\n

\n \n 2020\n \n \n (1)\n \n \n

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\n \n\n \n \n \n \n \n Evaluating Success Factors of a Medication Adherence Tracker Pilot Program in Improving Part D Medication Adherence Metrics in a Medicare Advantage Plan: Importance of Provider Engagement.\n \n \n \n\n\n \n Hong, M.; Esse, T.; Vadhariya, A.; Gallardo, E.; Fosshat, M. A.; Mamvou, J.; Bruce, L.; Serna, O.; and Abughosh, S.\n\n\n \n\n\n\n Journal of managed care & specialty pharmacy, 26: 662–667. May 2020.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@Article{Hong2020,\r\n  author          = {Hong, Minh and Esse, Tara and Vadhariya, Aisha and Gallardo, Esteban and Fosshat, Maream Ashley and Mamvou, Jocelyne and Bruce, Liana and Serna, Omar and Abughosh, Susan},\r\n  title           = {Evaluating Success Factors of a Medication Adherence Tracker Pilot Program in Improving Part D Medication Adherence Metrics in a Medicare Advantage Plan: Importance of Provider Engagement.},\r\n  doi             = {10.18553/jmcp.2020.26.5.662},\r\n  issn            = {2376-1032},\r\n  issue           = {5},\r\n  pages           = {662--667},\r\n  pubstate        = {ppublish},\r\n  volume          = {26},\r\n  abstract        = {Health plans and providers can increase quality by improving adherence to chronic disease medications included in star ratings among Medicare Advantage Part D (MAPD) plan enrollees. Research is needed to evaluate effective means of collaboration between health plans and providers. The Medication Adherence Tracker (MAT) is a health plan initiative to help primary care providers use outreach to improve their patients' adherence. To quantify the contribution of structural and process factors on the success of a health plan-initiated tracking system in improving chronic disease medication adherence over 6 months. The MAT quality improvement initiative was carried out in South Texas from June to December 2016. Health plan pharmacists used claims data to identify MAPD enrollees at risk of nonadherence to triple-weighted star medications: renin-angiotensin system antagonists, oral diabetes medications, and statins. Actionable reports were delivered biweekly to each provider, either by fax or in person, by embedded health plan nurses. Multivariable regression was used to evaluate sociodemographic and clinical factors as well as the role of provider outreach in increasing paid pharmacy claims and medication adherence as measured by proportion of days covered (PDC) > 0.8. Of 3,542 patients in 5 Texas physician-organized delivery system groups whose 67 providers received tracking reports from June through December 2016, 1,901 (54%) patients had more than 1 related prescription, and 3,064 (87%) received provider outreach on at least 1 prescription. 2,493 (70%) had at least 1 paid pharmacy claim. Provider outreach was associated with greater likelihood of paid prescription claims (relative risk [RR] = 4.59, 95% CI = 3.74-5.62) and greater year-end adherence (PDC > 0.8, RR = 1.86, 95% CI = 1.63-2.12) in multivariable predictive models. 95% CIs for age, gender, low-income subsidy eligibility, and number of prescriptions did not exclude the null value. Provider engagement is critical to effective health plan-provider partnerships to overcome barriers, change behavior, and improve chronic disease care quality and population outcomes. This study was funded by Cigna. The manuscript was prepared as a work for hire. Hong, Esse, Gallardo, Serna, Fosshat, and Mamvou are employees of CareAllies, a Cigna company. Bruce was employed by Cigna at the time of the study. Vadhariya reports a past internship at Regeneron Pharmaceuticals, unrelated to this work. Abughosh reports grants from Regeneron Pharmaceuticals, Valeant Pharmaceuticals, Sanofi, and BMS/Pfizer, unrelated to this work.},\r\n  citation-subset = {IM},\r\n  country         = {United States},\r\n  journal         = {Journal of managed care & specialty pharmacy},\r\n  month           = may,\r\n  nlm-id          = {101644425},\r\n  owner           = {NLM},\r\n  pmid            = {32347173},\r\n  pubmodel        = {Print},\r\n  revised         = {2020-04-29},\r\n  year            = {2020},\r\n}\r\n\r\n

\n

\n\n\n

\n Health plans and providers can increase quality by improving adherence to chronic disease medications included in star ratings among Medicare Advantage Part D (MAPD) plan enrollees. Research is needed to evaluate effective means of collaboration between health plans and providers. The Medication Adherence Tracker (MAT) is a health plan initiative to help primary care providers use outreach to improve their patients' adherence. To quantify the contribution of structural and process factors on the success of a health plan-initiated tracking system in improving chronic disease medication adherence over 6 months. The MAT quality improvement initiative was carried out in South Texas from June to December 2016. Health plan pharmacists used claims data to identify MAPD enrollees at risk of nonadherence to triple-weighted star medications: renin-angiotensin system antagonists, oral diabetes medications, and statins. Actionable reports were delivered biweekly to each provider, either by fax or in person, by embedded health plan nurses. Multivariable regression was used to evaluate sociodemographic and clinical factors as well as the role of provider outreach in increasing paid pharmacy claims and medication adherence as measured by proportion of days covered (PDC) > 0.8. Of 3,542 patients in 5 Texas physician-organized delivery system groups whose 67 providers received tracking reports from June through December 2016, 1,901 (54%) patients had more than 1 related prescription, and 3,064 (87%) received provider outreach on at least 1 prescription. 2,493 (70%) had at least 1 paid pharmacy claim. Provider outreach was associated with greater likelihood of paid prescription claims (relative risk [RR] = 4.59, 95% CI = 3.74-5.62) and greater year-end adherence (PDC > 0.8, RR = 1.86, 95% CI = 1.63-2.12) in multivariable predictive models. 95% CIs for age, gender, low-income subsidy eligibility, and number of prescriptions did not exclude the null value. Provider engagement is critical to effective health plan-provider partnerships to overcome barriers, change behavior, and improve chronic disease care quality and population outcomes. This study was funded by Cigna. The manuscript was prepared as a work for hire. Hong, Esse, Gallardo, Serna, Fosshat, and Mamvou are employees of CareAllies, a Cigna company. Bruce was employed by Cigna at the time of the study. Vadhariya reports a past internship at Regeneron Pharmaceuticals, unrelated to this work. Abughosh reports grants from Regeneron Pharmaceuticals, Valeant Pharmaceuticals, Sanofi, and BMS/Pfizer, unrelated to this work.\n

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\n \n 2019\n \n \n (5)\n \n \n

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\n \n\n \n \n \n \n \n Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a Guidepost for Telephonic Oncology Case Management.\n \n \n \n\n\n \n Swanson, A. J.; Castel, L. D.; McKenna, P. A.; Shen, Y. A.; and Sagar, B.\n\n\n \n\n\n\n Professional case management, 24: 148–154. 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Swanson2019,\r\n  author          = {Swanson, Alysia Jean and Castel, Liana DesHarnais and McKenna, Patricia A. and Shen, Yuming Albert and Sagar, Bhuvana},\r\n  title           = {Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a Guidepost for Telephonic Oncology Case Management.},\r\n  doi             = {10.1097/NCM.0000000000000336},\r\n  issn            = {1932-8095},\r\n  issue           = {3},\r\n  pages           = {148--154},\r\n  pubstate        = {ppublish},\r\n  volume          = {24},\r\n  abstract        = {Cigna's oncology case management programs identified the opportunity for case managers to integrate distress screening as recommended by the National Comprehensive Cancer Network (NCCN) in oncology populations. Our purpose in conducting this study was to quantify oncology case management program improvements as a result of using the NCCN Distress Screening Tool to guide telephonic case management. The program improvements we measured comprised more efficient identification of biopsychosocial problems and appropriate resource referrals. Case managers in a large commercial health plan piloted integration of distress screening into telephonic case management among U.S. oncology customers experiencing a new diagnosis or care transition from September 2016 to April 2017. A retrospective, matched case-control study was conducted among Cigna customers eligible for oncology case management. The pilot group of 317 received distress screening early in the oncology case management assessment. Outcomes included distress severity ranging from 0 to 10 (where 0 = no distress, 1-3 = mild, 4-7 = moderate, and 8-10 = severe), identification and number of biopsychosocial health problems, and percentage of direct resource referrals by case managers to supportive services. More than half (54%) of the screened customers reported mild or greater distress, and there was a strong correlation between degree of distress and average numbers of biopsychosocial health problems or direct resource referrals. Screened customers were 16% more likely to be referred to internal and external resources than customers not screened with the tool (66% vs. 50%, χp < .001). This study advances evidence-based oncology case management practice during care transitions by providing quantitative evidence for the utility of integrating the NCCN Distress Screening Tool into telephonic oncology case management. Using the tool (thermometer and problem list) to guide telephonic oncology case management and care coordination facilitated more tailored referrals to individuals with cancer enrolled in a large commercial health plan. On the basis of our findings, we integrated distress screening to address unmet biopsychosocial needs in patients with cancer.},\r\n  citation-subset = {N},\r\n  completed       = {2019-09-02},\r\n  country         = {United States},\r\n  issn-linking    = {1932-8087},\r\n  journal         = {Professional case management},\r\n  keywords        = {Adult; Case Management, standards, statistics & numerical data; Case Managers, standards, statistics & numerical data; Case-Control Studies; Delivery of Health Care, standards; Early Detection of Cancer, methods, psychology; Female; Humans; Male; Mass Screening, methods, psychology; Medical Oncology, standards; Middle Aged; Neoplasms, psychology; Practice Guidelines as Topic; Retrospective Studies; Stress, Psychological, diagnosis; Telemedicine, standards; United States},\r\n  nlm-id          = {101291585},\r\n  owner           = {NLM},\r\n  pii             = {01269241-201905000-00007},\r\n  pmid            = {30946253},\r\n  pubmodel        = {Print},\r\n  revised         = {2019-09-02},\r\n  year            = {2019},\r\n}\r\n\r\n

\n

\n\n\n

\n Cigna's oncology case management programs identified the opportunity for case managers to integrate distress screening as recommended by the National Comprehensive Cancer Network (NCCN) in oncology populations. Our purpose in conducting this study was to quantify oncology case management program improvements as a result of using the NCCN Distress Screening Tool to guide telephonic case management. The program improvements we measured comprised more efficient identification of biopsychosocial problems and appropriate resource referrals. Case managers in a large commercial health plan piloted integration of distress screening into telephonic case management among U.S. oncology customers experiencing a new diagnosis or care transition from September 2016 to April 2017. A retrospective, matched case-control study was conducted among Cigna customers eligible for oncology case management. The pilot group of 317 received distress screening early in the oncology case management assessment. Outcomes included distress severity ranging from 0 to 10 (where 0 = no distress, 1-3 = mild, 4-7 = moderate, and 8-10 = severe), identification and number of biopsychosocial health problems, and percentage of direct resource referrals by case managers to supportive services. More than half (54%) of the screened customers reported mild or greater distress, and there was a strong correlation between degree of distress and average numbers of biopsychosocial health problems or direct resource referrals. Screened customers were 16% more likely to be referred to internal and external resources than customers not screened with the tool (66% vs. 50%, χp < .001). This study advances evidence-based oncology case management practice during care transitions by providing quantitative evidence for the utility of integrating the NCCN Distress Screening Tool into telephonic oncology case management. Using the tool (thermometer and problem list) to guide telephonic oncology case management and care coordination facilitated more tailored referrals to individuals with cancer enrolled in a large commercial health plan. On the basis of our findings, we integrated distress screening to address unmet biopsychosocial needs in patients with cancer.\n

\n\n\n

\n \n\n \n \n \n \n \n Introducing the first articles of the veterans and military patient-related health outcomes thematic series.\n \n \n \n\n\n \n Castel, L. D. H.\n\n\n \n\n\n\n Patient related outcome measures, 10: 81–82. 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

\n

@Article{Castel2019,\r\n  author       = {Castel, Liana Des Harnais},\r\n  title        = {Introducing the first articles of the veterans and military patient-related health outcomes thematic series.},\r\n  doi          = {10.2147/PROM.S204114},\r\n  issn         = {1179-271X},\r\n  pages        = {81--82},\r\n  pubstate     = {epublish},\r\n  volume       = {10},\r\n  country      = {New Zealand},\r\n  issn-linking = {1179-271X},\r\n  journal      = {Patient related outcome measures},\r\n  nlm-id       = {101551170},\r\n  owner        = {NLM},\r\n  pii          = {prom-10-081},\r\n  pmc          = {PMC6398394},\r\n  pmid         = {30881165},\r\n  pubmodel     = {Electronic-eCollection},\r\n  revised      = {2019-11-20},\r\n  year         = {2019},\r\n}\r\n\r\n

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\n \n\n \n \n \n \n \n Effectiveness of mailed letters to improve medication adherence among Medicare Advantage Plan participants with chronic conditions.\n \n \n \n\n\n \n Mann, A.; Esse, T. W.; Serna, O.; Castel, L. D.; and Abughosh, S. M.\n\n\n \n\n\n\n Patient preference and adherence, 13: 37–46. 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n\n\n\n

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@Article{Mann2019,\r\n  author       = {Mann, Amanda and Esse, Tara W. and Serna, Omar and Castel, Liana D. and Abughosh, Susan M.},\r\n  title        = {Effectiveness of mailed letters to improve medication adherence among Medicare Advantage Plan participants with chronic conditions.},\r\n  doi          = {10.2147/PPA.S185848},\r\n  issn         = {1177-889X},\r\n  pages        = {37--46},\r\n  pubstate     = {epublish},\r\n  volume       = {13},\r\n  abstract     = {Medication adherence is associated with improved health outcomes in multiple chronic diseases. Information is needed on the effectiveness of specific adherence interventions. This study's objectives were to quantify effects of a targeted mailing intervention on adherence among older adults at risk for nonadherence, and to examine associations of individual and plan characteristics with adherence. Among adults enrolled in a Medicare Advantage Plan with prescription drug coverage from May 2014 to June 2015, those identified as eligible for the mailing intervention had a late refill for oral antidiabetic medication, statin, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker medication and were previously unreachable by telephone. Pharmacy claims data were analyzed with the outcome of 6-month proportion of days covered (PDC) before and after the mailing. The  -test and chi-square analyses were used to evaluate univariate associations. Multivariable linear and logistic regression models were conducted to assess relative covariate effects. A sub-analysis of those with at least one medication fill post-mailing was also performed. A total of 460 non-adherent individuals aged 70±10.5 years, with 50.2% female and 66.7% white individuals, were included. Of those who were mailed a letter, 24.1% became adherent to the specified maintenance medication. Those who received >30-day supplies were more than twice as likely to become adherent after the mailed letter than those who received 30-day supplies or less ( <0.05). Baseline higher PDC was also associated with greater adherence post-mailing ( <0.01). A total of 284 (61.7%) individuals filled their medication at least once after the mailed letter; of those, 39.1% became adherent (mean [SD] change in PDC =0.15 [±0.28]). Our findings suggest that a single mailed letter improved medication adherence by 24.1% in adults with chronic conditions. As a health plan seeking to improve its customers' well-being and outcomes, Cigna continues to utilize targeted mail interventions to improve medication adherence.},\r\n  country      = {New Zealand},\r\n  issn-linking = {1177-889X},\r\n  journal      = {Patient preference and adherence},\r\n  keywords     = {Medicare; Medicare Part C; Medicare Part D; chronic disease; mail distributions; managed care programs; patient compliance; population health; program evaluation},\r\n  nlm-id       = {101475748},\r\n  owner        = {NLM},\r\n  pii          = {ppa-13-037},\r\n  pmc          = {PMC6304824},\r\n  pmid         = {30587942},\r\n  pubmodel     = {Electronic-eCollection},\r\n  revised      = {2020-02-25},\r\n  year         = {2019},\r\n}\r\n\r\n

