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  • Ovid Technologies (Wolters Kluwer Health)  (10)
  • 1
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 97, No. 10 ( 2022-10), p. 1564-1572
    Abstract: Learning health systems (LHSs), defined as a systematic process for aligning science, informatics, and clinical practice to integrate providers, researchers, and patients as active participants in an evidence-based care continuum, can provide an ideal environment for academic health centers to rapidly adopt evidence-based guidelines and translate research into practice. However, few LHS frameworks are specifically adapted for academic health centers. The authors wanted to identify the definitions, components, and other features of LHSs to develop an interdisciplinary LHS framework for use within academic health centers. Method The authors conducted a scoping review of the literature to identify definitions, components, and other features of LHSs that are useful to academic health centers. In January 2021, they searched PubMed, Academic Search Premier, and Scopus databases and identified English-language, peer-reviewed articles pertaining to LHS, LHS frameworks, organization, components, and models. Since the phrase learning health system is relatively new terminology, they conducted a supplemental review with alternative phrases, including embedded research and coordinated or collaborative research network . They used the Knowledge to Action (KTA) Framework to integrate the generation and flow of research into practice. Results The primary review retrieved 719 articles and the supplemental review retrieved 209; of these, 49 articles were retained to synthesize common definitions, components, and other features of LHS frameworks. Seven structural components of LHSs were identified: organization and collaborations, performance, ethics and security, scientific approaches, data, information technology, and patient outcomes. An adapted interdisciplinary LHS framework was developed that incorporated research and learning engines derived from the KTA and adaptations of common components and other features within the reviewed articles to fit the interests of providers, researchers, and patients within academic health centers. Conclusions The adapted LHS framework can be used as a dynamic foundation for development and organization of interdisciplinary LHSs within academic health centers.
    Type of Medium: Online Resource
    ISSN: 1040-2446
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2025367-9
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  • 2
    In: Journal of Ambulatory Care Management, Ovid Technologies (Wolters Kluwer Health), Vol. 42, No. 4 ( 2019-10), p. 312-320
    Abstract: Among nonelderly adults with diabetes, we compared hospitalizations for ambulatory care–sensitive conditions from 2013 (pre-Medicaid expansion) and 2014 (post-Medicaid expansion) for 13 expansion and 4 nonexpansion states using State Inpatient Databases. Medicaid expansion was associated with decreases in proportions of hospitalizations for chronic conditions (difference between 2014 and 2013 −0.17 percentage points in expansion and 0.37 in nonexpansion states, P = .04), specifically diabetes short-term complications (difference between 2014 and 2013 −0.05 percentage points in expansion and 0.21 in nonexpansion states, P = .04). Increased access to care through Medicaid expansion may improve disease management in nonelderly adults with diabetes.
    Type of Medium: Online Resource
    ISSN: 0148-9917
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2053457-7
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  • 3
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  CIN: Computers, Informatics, Nursing Vol. 33, No. 7 ( 2015-07), p. 315-324
    In: CIN: Computers, Informatics, Nursing, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 7 ( 2015-07), p. 315-324
    Type of Medium: Online Resource
    ISSN: 1538-2931
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2028462-7
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  • 4
    In: Family & Community Health, Ovid Technologies (Wolters Kluwer Health), Vol. 41, No. 3 ( 2018-07), p. 178-184
    Abstract: Cognitive behavioral therapy (CBT) programs have the potential to improve quality of life in individuals with chronic pain and diabetes. Rural communities often lack the infrastructure necessary to implement such programs. CBT traditionally requires trained therapists, who are rarely available in these areas. An alternative may be programs delivered by community health workers (CHWs). We present an iterative developmental approach that combined program adaptation, pretesting, and CHW training processes for a CBT-based diabetes self-care program for individuals living with diabetes and chronic pain. Collaborative intervention refinement, combined with CHW training, is a promising methodology for community-engaged research in remote, underresourced communities.
