description methodology, we conducted 12 in-depth interviews with participants who were diagnosed with an eating disorder and were receiving team-based treatment. Patients uniformly advocated for the coordinated, multidisciplinary treatment approach. Analysis of participants' experiences yielded four categories: relying on the lifeline of communication, supporting autonomy, drawing on individual strengths, and valuing synergy. These findings build on previous research emphasizing the importance of autonomy support and connectedness in the recovery process from an eating disorder. Findings highlight the importance of nurses to support a multidisciplinary care approach to working with this patient population; these women's voices also support a treatment approach that, despite being widely recommended, is vastly understudied and underutilized.
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http://dx.doi.org/10.1177/2333393620913271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218325PMC
May 2020

Food impactions in Eosinophilic esophagitis and acute exposures to fine particulate pollution.

Allergy 2019 12 24;74(12):2529-2530. Epub 2019 Jun 24.

Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.

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http://dx.doi.org/10.1111/all.13932DOI Listing
December 2019

Address risk factors to prevent bone stress injuries in male and female athletes.

Br J Sports Med 2019 Feb 3;53(4):205-206. Epub 2019 Jan 3.

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http://dx.doi.org/10.1136/bjsports-2018-100329DOI Listing
February 2019

Practical Tips for Implementing the Diabetes Prevention Program in Clinical Practice.

Curr Diab Rep 2018 08 8;18(9):70. Epub 2018 Aug 8.

American Medical Association, American Medical Association 330 N Wabash Ave, Chicago, IL, 60611, USA.

Purpose Of Review: The Diabetes Prevention Program (DPP) is an evidence-based lifestyle change program for prediabetes that is associated with a 58% reduction in 3-year diabetes incidence, and it has been supported by the American Medical Association and the Centers for Disease Control and Prevention. However, 9 in 10 patients are unaware they have the condition.

Recent Findings: With the passage of the Affordable Care Act (ACA) and broadened coverage for preventive services, the DPP has emerged as an accessible intervention in patients at risk. In 2018, Medicare began to cover the DPP, making it widely available for the first time to any patient over the age of 65 meeting eligibility criteria. The DPP is an evidence-based, widely available, frequently covered benefit, for lifestyle change for patients with prediabetes. To take advantage of this intervention, providers need to develop prediabetes screening and DPP referral workflows.
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http://dx.doi.org/10.1007/s11892-018-1034-0DOI Listing
August 2018

A Pragmatic Application of the RE-AIM Framework for Evaluating the Implementation of Physical Activity as a Standard of Care in Health Systems.

Prev Chronic Dis 2018 05 10;15:E54. Epub 2018 May 10.

Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska.

Introduction: Exercise is Medicine (EIM) is an initiative that seeks to integrate physical activity assessment, prescription, and patient referral as a standard in patient care. Methods to assess this integration have lagged behind its implementation.

Purpose And Objectives: The purpose of this work is to provide a pragmatic framework to guide health care systems in assessing the implementation and impact of EIM.

Evaluation Methods: A working group of experts from health care, public health, and implementation science convened to develop an evaluation model based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The working group aimed to provide pragmatic guidance on operationalizing EIM across the different RE-AIM dimensions based on data typically available in health care settings.

Results: The Reach of EIM can be determined by the number and proportion of patients that were screened for physical inactivity, received brief counseling and/or a physical activity prescription, and were referred to physical activity resources. Effectiveness can be assessed through self-reported changes in physical activity, cardiometabolic biometric factors, incidence/burden of chronic disease, as well as health care utilization and costs. Adoption includes assessing the number and representativeness of health care settings that adopt any component of EIM, and Implementation involves assessing the extent to which health care teams implement EIM in their clinic. Finally, Maintenance involves assessing the long-term effectiveness (patient level) and sustained implementation (clinic level) of EIM in a given health care setting.

Implications For Public Health: The availability of a standardized, pragmatic, evaluation framework is critical in determining the impact of implementing EIM as a standard of care across health care systems.
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http://dx.doi.org/10.5888/pcd15.170344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5951671PMC
May 2018

Short-Term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection.

Am J Respir Crit Care Med 2018 09;198(6):759-766

7 Department of Economics and.

Rationale: Nearly 60% of U.S. children live in counties with particulate matter less than or equal to 2.5 μm in aerodynamic diameter (PM) concentrations above air quality standards. Understanding the relationship between ambient air pollution exposure and health outcomes informs actions to reduce exposure and disease risk.