\n

\n\n\n

\n Medication adherence is associated with improved health outcomes in multiple chronic diseases. Information is needed on the effectiveness of specific adherence interventions. This study's objectives were to quantify effects of a targeted mailing intervention on adherence among older adults at risk for nonadherence, and to examine associations of individual and plan characteristics with adherence. Among adults enrolled in a Medicare Advantage Plan with prescription drug coverage from May 2014 to June 2015, those identified as eligible for the mailing intervention had a late refill for oral antidiabetic medication, statin, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker medication and were previously unreachable by telephone. Pharmacy claims data were analyzed with the outcome of 6-month proportion of days covered (PDC) before and after the mailing. The -test and chi-square analyses were used to evaluate univariate associations. Multivariable linear and logistic regression models were conducted to assess relative covariate effects. A sub-analysis of those with at least one medication fill post-mailing was also performed. A total of 460 non-adherent individuals aged 70±10.5 years, with 50.2% female and 66.7% white individuals, were included. Of those who were mailed a letter, 24.1% became adherent to the specified maintenance medication. Those who received >30-day supplies were more than twice as likely to become adherent after the mailed letter than those who received 30-day supplies or less ( <0.05). Baseline higher PDC was also associated with greater adherence post-mailing ( <0.01). A total of 284 (61.7%) individuals filled their medication at least once after the mailed letter; of those, 39.1% became adherent (mean [SD] change in PDC =0.15 [±0.28]). Our findings suggest that a single mailed letter improved medication adherence by 24.1% in adults with chronic conditions. As a health plan seeking to improve its customers' well-being and outcomes, Cigna continues to utilize targeted mail interventions to improve medication adherence.\n

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\n \n\n \n \n \n \n \n Loneliness in the United States: A 2018 National Panel Survey of Demographic, Structural, Cognitive, and Behavioral Characteristics.\n \n \n \n\n\n \n Bruce, L. D.; Wu, J. S.; Lustig, S. L.; Russell, D. W.; and Nemecek, D. A.\n\n\n \n\n\n\n American journal of health promotion : AJHP, 33: 1123–1133. November 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 2 downloads\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n\n\n\n

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@Article{Bruce2019,\r\n  author          = {Bruce, Liana DesHarnais and Wu, Joshua S. and Lustig, Stuart L. and Russell, Daniel W. and Nemecek, Douglas A.},\r\n  title           = {Loneliness in the United States: A 2018 National Panel Survey of Demographic, Structural, Cognitive, and Behavioral Characteristics.},\r\n  doi             = {10.1177/0890117119856551},\r\n  issn            = {2168-6602},\r\n  issue           = {8},\r\n  pages           = {1123--1133},\r\n  pubstate        = {ppublish},\r\n  volume          = {33},\r\n  abstract        = {To inform health behavior intervention design, we sought to quantify loneliness and its correlates, including social media use, among adults in the United States. Cross-sectional research panel questionnaire. Responses were gathered from individuals in all 50 states surveyed via Internet from February 2018 to March 2018. A total of 20 096 US panel respondents aged 18+. The University of California at Los Angeles (UCLA) Loneliness Scale (theoretical score range = 20-80) was administered along with demographic, structural, cognitive, and behavioral items. After calibrating the sample to population norms, we conducted multivariable linear regression analysis. The overall mean survey-weighted loneliness score was 44.03 (standard error = 0.09). Social support (standardized β [sβ] = -0.19) and meaningful daily interactions (sβ = -0.14) had the strongest associations with lower loneliness, along with reporting good relationships, family life, physical and mental health, friendships, greater age, being in a couple, and balancing one's daily time. Social anxiety was most strongly associated with greater loneliness (sβ = +0.20), followed by self-reported social media overuse (sβ = +0.05) and daily use of text-based social media (sβ = +0.03). Our findings confirm that loneliness decreases with age, and that being in a relationship as well as everyday behavioral factors in people's control are most strongly related to loneliness. Population health promotion efforts to reduce loneliness should focus on improving social support, decreasing social anxiety, and promoting healthy daily behaviors.},\r\n  citation-subset = {T},\r\n  country         = {United States},\r\n  issn-linking    = {0890-1171},\r\n  journal         = {American journal of health promotion : AJHP},\r\n  keywords        = {awareness; interventions; loneliness; mental health; mental illness; mind–body health; opportunity; population health; social media; social support; spiritual health; strategies},\r\n  month           = nov,\r\n  nlm-id          = {8701680},\r\n  owner           = {NLM},\r\n  pmid            = {31203639},\r\n  pubmodel        = {Print-Electronic},\r\n  revised         = {2020-03-03},\r\n  year            = {2019},\r\n}\r\n\r\n

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\n \n\n \n \n \n \n \n Peer Benchmarking and Norm-Based Scoring to Improve Telephonic Health Coaching Quality.\n \n \n \n\n\n \n Manocchia, M.; Donatell, R. C.; Brown, R.; and Bruce, L. D.\n\n\n \n\n\n\n Joint Commission journal on quality and patient safety, 45: 613–619. September 2019.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n\n\n\n

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@Article{Manocchia2019,\r\n  author          = {Manocchia, Michael and Donatell, Rheata C. and Brown, Renee and Bruce, Liana DesHarnais},\r\n  title           = {Peer Benchmarking and Norm-Based Scoring to Improve Telephonic Health Coaching Quality.},\r\n  doi             = {10.1016/j.jcjq.2019.05.008},\r\n  issn            = {1938-131X},\r\n  issue           = {9},\r\n  pages           = {613--619},\r\n  pubstate        = {ppublish},\r\n  volume          = {45},\r\n  abstract        = {Studies evaluating telephonic coaching to improve population health have focused on outcomes, but measurement of consistency of coaching quality is also needed. The aim of this study was to describe how one multistate health plan developed, scored, and implemented a Coach Case Quality Assessment (CCQA) for quality improvement. The nine-item CCQA is a checklist of elements selected by quality improvement teams for peer benchmarking to improve telephonic coaching. The health plan fielded the CCQA to 470 clinical coaches in 2016. Quality reviewers rated coaches' call quality on each item (1 = learning; 2 = progressing; 3 = succeeding) and planned training around composite scores in relation to team norms. A total of 470 coaches completed CCQAs with a norm-based mean score of 50.0 (standard deviation [SD] ± 10.0); 54.0% of coaches had scores within ±1 SD of the mean ("norm"), with 20.9% of coaches scoring below that range, and 25.1% scoring above it. Ninety-six percent (451/470) of coaches completed a nine-month follow-up. The mean norm-based score improved to 56.2 (SD ± 9.3), with 8.2% performing below, 42.4% at, and 49.4% above the peer norm. Scores represent significant mean and proportional changes over time, reflecting improvement on the part of whole teams. This study demonstrates norm-based scoring as an effective strategy for measuring and improving coaching quality in a telephonic behavioral change program. Health plans can implement case quality review with norm-based scoring and peer benchmarking to aid coaches in continuous quality improvement.},\r\n  citation-subset = {IM},\r\n  country         = {Netherlands},\r\n  issn-linking    = {1553-7250},\r\n  journal         = {Joint Commission journal on quality and patient safety},\r\n  month           = sep,\r\n  nlm-id          = {101238023},\r\n  owner           = {NLM},\r\n  pii             = {S1553-7250(19)30031-5},\r\n  pmid            = {31307916},\r\n  pubmodel        = {Print-Electronic},\r\n  revised         = {2020-06-11},\r\n  year            = {2019},\r\n}\r\n\r\n

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\n \n\n \n \n \n \n \n Economic and Clinical Outcomes Resulting From the Stage 4 Chronic Kidney Disease Case Management Quality Improvement Initiative.\n \n \n \n\n\n \n Everett, B.; Castel, L. D.; McGinnis, M.; Beresky, A.; Cane, R. C.; Cooper, T.; Davda, R. K.; Farmer, D.; John, S. M.; Sollars, D. L.; and Rausch, J. F.\n\n\n \n\n\n\n Professional case management, 22: 291–298. 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 1 download\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Everett2017,\r\n  author          = {Everett, Beverly and Castel, Liana D. and McGinnis, Matthew and Beresky, Amy and Cane, Rudolph C. and Cooper, Tasha and Davda, Rajesh K. and Farmer, Donna and John, Stella M. and Sollars, Denise L. and Rausch, John F.},\r\n  title           = {Economic and Clinical Outcomes Resulting From the Stage 4 Chronic Kidney Disease Case Management Quality Improvement Initiative.},\r\n  doi             = {10.1097/NCM.0000000000000253},\r\n  issn            = {1932-8095},\r\n  issue           = {6},\r\n  pages           = {291--298},\r\n  pubstate        = {ppublish},\r\n  volume          = {22},\r\n  abstract        = {Chronic kidney disease (CKD) is a costly and burdensome public health concern. The goal of this study was to evaluate the impact on outcomes and utilization of a pilot program to identify and engage beneficiaries with CKD at risk for progression from Stage 4 to Stage 5. A quality improvement initiative was conducted to assess the impact of case management on costs and outcomes among 7,720 Cigna commercial medical beneficiaries with Stage 4 CKD enrolled in the United States between January 2012 and October 2012. Claims data were analyzed to compare 3,861 beneficiaries randomized to receive condition-focused case management with 3,859 controls, with follow-up through July 2013. After using an algorithm to identify beneficiaries at highest risk of progression, a case management team implemented, among those assigned to the intervention, an evidence-based assessment tool, provided education and follow-up, engaged nephrologists and other providers, and conducted weekly rounds. Primary outcome measures were hospital admissions, emergency department visits, nephrologist visits, dialysis, arteriovenous (AV) fistula creation, and total medical costs. Analysis of variance techniques were used to test group differences. As compared with controls, intervention beneficiaries were 12% more likely to have fistula creation (p = .004). Intervention beneficiaries were observed to have savings of $199 per member per month (PMPM), F = 23.05, p = .04. This difference equated to 6% lower total medical costs in the intervention group. Savings observed were derived half from improved in-network utilization and half from reduced hospital costs. .},\r\n  citation-subset = {N},\r\n  completed       = {2018-09-17},\r\n  country         = {United States},\r\n  issn-linking    = {1932-8087},\r\n  journal         = {Professional case management},\r\n  keywords        = {Adult; Aged; Aged, 80 and over; Case Management, economics; Cost-Benefit Analysis, statistics & numerical data; Disease Management; Female; Humans; Male; Middle Aged; Pilot Projects; Quality Improvement, economics; Renal Insufficiency, Chronic, economics, therapy; Treatment Outcome; United States},\r\n  nlm-id          = {101291585},\r\n  owner           = {NLM},\r\n  pmc             = {PMC5636199},\r\n  pmid            = {28902768},\r\n  pubmodel        = {Print},\r\n  revised         = {2018-11-13},\r\n  year            = {2017},\r\n}\r\n\r\n

\n

\n\n\n\n\n\n

\n\n\n

\n \n\n \n \n \n \n \n Cost drivers for breast, lung, and colorectal cancer care in a commercially insured population over a 6-month episode: an economic analysis from a health plan perspective.\n \n \n \n\n\n \n Sagar, B.; Lin, Y. S.; and Castel, L. D.\n\n\n \n\n\n\n Journal of medical economics, 20: 1018–1023. October 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Sagar2017,\r\n  author          = {Sagar, Bhuvana and Lin, Yu Shen and Castel, Liana D.},\r\n  title           = {Cost drivers for breast, lung, and colorectal cancer care in a commercially insured population over a 6-month episode: an economic analysis from a health plan perspective.},\r\n  doi             = {10.1080/13696998.2017.1339353},\r\n  issn            = {1941-837X},\r\n  issue           = {10},\r\n  pages           = {1018--1023},\r\n  pubstate        = {ppublish},\r\n  volume          = {20},\r\n  abstract        = {In the absence of clinical data, accurate identification of cost drivers is needed for economic comparison in an alternate payment model. From a health plan perspective using claims data in a commercial population, the objective was to identify and quantify the effects of cost drivers in economic models of breast, lung, and colorectal cancer costs over a 6-month episode following initial chemotherapy. This study analyzed claims data from 9,748 Cigna beneficiaries with diagnosis of breast, lung, and colorectal cancer following initial chemotherapy from January 1, 2014 to December 31, 2015. We used multivariable regression models to quantify the impact of key factors on cost during the initial 6-month cancer care episode. Metastasis, facility provider affiliation, episode risk group (ERG) risk score, and radiation were cost drivers for all three types of cancer (breast, lung, and colorectal). In addition, younger age (p < .0001) and human epidermal growth factor receptor-2 oncogene overexpression (HER2+)-directed therapy (p < .0001) were associated with higher costs in breast cancer. Younger age (p < .0001) and female gender (p < .0001) were also associated with higher costs in colorectal cancer. Metastasis was also associated with 50% more hospital admissions and increased hospital length of stay (p < .001) in all three cancers over the 6-month episode duration. Chemotherapy and supportive drug therapies accounted for the highest proportion (48%) of total medical costs among beneficiaries observed. Value-based reimbursement models in oncology should appropriately account for key cost drivers. Although claims-based methodologies may be further augmented with clinical data, this study recommends adjusting for the factors identified in these models to predict costs in breast, lung, and colorectal cancers.},\r\n  chemicals       = {Antineoplastic Agents, ERBB2 protein, human, Receptor, ErbB-2},\r\n  citation-subset = {IM},\r\n  completed       = {2018-06-04},\r\n  country         = {England},\r\n  issn-linking    = {1369-6998},\r\n  journal         = {Journal of medical economics},\r\n  keywords        = {Adolescent; Adult; Age Factors; Aged; Antineoplastic Agents, economics; Breast Neoplasms, economics; Colorectal Neoplasms, economics; Comorbidity; Female; Health Expenditures, statistics & numerical data; Hospitalization, economics; Humans; Insurance Claim Review, statistics & numerical data; Insurance, Health, Reimbursement, statistics & numerical data; Lung Neoplasms, economics; Male; Middle Aged; Models, Economic; Neoplasm Metastasis; Neoplasms, economics, pathology, therapy; Radiotherapy, economics; Receptor, ErbB-2, biosynthesis; Regression Analysis; Retrospective Studies; Risk Factors; Sex Factors; United States; Young Adult; Breast neoplasms; colorectal neoplasms; economics; lung neoplasms; risk adjustment},\r\n  month           = oct,\r\n  nlm-id          = {9892255},\r\n  owner           = {NLM},\r\n  pmid            = {28581874},\r\n  pubmodel        = {Print-Electronic},\r\n  revised         = {2018-06-04},\r\n  year            = {2017},\r\n}\r\n\r\n