    Type of Medium: Online Resource
    ISSN: 0160-6379
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2093306-X
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  • 5
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Journal of Ambulatory Care Management Vol. 38, No. 4 ( 2015-10), p. 333-345
    In: Journal of Ambulatory Care Management, Ovid Technologies (Wolters Kluwer Health), Vol. 38, No. 4 ( 2015-10), p. 333-345
    Type of Medium: Online Resource
    ISSN: 0148-9917
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2053457-7
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  • 6
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of the American Heart Association Vol. 12, No. 12 ( 2023-06-20)
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 12 ( 2023-06-20)
    Abstract: Ambulatory follow‐up for all patients with heart failure (HF) is recommended within 7 to 14 days after hospital discharge to improve HF outcomes. We examined postdischarge ambulatory follow‐up of patients with comorbid diabetes and HF from a low‐income population in primary and specialty care. Methods and Results Adults with diabetes and first hospitalizations for HF, covered by Alabama Medicaid in 2010 to 2019, were included and the claims analyzed for ambulatory care use (any, primary care, cardiology, or endocrinology) within 60 days after discharge using restricted mean survival time regression and negative binomial regression. Among 9859 Medicaid‐covered adults with diabetes and first hospitalization for HF (mean age, 53.7 years; SD, 9.2 years; 47.3% Black; 41.8% non‐Hispanic White; 10.9% Hispanic/Other [Other included non‐White Hispanic, American Indian, Pacific Islander and Asian adults]; 65.4% women, 34.6% men), 26.7% had an ambulatory visit within 0 to 7 days, 15.2% within 8 to 14 days, 31.3% within 15 to 60 days, and 26.8% had no visit; 71% saw a primary care physician and 12% a cardiology physician. Black and Hispanic/Other adults were less likely to have any postdischarge ambulatory visit ( P 〈 0.0001) or the visit was delayed (by 1.8 days, P =0.0006 and by 2.8 days, P =0.0016, respectively) and were less likely to see a primary care physician than non‐Hispanic White adults (adjusted incidence rate ratio, 0.96 [95% CI, 0.91–1.00] and 0.91 [95% CI, 0.89–0.98] ; respectively). Conclusions More than half of Medicaid‐covered adults with diabetes and HF in Alabama did not receive guideline‐concordant postdischarge care. Black and Hispanic/Other adults were less likely to receive recommended postdischarge care for comorbid diabetes and HF.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2653953-6
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  • 7
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 7 ( 2022-04-05)
    Abstract: Depressive symptoms are risk factors for several forms of cardiovascular disease including coronary heart disease (CHD). However, it is unclear whether depressive symptoms are associated with incident heart failure (HF), including hospitalization for HF overall or by subtype: HF with preserved (HFpEF) or reduced ejection fraction (HFrEF). Methods and Results Among 26 268 HF‐free participants in the REGARDS (Reasons for Geographic And Racial Differences in Stroke) study, a prospective biracial cohort of US community‐dwelling adults ≥45 years, baseline depressive symptoms were defined as a score ≥4 on the 4‐item Center for Epidemiologic Studies Depression scale. Incident HF hospitalizations were expert‐adjudicated and categorized as HFpEF (EF ≥50%) and HFrEF, including mid‐range EF (EF 〈 50%). Over a median of 9.2 [IQR 6.2–10.9] years of follow‐up, there were 872 incident HF hospitalizations, 526 among those without CHD and 334 among those with CHD. The age‐adjusted HF hospitalization incidence rates per 1000 person‐years were 4.9 (95% CI 4.0–5.9) for participants with depressive symptoms versus 3.2 (95% CI 3.0–3.5) for those without depressive symptoms ( P 〈 0.001). For overall HF, the elevated risk became attenuated after controlling for covariates. When HFpEF was assessed separately, depressive symptoms were associated with incident hospitalization after controlling for all covariates (hazard ratio [HR] 1.48, 95% CI 1.00–2.18) among those without baseline CHD. In contrast, depressive symptoms were not associated with incident HFrEF hospitalizations. Conclusions Among individuals free of CHD at baseline, depressive symptoms were associated with incident hospitalization for HFpEF, but not for HFrEF, or among those with baseline CHD.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2653953-6
