The Experts below are selected from a list of 4092 Experts worldwide ranked by ideXlab platform
Karen E. Lasser - One of the best experts on this subject based on the ideXlab platform.
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effect of patient navigation and financial incentives on smoking cessation among primary care patients at an urban Safety Net Hospital a randomized clinical trial
JAMA Internal Medicine, 2017Co-Authors: Karen E. Lasser, Ve Truong, Lisa M Quintiliani, Ziming Xuan, Jennifer Murillo, Cheryl Jean, Lori PbertAbstract:Importance While the proportion of adults who smoke cigarettes has declined substantially in the past decade, socioeconomic disparities in cigarette smoking remain. Few interventions have targeted low socioeconomic status (SES) and minority smokers in primary care settings. Objective To evaluate a multicomponent intervention to promote smoking cessation among low-SES and minority smokers. Design, Setting, and Participants For this prospective, unblinded, randomized clinical trial conducted between May 1, 2015, and September 4, 2017, adults 18 years and older who spoke English, smoked 10 or more cigarettes per day in the past week, were contemplating or preparing to quit smoking, and had a primary care clinician were recruited from general internal medicine and family medicine practices at 1 large Safety-Net Hospital in Boston, Massachusetts. Interventions Patients were randomized to a control group that received an enhancement of usual care (n = 175 participants) or to an intervention group that received up to 4 hours of patient navigation delivered over 6 months in addition to usual care, as well as financial incentives for biochemically confirmed smoking cessation at 6 and 12 months following enrollment (n = 177 participants). Main Outcomes and Measures The primary outcome determined a priori was biochemically confirmed smoking cessation at 12 months. Results Among 352 patients who were randomized (mean [SD] age, 50.0 [11.0] years; 191 women [54.3%]; 197 participants who identified as non–Hispanic black [56.0%]; 40 participants who identified as Hispanic of any race [11.4%]), all were included in the intention-to-treat analysis. At 12 months following enrollment, 21 participants [11.9%] in the navigation and incentives group, compared with 4 participants [2.3%] in the control group, had quit smoking (odds ratio, 5.8; 95% CI, 1.9-17.1; number needed to treat, 10.4; P P P P = .003), and nonwhite participants (21 [15.2%] vs 4 [3.0%]; P Conclusions and Relevance In this study of adult daily smokers at 1 large urban Safety-Net Hospital, patient navigation and financial incentives for smoking cessation significantly increased the rates of smoking cessation. Trial Registration clinicaltrials.gov Identifier:NCT02351609
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A Hepatitis C Treatment Program Based in a Safety-Net Hospital Patient-Centered Medical Home.
Annals of family medicine, 2017Co-Authors: Karen E. Lasser, Alexandra Heinz, Leandra Battisti, Alexandria Akoumianakis, Ve Truong, Judith I. Tsui, Glorimar Ruiz, Jeffrey H. SametAbstract:Hepatitis C virus (HCV) infection is a major public health problem. Urban Safety-Net Hospitals are a prime location for HCV treatment delivery. Showing that physicians in primary care settings can deliver HCV infection care is important to expand treatment; models doing so in the era of newer oral HCV medications are needed. This article describes an innovative and successful HCV primary care treatment program in a patient-centered medical home based at an urban, Safety-Net Hospital. The program is public health oriented in that a central team member is a public health social worker who performs population management and addresses underlying social determinants of health to facilitate engagement in HCV treatment. Other team members include general internists trained to treat HCV infections, a pharmacist, and a pharmacy technician. The program is funded with revenue generated by the 340b drug discount program, which allows providers to generate revenue when patients fill prescriptions at pharmacies in Safety-Net settings, as insurance reimbursements for medications exceed the cost at which Safety-Net providers purchase medications. During the course of 1 year, the program received 302 referrals. Of these approximately 23% have received treatment.
Lillian S. Kao - One of the best experts on this subject based on the ideXlab platform.