\n

\n\n\n\n\n\n

\n\n\n

\n \n\n \n \n \n \n \n Lumbar fusion surgery for degenerative conditions is associated with significant resource and narcotic use 2 years postoperatively in the commercially insured: a medical and pharmacy claims study.\n \n \n \n\n\n \n Mino, D. E.; Munterich, J. E.; and Castel, L. D.\n\n\n \n\n\n\n Journal of spine surgery (Hong Kong), 3: 141–148. June 2017.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n\n\n\n

\n

@Article{Mino2017,\r\n  author       = {Mino, David E. and Munterich, James E. and Castel, Liana D.},\r\n  title        = {Lumbar fusion surgery for degenerative conditions is associated with significant resource and narcotic use 2 years postoperatively in the commercially insured: a medical and pharmacy claims study.},\r\n  doi          = {10.21037/jss.2017.04.02},\r\n  issn         = {2414-469X},\r\n  issue        = {2},\r\n  pages        = {141--148},\r\n  pubstate     = {ppublish},\r\n  volume       = {3},\r\n  abstract     = {Chronic back pain is one of the costliest and most complex medical conditions to manage, involving physiological, psychological, mechanical, social, and environmental factors. An increasing trend of lumbar fusion (LF) surgery for chronic back pain continues despite conflicting evidence for pain relief or improved long-term outcomes. Our goal was to assess medical and pharmacy utilization (including continued use of pain medication) over a 2-year period among patients receiving LF to relieve back pain for degenerative conditions without instability. We conducted a 2-year longitudinal cohort study of 1,422 commercially insured patients who received LF from January through September 2009, and who had continuous benefit eligibility through 2011. We assessed resource use among patients with ICD-9-CM diagnostic codes consistent with a degenerative condition, identified from Cigna's national claim database (CPT codes 22612, 22630 and/or 22558). Patients with fracture, tumor, infection, spondylolisthesis, inflammatory arthritis, or deformity diagnostic codes were excluded. Over the 2 years following LF, 992 patients (70%) incurred $9.0 million in additional medical claims payments which averaged $9,383 per patient. These payments included pain management interventions and long term therapy services in 30% of patients. A subset of 850 patients (60%) also had pharmacy benefits and 829 (97.5%) received multiple pain-related classes of medication over the same period. The majority of patients continued on chronic narcotic use (62.5%), and 95% of patients on narcotics preoperatively continued narcotic utilization at two years. This pharmacy benefit subset incurred an additional $2.2 million for pain-related medications at an average cost of $2,600 per patient. Total average payment for patients with combined medical and pharmacy benefits was $12,283. LF for patients with a degenerative lumbar diagnosis incurred significant resources postoperatively, and was followed by long-term pain and psychotropic medication utilization.},\r\n  country      = {China},\r\n  issn-linking = {2414-4630},\r\n  journal      = {Journal of spine surgery (Hong Kong)},\r\n  keywords     = {Lumbar fusion (LF); chronic back pain; degenerative disc; narcotic; opioid},\r\n  month        = jun,\r\n  nlm-id       = {101685460},\r\n  owner        = {NLM},\r\n  pii          = {jss-03-02-141},\r\n  pmc          = {PMC5506322},\r\n  pmid         = {28744493},\r\n  pubmodel     = {Print},\r\n  revised      = {2019-11-20},\r\n  year         = {2017},\r\n}\r\n\r\n

\n

\n\n\n

\n Chronic back pain is one of the costliest and most complex medical conditions to manage, involving physiological, psychological, mechanical, social, and environmental factors. An increasing trend of lumbar fusion (LF) surgery for chronic back pain continues despite conflicting evidence for pain relief or improved long-term outcomes. Our goal was to assess medical and pharmacy utilization (including continued use of pain medication) over a 2-year period among patients receiving LF to relieve back pain for degenerative conditions without instability. We conducted a 2-year longitudinal cohort study of 1,422 commercially insured patients who received LF from January through September 2009, and who had continuous benefit eligibility through 2011. We assessed resource use among patients with ICD-9-CM diagnostic codes consistent with a degenerative condition, identified from Cigna's national claim database (CPT codes 22612, 22630 and/or 22558). Patients with fracture, tumor, infection, spondylolisthesis, inflammatory arthritis, or deformity diagnostic codes were excluded. Over the 2 years following LF, 992 patients (70%) incurred $9.0 million in additional medical claims payments which averaged $9,383 per patient. These payments included pain management interventions and long term therapy services in 30% of patients. A subset of 850 patients (60%) also had pharmacy benefits and 829 (97.5%) received multiple pain-related classes of medication over the same period. The majority of patients continued on chronic narcotic use (62.5%), and 95% of patients on narcotics preoperatively continued narcotic utilization at two years. This pharmacy benefit subset incurred an additional $2.2 million for pain-related medications at an average cost of $2,600 per patient. Total average payment for patients with combined medical and pharmacy benefits was $12,283. LF for patients with a degenerative lumbar diagnosis incurred significant resources postoperatively, and was followed by long-term pain and psychotropic medication utilization.\n

\n\n\n

\n\n\n\n\n\n

\n

\n \n 2016\n \n \n (1)\n \n \n

\n

\n \n \n

\n \n\n \n \n \n \n \n A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Trials of Clinical Emotional Freedom Techniques (EFT) for the Treatment of Depression.\n \n \n \n\n\n \n Nelms, J. A.; and Castel, L.\n\n\n \n\n\n\n Explore (New York, N.Y.), 12: 416–426. 2016.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Nelms2016,\r\n  author          = {Nelms, Jerrod A. and Castel, Liana},\r\n  title           = {A Systematic Review and Meta-Analysis of Randomized and Nonrandomized Trials of Clinical Emotional Freedom Techniques (EFT) for the Treatment of Depression.},\r\n  doi             = {10.1016/j.explore.2016.08.001},\r\n  issn            = {1878-7541},\r\n  issue           = {6},\r\n  pages           = {416--426},\r\n  pubstate        = {ppublish},\r\n  volume          = {12},\r\n  abstract        = {Among a group of therapies collectively known as energy psychology (EP), emotional freedom techniques (EFT) is the most widely practiced. Clinical EFT is an evidence-based practice combining elements of cognitive and exposure therapies with the manual stimulation of acupuncture points (acupoints). Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of outcomes after clinical EFT treatment in reducing depression. All studies (2005-2015) evaluating EFT for sufferers of depression were identified by electronic search; these included both outcome studies and randomized controlled trials (RCTs). Our focus was depressive symptoms as measured by a variety of psychometric questionnaires and scales. We used meta-analysis to calculate effect sizes at three time points including posttest, follow-ups less than 90 days, and follow-ups more than 90 days. In total, 20 studies were qualified for inclusion, 12 RCTs and 8 outcome studies. The number of participants treated with EFT included N = 461 in outcome studies and N = 398 in RCTs. Clinical EFT showed a large effect size in the treatment of depression in RCTs. At posttest, Cohen׳s d for RCTs was 1.85 and for outcome studies was 0.70. Effect sizes for follow-ups less than 90 days were 1.21, and for ≥ 90 days were 1.11. EFT were more efficacious than diaphragmatic breathing (DB) and supportive interview (SI) in posttest measurements (P = .06 versus DB, P < .001 versus SI), and sleep hygiene education (SHE) at follow-up (P = .036). No significant treatment effect difference between EFT and eye movement desensitization and reprocessing (EMDR) was found. EFT were superior to treatment as usual (TAU), and efficacious in treatment time frames ranging from 1 to 10 sessions. The mean of symptom reductions across all studies was -41%. The results show that Clinical EFT were highly effective in reducing depressive symptoms in a variety of populations and settings. EFT were equal or superior to TAU and other active treatment controls. The posttest effect size for EFT (d = 1.31) was larger than that measured in meta-analyses of antidepressant drug trials and psychotherapy studies. EFT produced large treatment effects whether delivered in group or individual format, and participants maintained their gains over time. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of depression improvement subsequent to EFT treatment.},\r\n  citation-subset = {IM},\r\n  completed       = {2017-06-06},\r\n  country         = {United States},\r\n  issn-linking    = {1550-8307},\r\n  journal         = {Explore (New York, N.Y.)},\r\n  keywords        = {Acupressure, methods; Cognitive Behavioral Therapy, methods; Depression, therapy; Depressive Disorder, therapy; Emotions; Humans; Implosive Therapy, methods; Randomized Controlled Trials as Topic; Treatment Outcome; PTSD; depression; meta-analysis},\r\n  nlm-id          = {101233160},\r\n  owner           = {NLM},\r\n  pii             = {S1550-8307(16)30106-9},\r\n  pmid            = {27843054},\r\n  pubmodel        = {Print-Electronic},\r\n  revised         = {2018-12-02},\r\n  year            = {2016},\r\n}\r\n\r\n

\n

\n\n\n

\n Among a group of therapies collectively known as energy psychology (EP), emotional freedom techniques (EFT) is the most widely practiced. Clinical EFT is an evidence-based practice combining elements of cognitive and exposure therapies with the manual stimulation of acupuncture points (acupoints). Lacking is a recent quantitative meta-analysis that enhances understanding of the variability and clinical significance of outcomes after clinical EFT treatment in reducing depression. All studies (2005-2015) evaluating EFT for sufferers of depression were identified by electronic search; these included both outcome studies and randomized controlled trials (RCTs). Our focus was depressive symptoms as measured by a variety of psychometric questionnaires and scales. We used meta-analysis to calculate effect sizes at three time points including posttest, follow-ups less than 90 days, and follow-ups more than 90 days. In total, 20 studies were qualified for inclusion, 12 RCTs and 8 outcome studies. The number of participants treated with EFT included N = 461 in outcome studies and N = 398 in RCTs. Clinical EFT showed a large effect size in the treatment of depression in RCTs. At posttest, Cohen׳s d for RCTs was 1.85 and for outcome studies was 0.70. Effect sizes for follow-ups less than 90 days were 1.21, and for ≥ 90 days were 1.11. EFT were more efficacious than diaphragmatic breathing (DB) and supportive interview (SI) in posttest measurements (P = .06 versus DB, P < .001 versus SI), and sleep hygiene education (SHE) at follow-up (P = .036). No significant treatment effect difference between EFT and eye movement desensitization and reprocessing (EMDR) was found. EFT were superior to treatment as usual (TAU), and efficacious in treatment time frames ranging from 1 to 10 sessions. The mean of symptom reductions across all studies was -41%. The results show that Clinical EFT were highly effective in reducing depressive symptoms in a variety of populations and settings. EFT were equal or superior to TAU and other active treatment controls. The posttest effect size for EFT (d = 1.31) was larger than that measured in meta-analyses of antidepressant drug trials and psychotherapy studies. EFT produced large treatment effects whether delivered in group or individual format, and participants maintained their gains over time. This meta-analysis extends the existing literature through facilitation of a better understanding of the variability and clinical significance of depression improvement subsequent to EFT treatment.\n

\n\n\n

\n\n\n\n\n\n

\n

\n \n 2015\n \n \n (1)\n \n \n

\n

\n \n \n

\n \n\n \n \n \n \n \n Validity and reliability of the Patient-Reported Arthralgia Inventory: validation of a newly-developed survey instrument to measure arthralgia.\n \n \n \n\n\n \n Castel, L. D.; Wallston, K. A.; Saville, B. R.; Alvarez, J. R.; Shields, B. D.; Feurer, I. D.; and Cella, D.\n\n\n \n\n\n\n Patient related outcome measures, 6: 205–214. 2015.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n\n\n\n

\n

@Article{Castel2015,\r\n  author       = {Castel, Liana D. and Wallston, Kenneth A. and Saville, Benjamin R. and Alvarez, JoAnn R. and Shields, Bradley D. and Feurer, Irene D. and Cella, David},\r\n  title        = {Validity and reliability of the Patient-Reported Arthralgia Inventory: validation of a newly-developed survey instrument to measure arthralgia.},\r\n  doi          = {10.2147/PROM.S47997},\r\n  issn         = {1179-271X},\r\n  pages        = {205--214},\r\n  pubstate     = {epublish},\r\n  volume       = {6},\r\n  abstract     = {There is a need for a survey instrument to measure arthralgia (joint pain) that has been psychometrically validated in the context of existing reference instruments. We developed the 16-item Patient-Reported Arthralgia Inventory (PRAI) to measure arthralgia severity in 16 joints, in the context of a longitudinal cohort study to assess aromatase inhibitor-associated arthralgia in breast cancer survivors and arthralgia in postmenopausal women without breast cancer. We sought to evaluate the reliability and validity of the PRAI instrument in these populations, as well as to examine the relationship of patient-reported morning stiffness and arthralgia. We administered the PRAI on paper in 294 women (94 initiating aromatase inhibitor therapy and 200 postmenopausal women without breast cancer) at weeks 0, 2, 4, 6, 8, 12, 16, and 52, as well as once in 36 women who had taken but were no longer taking aromatase inhibitor therapy. Cronbach's alpha was 0.9 for internal consistency of the PRAI. Intraclass correlation coefficients of test-retest reliability were in the range of 0.87-0.96 over repeated PRAI administrations; arthralgia severity was higher in the non-cancer group at baseline than at subsequent assessments. Women with joint comorbidities tended to have higher PRAI scores than those without (estimated difference in mean scores: -0.3, 95% confidence interval [CI] -0.5, -0.2; P<0.001). The PRAI was highly correlated with the Functional Assessment of Cancer Therapy-Endocrine Subscale item "I have pain in my joints" (reference instrument; Spearman r range: 0.76-0.82). Greater arthralgia severity on the PRAI was also related to decreased physical function (r=-0.47, 95% CI -0.55, -0.37; P<0.001), higher pain interference (r=0.65, 95% CI 0.57-0.72; P<0.001), less active performance status (estimated difference in location (-0.6, 95% CI -0.9, -0.4; P<0.001), and increased morning stiffness duration (r=0.62, 95% CI 0.54-0.69; P<0.0001). We conclude that the psychometric properties of the PRAI are satisfactory for measuring arthralgia severity.},\r\n  completed    = {2015-08-07},\r\n  country      = {New Zealand},\r\n  issn-linking = {1179-271X},\r\n  journal      = {Patient related outcome measures},\r\n  keywords     = {aromatase inhibitors; arthralgia; joint pain; pain measurement; postmenopause; questionnaire design; validation studies},\r\n  nlm-id       = {101551170},\r\n  owner        = {NLM},\r\n  pii          = {prom-6-205},\r\n  pmc          = {PMC4524452},\r\n  pmid         = {26251635},\r\n  pubmodel     = {Electronic-eCollection},\r\n  revised      = {2018-11-13},\r\n  year         = {2015},\r\n}\r\n\r\n