Objectives: To evaluate the association between ambient PM levels and healthcare encounters for acute lower respiratory infection (ALRI).

Methods: Using an observational case-crossover design, subjects (n = 146,397) were studied if they had an ALRI diagnosis and resided on Utah's Wasatch Front. PM air pollution concentrations were measured using community-based air quality monitors between 1999 and 2016. Odds ratios for ALRI healthcare encounters were calculated after stratification by ages 0-2, 3-17, and 18 or more years.

Measurements And Main Results: Approximately 77% (n = 112,467) of subjects were 0-2 years of age. The odds of ALRI encounter for these young children increased within 1 week of elevated PM and peaked after 3 weeks with a cumulative 28-day odds ratio of 1.15 per +10 μg/m (95% confidence interval, 1.12-1.19). ALRI encounters with diagnosed and laboratory-confirmed respiratory syncytial virus and influenza increased following elevated ambient PM levels. Similar elevated odds for ALRI were also observed for older children, although the number of events and precision of estimates were much lower.

Conclusions: In this large sample of urban/suburban patients, short-term exposure to elevated PM air pollution was associated with greater healthcare use for ALRI in young children, older children, and adults. Further exploration is needed of causal interactions between PM and ALRI.
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http://dx.doi.org/10.1164/rccm.201709-1883OCDOI Listing
September 2018

Routine Assessment and Promotion of Physical Activity in Healthcare Settings: A Scientific Statement From the American Heart Association.

Circulation 2018 05 4;137(18):e495-e522. Epub 2018 Apr 4.

Physical inactivity is one of the most prevalent major health risk factors, with 8 in 10 US adults not meeting aerobic and muscle-strengthening guidelines, and is associated with a high burden of cardiovascular disease. Improving and maintaining recommended levels of physical activity leads to reductions in metabolic, hemodynamic, functional, body composition, and epigenetic risk factors for noncommunicable chronic diseases. Physical activity also has a significant role, in many cases comparable or superior to drug interventions, in the prevention and management of >40 conditions such as diabetes mellitus, cancer, cardiovascular disease, obesity, depression, Alzheimer disease, and arthritis. Whereas most of the modifiable cardiovascular disease risk factors included in the American Heart Association's My Life Check - Life's Simple 7 are evaluated routinely in clinical practice (glucose and lipid profiles, blood pressure, obesity, and smoking), physical activity is typically not assessed. The purpose of this statement is to provide a comprehensive review of the evidence on the feasibility, validity, and effectiveness of assessing and promoting physical activity in healthcare settings for adult patients. It also adds concrete recommendations for healthcare systems, clinical and community care providers, fitness professionals, the technology industry, and other stakeholders in order to catalyze increased adoption of physical activity assessment and promotion in healthcare settings and to contribute to meeting the American Heart Association's 2020 Impact Goals.
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http://dx.doi.org/10.1161/CIR.0000000000000559DOI Listing
May 2018

Addressing Social Determinants to Improve Community Health.

Qual Manag Health Care 2018 Jan/Mar;27(1):58-60

Intermountain Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah (Knighton); and Community Health, Intermountain Healthcare, Salt Lake City, Utah (Joy and Moore).

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http://dx.doi.org/10.1097/QMH.0000000000000153DOI Listing
July 2019

Clearance and Return to Play for the Female Athlete Triad: Clinical Guidelines, Clinical Judgment, and Evolving Evidence.

Curr Sports Med Rep 2017 Nov/Dec;16(6):382-385

1Community Health and Food & Nutrition, Intermountain Healthcare, Salt Lake City, UT; and 2Division of Sports Medicine and Non-Operative Orthopaedics, Departments of Family Medicine and Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Department of Athletics, University of California, Los Angeles, CA.

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http://dx.doi.org/10.1249/JSR.0000000000000423DOI Listing
May 2018

Stepping Back to Move Forward: Evaluating the Effectiveness of a Diabetes Prevention Program Within a Large Integrated Healthcare Delivery System.

J Healthc Qual 2017 Sep/Oct;39(5):278-293

Objective: To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention Program (DPP) for patients with prediabetes (preDM) deployed within primary care clinics.

Study Design: A quasi-experimental study design was used to deploy the DPP within the IH system to identify patients with preDM and target a primary goal of a 5% weight loss within 6-12 months of enrollment.