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underserved patients seeking care for ventral hernias at a Safety Net Hospital impact on quality of life and expectations of treatment
Journal of The American College of Surgeons, 2017Co-Authors: Zeinab M. Alawadi, Mike K. Liang, Julie L. Holihan, Isabel M Leal, Juan R Flores, Blake E Henchcliffe, Thomas O Mitchell, Lillian S. KaoAbstract:Background The purpose of this study was to identify issues important to patients in their decision-making, expectations, and satisfaction when seeking treatment for a ventral hernia. Study Design An exploratory qualitative study was conducted of adult patients with ventral hernias seeking care at a Safety-Net Hospital. Two semi-structured interviews were conducted with each patient: before and 6 months after surgical consultation. Interviews were audiotaped, transcribed, and coded using latent content analysis until data saturation was achieved. Results Of patients completing an initial interview (n = 30), 27 (90%) completed follow-up interviews. Half of the patients were Spanish-speaking, one-third had a previous ventral hernia repair, and two-thirds underwent initial nonoperative management after surgical consultation. Patient-described factors guiding management decisions included impact on quality of life, primarily pain and limited function; overwhelming challenges to meeting surgical criteria, primarily obesity; and assuming responsibility to avoid recurrence. Patients were uninformed regarding potential poor outcomes and contributing factors, even among patients with a previous ventral hernia repair, with most attributing recurrence to inadequate self-management. Conclusions Understanding patients' perspective is crucial to engaging them as stakeholders in their care, addressing their concerns, and improving clinical and patient-centered outcomes. Patient reports suggest how care can be improved through developing more effective strategies for addressing patients' concerns during nonoperative management, preoperative risk reduction strategies that are sensitive to their sociodemographic characteristics, treatment plans that harness patients' willingness for self-management, and patient education and decision-making tools.
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facilitators and barriers of implementing enhanced recovery in colorectal surgery at a Safety Net Hospital a provider and patient perspective
Surgery, 2016Co-Authors: Zeinab M. Alawadi, Stefanos G. Millas, Burzeen E. Karanjawala, Julie L. Holihan, Uma R. Phatak, Isabel Leal, Juan R Floresgonzalez, Lillian S. KaoAbstract:Background Enhanced Recovery After Surgery (ERAS) pathways are known to decrease complications and duration of stay in colorectal surgery patients. However, it is unclear whether an ERAS pathway would be feasible and effective at a Safety-Net Hospital. The aim of this study was to identify local barriers and facilitators before the adoption of an ERAS pathway for patients undergoing colorectal operations at a Safety-Net Hospital. Methods Semistructured interviews were conducted to assess the perceived barriers and facilitators before ERAS adoption. Stratified purposive sampling was used. Interviews were audiotaped, transcribed verbatim, and analyzed using content analysis. Analytic and investigator triangulation were used to establish credibility. Results Interviewees included 8 anesthesiologists, 5 surgeons, 6 nurses, and 18 patients. Facilitators identified across the different medical professions were (1) feasibility and alignment with current practice, (2) standardization of care, (3) smallness of community, (4) good teamwork and communication, and (5) caring for patients. The barriers were (1) difficulty in adapting to change, (2) lack of coordination between different departments, (3) special needs of a highly comorbid and socioeconomically disadvantaged patient population, (4) limited resources, and (5) rotating residents. Facilitators identified by the patients were (1) welcoming a speedy recovery, (2) being well-cared for and satisfied with treatment, (3) adequate social support, (4) welcoming early mobilization, and (5) effective pain management. The barriers were (1) lack of quiet and private space, (2) need for more patient education and counseling, and (3) unforeseen complications. Conclusion Although limited Hospital resources are perceived as a barrier to ERAS implementation at a Safety-Net Hospital, there is strong support for such pathways and multiple factors were identified that may facilitate change. Inclusion of patient perspectives is critical to identifying challenges and facilitators to implementing ERAS changes focused on optimizing patient perioperative health and outcomes.