\n

\n\n\n

\n There is a need for a survey instrument to measure arthralgia (joint pain) that has been psychometrically validated in the context of existing reference instruments. We developed the 16-item Patient-Reported Arthralgia Inventory (PRAI) to measure arthralgia severity in 16 joints, in the context of a longitudinal cohort study to assess aromatase inhibitor-associated arthralgia in breast cancer survivors and arthralgia in postmenopausal women without breast cancer. We sought to evaluate the reliability and validity of the PRAI instrument in these populations, as well as to examine the relationship of patient-reported morning stiffness and arthralgia. We administered the PRAI on paper in 294 women (94 initiating aromatase inhibitor therapy and 200 postmenopausal women without breast cancer) at weeks 0, 2, 4, 6, 8, 12, 16, and 52, as well as once in 36 women who had taken but were no longer taking aromatase inhibitor therapy. Cronbach's alpha was 0.9 for internal consistency of the PRAI. Intraclass correlation coefficients of test-retest reliability were in the range of 0.87-0.96 over repeated PRAI administrations; arthralgia severity was higher in the non-cancer group at baseline than at subsequent assessments. Women with joint comorbidities tended to have higher PRAI scores than those without (estimated difference in mean scores: -0.3, 95% confidence interval [CI] -0.5, -0.2; P<0.001). The PRAI was highly correlated with the Functional Assessment of Cancer Therapy-Endocrine Subscale item \"I have pain in my joints\" (reference instrument; Spearman r range: 0.76-0.82). Greater arthralgia severity on the PRAI was also related to decreased physical function (r=-0.47, 95% CI -0.55, -0.37; P<0.001), higher pain interference (r=0.65, 95% CI 0.57-0.72; P<0.001), less active performance status (estimated difference in location (-0.6, 95% CI -0.9, -0.4; P<0.001), and increased morning stiffness duration (r=0.62, 95% CI 0.54-0.69; P<0.0001). We conclude that the psychometric properties of the PRAI are satisfactory for measuring arthralgia severity.\n

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\n

\n \n 2014\n \n \n (2)\n \n \n

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\n \n \n

\n \n\n \n \n \n \n \n Determinants of health after hospital discharge: rationale and design of the Vanderbilt Inpatient Cohort Study (VICS).\n \n \n \n\n\n \n Meyers, A. G.; Salanitro, A.; Wallston, K. A.; Cawthon, C.; Vasilevskis, E. E.; Goggins, K. M.; Davis, C. M.; Rothman, R. L.; Castel, L. D.; Donato, K. M.; Schnelle, J. F.; Bell, S. P.; Schildcrout, J. S.; Osborn, C. Y.; Harrell, F. E.; and Kripalani, S.\n\n\n \n\n\n\n BMC health services research, 14: 10. January 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Meyers2014,\r\n  author          = {Meyers, Abby G. and Salanitro, Amanda and Wallston, Kenneth A. and Cawthon, Courtney and Vasilevskis, Eduard E. and Goggins, Kathryn M. and Davis, Corinne M. and Rothman, Russell L. and Castel, Liana D. and Donato, Katharine M. and Schnelle, John F. and Bell, Susan P. and Schildcrout, Jonathan S. and Osborn, Chandra Y. and Harrell, Frank E. and Kripalani, Sunil},\r\n  title           = {Determinants of health after hospital discharge: rationale and design of the Vanderbilt Inpatient Cohort Study (VICS).},\r\n  doi             = {10.1186/1472-6963-14-10},\r\n  issn            = {1472-6963},\r\n  pages           = {10},\r\n  pubstate        = {epublish},\r\n  volume          = {14},\r\n  abstract        = {The period following hospital discharge is a vulnerable time for patients when errors and poorly coordinated care are common. Suboptimal care transitions for patients admitted with cardiovascular conditions can contribute to readmission and other adverse health outcomes. Little research has examined the role of health literacy and other social determinants of health in predicting post-discharge outcomes. The Vanderbilt Inpatient Cohort Study (VICS), funded by the National Institutes of Health, is a prospective longitudinal study of 3,000 patients hospitalized with acute coronary syndromes or acute decompensated heart failure. Enrollment began in October 2011 and is planned through October 2015. During hospitalization, a set of validated demographic, cognitive, psychological, social, behavioral, and functional measures are administered, and health status and comorbidities are assessed. Patients are interviewed by phone during the first week after discharge to assess the quality of hospital discharge, communication, and initial medication management. At approximately 30 and 90 days post-discharge, interviewers collect additional data on medication adherence, social support, functional status, quality of life, and health care utilization. Mortality will be determined with up to 3.5 years follow-up. Statistical models will examine hypothesized relationships of health literacy and other social determinants on medication management, functional status, quality of life, utilization, and mortality. In this paper, we describe recruitment, eligibility, follow-up, data collection, and analysis plans for VICS, as well as characteristics of the accruing patient cohort. This research will enhance understanding of how health literacy and other patient factors affect the quality of care transitions and outcomes after hospitalization. Findings will help inform the design of interventions to improve care transitions and post-discharge outcomes.},\r\n  citation-subset = {IM},\r\n  completed       = {2014-09-26},\r\n  country         = {England},\r\n  issn-linking    = {1472-6963},\r\n  journal         = {BMC health services research},\r\n  keywords        = {Acute Coronary Syndrome, therapy; Aged; Continuity of Patient Care, standards, statistics & numerical data; Female; Health Literacy, standards, statistics & numerical data; Health Status; Heart Failure, therapy; Humans; Inpatients, psychology, statistics & numerical data; Male; Middle Aged; Patient Discharge, standards, statistics & numerical data; Patient Outcome Assessment; Prospective Studies; Quality of Health Care, standards, statistics & numerical data; Self Care, standards, statistics & numerical data; Severity of Illness Index; Social Determinants of Health, statistics & numerical data; Social Support},\r\n  month           = jan,\r\n  nlm-id          = {101088677},\r\n  owner           = {NLM},\r\n  pii             = {1472-6963-14-10},\r\n  pmc             = {PMC3893361},\r\n  pmid            = {24397292},\r\n  pubmodel        = {Electronic},\r\n  revised         = {2018-11-13},\r\n  year            = {2014},\r\n}\r\n\r\n

\n

\n\n\n\n\n\n

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\n \n\n \n \n \n \n \n Health literacy, numeracy, and other characteristics associated with hospitalized patients' preferences for involvement in decision making.\n \n \n \n\n\n \n Goggins, K. M.; Wallston, K. A.; Nwosu, S.; Schildcrout, J. S.; Castel, L.; Kripalani, S.; and (VICS), V. I. C. S.\n\n\n \n\n\n\n Journal of health communication, 19 Suppl 2: 29–43. 2014.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Goggins2014,\r\n  author          = {Goggins, Kathryn M. and Wallston, Kenneth A. and Nwosu, Samuel and Schildcrout, Jonathan S. and Castel, Liana and Kripalani, Sunil and (VICS), Vanderbilt Inpatient Cohort Study},\r\n  title           = {Health literacy, numeracy, and other characteristics associated with hospitalized patients' preferences for involvement in decision making.},\r\n  doi             = {10.1080/10810730.2014.938841},\r\n  issn            = {1087-0415},\r\n  pages           = {29--43},\r\n  pubstate        = {ppublish},\r\n  volume          = {19 Suppl 2},\r\n  abstract        = {Little research has examined the association of health literacy and numeracy with patients' preferred involvement in the problem-solving and decision-making process in the hospital. Using a sample of 1,249 patients hospitalized with cardiovascular disease from the Vanderbilt Inpatient Cohort Study (VICS), we assessed patients' preferred level of involvement using responses to two scenarios of differing symptom severity from the Problem-Solving Decision-Making Scale. Using multivariable modeling, we determined the relationship of health literacy, subjective numeracy, and other patient characteristics with preferences for involvement in decisions, and how this differed by scenario. The authors found that patients with higher levels of health literacy desired more participation in the problem-solving and decision-making process, as did patients with higher subjective numeracy skills, greater educational attainment, female gender, less perceived social support, or greater health care system distrust (p<.05 for each predictor in multivariable models). Patients also preferred to participate more in the decision-making process when the hypothetical symptom they were experiencing was less severe (i.e., they deferred more to their physician when the hypothetical symptom was more severe). These findings underscore the role that patient characteristics, especially health literacy and numeracy, play in decisional preferences among hospitalized patients.},\r\n  citation-subset = {T},\r\n  completed       = {2015-07-09},\r\n  country         = {United States},\r\n  investigator    = {Bell, Susan P and Cawthon, Courtney and Couey, Catherine and Donato, Katharine M and Fuentes, Vanessa and Harrell, Frank E and Hendrickson, Blake and Leak, Cardella and Lewis, Daniel and Meyers, Abby G and Rothman, Russell L and Mixon, Amanda S and Schnelle, John F and Vasilevskis, Eduard E and Wright, Kelly H S},\r\n  issn-linking    = {1081-0730},\r\n  journal         = {Journal of health communication},\r\n  keywords        = {Adult; Aged; Attitude to Health; Cardiovascular Diseases, therapy; Educational Status; Female; Health Literacy, statistics & numerical data; Humans; Inpatients, psychology, statistics & numerical data; Male; Mathematical Concepts; Middle Aged; Multivariate Analysis; Patient Participation; Patient Preference, statistics & numerical data; Prospective Studies; Sex Factors; Social Support; Trust},\r\n  mid             = {NIHMS655259},\r\n  nlm-id          = {9604100},\r\n  owner           = {NLM},\r\n  pmc             = {PMC4306288},\r\n  pmid            = {25315582},\r\n  pubmodel        = {Print},\r\n  revised         = {2018-11-13},\r\n  year            = {2014},\r\n}\r\n\r\n

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\n

\n \n 2013\n \n \n (1)\n \n \n

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\n \n \n

\n \n\n \n \n \n \n \n Time course of arthralgia among women initiating aromatase inhibitor therapy and a postmenopausal comparison group in a prospective cohort.\n \n \n \n\n\n \n Castel, L. D.; Hartmann, K. E.; Mayer, I. A.; Saville, B. R.; Alvarez, J.; Boomershine, C. S.; Abramson, V. G.; Chakravarthy, A. B.; Friedman, D. L.; and Cella, D. F.\n\n\n \n\n\n\n Cancer, 119: 2375–2382. July 2013.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Castel2013,\r\n  author          = {Castel, Liana D. and Hartmann, Katherine E. and Mayer, Ingrid A. and Saville, Benjamin R. and Alvarez, JoAnn and Boomershine, Chad S. and Abramson, Vandana G. and Chakravarthy, A. Bapsi and Friedman, Debra L. and Cella, David F.},\r\n  title           = {Time course of arthralgia among women initiating aromatase inhibitor therapy and a postmenopausal comparison group in a prospective cohort.},\r\n  doi             = {10.1002/cncr.28016},\r\n  issn            = {1097-0142},\r\n  issue           = {13},\r\n  pages           = {2375--2382},\r\n  pubstate        = {ppublish},\r\n  volume          = {119},\r\n  abstract        = {More than 80,000 postmenopausal breast cancer patients in the United States each year are estimated to begin a 5-year course of aromatase inhibitors (AIs) to prevent recurrence. AI-related arthralgia (joint pain and/or stiffness) may contribute to nonadherence, but longitudinal data are needed on arthralgia risk factors, trajectories, and background in postmenopause. This study sought to describe 1-year arthralgia trajectories and baseline covariates among patients with AI and a postmenopausal comparison group. Patients initiating AIs (n = 91) were surveyed at the time of AI initiation and at 6 repeated assessments over 1 year. A comparison group of postmenopausal women without breast cancer (n = 177) completed concomitantly timed surveys. Numeric rating scales (0-10) were used to measure pain in 8 joint pair groups (bilateral fingers, wrists, elbows, shoulders, hips, knees, ankles, and toes). Poisson regression models were used to analyze arthralgia trajectories and risk factors. By week 6, the AI-initiating group had more severe arthralgia than did the comparison group (ratio of means = 1.8, 95% confidence interval = 1.24-2.7, P = .002), adjusting for baseline characteristics. Arthralgia then worsened further over 1 year in the AI group. Menopausal symptom severity and existing joint-related comorbidity at baseline among women initiating AI were associated with more severe arthralgia over time. Patients initiating AI should be told about the timing of arthralgia over the first year of therapy, and advised that it does not appear to resolve over the course of a year. Menopausal symptoms and joint-related comorbidity at AI initiation can help identify patients at risk for developing AI-related arthralgia.},\r\n  chemicals       = {Antineoplastic Agents, Hormonal, Aromatase Inhibitors},\r\n  citation-subset = {AIM, IM},\r\n  completed       = {2013-08-16},\r\n  country         = {United States},\r\n  issn-linking    = {0008-543X},\r\n  journal         = {Cancer},\r\n  keywords        = {Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal, administration & dosage, adverse effects; Aromatase Inhibitors, administration & dosage, adverse effects; Arthralgia, chemically induced; Breast Neoplasms, drug therapy, prevention & control; Female; Follow-Up Studies; Humans; Middle Aged; Multivariate Analysis; Poisson Distribution; Postmenopause; Prospective Studies; Risk Factors},\r\n  mid             = {NIHMS444868},\r\n  month           = jul,\r\n  nlm-id          = {0374236},\r\n  owner           = {NLM},\r\n  pmc             = {PMC3687009},\r\n  pmid            = {23575918},\r\n  pubmodel        = {Print-Electronic},\r\n  revised         = {2018-11-13},\r\n  year            = {2013},\r\n}\r\n\r\n

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\n \n 2010\n \n \n (2)\n \n \n

