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1.
J Prim Care Community Health ; 11: 2150132720932408, 2020.
Article in English | MEDLINE | ID: mdl-32508202

ABSTRACT

The ability to analyze data to identify best practices is key to improving quality of care for community-based health care organizations (CBOs). Leading commercial statistical software remains too costly for many CBOs operating in underserved communities. The St Louis Integrated Health Network (IHN) collaborates with CBOs to increase access to health care. IHN and a local university developed the Community Analytics Academy (CAA), a training collaborative designed to meet the need for data-informed decision making among CBOs. Establishing analytics training collaboratives for CBOs empowers organizations to respond to the ever-growing amounts of health care data and the need for data-driven decision making.


Subject(s)
Community Health Services , Humans
2.
Ophthalmol Retina ; 3(4): 362-370, 2019 04.
Article in English | MEDLINE | ID: mdl-31014689

ABSTRACT

PURPOSE: To describe the treatment patterns and the predictors of different treatment standards in recently diagnosed diabetic macular edema (DME) patients in a nationally representative sample. DESIGN: A retrospective cohort study using administrative claims data from January 1, 2007, through March 31, 2015. Patients were grouped into yearly cohorts. PARTICIPANTS: A total of 96 316 patients were included. METHODS: Patients with a diagnosis of DME were identified using International Classification of Diseases, Ninth Edition, Clinical Modification, codes. Predictors of anti-vascular endothelial growth factor (VEGF) use and number of anti-VEGF injections per patient were assessed using generalized linear regression (logistic and negative binomial, respectively), and yearly trends in different treatments were analyzed with Mann-Kendall tests. MAIN OUTCOME MEASURES: Predictors of anti-VEGF treatment and of anti-VEGF injections per patient and the changes in relative use of DME therapies per cohort. RESULTS: Among those with any treatment, the odds of being prescribed anti-VEGF therapy increased by 700% from 2009 to 2014 and by 154% for those seen by a retina specialist. Those in the cohort of year 2014 received 3.5 times more injections than those in 2009, whereas those covered by Managed Medicare, Medicaid, and Medicare received 31%, 24%, and 11% less injections. Anti-VEGF were 11.6% of all DME treatments in 2009 increasing to 61.9% in 2014, while corticosteroids and focal laser procedures dropped from 6.1% to 3% and 75% to 24%, respectively. Procedures per patient (PPP) were much lower than those observed in clinical trials of anti-VEGF. Procedures per patient increased in the cases of aflibercept (from 1 in 2011 to 2.20 in 2014), bevacizumab (from 1.84 in 2009 to 3.40 in 2014), and ranibizumab (from 3.11 in 2009 to 4.48 in 2014), whereas applications of laser procedures and corticosteroids per patient remained roughly stable. CONCLUSIONS: Year of diagnosis and being seen by a retina specialist were important predictors of receiving anti-VEGF therapy, and after one received such therapy, the number of additional injections was smaller for those with government-provided insurance. Anti-VEGF therapy has become a mainstay in DME treatment, with PPP, although relatively low, also increasing.


Subject(s)
Angiogenesis Inhibitors/administration & dosage , Diabetic Retinopathy/drug therapy , Glucocorticoids/administration & dosage , Macular Edema/drug therapy , Visual Acuity , Diabetic Retinopathy/complications , Diabetic Retinopathy/diagnosis , Female , Follow-Up Studies , Humans , Intravitreal Injections , Macula Lutea/pathology , Macular Edema/diagnosis , Macular Edema/etiology , Male , Middle Aged , Retrospective Studies , Time Factors , Tomography, Optical Coherence , Treatment Outcome , Vascular Endothelial Growth Factor A/antagonists & inhibitors
3.
Breast J ; 25(1): 112-116, 2019 01.
Article in English | MEDLINE | ID: mdl-30536478

ABSTRACT

The purpose of this study was to determine whether racial disparities in reconstruction in the United States vary by geographic region. The SEER database years 2000-2013 was queried for all mastectomies in women ages 20-85+. Logistic regression was used to examine the main effects and interaction of race and geographic region on reconstruction. Hot spot Analysis was used to examine clustering of reconstruction across counties by race. We found large regional variation in racial differences in the rate of immediate postmastectomy reconstruction. Understanding how racial disparities vary by region can identify important factors for intervention to reduce disparities in practice.


Subject(s)
Breast Neoplasms/surgery , Healthcare Disparities/statistics & numerical data , Mammaplasty/statistics & numerical data , Adult , Black or African American/statistics & numerical data , Aged , Aged, 80 and over , Female , Humans , Logistic Models , Mastectomy , Middle Aged , SEER Program , United States , White People
4.
PLoS One ; 13(5): e0196446, 2018.
Article in English | MEDLINE | ID: mdl-29746599

ABSTRACT

PURPOSE: To examine predictors of information seeking behavior among individuals diagnosed with cancer versus those without. METHODS: Cross-sectional data from the Health Information National Trends Survey 4 Cycles 1-3 (October 2011 to November 2013) were analyzed for 10,774 survey respondents aged ≥18 years. Binary logistic regression was used to examine the effect of socio-demographic and behavioral factors on health information seeking. RESULTS: Cancer diagnosis did not predict health information seeking. However, respondents diagnosed with cancer were more likely to seek health information from a healthcare practitioner. Compared to males, females were more likely to seek health information irrespective of cancer diagnosis. Regardless of cancer diagnosis, those without a regular healthcare provider were less likely to seek health information. Likelihood of seeking health information declined across education strata, and significantly worsened among respondents without high school diplomas irrespective of cancer diagnosis. CONCLUSIONS: Respondents sought health information irrespective of cancer diagnosis. However, the source of health information sought differed by cancer diagnosis. Gender, education, and having a regular healthcare provider were predictors of health information seeking. Future health communication interventions targeting cancer patients and the general public should consider these findings for tailored interventions to achieve optimal results.