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Treatment delays of colon cancer in a Safety-Net Hospital system
The Journal of surgical research, 2015Co-Authors: Stefanos G. Millas, Zeinab M. Alawadi, Curtis J. Wray, Eric J. Silberfein, Richard J. Escamilla, Burzeen E. Karanjawala, Lillian S. KaoAbstract:Abstract Background Disparities in colon cancer survival have been reported to result from advanced stage at diagnosis and delayed therapy. We hypothesized that delays in treatment among medically underserved patients occur as a result of system-level barriers in a Safety-Net Hospital system. Materials and methods Retrospective review and analysis of colon cancer patients treated in a large Safety-Net Hospital system between May 2008 and May 2012. Data were collected on demographics, stage at diagnosis, time to surgery, time to adjuvant chemotherapy, and vital status. Regression analyses were performed to determine predictors of delays and failure to receive therapy. Results Of 248 patients treated for colon cancer, 56% (n = 140) had advanced disease at the time of presentation; furthermore, 29.1% of all colectomies for colon cancer were performed on an urgent or emergent basis. Thirty-six patients with stage III and IV disease did not receive chemotherapy (26%). Race, age, gender, and hospice care did not predict receipt of chemotherapy or delays to treatment. Patients with stage I colon cancer had a significantly longer interval between diagnosis and elective surgery when compared with patients with stage II, III, and IV colon cancer, with only 10% (n = 3) undergoing resection sooner than 6 wk after diagnosis. Conclusions One in three patients diagnosed with colon cancer in a large Safety-Net Hospital system require urgent or emergent surgery, and one in two present with advanced disease. Reducing disparities should focus on earlier diagnosis of colon cancer and improving access to surgical specialists.
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Abstract C41: Palliative care consults in terminal cancer patients dying in a Safety-Net Hospital: Are they underutilized?
Cancer Treatment and Outcomes, 2014Co-Authors: Rebecca L. Wiatrek, Lillian S. Kao, Zeinab I. Alawadi, Debbie F. Lew, Melanie E. Zuo, Jeanette G. Ferrer, Curtis J. WrayAbstract:Introduction: Terminal patients with limited resources are more likely to die in the Hospital which may be due in part to lack of access to palliative care. We hypothesized that the majority of terminal cancer patients who were treated and who died in a Safety-Net Hospital did not receive a palliative care consult. Methods: A retrospective review of terminal cancer patients who were admitted and died at Lyndon Baines Johnson General Hospital, a Safety-Net Hospital, from January through December 2012 was completed. Terminal cancer was defined as Stage IV or recurrent cancer with only palliative treatment options. Data was gathered on age, race/ethnicity, sex, length of stay (LOS) of final admission, underlying terminal cancer, insurance status, and receipt of a palliative consult. Univariate analysis was performed using chi-square and Kruskal-Wallis test. Results: Seventy-four patients with terminal cancer died in the Hospital. The majority of patients were minorities: African Americans (n=28, 38%), Hispanics (n=27, 36%), Caucasians (n=14, 19%), and Asian/other ethnicities (n=5, 7%). Two-thirds of patients (n=49, 66%) received palliative consults. There was no difference in race/ethnicity, gender, or age between patients who did and did not receive palliative consults. Patients who received a palliative consult were more likely to be uninsured (90% vs. 56%, p=0.003). There was no difference in median LOS (interquartile range, days) of the final admission between patients who did and did not receive a palliative consult (7, 3-16 versus 6, 2-15 days; p=0.47). Conclusions: In a Safety-Net Hospital, in-Hospital deaths still occur among terminal cancer patients even when palliative care consults are received. Further studies are necessary to determine how palliative care can best address the needs of vulnerable patients in order to reduce in-Hospital deaths and improve patient-centered outcomes. Citation Format: Rebecca L. Wiatrek, Zeinab I. Alawadi, Debbie F. Lew, Melanie E. Zuo, JeaNette G. Ferrer, Tien C. Ko, Lillian S. Kao, Curtis J. Wray. Palliative care consults in terminal cancer patients dying in a Safety-Net Hospital: Are they underutilized?. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C41. doi:10.1158/1538-7755.DISP13-C41
Teviah E Sachs - One of the best experts on this subject based on the ideXlab platform.