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\n \n\n \n \n \n \n \n Measuring participation: the Patient-Reported Outcomes Measurement Information System experience.\n \n \n \n\n\n \n Bode, R. K.; Hahn, E. A.; DeVellis, R.; Cella, D.; and Group, P. O. M. I. S. S. D. W.\n\n\n \n\n\n\n Archives of physical medicine and rehabilitation, 91: S60–S65. September 2010.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Bode2010,\r\n  author          = {Bode, Rita K. and Hahn, Elizabeth A. and DeVellis, Robert and Cella, David and Group, Patient-Reported Outcomes Measurement Information System Social Domain Working},\r\n  title           = {Measuring participation: the Patient-Reported Outcomes Measurement Information System experience.},\r\n  doi             = {10.1016/j.apmr.2009.10.035},\r\n  issn            = {1532-821X},\r\n  issue           = {9 Suppl},\r\n  pages           = {S60--S65},\r\n  pubstate        = {ppublish},\r\n  volume          = {91},\r\n  abstract        = {To describe the lessons learned in the initial development of Patient-Reported Outcomes Measurement Information System social function item banks. Development and testing of 2 item pools within a general population to create item banks that measure ability to participate and satisfaction with participation in social activities. Administration via the Internet. General population members (N=956) of a national polling organization registry participated; data for 768 and 778 participants were used in the analysis. Not applicable. Measures of ability to participate and satisfaction with participation in social activities. Fifty-six items measuring the ability to participate were essentially unidimensional but did not fit an item response theory model. As a result, item banks were not developed for these items. Of the 56 items measuring satisfaction with participation, 14 items measuring social roles and 12 items measuring discretionary activities were unidimensional and met item response theory model assumptions. Two 7-item short forms were also developed. Four lessons, mostly concerning item content, were learned in the development of banks measuring social function. These lessons led to item revisions that are being tested in subsequent studies.},\r\n  citation-subset = {AIM, IM},\r\n  completed       = {2010-09-22},\r\n  country         = {United States},\r\n  investigator    = {DeVellis, Robert and Bode, Rita and Castel, Liana and Cella, Dave and DeWalt, Darren and Eisen, Sue and Ghinassi, Frank and Hahn, Elizabeth and Yorkston, Kathy},\r\n  issn-linking    = {0003-9993},\r\n  journal         = {Archives of physical medicine and rehabilitation},\r\n  keywords        = {Adult; Aged; Female; Humans; Internet; Interpersonal Relations; Male; Middle Aged; Outcome Assessment, Health Care, methods; Patient Participation, methods, psychology; Patient Satisfaction; Quality of Life; Rehabilitation; Research Design; Surveys and Questionnaires},\r\n  mid             = {NIHMS463437},\r\n  month           = sep,\r\n  nlm-id          = {2985158R},\r\n  owner           = {NLM},\r\n  pii             = {S0003-9993(10)00093-6},\r\n  pmc             = {PMC3671872},\r\n  pmid            = {20801282},\r\n  pubmodel        = {Print},\r\n  revised         = {2019-12-10},\r\n  year            = {2010},\r\n}\r\n\r\n

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\n\n\n\n\n\n

\n\n\n

\n \n\n \n \n \n \n \n Measuring social health in the patient-reported outcomes measurement information system (PROMIS): item bank development and testing.\n \n \n \n\n\n \n Hahn, E. A.; Devellis, R. F.; Bode, R. K.; Garcia, S. F.; Castel, L. D.; Eisen, S. V.; Bosworth, H. B.; Heinemann, A. W.; Rothrock, N.; Cella, D.; and Group, P. C.\n\n\n \n\n\n\n Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 19: 1035–1044. September 2010.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n\n\n\n

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@Article{Hahn2010,\r\n  author          = {Hahn, Elizabeth A. and Devellis, Robert F. and Bode, Rita K. and Garcia, Sofia F. and Castel, Liana D. and Eisen, Susan V. and Bosworth, Hayden B. and Heinemann, Allen W. and Rothrock, Nan and Cella, David and Group, P.R.O.M.I.S. Cooperative},\r\n  title           = {Measuring social health in the patient-reported outcomes measurement information system (PROMIS): item bank development and testing.},\r\n  doi             = {10.1007/s11136-010-9654-0},\r\n  issn            = {1573-2649},\r\n  issue           = {7},\r\n  pages           = {1035--1044},\r\n  pubstate        = {ppublish},\r\n  volume          = {19},\r\n  abstract        = {To develop a social health measurement framework, to test items in diverse populations and to develop item response theory (IRT) item banks. A literature review guided framework development of Social Function and Social Relationships sub-domains. Items were revised based on patient feedback, and Social Function items were field-tested. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), two-parameter IRT modeling and evaluation of differential item functioning (DIF). The analytic sample included 956 general population respondents who answered 56 Ability to Participate and 56 Satisfaction with Participation items. EFA and CFA identified three Ability to Participate sub-domains. However, because of positive and negative wording, and content redundancy, many items did not fit the IRT model, so item banks do not yet exist. EFA, CFA and IRT identified two preliminary Satisfaction item banks. One item exhibited trivial age DIF. After extensive item preparation and review, EFA-, CFA- and IRT-guided item banks help provide increased measurement precision and flexibility. Two Satisfaction short forms are available for use in research and clinical practice. This initial validation study resulted in revised item pools that are currently undergoing testing in new clinical samples and populations.},\r\n  citation-subset = {IM},\r\n  completed       = {2010-12-08},\r\n  country         = {Netherlands},\r\n  issn-linking    = {0962-9343},\r\n  journal         = {Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation},\r\n  keywords        = {Adult; Aged; Emotional Intelligence; Factor Analysis, Statistical; Female; Humans; Information Systems; Male; Middle Aged; Quality of Life; Self Report; Social Adjustment; Social Support; Surveys and Questionnaires},\r\n  mid             = {NIHMS305456},\r\n  month           = sep,\r\n  nlm-id          = {9210257},\r\n  owner           = {NLM},\r\n  pmc             = {PMC3138729},\r\n  pmid            = {20419503},\r\n  pubmodel        = {Print-Electronic},\r\n  revised         = {2019-12-10},\r\n  year            = {2010},\r\n}\r\n\r\n

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\n \n 2009\n \n \n (4)\n \n \n

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\n \n\n \n \n \n \n \n A long way to go: practice patterns and evidence in chronic low back pain care.\n \n \n \n\n\n \n Carey, T. S.; Freburger, J. K.; Holmes, G. M.; Castel, L.; Darter, J.; Agans, R.; Kalsbeek, W.; and Jackman, A.\n\n\n \n\n\n\n Spine, 34: 718–724. April 2009.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Carey2009,\r\n  author          = {Carey, Timothy S. and Freburger, Janet K. and Holmes, George M. and Castel, Liana and Darter, Jane and Agans, Robert and Kalsbeek, William and Jackman, Anne},\r\n  title           = {A long way to go: practice patterns and evidence in chronic low back pain care.},\r\n  doi             = {10.1097/BRS.0b013e31819792b0},\r\n  issn            = {1528-1159},\r\n  issue           = {7},\r\n  pages           = {718--724},\r\n  pubstate        = {ppublish},\r\n  volume          = {34},\r\n  abstract        = {A cross-sectional, telephone survey of a representative sample of North Carolina households in 2006. The primary objectives of these analyses were to describe health care use (providers, medications, treatments, diagnostic tests) for chronic low back pain (LBP) and relate current patterns of use to current best evidence for care of the condition. Chronic LBP is common and expensive. Prior research on care utilization often was derived from medical claims databases, reflecting reimbursed health care use, often by one payer. Five thousand three hundred fifty-seven households were contacted in 2006 to identify 732 noninstitutionalized adults 21 years and older with chronic LBP. Five hundred ninety individuals sought care. Patient reported health care utilization, comparison with efficacy was demonstrated by current systematic reviews. Individuals with chronic back pain were middle-aged (mean age 53 years), and the majority were women (62%). Provider and treatment use was common and varied. Sixty percent used narcotics in the previous month. The mean number of provider visits was 21, and over one-third had an advanced imaging procedure in the past year. Physical treatments were common, and often not supported by evidence. Only 3% had engaged in a formal spine rehabilitation program. Half of patients not taking antidepressants were positive on a 2-item depression screen. Although this study was population-based, it was conducted in only one state. Provider and treatment use for chronic LBP are both very common and varied. Current treatment patterns are consistent with overutilization of some medications and treatments, and underutilization of exercise and depression treatment.},\r\n  chemicals       = {Narcotics},\r\n  citation-subset = {IM},\r\n  completed       = {2009-06-30},\r\n  country         = {United States},\r\n  issn-linking    = {0362-2436},\r\n  journal         = {Spine},\r\n  keywords        = {Adult; Aged; Chronic Disease, epidemiology, therapy; Comorbidity; Cross-Sectional Studies; Depressive Disorder, epidemiology; Evidence-Based Medicine; Female; Humans; Interviews as Topic; Low Back Pain, epidemiology, psychology, therapy; Male; Middle Aged; Narcotics, therapeutic use; Office Visits, statistics & numerical data; Practice Patterns, Physicians', statistics & numerical data, trends},\r\n  mid             = {NIHMS87303},\r\n  month           = apr,\r\n  nlm-id          = {7610646},\r\n  owner           = {NLM},\r\n  pmc             = {PMC2664198},\r\n  pmid            = {19282797},\r\n  pubmodel        = {Print},\r\n  revised         = {2018-11-13},\r\n  year            = {2009},\r\n}\r\n\r\n

\n

\n\n\n\n\n\n

\n\n\n

\n \n\n \n \n \n \n \n The rising prevalence of chronic low back pain.\n \n \n \n\n\n \n Freburger, J. K.; Holmes, G. M.; Agans, R. P.; Jackman, A. M.; Darter, J. D.; Wallace, A. S.; Castel, L. D.; Kalsbeek, W. D.; and Carey, T. S.\n\n\n \n\n\n\n Archives of internal medicine, 169: 251–258. February 2009.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Freburger2009,\r\n  author          = {Freburger, Janet K. and Holmes, George M. and Agans, Robert P. and Jackman, Anne M. and Darter, Jane D. and Wallace, Andrea S. and Castel, Liana D. and Kalsbeek, William D. and Carey, Timothy S.},\r\n  title           = {The rising prevalence of chronic low back pain.},\r\n  doi             = {10.1001/archinternmed.2008.543},\r\n  issn            = {1538-3679},\r\n  issue           = {3},\r\n  pages           = {251--258},\r\n  pubstate        = {ppublish},\r\n  volume          = {169},\r\n  abstract        = {National or state-level estimates on trends in the prevalence of chronic low back pain (LBP) are lacking. The objective of this study was to determine whether the prevalence of chronic LBP and the demographic, health-related, and health care-seeking characteristics of individuals with the condition have changed over the last 14 years. A cross-sectional, telephone survey of a representative sample of North Carolina households was conducted in 1992 and repeated in 2006. A total of 4437 households were contacted in 1992 and 5357 households in 2006 to identify noninstitutionalized adults 21 years or older with chronic (>3 months), impairing LBP or neck pain that limits daily activities. These individuals were interviewed in more detail about their health and health care seeking. The prevalence of chronic, impairing LBP rose significantly over the 14-year interval, from 3.9% (95% confidence interval [CI], 3.4%-4.4%) in 1992 to 10.2% (95% CI, 9.3%-11.0%) in 2006. Increases were seen for all adult age strata, in men and women, and in white and black races. Symptom severity and general health were similar for both years. The proportion of individuals who sought care from a health care provider in the past year increased from 73.1% (95% CI, 65.2%-79.8%) to 84.0% (95% CI, 80.8%-86.8%), while the mean number of visits to all health care providers were similar (19.5 [1992] vs 19.4 [2006]). The prevalence of chronic, impairing LBP has risen significantly in North Carolina, with continuing high levels of disability and health care use. A substantial portion of the rise in LBP care costs over the past 2 decades may be related to this rising prevalence.},\r\n  citation-subset = {AIM, IM},\r\n  completed       = {2009-03-03},\r\n  country         = {United States},\r\n  issn-linking    = {0003-9926},\r\n  journal         = {Archives of internal medicine},\r\n  keywords        = {Adult; Age Distribution; Aged; Chronic Disease; Continental Population Groups, statistics & numerical data; Cross-Sectional Studies; Disability Evaluation; Female; Health Surveys; Humans; Low Back Pain, epidemiology; Male; Middle Aged; North Carolina, epidemiology; Office Visits, statistics & numerical data; Patient Acceptance of Health Care, statistics & numerical data; Prevalence; Sex Distribution; Young Adult},\r\n  mid             = {NIHMS662073},\r\n  month           = feb,\r\n  nlm-id          = {0372440},\r\n  owner           = {NLM},\r\n  pii             = {169/3/251},\r\n  pmc             = {PMC4339077},\r\n  pmid            = {19204216},\r\n  pubmodel        = {Print},\r\n  revised         = {2018-11-13},\r\n  year            = {2009},\r\n}\r\n\r\n

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\n \n\n \n \n \n \n \n Spine and pain clinics serving North Carolina patients with back and neck pain: what do they do, and are they multidisciplinary?.\n \n \n \n\n\n \n Castel, L. D.; Freburger, J. K.; Holmes, G. M.; Scheinman, R. P.; Jackman, A. M.; and Carey, T. S.\n\n\n \n\n\n\n Spine, 34: 615–622. March 2009.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Castel2009,\r\n  author          = {Castel, Liana D. and Freburger, Janet K. and Holmes, George M. and Scheinman, Rachael P. and Jackman, Anne M. and Carey, Timothy S.},\r\n  title           = {Spine and pain clinics serving North Carolina patients with back and neck pain: what do they do, and are they multidisciplinary?},\r\n  doi             = {10.1097/BRS.0b013e31817b8fa2},\r\n  issn            = {1528-1159},\r\n  issue           = {6},\r\n  pages           = {615--622},\r\n  pubstate        = {ppublish},\r\n  volume          = {34},\r\n  abstract        = {Cross-sectional survey. Our primary objective was to describe spine and pain clinics serving North Carolina residents with respect to organizational characteristics. Our secondary objective was to assess the multidisciplinary nature of the clinics surveyed. Pain clinics have become common in the United States, and patients with chronic back pain have increasingly been seeking services at these clinics. Little is known about the organizational characteristics of spine and pain clinics. We identified and surveyed spine and pain clinics serving North Carolina residents with chronic back and neck pain. Practice managers at 46 clinics completed a 20-minute questionnaire about the characteristics of their clinic, including providers on staff and services offered. Descriptive and exploratory analyses were conducted to summarize the data. Several variables were constructed to assess the multidisciplinary nature of the clinics. The response rate was 75%. There was marked heterogeneity among the clinics surveyed. Fifty-nine percent of practices were free-standing (n = 27) and 61% were physician-owned (n = 28). Twenty-five clinics (54%) had an anesthesiologist. Other common physician providers were physiatrists and surgeons. Less than one third of sites had mental health providers (n = 12; 26%); only 26% employed physical therapists. Seventy-six percent of sites offered epidural injections, 74% long-term narcotic prescriptions, and 67% antidepressants. The majority of clinics (30 of 33) prescribing narcotics provided monitoring of therapy using periodic urine toxicology testing. Forty-eight percent of sites (n = 22) offered exercise instruction. Few clinics were multidisciplinary in nature. Only 3 (7%) met the criteria of having a medical physician, registered nurse, physical therapist, and mental health specialist. Clinics varied widely in their organizational characteristics, including providers and scope of services available. Few clinics were multidisciplinary in nature. This information should be used to determine how pain clinics can better serve patients and improve outcomes.},\r\n  citation-subset = {IM},\r\n  completed       = {2009-05-11},\r\n  country         = {United States},\r\n  issn-linking    = {0362-2436},\r\n  journal         = {Spine},\r\n  keywords        = {Back Pain, epidemiology, therapy; Chronic Disease; Cross-Sectional Studies; Health Services Research; Humans; Neck Pain, epidemiology, therapy; North Carolina, epidemiology; Pain Clinics, organization & administration, statistics & numerical data; Prevalence; Private Practice, organization & administration, statistics & numerical data; Spinal Diseases, epidemiology, therapy; Surveys and Questionnaires},\r\n  mid             = {NIHMS128326},\r\n  month           = mar,\r\n  nlm-id          = {7610646},\r\n  owner           = {NLM},\r\n  pii             = {00007632-200903150-00015},\r\n  pmc             = {PMC2757449},\r\n  pmid            = {19282742},\r\n  pubmodel        = {Print},\r\n  revised         = {2018-11-13},\r\n  year            = {2009},\r\n}\r\n\r\n