Study Population: Adults (aged 18-75 years) who met the American Diabetes Association criteria for preDM were included for study. Patients who attended DPP counseling between August 2013 and July 2014 were considered as the intervention (or DPP) group. The DPP group was matched using propensity scores at a 1:4 ratio with a control group of patients with preDM who did not participate in DPP.

Results: Of the 17,142 patients who met the inclusion criteria for preDM, 40% had an in-person office visit with their provider. On average, patients were 58 years old, and greater than 60% were women. Based on multivariate logistic regression, the DPP group was more likely to achieve a 5% weight loss within 6-12 months after enrollment (OR = 1.70; 95% CI = 1.29-2.25; p < .001) when compared with the no-DPP group.

Conclusions: Diabetes Prevention Program-based lifestyle interventions demonstrated significant reduction in body weight and incident Type 2 diabetes mellitus when compared with nonenrollees.
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http://dx.doi.org/10.1097/JHQ.0000000000000103DOI Listing
June 2018

A Formative Evaluation of a Diabetes Prevention Program Using the RE-AIM Framework in a Learning Health Care System, Utah, 2013-2015.

Prev Chronic Dis 2017 07 20;14:E58. Epub 2017 Jul 20.

Intermountain Healthcare, Salt Lake City, Utah.

Introduction: Evaluation of interventions can help to close the gap between research and practice but seldom takes place during implementation. Using the RE-AIM framework, we conducted a formative evaluation of the first year of the Intermountain Healthcare Diabetes Prevention Program (DPP).

Methods: Adult patients who met the criteria for prediabetes (HbA1c of 5.70%-6.49% or fasting plasma glucose of 100-125 mg/dL) were attributed to a primary care provider from August 1, 2013, through July 31, 2014. Physicians invited eligible patients to participate in the program during an office visit. We evaluated 1) reach, with data on patient eligibility, participation, and representativeness; 2) effectiveness, with data on attaining a 5% weight loss; 3) adoption, with data on providers and clinics that referred patients to the program; and 4) implementation, with data on patient encounters. We did not measure maintenance.

Results: Of the 6,862 prediabetes patients who had an in-person office visit with their provider, 8.4% of eligible patients enrolled. Likelihood of participation was higher among patients who were female, aged 70 years or older, or overweight; had depression and higher weight at study enrollment; or were prescribed metformin. DPP participants were more likely than nonparticipants to achieve a 5% weight loss (odds ratio, 1.70; 95% confidence interval, 1.29-2.25; P < .001). Providers from 7 of 8 regions referred patients to the DPP; 174 providers at 53 clinics enrolled patients. The mean number of DPP counseling encounters per patient was 2.3 (range, 1-16).

Conclusion: The RE-AIM framework was useful for estimating the formative impact (ie, reach, effectiveness, adoption, and implementation fidelity) of a DPP-based lifestyle intervention deployed in a learning health care system.
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http://dx.doi.org/10.5888/pcd14.160556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524524PMC
July 2017

Promoting the athlete in every child: physical activity assessment and promotion in healthcare.

Br J Sports Med 2017 Feb 5;51(3):143-145. Epub 2016 Dec 5.

Department of Global Health, Emory University-Rollins School of Public Health, Atlanta, Georgia, USA.

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http://dx.doi.org/10.1136/bjsports-2016-096791DOI Listing
February 2017

Association of Age, Systolic Blood Pressure, and Heart Rate with Adult Morbidity and Mortality after Urgent Care Visits.

West J Emerg Med 2016 Sep 8;17(5):591-9. Epub 2016 Aug 8.

Intermountain Healthcare, Intermountain Medical Center, Department of Emergency Medicine, Salt Lake City, Utah; Intermountain Healthcare, Institute for Healthcare Leadership, Salt Lake City, Utah.

Introduction: Little data exists to help urgent care (UC) clinicians predict morbidity and mortality risk. Age, systolic blood pressure (SBP), and heart rate (HR) are easily obtainable and have been used in other settings to predict short-term risk of deterioration. We hypothesized that there is a relationship between advancing age, SBP, HR, and short-term health outcomes in the UC setting.

Methods: We collected retrospective data from 28 UC clinics and 22 hospitals in the Intermountain Healthcare system between years 2008-2013. Adult patients (≥18 years) were included if they had a unique UC visit and HR or SBP data. Three endpoints following UC visit were assessed: emergency department (ED) visit within three days, hospitalization within three days, and death within seven days. We analyzed associations between age, SBP, HR and endpoints using local regression with a binomial likelihood. Five age groups were chosen from previously published national surveys. Vital sign (VS) distributions were determined for each age group, and the central tendency was compared against previously published norms (90-120mmHg for SBP and 60-100bpm for HR.).