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impact of race insurance status and primary language on presentation treatment and outcomes of patients with pancreatic adenocarcinoma at a Safety Net Hospital
Journal of The American College of Surgeons, 2019Co-Authors: Praveen Sridhar, Michael R Cassidy, Susanna W Degeus, Jennifer F Tseng, Priya Misir, Hyunjee Kwak, Frederick Thurston Drake, David A Mcaneny, Teviah E SachsAbstract:Background Social determinants of health impact the delivery of care and outcomes in patients with pancreatic cancer. We explored the relationship between social determinants of health and presentation, treatment, and outcomes of patients with pancreatic adenocarcinoma at an urban Safety-Net medical center. Design A single-institution retrospective chart review of patients with pancreatic adenocarcinoma was conducted. Demographic, tumor, and treatment characteristics were obtained. Median overall survival, stage-specific survival, receipt of curative operation, and receipt of perioperative therapy were analyzed. Chi-square tests were used for categorical variables. Survival was determined by the Kaplan-Meier method. Results We identified 240 patients with pancreatic adenocarcinoma treated between January 2006 and December 2017. Median age was 66 years, 51% were female, 48% were non-white, 22% were non-English-speaking, 16% were Hispanic, and 40% were Medicaid/uninsured. There were 74 (31%) patients with early-stage (I/II) disease. There were no statistically significant differences between race, primary language, or ethnicity and receipt of surgical therapy or receipt of perioperative therapy. Relatively more patients with private insurance (100%) received perioperative therapy compared with Medicaid/uninsured (64%) and Medicare-insured (50%) patients (p = 0.018). Nearly 30% of patients with operable disease either declined having an intervention or were found to be too frail to undergo surgical intervention. Conclusions There were no statistically significant relationships between examined social determinants of health and use of operation or perioperative therapy. Patients treated at an urban Safety-Net Hospital with a focus on vulnerable patient populations are able to provide outcomes similar to national averages. Additional exploration of factors affecting outcomes for pancreatic cancer in these patients will be important, as many centers absorb higher immigrant and indigent populations.
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presentation and survival of gastric cancer patients at an urban academic Safety Net Hospital
Journal of Gastrointestinal Surgery, 2019Co-Authors: Ryan Morgan, David Mcaneny, Michael R Cassidy, Susanna W Degeus, Jennifer F Tseng, Teviah E SachsAbstract:Gastric cancer is decreasing nationally but remains pervasive globally. We evaluated our experience with gastric cancer at a Safety-Net Hospital with a substantial immigrant population. Demographics, pathology, and treatment were analyzed for gastric adenocarcinoma at our institution (2004–2017). Chi-square analyses were performed for dependence of staging on demographics. Survival was evaluated with Kaplan-Meier and Cox regression analyses. We identified 249 patients (median age 65 years). Patients were predominantly born outside the USA or Canada (74.3%), non-white (70.7%), and federally insured (71.4%), and presented with late-stage disease (52.2%). Hispanic ethnicity, Central American birthplace, Medicaid insurance, and zip code poverty > 20% were associated with late-stage presentation (all p < 0.05). Univariate analyses showed decreased survival for patients with late-stage disease, highest zip code poverty, and age ≥ 65 (all p < 0.05). On multivariate analysis, survival was negatively associated with late-stage presentation (HR 4.45, p < 0.001), age ≥ 65 (1.80, p = 0.018), and H. pylori infection (2.02, p = 0.036). Hispanic ethnicity, Central American birthplace, Medicaid insurance, and increased neighborhood poverty were associated with late-stage presentation of gastric cancer with poor outcomes. Further study of these populations may lead to screening protocols in order to increase earlier detection and improve survival.