\n

\n\n\n

\n Cross-sectional survey. Our primary objective was to describe spine and pain clinics serving North Carolina residents with respect to organizational characteristics. Our secondary objective was to assess the multidisciplinary nature of the clinics surveyed. Pain clinics have become common in the United States, and patients with chronic back pain have increasingly been seeking services at these clinics. Little is known about the organizational characteristics of spine and pain clinics. We identified and surveyed spine and pain clinics serving North Carolina residents with chronic back and neck pain. Practice managers at 46 clinics completed a 20-minute questionnaire about the characteristics of their clinic, including providers on staff and services offered. Descriptive and exploratory analyses were conducted to summarize the data. Several variables were constructed to assess the multidisciplinary nature of the clinics. The response rate was 75%. There was marked heterogeneity among the clinics surveyed. Fifty-nine percent of practices were free-standing (n = 27) and 61% were physician-owned (n = 28). Twenty-five clinics (54%) had an anesthesiologist. Other common physician providers were physiatrists and surgeons. Less than one third of sites had mental health providers (n = 12; 26%); only 26% employed physical therapists. Seventy-six percent of sites offered epidural injections, 74% long-term narcotic prescriptions, and 67% antidepressants. The majority of clinics (30 of 33) prescribing narcotics provided monitoring of therapy using periodic urine toxicology testing. Forty-eight percent of sites (n = 22) offered exercise instruction. Few clinics were multidisciplinary in nature. Only 3 (7%) met the criteria of having a medical physician, registered nurse, physical therapist, and mental health specialist. Clinics varied widely in their organizational characteristics, including providers and scope of services available. Few clinics were multidisciplinary in nature. This information should be used to determine how pain clinics can better serve patients and improve outcomes.\n

\n\n\n

\n \n\n \n \n \n \n \n Exercise prescription for chronic back or neck pain: who prescribes it? who gets it? What is prescribed?.\n \n \n \n\n\n \n Freburger, J. K.; Carey, T. S.; Holmes, G. M.; Wallace, A. S.; Castel, L. D.; Darter, J. D.; and Jackman, A. M.\n\n\n \n\n\n\n Arthritis and rheumatism, 61: 192–200. February 2009.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Freburger2009a,\r\n  author          = {Freburger, Janet K. and Carey, Timothy S. and Holmes, George M. and Wallace, Andrea S. and Castel, Liana D. and Darter, Jane D. and Jackman, Anne M.},\r\n  title           = {Exercise prescription for chronic back or neck pain: who prescribes it? who gets it? What is prescribed?},\r\n  doi             = {10.1002/art.24234},\r\n  issn            = {0004-3591},\r\n  issue           = {2},\r\n  pages           = {192--200},\r\n  pubstate        = {ppublish},\r\n  volume          = {61},\r\n  abstract        = {To describe exercise prescription in routine clinical practice for individuals with chronic back or neck pain because, although current practice guidelines promote exercise for chronic back and neck pain, little is known about exercise prescription in routine care. We conducted a computer-assisted telephone survey of a representative sample of individuals (n = 684) with chronic back or neck pain who saw a physician, chiropractor, and/or physical therapist (PT) in the past 12 months. Individuals were asked about whether they were prescribed exercise, the amount of supervision received, and the type, duration, and frequency of the prescribed exercise. Descriptive and multivariable regression analyses were conducted. Of the 684 subjects, 48% were prescribed exercise. Of those prescribed exercise, 46% received the prescription from a PT, 29% from a physician, 21% from a chiropractor, and 4% from other. In multivariable analyses, seeing a PT or a chiropractor were the strongest predictors of exercise prescription. The likelihood of exercise prescription was increased in women, those with higher education, and those receiving worker's compensation. PTs were more likely to provide supervision and prescribe strengthening exercises compared with physicians and chiropractors, and were more likely to prescribe stretching exercises compared with physicians. Our findings suggest that exercise is being underutilized as a treatment for chronic back and neck pain and, to some extent, that the amount of supervision and types of exercises prescribed do not follow current practice guidelines. Exercise prescription provided by PTs appears to be most in line with current guidelines.},\r\n  citation-subset = {AIM, IM},\r\n  completed       = {2009-04-14},\r\n  country         = {United States},\r\n  issn-linking    = {0004-3591},\r\n  journal         = {Arthritis and rheumatism},\r\n  keywords        = {Allied Health Personnel; Back Pain, therapy; Cross-Sectional Studies; Exercise Therapy, statistics & numerical data; Female; Health Care Surveys; Humans; Interviews as Topic; Male; Middle Aged; Neck Pain, therapy; Physicians; Practice Guidelines as Topic; Prescriptions, statistics & numerical data},\r\n  mid             = {NIHMS662095},\r\n  month           = feb,\r\n  nlm-id          = {0370605},\r\n  owner           = {NLM},\r\n  pmc             = {PMC4339066},\r\n  pmid            = {19177524},\r\n  pubmodel        = {Print},\r\n  revised         = {2018-11-13},\r\n  year            = {2009},\r\n}\r\n\r\n

\n

\n\n\n\n\n\n

\n

\n \n 2008\n \n \n (2)\n \n \n

\n

\n \n \n

\n \n\n \n \n \n \n \n Content validity in the PROMIS social-health domain: a qualitative analysis of focus-group data.\n \n \n \n\n\n \n Castel, L. D.; Williams, K. A.; Bosworth, H. B.; Eisen, S. V.; Hahn, E. A.; Irwin, D. E.; Kelly, M. A. R.; Morse, J.; Stover, A.; DeWalt, D. A.; and DeVellis, R. F.\n\n\n \n\n\n\n Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 17: 737–749. June 2008.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Castel2008,\r\n  author          = {Castel, Liana D. and Williams, Kelly A. and Bosworth, Hayden B. and Eisen, Susan V. and Hahn, Elizabeth A. and Irwin, Debra E. and Kelly, Morgen A. R. and Morse, Jennifer and Stover, Angela and DeWalt, Darren A. and DeVellis, Robert F.},\r\n  title           = {Content validity in the PROMIS social-health domain: a qualitative analysis of focus-group data.},\r\n  doi             = {10.1007/s11136-008-9352-3},\r\n  issn            = {0962-9343},\r\n  issue           = {5},\r\n  pages           = {737--749},\r\n  pubstate        = {ppublish},\r\n  volume          = {17},\r\n  abstract        = {Our aim was to assess the content validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) social health item banks by comparing a prespecified conceptual model with concepts that focus-group participants identified as important social-health-related outcomes. These data will inform the process of improving health-related quality-of-life measures. Twenty-five patients with a range of social limitations due to chronic health conditions were recruited at two sites; four focus groups were conducted. Raters independently classified participants' statements using a hierarchical, nested schema that included health-related outcomes, role performance, role satisfaction, family/friends, work, and leisure. Key themes that emerged were fulfilling both family and work responsibilities and the distinction between activities done out of responsibility versus enjoyment. Although focus-group participants identified volunteerism and pet ownership as important social-health-related concepts, these were not in our original conceptual model. The concept of satisfaction was often found to overlap with the concept of performance. Our conceptual model appears comprehensive but is being further refined to more appropriately (a) distinguish between responsibilities versus discretionary activities, and (b) situate the outcome of satisfaction as it relates to impairment in social and other domains of health.},\r\n  citation-subset = {IM},\r\n  completed       = {2008-09-23},\r\n  country         = {Netherlands},\r\n  issn-linking    = {0962-9343},\r\n  journal         = {Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation},\r\n  keywords        = {Adolescent; Child; Chronic Disease; Female; Focus Groups; Health Status; Humans; Male; Outcome Assessment, Health Care, methods; Quality of Life; Social Adjustment; Surveys and Questionnaires},\r\n  mid             = {NIHMS120557},\r\n  month           = jun,\r\n  nlm-id          = {9210257},\r\n  owner           = {NLM},\r\n  pmc             = {PMC2757448},\r\n  pmid            = {18478368},\r\n  pubmodel        = {Print-Electronic},\r\n  revised         = {2019-12-10},\r\n  year            = {2008},\r\n}\r\n\r\n

\n

\n\n\n\n\n\n

\n\n\n

\n \n\n \n \n \n \n \n Racial differences in pain during 1 year among women with metastatic breast cancer: a hazards analysis of interval-censored data.\n \n \n \n\n\n \n Castel, L. D.; Saville, B. R.; Depuy, V.; Godley, P. A.; Hartmann, K. E.; and Abernethy, A. P.\n\n\n \n\n\n\n Cancer, 112: 162–170. January 2008.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Castel2008a,\r\n  author          = {Castel, Liana D. and Saville, Benjamin R. and Depuy, Venita and Godley, Paul A. and Hartmann, Katherine E. and Abernethy, Amy P.},\r\n  title           = {Racial differences in pain during 1 year among women with metastatic breast cancer: a hazards analysis of interval-censored data.},\r\n  doi             = {10.1002/cncr.23133},\r\n  issn            = {0008-543X},\r\n  issue           = {1},\r\n  pages           = {162--170},\r\n  pubstate        = {ppublish},\r\n  volume          = {112},\r\n  abstract        = {Longitudinal tumor-specific studies of cancer pain across the disease trajectory provide insight into the course of pain. Information on pain predictors refines our understanding of patients with greatest distress and need. The authors studied 1124 women with metastatic breast cancer and bone metastases, all of whom received standard treatment in an international clinical trial conducted from October 1998 to January 2001. The Brief Pain Inventory (BPI) was administered repeatedly during the course of 1 year. Hazard models were fitted to identify baseline and time-dependent covariates as predictors of pain worsening within cumulative 80-day intervals during the year. Increased severe pain hazards were associated with non-Caucasian race (hazard ratio [HR] = 2.52; 95% CI, 1.69-3.76), restricted performance status (HR = 1.73; 95% CI, 1.13-2.64), and radiation therapy in a previous interval (HR = 2.86; 95% CI, 1.61-5.09). Estimated cumulative rates for not yet reaching a BPI score of 7 or above ranged from 0.79 (0.72-0.85) in the first interval to 0.64 (0.55-0.74) in the last interval for non-Caucasian women, whereas these rates ranged from 0.91 (0.89-0.93) to 0.84 (0.81-0.87) for Caucasian women. By using a time-to-event hazards analysis for cancer symptom data, the authors demonstrated that non-Caucasian race predicted poorer pain control among women with metastatic breast cancer. Disparity findings from cross-sectional studies were confirmed. Pain management strategies should take race into account as a risk factor for worsening pain outcomes, and further investigation should seek to uncover and resolve the reasons for this obvious disparity.},\r\n  chemicals       = {Diphosphonates},\r\n  citation-subset = {AIM, IM},\r\n  completed       = {2008-02-12},\r\n  country         = {United States},\r\n  issn-linking    = {0008-543X},\r\n  journal         = {Cancer},\r\n  keywords        = {Bone Neoplasms, secondary; Breast Neoplasms, ethnology, pathology, psychology; Clinical Trials as Topic; Continental Population Groups; Diphosphonates; European Continental Ancestry Group; Female; Humans; Middle Aged; Neoplasm Metastasis; Pain, prevention & control; Pain Measurement; Proportional Hazards Models; Risk Factors; Time Factors},\r\n  month           = jan,\r\n  nlm-id          = {0374236},\r\n  owner           = {NLM},\r\n  pmid            = {18040997},\r\n  pubmodel        = {Print},\r\n  revised         = {2007-12-24},\r\n  year            = {2008},\r\n}\r\n\r\n