Results: A total of 1,720,207 encounters (714,339 unique patients) met the inclusion criteria; 51,446 encounters (2.99%) had ED visit within three days; 12,397 (0.72%) experienced hospitalization within three days; 302 (0.02%) died within seven days of UC visit. Heart rate and SBP combined with advanced age predicted the probability of ED visit (p<0.0001) and hospitalization (p<0.0001) following UC visit. Significant associations between advancing age and death (p<0.0001), and VS and death (p<0.0001) were observed. Odds ratios of risk were highest for elderly patients with lower SBP or higher HR. Observed distributions of SBP were higher than published normal ranges for all age groups.

Conclusion: Among adults seeking care in the UC, associations between HR and SBP and likelihood of ED visits and hospitalization were more pronounced with advancing age. Death following UC visit had a more limited association with advancing age or the VS evaluated. Rapidly increasing risk below SBP of 100-110 mmHg in older patients suggests that accepted normal ranges for SBP may need to be redefined for patients treated in the UC clinic.
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http://dx.doi.org/10.5811/westjem.2016.6.30353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017844PMC
September 2016

Incidental Risk of Type 2 Diabetes Mellitus among Patients with Confirmed and Unconfirmed Prediabetes.

PLoS One 2016 18;11(7):e0157729. Epub 2016 Jul 18.

Division of Public Health, School of Medicine, University of Utah, Salt Lake City, Utah, United States of America.

Objective: To determine the risk of type 2 diabetes (T2DM) diagnosis among patients with confirmed and unconfirmed prediabetes (preDM) relative to an at-risk group receiving care from primary care physicians over a 5-year period.

Study Design: Utilizing data from the Intermountain Healthcare (IH) Enterprise Data Warehouse (EDW) from 2006-2013, we performed a prospective analysis using discrete survival analysis to estimate the time to diagnosis of T2DM among groups.

Population Studied: Adult patients who had at least one outpatient visit with a primary care physician during 2006-2008 at an IH clinic and subsequent visits through 2013. Patients were included for the study if they were (a) at-risk for diabetes (BMI ≥ 25 kg/m2 and one additional risk factor: high risk ethnicity, first degree relative with diabetes, elevated triglycerides or blood pressure, low HDL, diagnosis of gestational diabetes or polycystic ovarian syndrome, or birth of a baby weighing >9 lbs); or (b) confirmed preDM (HbA1c ≥ 5.7-6.49% or fasting blood glucose 100-125 mg/dL); or (c) unconfirmed preDM (documented fasting lipid panel and glucose 100-125 mg/dL on the same day).

Principal Findings: Of the 33,838 patients who were eligible for study, 57.0% were considered at-risk, 38.4% had unconfirmed preDM, and 4.6% had confirmed preDM. Those with unconfirmed and confirmed preDM tended to be Caucasian and a greater proportion were obese compared to those at-risk for disease. Patients with unconfirmed and confirmed preDM tended to have more prevalent high blood pressure and depression as compared to the at-risk group. Based on the discrete survival analyses, patients with unconfirmed preDM and confirmed preDM were more likely to develop T2DM when compared to at-risk patients.

Conclusions: Unconfirmed and confirmed preDM are strongly associated with the development of T2DM as compared to patients with only risk factors for disease.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157729PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4948775PMC
July 2017

Pre-exercise screening: role of the primary care physician.

Isr J Health Policy Res 2016 28;5:29. Epub 2016 Jun 28.

Department of Kinesiology & Human Performance Laboratory, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, Conneticut USA.

Participation in regular physical activity is associated with a multitude of benefits including a reduction in chronic disease and premature mortality, and improved quality of life. All segments of society need to collaborate with one another in an effort to promote active lives. The Israeli "Gymnasium Law" requires pre-exercise evaluation prior to exercise participation in a health club. Recently that law was modified to allow for participant pre-screening with the Physical Activity Readiness Questionnaire for Everyone (PAR-Q+). This change reflects the evidence that the risk of catastrophic events (e.g. heart attack) during moderate intensity physical activity is low, and the likelihood of detecting heart disease in asymptomatic adults is low. This change will likely reduce the number of individuals who require physician evaluation. The American College of Sports Medicine (ACSM) recently updated their recommendations for pre-exercise evaluation. The ACSM guidelines have replaced risk factor assessment, with an algorithm that first stratifies based on current physical activity level, then by the presence of chronic disease, and/or signs and symptoms of chronic disease, and last by desired exercise intensity. The goal of these efforts is to reduce barriers to regular physical activity, by eliminating unnecessary medical evaluations. All adults should be encouraged to be physically active.
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http://dx.doi.org/10.1186/s13584-016-0089-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926293PMC
June 2016

Call to Action on Making Physical Activity Assessment and Prescription a Medical Standard of Care.