Neda Ratanawongsa - One of the best experts on this subject based on the ideXlab platform.
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disparities in patient reported interest in web based patient portals survey at an urban academic Safety Net Hospital
Journal of Medical Internet Research, 2019Co-Authors: Shobha Sadasivaiah, Courtney R Lyles, Stephen Kiyoi, Piera Wong, Neda RatanawongsaAbstract:Author(s): Sadasivaiah, Shobha; Lyles, Courtney R; Kiyoi, Stephen; Wong, Piera; Ratanawongsa, Neda | Abstract: BACKGROUND:Offering Hospitalized patients' enrollment into a health system's patient portal may improve patient experience and engagement throughout the care continuum, especially across care transitions, but this process is less studied than portal engagement in the ambulatory setting. Patient portal disparities exist and may lead to differences in access or outcomes. As such, it is important to study upstream factors in a typical Hospital workflow that could lead to those disparities in Safety-Net settings. OBJECTIVE:The objective of this study was to evaluate sociodemographic characteristics associated with interest in a health care system's portal among Hospitalized patients and reasons for no interest. METHODS:Nurses assessed interest in a Web-based patient portal, expressed by the patient as "yes" or "no," as part of the admission nursing assessment among patients at an academic urban Safety-Net Hospital and recorded responses in the electronic health record (EHR), including reasons for no interest. We extracted patient responses from the EHR. RESULTS:Among 23,994 Hospitalizations over a 2-year period, 35.90% (8614/ 23,994) reported an interest in a Web-based portal. Reasons for no interest included the following: not interested/other reason 41.68% (6410/15,380), no ability to use/access computers/interNet 29.59% (4551/15,380), doesn't speak English 11.15% (1715/15,380), physically or mentally unable 8.70% (1338/15,380), does not want to say 8.70% (1338/15,380), security concerns 0.03% (4/15,380), and not useful 0.16% (24/15,380). Among the 16,507 unique patients included in this sample, portal interest was lower in older, African American, non-English speaking, and homeless patient populations. CONCLUSIONS:In a Safety-Net system, patient interest at the time of Hospitalization in a Web-based enterprise portal-a required step before enrollment-is low with significant disparities by sociodemographic characteristics. To avoid worsening the digital divide, new strategies are needed and should be embedded within routine workflows to engage vulnerable Safety-Net patients in the use of Web-based health technologies.
Chris Andry - One of the best experts on this subject based on the ideXlab platform.
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rapid implementation of a sars cov 2 diagnostic qrt pcr test with emergency use authorization at a large academic Safety Net Hospital
Social Science Research Network, 2020Co-Authors: Kim Vanuytsel, Aditya Mithal, Richard M Giadone, Anthony K Yeung, Taylor M Matte, Todd W Dowrey, Rhiannon B Werder, Gregory J Miller, Nancy S Miller, Chris AndryAbstract:The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now a major global public health crisis. In the United States, significant delays in the rapid development and distribution of diagnostic testing for SARS-CoV-2 infection have prevented adequate COVID-19 patient care and public health management of the pandemic, impacting the timely mapping of the dynamics of viral spread in the general population, and more topically, the conservation of personal protective equipment. Furthermore, vulnerable populations such as those served by Boston Medical Center (BMC), the largest Safety Net Hospital in New England, represent a high-risk group across multiple dimensions, including a higher prevalence of pre-existing conditions and substance use disorders, lower general health maintenance, unstable housing, and a propensity for rapid community spread, highlighting the urgent need for rapid and reliable in-house testing infrastructure. Here, we report the rapid implementation of a SARS-CoV-2 diagnostic RT-PCR assay with Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA). Our test offers a more rapid turnaround time in comparison to currently available commercial or state laboratory facilities, and enables clinicians and patients to make more informed decisions with personal and public health ramifications. The template and protocol that we have generated and validated could be useful for other smaller community Hospitals lacking capital intensive automated clinical laboratory machinery to run molecular biology assays.