\n

\n\n\n\n\n\n

\n

\n \n 2007\n \n \n (2)\n \n \n

\n

\n \n \n

\n \n\n \n \n \n \n \n Hazards for pain severity and pain interference with daily living, with exploration of brief pain inventory cutpoints, among women with metastatic breast cancer.\n \n \n \n\n\n \n Castel, L. D.; Abernethy, A. P.; Li, Y.; Depuy, V.; Saville, B. R.; and Hartmann, K. E.\n\n\n \n\n\n\n Journal of pain and symptom management, 34: 380–392. October 2007.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{Castel2007,\r\n  author          = {Castel, Liana D. and Abernethy, Amy P. and Li, Yun and Depuy, Venita and Saville, Benjamin R. and Hartmann, Katherine E.},\r\n  title           = {Hazards for pain severity and pain interference with daily living, with exploration of brief pain inventory cutpoints, among women with metastatic breast cancer.},\r\n  doi             = {10.1016/j.jpainsymman.2006.12.007},\r\n  issn            = {0885-3924},\r\n  issue           = {4},\r\n  pages           = {380--392},\r\n  pubstate        = {ppublish},\r\n  volume          = {34},\r\n  abstract        = {Few longitudinal studies have assessed risk factors for pain outcomes in tumor-specific populations. Such studies are needed to improve clinical practice guidelines for cancer pain management over the course of treatment. Among patients with metastatic breast cancer, we assessed the impact of baseline clinical and demographic risk factors on patients reaching different pain severity and interference scores. We analyzed data originally collected in a clinical trial of two bisphosphonate therapies. Pain was measured by the Brief Pain Inventory (BPI) severity and interference with daily living 0-10 subscales. We fit univariate (per-cutpoint) and multivariate (cutpoints 3, 4, 5, 6, and 7 on the BPI) proportional hazards models to identify predictors of pain outcomes over 51 weeks among 1,124 women with metastatic breast cancer. Predictors included race, age, education, geographic region, performance status, chemotherapy versus hormonal therapy only, time from first bone metastasis to randomization, and previous skeletal-related event (SRE, e.g., fractures, spinal cord compression). Non-Caucasian women had greater hazards for reaching higher cutpoints (5 and above) on the severity scale than Caucasian women (hazard ratio [HR] for cutpoint 5 interaction term=1.76; 95% confidence interval [CI]=1.37-2.26). For the interference scale, these hazards were greater for those patients with restricted (versus active) baseline Eastern Cooperative Oncology Group (ECOG) performance status (HR for cutpoint 5 interaction term=2.51; 95% CI=2.01-3.13). In the multivariate severity model, other factors associated with higher pain severity were restricted baseline ECOG performance status, previous SRE, and not being employed full-time at baseline (HRs=1.70, 1.23, and 1.33, respectively). Our findings that non-Caucasian race and restricted performance status were associated with greater pain hazards over time confirm previous cross-sectional findings that these characteristics are pain risk factors. Because we found that the most influential demographic and clinical baseline factors had predictive value for worsening outcomes as early as cutpoint 5, we recommend that pain management strategies use cutpoints informed by risk factors for worsening outcomes as cues for earlier intervention, thus delaying or preventing worst pain among women with metastatic disease who are at greatest risk.},\r\n  citation-subset = {IM},\r\n  completed       = {2007-11-26},\r\n  country         = {United States},\r\n  issn-linking    = {0885-3924},\r\n  journal         = {Journal of pain and symptom management},\r\n  keywords        = {Activities of Daily Living; Adult; Breast Neoplasms, diagnosis, epidemiology, secondary, therapy; Comorbidity; Female; Humans; Middle Aged; North Carolina, epidemiology; Pain, diagnosis, epidemiology, psychology; Pain Measurement, statistics & numerical data; Prevalence; Proportional Hazards Models; Retrospective Studies; Risk Assessment, methods; Risk Factors; Severity of Illness Index},\r\n  month           = oct,\r\n  nlm-id          = {8605836},\r\n  owner           = {NLM},\r\n  pii             = {S0885-3924(07)00339-9},\r\n  pmid            = {17583467},\r\n  pubmodel        = {Print-Electronic},\r\n  revised         = {2007-10-01},\r\n  year            = {2007},\r\n}\r\n\r\n

\n

\n\n\n

\n Few longitudinal studies have assessed risk factors for pain outcomes in tumor-specific populations. Such studies are needed to improve clinical practice guidelines for cancer pain management over the course of treatment. Among patients with metastatic breast cancer, we assessed the impact of baseline clinical and demographic risk factors on patients reaching different pain severity and interference scores. We analyzed data originally collected in a clinical trial of two bisphosphonate therapies. Pain was measured by the Brief Pain Inventory (BPI) severity and interference with daily living 0-10 subscales. We fit univariate (per-cutpoint) and multivariate (cutpoints 3, 4, 5, 6, and 7 on the BPI) proportional hazards models to identify predictors of pain outcomes over 51 weeks among 1,124 women with metastatic breast cancer. Predictors included race, age, education, geographic region, performance status, chemotherapy versus hormonal therapy only, time from first bone metastasis to randomization, and previous skeletal-related event (SRE, e.g., fractures, spinal cord compression). Non-Caucasian women had greater hazards for reaching higher cutpoints (5 and above) on the severity scale than Caucasian women (hazard ratio [HR] for cutpoint 5 interaction term=1.76; 95% confidence interval [CI]=1.37-2.26). For the interference scale, these hazards were greater for those patients with restricted (versus active) baseline Eastern Cooperative Oncology Group (ECOG) performance status (HR for cutpoint 5 interaction term=2.51; 95% CI=2.01-3.13). In the multivariate severity model, other factors associated with higher pain severity were restricted baseline ECOG performance status, previous SRE, and not being employed full-time at baseline (HRs=1.70, 1.23, and 1.33, respectively). Our findings that non-Caucasian race and restricted performance status were associated with greater pain hazards over time confirm previous cross-sectional findings that these characteristics are pain risk factors. Because we found that the most influential demographic and clinical baseline factors had predictive value for worsening outcomes as early as cutpoint 5, we recommend that pain management strategies use cutpoints informed by risk factors for worsening outcomes as cues for earlier intervention, thus delaying or preventing worst pain among women with metastatic disease who are at greatest risk.\n

\n\n\n

\n \n\n \n \n \n \n \n Effects of skeletal morbidities on longitudinal patient-reported outcomes and survival in patients with metastatic prostate cancer.\n \n \n \n\n\n \n DePuy, V.; Anstrom, K. J.; Castel, L. D.; Schulman, K. A.; Weinfurt, K. P.; and Saad, F.\n\n\n \n\n\n\n Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 15: 869–876. July 2007.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

\n

@Article{DePuy2007,\r\n  author          = {DePuy, Venita and Anstrom, Kevin J. and Castel, Liana D. and Schulman, Kevin A. and Weinfurt, Kevin P. and Saad, Fred},\r\n  title           = {Effects of skeletal morbidities on longitudinal patient-reported outcomes and survival in patients with metastatic prostate cancer.},\r\n  doi             = {10.1007/s00520-006-0203-x},\r\n  issn            = {0941-4355},\r\n  issue           = {7},\r\n  pages           = {869--876},\r\n  pubstate        = {ppublish},\r\n  volume          = {15},\r\n  abstract        = {Patients with prostate cancer metastasized to bone frequently experience skeletal morbidities as a result of their disease. We sought to quantify the longitudinal effects on patient-reported outcomes of skeletal-related events (SREs) and to ascertain the declines in health-related quality of life (HRQOL) and pain experienced by patients who experienced SREs. Data are from a clinical trial for the treatment of SREs associated with advanced prostate cancer metastatic to bone. Outcome measures included the Functional Assessment of Cancer Therapy-General (FACT-G) and the Brief Pain Inventory. Among patients who survived 6 months after randomization, patients with no SREs in the initial 6 months after randomization were matched via propensity scores with those experiencing one or more SREs. Similarly, patients with one SRE were matched with a subset of patients with two or more SREs. Patients with SREs in the initial period had significantly worse survival and HRQOL than those with no SREs. Significant differences were found between the pain differences, FACT-G total scores, and FACT-G physical, emotional, and functional subscales. Comparisons of patients with single vs multiple SREs showed similar patterns. The presence of SREs is significantly associated with worse survival and poorer HRQOL in this patient population. Increasing SRE intensity shows a pattern of increasingly decreased survival and poorer HRQOL.},\r\n  chemicals       = {Diphosphonates, Imidazoles, Zoledronic Acid},\r\n  citation-subset = {IM},\r\n  completed       = {2007-11-13},\r\n  country         = {Germany},\r\n  issn-linking    = {0941-4355},\r\n  journal         = {Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer},\r\n  keywords        = {Aged; Bone Neoplasms, drug therapy, psychology, secondary; Diphosphonates, therapeutic use; Humans; Imidazoles; Male; Musculoskeletal System, pathology; Neoplasm Metastasis; Prognosis; Prostatic Neoplasms, mortality, pathology, psychology; Quality of Life; Risk Factors; Survival; Treatment Outcome; Zoledronic Acid},\r\n  month           = jul,\r\n  nlm-id          = {9302957},\r\n  owner           = {NLM},\r\n  pmid            = {17262196},\r\n  pubmodel        = {Print},\r\n  revised         = {2018-12-01},\r\n  year            = {2007},\r\n}\r\n\r\n

\n

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\n

\n \n 2005\n \n \n (1)\n \n \n

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\n \n\n \n \n \n \n \n Understanding of an aggregate probability statement by patients who are offered participation in Phase I clinical trials.\n \n \n \n\n\n \n Weinfurt, K. P.; Depuy, V.; Castel, L. D.; Sulmasy, D. P.; Schulman, K. A.; and Meropol, N. J.\n\n\n \n\n\n\n Cancer, 103: 140–147. January 2005.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Weinfurt2005,\r\n  author          = {Weinfurt, Kevin P. and Depuy, Venita and Castel, Liana D. and Sulmasy, Daniel P. and Schulman, Kevin A. and Meropol, Neal J.},\r\n  title           = {Understanding of an aggregate probability statement by patients who are offered participation in Phase I clinical trials.},\r\n  doi             = {10.1002/cncr.20730},\r\n  issn            = {0008-543X},\r\n  issue           = {1},\r\n  pages           = {140--147},\r\n  pubstate        = {ppublish},\r\n  volume          = {103},\r\n  abstract        = {There is concern that patients with poor numeracy may have difficulty understanding the information necessary to make informed treatment decisions. The authors sought to characterize a special form of numeracy among patients with advanced cancer who were offered participation in Phase I oncology clinical trials. Surveys were administered to 328 cancer patients who were considering Phase I trials. Their frequency-type numeracy was assessed using a multiple-choice question involving a hypothetical scenario in which a physician stated that an experimental treatment would control cancer in "40% of cases like yours." In univariate and multivariable analyses, patient characteristics that were associated with better numeracy were identified. The correct frequency-type interpretation was selected by 72% of respondents. Fourteen percent of respondents incorrectly selected a belief-type answer, "The doctor is 40% confident that the treatment will control my cancer." In a multivariable model, patients who answered incorrectly tended to have less formal education and less experience with experimental therapies. Because the misunderstandings some patients demonstrated may influence their treatment decision making adversely, it is critical to identify such patients and to give them special consideration when communicating information about potential risks and benefits of treatment.},\r\n  citation-subset = {AIM, IM},\r\n  completed       = {2005-01-14},\r\n  country         = {United States},\r\n  issn-linking    = {0008-543X},\r\n  journal         = {Cancer},\r\n  keywords        = {Adult; Aged; Clinical Trials, Phase I as Topic, ethics; Cognition Disorders; Communication; Decision Making; Female; Health Care Surveys; Humans; Informed Consent; Male; Middle Aged; Neoplasms, therapy; Patient Participation; Physician-Patient Relations; Risk Factors; Sampling Studies; Truth Disclosure},\r\n  month           = jan,\r\n  nlm-id          = {0374236},\r\n  owner           = {NLM},\r\n  pmid            = {15534885},\r\n  pubmodel        = {Print},\r\n  revised         = {2007-11-15},\r\n  year            = {2005},\r\n}\r\n\r\n

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\n \n 2004\n \n \n (2)\n \n \n

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\n \n\n \n \n \n \n \n An exploration of relative health stock in advanced cancer patients.\n \n \n \n\n\n \n Gaskin, D. J.; Weinfurt, K. P.; Castel, L. D.; DePuy, V.; Li, Y.; Balshem, A.; Benson, A.; Burnett, C. B.; Corbett, S.; Marshall, J.; Slater, E.; Sulmasy, D. P.; Van Echo, D.; Meropol, N. J.; and Schulman, K. A.\n\n\n \n\n\n\n Medical decision making : an international journal of the Society for Medical Decision Making, 24: 614–624. 2004.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n \n \n 1 download\n \n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Gaskin2004,\r\n  author          = {Gaskin, Darrell J. and Weinfurt, Kevin P. and Castel, Liana D. and DePuy, Venita and Li, Yun and Balshem, Andrew and Benson, Al and Burnett, Caroline B. and Corbett, Sandra and Marshall, John and Slater, Elyse and Sulmasy, Daniel P. and Van Echo, David and Meropol, Neal J. and Schulman, Kevin A.},\r\n  title           = {An exploration of relative health stock in advanced cancer patients.},\r\n  doi             = {10.1177/0272989X04271041},\r\n  issn            = {0272-989X},\r\n  issue           = {6},\r\n  pages           = {614--624},\r\n  pubstate        = {ppublish},\r\n  volume          = {24},\r\n  abstract        = {The authors sought to empirically test whether relative health stock, a measure of patients' sense of loss in their health due to illness, influences the treatment decisions of patients facing life-threatening conditions. Specifically, they estimated the effect of relative health stock on advanced cancer patients' decisions to participate in phase I clinical trials. A multicenter study was conducted to survey 328 advanced cancer patients who were offered the opportunity to participate in phase I trials. The authors asked patients to estimate the probabilities of therapeutic benefits and toxicity, their relative health stock, risk preference, and the importance of quality of life. Controlling for health-related quality of life, an increase in relative health stock by 10 percentage points reduced the odds of choosing to participate in a phase I trial by 16% (odds ratio = 0.84, 95% confidence interval = 0.72, 0.97). Relative health stock affects advanced cancer patients' treatment decisions.},\r\n  citation-subset = {IM},\r\n  completed       = {2005-03-03},\r\n  country         = {United States},\r\n  issn-linking    = {0272-989X},\r\n  journal         = {Medical decision making : an international journal of the Society for Medical Decision Making},\r\n  keywords        = {Clinical Trials, Phase I as Topic; Costs and Cost Analysis; Decision Making; Decision Support Techniques; Female; Health Knowledge, Attitudes, Practice; Health Status; Humans; Male; Middle Aged; Neoplasm Staging; Neoplasms, pathology, psychology, therapy; Patient Participation, psychology; Quality of Life, psychology; Risk Assessment},\r\n  nlm-id          = {8109073},\r\n  owner           = {NLM},\r\n  pii             = {24/6/614},\r\n  pmid            = {15534342},\r\n  pubmodel        = {Print},\r\n  revised         = {2007-11-15},\r\n  year            = {2004},\r\n}\r\n\r\n