Curr Sports Med Rep 2016 May-Jun;15(3):207-14

1Department of Family Medicine, Kaiser Permanente Medical Center, Fontana, CA; 2Chief of Sports Medicine, Excelsior Orthopaedics, Amherst, NY; 3Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, MA; 4Preventive Cardiology/Cardiac Rehab, William Beaumont Hospital, Royal Oak, MI; 5Dean, Graduate College, University of Illinois at Urbana-Champaign, Urbana, IL; 6University of North Florida School of Nursing; 7Associate Professor of Orthopedics & Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; 8Medical Director, Community Health & Clinical Nutrition, Family Medicine & Sports Medicine, Intermountain Healthcare, Salt Lake City, UT; 9Professor of Sports Medicine, Department of Orthopaedics, Stanford Medical School, Director of Sports Medicine and Head Team Physician, Stanford Department of Athletics, Stanford, CA; 10Professor of Medicine and Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; 11President and CEO, American Board of Family Medicine, Lexington, KY; 12Assistant Professor, Department of Biomedical Sciences Director, Human Performance Lab, University of South Carolina School of Medicine Greenville; 13Senior Program Manager, Population Health, Improving Health Outcomes, American Medical Association.

The U.S. population is plagued by physical inactivity, lack of cardiorespiratory fitness, and sedentary lifestyles, all of which are strongly associated with the emerging epidemic of chronic disease. The time is right to incorporate physical activity assessment and promotion into health care in a manner that engages clinicians and patients. In April 2015, the American College of Sports Medicine and Kaiser Permanente convened a joint consensus meeting of subject matter experts from stakeholder organizations to discuss the development and implementation of a physical activity vital sign (PAVS) to be obtained and recorded at every medical visit for every patient. This statement represents a summary of the discussion, recommendations, and next steps developed during the consensus meeting. Foremost, it is a "call to action" for current and future clinicians and the health care community to implement a PAVS in daily practice with every patient.
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http://dx.doi.org/10.1249/JSR.0000000000000249DOI Listing
February 2017

Concurrent Validity of a Self-Reported Physical Activity "Vital Sign" Questionnaire With Adult Primary Care Patients.

Prev Chronic Dis 2016 Feb 4;13:E16. Epub 2016 Feb 4.

Department of Exercise and Sport Science, University of Utah, Salt Lake City, Utah.

Introduction: No tool currently used by primary health care providers to assess physical activity has been evaluated for its ability to determine whether or not patients achieve recommended levels of activity. The purpose of this study was to assess concurrent validity of physical activity self-reported to the brief (<30 sec) Physical Activity "Vital Sign" questionnaire (PAVS) compared with responses to the lengthier (3-5 min), validated Modifiable Activity Questionnaire (MAQ).

Methods: Agreement between activity reported to the PAVS and MAQ by primary care patients at 2 clinics in 2014 was assessed by using percentages and κ coefficients. Agreement consisted of meeting or not meeting the 2008 Aerobic Physical Activity Guidelines for Americans (PA Guidelines) of the US Department of Health and Human Services. We compared self-reported usual minutes per week of moderate-to-vigorous physical activity among patients at a primary care clinic in 2014 who reported to PAVS and to MAQ by using Pearson correlation and Bland-Altman plots of agreement.

Results: Among 269 consenting patients who reported physical activity, PAVS results agreed with those of MAQ 89.6% of the time and demonstrated good agreement in identifying patients who did not meet PA Guidelines recommendations (κ = 0.55, ρ = 0.57; P < .001). Usual minutes per week of moderate-to-vigorous physical activity reported to PAVS had a high positive correlation with the same reported to MAQ (r = 0.71; P < .001).

Conclusion: PAVS may be a valid tool for identifying primary care patients who need counseling about physical activity. PAVS should be assessed further for agreement with repeated objective measures of physical activity in the patient population.
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http://dx.doi.org/10.5888/pcd13.150228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747440PMC
February 2016
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