Subject(s)
Information Seeking Behavior/ethics , Patient Acceptance of Health Care/psychology , Adult , Aged , Cross-Sectional Studies , Delivery of Health Care/statistics & numerical data , Delivery of Health Care/trends , Female , Forecasting , Humans , Logistic Models , Male , Middle Aged , Neoplasms/psychology , Socioeconomic Factors , Surveys and Questionnaires
5.
J Epidemiol Community Health ; 71(8): 786-793, 2017 08.
Article in English | MEDLINE | ID: mdl-28659387

ABSTRACT

BACKGROUND: Blacks have higher risk for stroke than whites. However, combining foreign-born and US-born blacks could mask important health differences. We examined the relationship between nativity and stroke risk in US adults. METHODS: Data were obtained from the National Health Interview Survey, 2006-2014. Study population (n=189, 409) included non-Hispanic whites and non-Hispanic blacks born in the Caribbean, and non-Hispanic blacks born in Africa. Logistic regression models were used to assess the association between stroke and race/nativity, adjusting for covariates such as insurance status, hypertension, age and duration of US residence. RESULTS: Foreign-born blacks had similar odds of stroke (95% CI 0.58 to 1.60 for non-Hispanic blacks from the Caribbean, and 95% CI 0.17 to 1.10 for blacks from Africa), while US-born blacks had increased odds of stroke (95% CI 1.22 to 1.46) compared with non-Hispanic whites. When compared with US-born blacks, both non-Hispanic blacks from the Caribbean and Africa showed reduced odds of stroke: 95% CI 0.50 to 0.94 and 95% CI 0.21 to 0.75, respectively. After adding a race/nativity × age interaction term to the model however, compared with non-Hispanic whites, blacks from Africa aged <65 years had lower odds of stroke (95% CI 0.13 to 0.72) while blacks from the Caribbean had similar odds of stroke at all ages. CONCLUSIONS: Homogenising 'Blacks' may mask important differences based on nativity. Public health prevention efforts should consider the heightened risk of stroke among younger US-born blacks and focus on primary prevention for immigrant blacks. Also, national surveys should incorporate more ethnicity-related variables.


Subject(s)
Emigrants and Immigrants , Stroke/etiology , White People , Africa/ethnology , Aged , Caribbean Region/ethnology , Health Surveys , Humans , Logistic Models , Male , Middle Aged
6.
J Community Health ; 42(6): 1156-1162, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28455672

ABSTRACT

The purpose of this study is to investigate the prevalence of receipt of written documentation of follow up care and of cancer treatments and to examine the predictors of receipt of such written documentation. Data from the 2010 National Health Interview Survey was used to identify individuals 18 years or older with a history of cancer. Binary and multinomial logistic regression were used to investigate patient-level variables associated with receipt of written documentation of cancer treatment, written advice about follow-up care, or both written documents. Patient-level variables included in the analysis were age, gender, region of residence, race/ethnicity, marital status, education level, insurance coverage, cancer type, employment status, and psychosocial support. Of the 1185 responses to the questions used to access receipt of a SCP, the prevalence of any receipt of a written documentation was 68%, where 30% obtained written advice only and 8% were provided a written treatment summary only; only 31% received both. Non-white race, cancer type, and psychosocial services were associated with increased odds of receiving written documentation. Patient-level characteristics are associated with receipt of care plan documentation. Further work needs to investigate the interaction of provider and patient-level characteristics. Understanding patient-level characteristics associated with receipt of written documentation may help uncover strategies for improved survivorship care plan implementation.


Subject(s)
Cancer Survivors/statistics & numerical data , Patient Care Planning/statistics & numerical data , Racial Groups/statistics & numerical data , Aftercare/statistics & numerical data , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , Middle Aged
7.
Breast ; 32: 13-17, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28012410

ABSTRACT

BACKGROUND: Marital status is strongly associated with improved health and longevity. Being married has been shown to be positively associated with survival in patients with multiple different types of malignancy; however, little is known about the relationship between marital status and breast cancer in younger women. The purpose of this study is to investigate the effect of marital status on diagnosis, and survival of women under the age of 65 with breast cancer. METHODS: The SEER 18 regions database was used to identify women between the ages of 25-64 diagnosed with invasive breast cancer in the years 2004-2009. Logistic regression was used to predict later stage diagnosis by marital status and Cox proportional hazards models were used to compare breast cancer-related and all-cause survival by marital status classification. Models were stratified by AJCC stage. RESULTS: After adjusting for age, race, and ER status, unmarried women were 1.18 times more likely to be diagnosed at a later stage than married women (95% CI 1.15, 1.20). In adjusted analysis unmarried women were more likely to die of breast cancer and more likely to die of all causes than married women across all AJCC stages. CONCLUSIONS: Younger unmarried women with breast cancer may benefit from additional counseling, psychosocial support and case management at the time of diagnosis to ensure their overall outcomes are optimized.


Subject(s)
Breast Neoplasms/mortality , Marital Status , Adult , Breast Neoplasms/pathology , Breast Neoplasms/psychology , Female , Humans , Logistic Models , Middle Aged , Neoplasm Staging , Proportional Hazards Models , SEER Program , Social Support , Survival Rate , Young Adult
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