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\n \n\n \n \n \n \n \n Health-related quality of life among patients with breast cancer receiving zoledronic acid or pamidronate disodium for metastatic bone lesions.\n \n \n \n\n\n \n Weinfurt, K. P.; Castel, L. D.; Li, Y.; Timbie, J. W.; Glendenning, G. A.; and Schulman, K. A.\n\n\n \n\n\n\n Medical care, 42: 164–175. February 2004.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Weinfurt2004,\r\n  author          = {Weinfurt, Kevin P. and Castel, Liana D. and Li, Yun and Timbie, Justin W. and Glendenning, G. Alastair and Schulman, Kevin A.},\r\n  title           = {Health-related quality of life among patients with breast cancer receiving zoledronic acid or pamidronate disodium for metastatic bone lesions.},\r\n  doi             = {10.1097/01.mlr.0000108746.69256.45},\r\n  issn            = {0025-7079},\r\n  issue           = {2},\r\n  pages           = {164--175},\r\n  pubstate        = {ppublish},\r\n  volume          = {42},\r\n  abstract        = {Research on individual differences in health-related quality of life (HRQOL) can identify intervention targets and important covariates in analyses of treatment outcomes. The objectives of this study were to describe HRQOL trajectories for women with metastatic breast cancer in a randomized trial of bisphosphonates and to identify characteristics associated with variations in HRQOL. We conducted a prospective quality-of-life study within a randomized, controlled trial. We studied women with metastatic breast cancer receiving zoledronic acid or pamidronate disodium to reduce the incidence of skeletal-related events (SREs). HRQOL was measured at fixed time points during the trial. Individual growth-curve modeling was used to describe longitudinal trajectories and to identify predictors of trajectories. For most domains of HRQOL, the mean trajectory reflected a mild increase, which leveled off later in the trial. Older age and full-time employment were associated with higher baseline HRQOL. Longer time from cancer diagnosis to randomization, lower Eastern Cooperative Oncology Group (ECOG) status (score of 2 ["inactive"]), and a history of SREs were associated with lower baseline HRQOL. Significant differences across geographic regions were observed for all domains. Active ECOG status (score of 0-1) at baseline was predictive of greater increases in all domains of HRQOL except Social/Family Well-Being. Age, geographic region, and time from first bone metastases to randomization were associated with longitudinal changes in some domains. Women with metastatic breast cancer receiving bisphosphonates for prevention of SREs experienced an overall increase in HRQOL. Variations among women's experiences are explained partly by such characteristics as a history of SREs.},\r\n  chemicals       = {Diphosphonates, Imidazoles, Zoledronic Acid, Pamidronate},\r\n  citation-subset = {IM},\r\n  completed       = {2004-03-09},\r\n  country         = {United States},\r\n  issn-linking    = {0025-7079},\r\n  journal         = {Medical care},\r\n  keywords        = {Bone Neoplasms, drug therapy, secondary; Breast Neoplasms, drug therapy, pathology; Canada; Diphosphonates, therapeutic use; Double-Blind Method; Female; Humans; Imidazoles, therapeutic use; Middle Aged; Outcome and Process Assessment, Health Care; Pamidronate; Prospective Studies; Quality of Life; United States; Zoledronic Acid},\r\n  month           = feb,\r\n  nlm-id          = {0230027},\r\n  owner           = {NLM},\r\n  pmid            = {14734954},\r\n  pubmodel        = {Print},\r\n  revised         = {2019-12-10},\r\n  year            = {2004},\r\n}\r\n\r\n

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\n \n 2003\n \n \n (3)\n \n \n

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\n \n\n \n \n \n \n \n The correlation between patient characteristics and expectations of benefit from Phase I clinical trials.\n \n \n \n\n\n \n Weinfurt, K. P.; Castel, L. D.; Li, Y.; Sulmasy, D. P.; Balshem, A. M.; Benson, A. B.; Burnett, C. B.; Gaskin, D. J.; Marshall, J. L.; Slater, E. F.; Schulman, K. A.; and Meropol, N. J.\n\n\n \n\n\n\n Cancer, 98: 166–175. July 2003.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Weinfurt2003,\r\n  author          = {Weinfurt, Kevin P. and Castel, Liana D. and Li, Yun and Sulmasy, Daniel P. and Balshem, Andrew M. and Benson, Al B. and Burnett, Caroline B. and Gaskin, Darrell J. and Marshall, John L. and Slater, Elyse F. and Schulman, Kevin A. and Meropol, Neal J.},\r\n  title           = {The correlation between patient characteristics and expectations of benefit from Phase I clinical trials.},\r\n  doi             = {10.1002/cncr.11483},\r\n  issn            = {0008-543X},\r\n  issue           = {1},\r\n  pages           = {166--175},\r\n  pubstate        = {ppublish},\r\n  volume          = {98},\r\n  abstract        = {Patients in Phase I clinical trials sometimes report high expectations regarding the benefit of treatment. The authors examined a range of patient characteristics to determine which factors were associated with greater expectations of benefit from Phase I trials. Participants were adult patients with cancer who had been offered participation in Phase I studies and had decided to participate. Patients completed interviewer-administered surveys before initiation of treatment. Physicians assessed Eastern Cooperative Oncology Group performance status for each patient. Statistical analyses (Pearson product moment correlation and t tests) used multiple imputation to account for missing data. Overall, 593 patients who were offered participation in Phase I trials were contacted, and 328 patients agreed to participate in a study of decision making by cancer patients. Of these, 260 patients (79%) enrolled in a Phase I trial. Patients' expectations regarding the chance that their disease would be controlled with experimental therapy were unrelated to age, gender, living situation, education level, or functional status. Expectations were correlated positively with beliefs about the benefit of standard therapy and the maximum benefit patients may experience from experimental therapy. Greater expectations of benefit were associated with better health-related quality of life, stronger religious faith, optimism, relative health stock, monetary risk seeking, and poorer numeracy. Expectations expressed as beliefs in personal outcomes may be related more to quality of life and personality variables than to patients' knowledge or functional status. Whether such expectations are accurate reflections of knowledge has important implications for evaluating the informed consent process.},\r\n  citation-subset = {AIM, IM},\r\n  completed       = {2003-10-01},\r\n  country         = {United States},\r\n  issn-linking    = {0008-543X},\r\n  journal         = {Cancer},\r\n  keywords        = {Adult; Aged; Clinical Trials, Phase I as Topic; Decision Making; Female; Humans; Informed Consent; Male; Middle Aged; Neoplasms, therapy; Patient Participation; Patient Selection; Patients, psychology; Perception; Quality of Life; Truth Disclosure},\r\n  month           = jul,\r\n  nlm-id          = {0374236},\r\n  owner           = {NLM},\r\n  pmid            = {12833469},\r\n  pubmodel        = {Print},\r\n  revised         = {2007-11-15},\r\n  year            = {2003},\r\n}\r\n\r\n

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\n \n\n \n \n \n \n \n Perceptions of patients and physicians regarding phase I cancer clinical trials: implications for physician-patient communication.\n \n \n \n\n\n \n Meropol, N. J.; Weinfurt, K. P.; Burnett, C. B.; Balshem, A.; Benson, A. B.; Castel, L.; Corbett, S.; Diefenbach, M.; Gaskin, D.; Li, Y.; Manne, S.; Marshall, J.; Rowland, J. H.; Slater, E.; Sulmasy, D. P.; Van Echo, D.; Washington, S.; and Schulman, K. A.\n\n\n \n\n\n\n Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 21: 2589–2596. July 2003.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Meropol2003,\r\n  author          = {Meropol, Neal J. and Weinfurt, Kevin P. and Burnett, Caroline B. and Balshem, Andrew and Benson, Al B. and Castel, Liana and Corbett, Sandra and Diefenbach, Michael and Gaskin, Darrell and Li, Yun and Manne, Sharon and Marshall, John and Rowland, Julia H. and Slater, Elyse and Sulmasy, Daniel P. and Van Echo, David and Washington, Shakira and Schulman, Kevin A.},\r\n  title           = {Perceptions of patients and physicians regarding phase I cancer clinical trials: implications for physician-patient communication.},\r\n  doi             = {10.1200/JCO.2003.10.072},\r\n  issn            = {0732-183X},\r\n  issue           = {13},\r\n  pages           = {2589--2596},\r\n  pubstate        = {ppublish},\r\n  volume          = {21},\r\n  abstract        = {To describe and compare the perceptions of cancer patients and their physicians regarding phase I clinical trials. Eligible patients had been offered phase I trial participation and had decided to participate but had not yet begun treatment. Each patient's physician also served as a study subject. Patients and physicians completed questionnaires with domains including perceptions of potential benefit and harm from treatment (experimental and standard), relative value of quality and length of life, and perceived content of patient-physician consultations. Three hundred twenty-eight patients and 48 physicians completed surveys. Patients had high expectations regarding treatment outcomes (eg, median 60% benefit from experimental therapy), with those choosing to participate in a phase I trial being more optimistic than those declining phase I participation. Patients predicted a higher likelihood of both benefit and adverse reactions from treatment (experimental and standard) than their physicians (P <.0001 for all comparisons). Although 95% of patients reported that quality of life was at least as important as length of life, only 28% reported that changes in quality of life with treatment were discussed with their physicians. In contrast, 73% of physicians reported that this topic was discussed (P <.0001). Cancer patients offered phase I trial participation have expectations for treatment benefit that exceed those of their physicians. The discordant perceptions of patients and physicians may possibly be explained by patient optimism and confidence; however, the discrepancies in reports of consultation content, particularly given patients' stated values regarding quality of life, raise the possibility that communication in this context is suboptimal.},\r\n  citation-subset = {IM},\r\n  completed       = {2003-07-15},\r\n  country         = {United States},\r\n  issn-linking    = {0732-183X},\r\n  journal         = {Journal of clinical oncology : official journal of the American Society of Clinical Oncology},\r\n  keywords        = {Adult; Aged; Attitude; Clinical Trials, Phase I as Topic; Communication; Data Collection; Decision Making; Female; Humans; Male; Middle Aged; Neoplasms, therapy; Patient Participation; Perception; Physician-Patient Relations; Prognosis; Quality of Life; Truth Disclosure},\r\n  month           = jul,\r\n  nlm-id          = {8309333},\r\n  owner           = {NLM},\r\n  pii             = {JCO.2003.10.072},\r\n  pmid            = {12829680},\r\n  pubmodel        = {Print},\r\n  revised         = {2007-11-15},\r\n  year            = {2003},\r\n}\r\n\r\n

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\n \n\n \n \n \n \n \n Toward estimating the impact of changes in immigrants' insurance eligibility on hospital expenditures for uncompensated care.\n \n \n \n\n\n \n Castel, L. D.; Timbie, J. W.; Sendersky, V.; Curtis, L. H.; Feather, K. A.; and Schulman, K. A.\n\n\n \n\n\n\n BMC health services research, 3: 1. January 2003.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Castel2003,\r\n  author          = {Castel, Liana D. and Timbie, Justin W. and Sendersky, Veronica and Curtis, Lesley H. and Feather, Keith A. and Schulman, Kevin A.},\r\n  title           = {Toward estimating the impact of changes in immigrants' insurance eligibility on hospital expenditures for uncompensated care.},\r\n  doi             = {10.1186/1472-6963-3-1},\r\n  issn            = {1472-6963},\r\n  issue           = {1},\r\n  pages           = {1},\r\n  pubstate        = {ppublish},\r\n  volume          = {3},\r\n  abstract        = {The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 gave states the option to withdraw Medicaid coverage of nonemergency care from most legal immigrants. Our goal was to assess the effect of PRWORA on hospital uncompensated care in the United States. We collected the following state-level data for the period from 1994 through 1999: foreign-born, noncitizen population and health uninsurance rates (US Census Current Population Survey); percentage of teaching hospitals (American Hospital Association Annual Survey of Hospitals); and each state's decision whether to implement the PRWORA Medicaid bar for legal permanent residents or to continue offering nonemergency Medicaid coverage using state-only funds (Urban Institute). We modeled uncompensated care expenditures by state (also from the Annual Survey of Hospitals) in both univariate and multivariable regression analyses. When measured at the state level, there was no significant relationship between uncompensated care expenditures and states' percentage of noncitizen immigrants. Uninsurance rates were the only significant factor in predicting uncompensated hospital care expenditures by state. Reducing the number of uninsured patients would most surely reduce hospital expenditures for uncompensated care. However, data limitations hampered our efforts to obtain a monetary estimate of hospitals' financial losses due specifically to the immigrant eligibility changes in PRWORA. Quantifying the impact of these provisions on hospitals will require better data sources.},\r\n  citation-subset = {IM},\r\n  completed       = {2003-05-12},\r\n  country         = {England},\r\n  issn-linking    = {1472-6963},\r\n  journal         = {BMC health services research},\r\n  keywords        = {Eligibility Determination, legislation & jurisprudence, trends; Emigration and Immigration, legislation & jurisprudence, statistics & numerical data; Employment, legislation & jurisprudence; Health Care Surveys; Hospital Costs, statistics & numerical data; Humans; Medicaid, legislation & jurisprudence; Medically Uninsured, statistics & numerical data; Poverty, statistics & numerical data; Social Welfare, economics, legislation & jurisprudence; State Health Plans, economics, legislation & jurisprudence; Uncompensated Care, statistics & numerical data; United States},\r\n  month           = jan,\r\n  nlm-id          = {101088677},\r\n  owner           = {NLM},\r\n  pmc             = {PMC140321},\r\n  pmid            = {12523939},\r\n  pubmodel        = {Print-Electronic},\r\n  revised         = {2019-11-06},\r\n  year            = {2003},\r\n}\r\n\r\n

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\n \n 2002\n \n \n (1)\n \n \n

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\n \n\n \n \n \n \n \n Welfare reform and Latinas' use of perinatal health care.\n \n \n \n\n\n \n Seils, D. M.; Castel, L. D.; Curtis, L. H.; and Weinfurt, K. P.\n\n\n \n\n\n\n American journal of public health, 92: 699–700; author reply 700. May 2002.\n \n\n\n\n
\n\n\n\n \n\n \n \n doi\n \n \n\n \n link\n \n \n\n bibtex\n \n\n \n\n \n\n \n \n \n \n \n \n \n\n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n

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@Article{Seils2002,\r\n  author          = {Seils, Damon M. and Castel, Liana D. and Curtis, Lesley H. and Weinfurt, Kevin P.},\r\n  title           = {Welfare reform and Latinas' use of perinatal health care.},\r\n  doi             = {10.2105/ajph.92.5.699-a},\r\n  issn            = {0090-0036},\r\n  issue           = {5},\r\n  pages           = {699--700; author reply 700},\r\n  pubstate        = {ppublish},\r\n  volume          = {92},\r\n  citation-subset = {AIM, IM},\r\n  completed       = {2002-05-15},\r\n  country         = {United States},\r\n  issn-linking    = {0090-0036},\r\n  journal         = {American journal of public health},\r\n  keywords        = {Eligibility Determination, legislation & jurisprudence; Employment, legislation & jurisprudence; Female; Health Services Research, standards; Hispanic Americans, statistics & numerical data; Humans; Maternal Welfare, economics, ethnology, legislation & jurisprudence; Medicaid, legislation & jurisprudence; Pregnancy; Pregnancy Outcome, economics, ethnology; Prenatal Care, economics, statistics & numerical data; United States},\r\n  month           = may,\r\n  nlm-id          = {1254074},\r\n  owner           = {NLM},\r\n  pmc             = {PMC1447143},\r\n  pmid            = {11988423},\r\n  pubmodel        = {Print},\r\n  revised         = {2019-05-14},\r\n  year            = {2002},\r\n}\r\n\r\n

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