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  • 8
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 78, No. 6 ( 2021-12), p. 1730-1741
    Abstract: Racial and ethnic differences in blood pressure (BP), regardless of antihypertensive medication use, contribute to cardiovascular disease disparities. We analyzed systolic BP (SBP) data from US adults in the National Health and Nutrition Examination Survey from 1999 to 2002 through 2015 to 2018 (n=51 743) to determine if racial and ethnicity disparities have changed over time. Among US adults not taking antihypertensive medication, the mean age-adjusted SBP (95% CI), mm Hg, in 1999 to 2002 and 2015 to 2018 was 119.6 (118.7–120.5) and 119.4 (118.7–120.1) for non-Hispanic White adults, 124.7 (123.7–125.7) and 124.9 (123.8–125.9) for non-Hispanic Black adults and 120.4 (118.6–122.2) and 120.4 (119.7–121.2) for Hispanic adults. The mean multivariable-adjusted SBP was 4.1 mm Hg (2.7–5.4) higher in 1999 to 2002 and 3.8 mm Hg (2.6–5.0) higher in 2015 to 2018 among non-Hispanic Black adults compared with non-Hispanic White adults, while there was no evidence of a difference between Hispanic adults and non-Hispanic White adults in 1999 to 2002 (−0.2 mm Hg [95% CI, −1.9 to 1.5]) or 2015 to 2018 (−0.8 mm Hg [95% CI, −1.8 to 0.1] ). Among US adults taking antihypertensive medication, the mean age-adjusted SBP (95% CI), mm Hg, in 1999 to 2002 and 2015 to 2018 was 129.6 (126.7–132.4) and 127.1 (125.6–128.6) for non-Hispanic White adults, 136.9 (133.8–140.0) and 135.3 (132.5–138.1) for non-Hispanic Black adults and 133.9 (128.0–139.7) and 131.8 (127.6–136.0) for Hispanic adults. After multivariable adjustment, in 1999 to 2002 and 2015 to 2018, mean SBP was 4.8 mm Hg (1.8–7.8) and 6.5 mm Hg (4.5–8.4) higher, respectively, among non-Hispanic Black adults versus White adults, and 2.4 mm Hg (−2.6 to 7.3) and 3.6 mm Hg (0.8 to 6.4) higher, respectively, among Hispanic adults versus non-Hispanic White adults. In the United States, non-Hispanic Black adults continue to have higher SBP levels compared with non-Hispanic White adults.
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2094210-2
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  • 9
    In: AIDS, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 13 ( 2022-11-1), p. 1811-1818
    Abstract: To examine type 2 diabetes mellitus incidence and associated risk factors among people with HIV (PWH). Design: A retrospective clinical cohort study of PWH at a Southeastern US academic HIV clinic between 2008 and 2018. Methods: PWH who attended at least two clinic visits were evaluated with demographic and clinical data extracted from the electronic medical record (EMR). Diabetes was defined as: hemoglobin A1C ≥6.5% and/or 2 glucose results 〉 200 mg/dl (at least 30 days apart), diagnosis of diabetes in the EMR, or exposure to diabetes medication. Time to diabetes incidence was computed from the entire clinic population for each year. Multivariable Cox proportional hazard regression models with time-dependent covariates were created to evaluate the independent association between covariates and time to incident diabetes. Results: Among 4113 PWH, we identified 252 incident cases of diabetes. Incidence increased from 1.04 incidents per 1000 person years (PY) in 2008, to 1.55 incidents per 1000 PY in 2018. Body mass index (hazard ratio [HR] 10.5 (6.2, 17.7)), liver disease (HR 1.9 (1.2, 3.1)), steroid exposure (HR 1.5 (1.1, 1.9)), and use of integrase inhibitors (HR 1.5 (1.1, 2.0)) were associated with incident diabetes. Additional associated factors included lower CD4 + cell counts, duration of HIV infection, exposure to nonstatin lipid-lowering therapy, and dyslipidemia. Conclusions: Rapidly increasing incident diabetes rates among PWH were associated with both traditional and HIV-related associated risk factors, particularly body weight, steroid exposure, and use of Integrase Inhibitors. Notably, several of the risk factors identified are modifiable and can be targeted for intervention.
    Type of Medium: Online Resource
    ISSN: 0269-9370 , 1473-5571
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2012212-3
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  • 10
    In: Family & Community Health, Ovid Technologies (Wolters Kluwer Health), Vol. 26, No. 1 ( 2003-01), p. 74-83
    Type of Medium: Online Resource
    ISSN: 0160-6379
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
    detail.hit.zdb_id: 2093306-X
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