Reimagining How We Synthesize Information to Impact Clinical Care, Policy, and Research Priorities in Real Time: Examples and Lessons Learned from COVID-19.

Real-time clinical care, policy, and research decisions need real-time evidence synthesis. However, as we found during the COVID-19 pandemic, it is challenging to rapidly address key clinical and policy questions through rigorous, relevant, and usable evidence. Our objective is to present three exemplar cases of rapid evidence synthesis products from the Veterans Healthcare Administration Evidence Synthesis Program (ESP) and, in the context of these examples, outline ESP products, challenges, and lessons learned.

Characteristics and Disease Burden of Patients With Eosinophilic Granulomatosis With Polyangiitis Initiating Mepolizumab in the United States.

Background/objective: Although the high disease burden associated with eosinophilic granulomatosis with polyangiitis (EGPA) has been established, the disease burden in patients initiating mepolizumab in real-world practice is poorly understood. This study aimed to assess characteristics and burden of real-world patients with EGPA initiating mepolizumab.

Methods: This was a database study (GSK study ID: 214156) of US patients (≥12 years old) with EGPA and ≥1 mepolizumab claim (index date) identified from the Merative MarketScan Commercial and Medicare Supplemental Databases (November 1, 2015, to March 31, 2020).

Widespread Community Transmission of Hepatitis A Virus Following an Outbreak at a Local Restaurant - Virginia, September 2021-September 2022.

Hepatitis A is a vaccine-preventable liver infection caused by the hepatitis A virus (HAV); it is transmitted through ingestion of food or drink that has been contaminated by small amounts of infected stool, or through direct contact, including sexual contact, with a person who is infected (1). After years of historically low rates of hepatitis A in the United States, the incidence began increasing in 2016, with outbreaks characterized by person-to-person HAV transmission among persons who use drugs, persons experiencing homelessness, and men who have sex with men (2,3). As of September 2022, 13 states were experiencing outbreaks, including Virginia (3).

Anatomic, stage-based repair of secondary mitral valve disease.

Objective: Intervention for repair of secondary mitral valve disease is frequently associated with recurrent regurgitation. We sought to determine if there was sufficient evidence to support inclusion of anatomic indices of leaflet dysfunction in the management of secondary mitral valve disease.

Methods: We performed a systematic review and meta-analysis of published reports comparing anatomic indices of leaflet dysfunction with the complexity of valve repair and the outcome from intervention.

Dashboard Design to Identify and Balance Competing Risk of Multiple Hospital-Acquired Conditions.

Background: Hospital-acquired conditions (HACs) are common, costly, and national patient safety priority. Catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure injury (HAPI), and falls are common HACs. Clinicians assess each HAC risk independent of other conditions.

Challenges in Heart Failure Disease Management in Skilled Nursing Facilities: A Qualitative Study.

Clinical guidelines recommend clinicians in skilled nursing facilities (SNFs) monitor body weight and signs and symptoms related to heart failure (HF) and encourage a sodium restricted diet to improve HF outcomes; however, SNFs face considerable challenges in HF disease management (HF-DM). In the current study, we characterized the challenges of HF-DM with data from semi-structured, in-depth interviews with patients, caregivers, staff, and physicians from nine SNFs. Patients receiving skilled nursing care were interviewed together as a dyad with their caregiver.

Psychological interventions with older adults during inpatient postacute rehabilitation: A systematic review.

Older adults in inpatient postacute care settings report high rates of depression and anxiety. Psychological interventions address these symptoms through educational, cognitive, behavioral, relaxation, and/or psychosocial approaches. The purpose of this study was to systematically evaluate the quality of existing literature on psychological interventions for depression and/or anxiety among older adults during an inpatient postacute care stay.

Information Needs of Skilled Nursing Facility Staff to Support Heart Failure Disease Management.

Objectives: Characterize key tasks and information needs for heart failure disease management (HF-DM) in the distinct care setting of skilled nursing facility (SNF) staff in partnership with community-based clinical stakeholders. Develop design recommendations contextualized to the SNF setting for informatics interventions for improved HF-DM in the SNF setting.

Methods: Semi-structured interviews with fifteen participants (registered nurses, licensed practical nurses, certified nursing aides and physicians) from 8 Denver-metro SNFs.

Economic burden of growth hormone deficiency in a US pediatric population.

Pediatric growth hormone deficiency (GHD) is a rare disorder of short stature that is currently treated with daily injections of somatropin. In addition to short stature, GHD is associated with other comorbidities such as impaired musculoskeletal development, cardiovascular disease, and decreased quality of life. To analyze somatropin utilization, adherence, and health care costs among children with GHD who had either Medicaid or commercial health insurance.

Design and Evaluation of Low-Fidelity Visual Display Prototypes for Multiple Hospital-Acquired Conditions.

Hospital-acquired conditions such as catheter-associated urinary tract infection, stage 3 or 4 hospital-acquired pressure injury, and falls with injury are common, costly, and largely preventable. This study used participatory design methods to design and evaluate low-fidelity prototypes of clinical dashboards to inform high-fidelity prototype designs to visualize integrated risks based on patient profiles. Five low-fidelity prototypes were developed through literature review and by engaging nurses, nurse managers, and providers as participants (N = 23) from two hospitals in different healthcare systems using focus groups and interviews.

A local health department's journey to the summit: a case study of a decade of quality improvement.

As the interest in quality improvement (QI) efforts in public health agencies gathers momentum, organizations looking to initiate or strengthen QI processes may benefit from learning about existing programs. This article serves as a case study for other agencies to consider as they embark upon their QI journey. Specifically, this article reviews more than a decade of QI efforts in a mid-sized local health department and highlights areas of success (including an annual QI summit), barriers to implementation of QI, and areas needing improvement.

Diabetes prevention and control in the workplace: a pilot project for county employees.

Objectives: To improve nutrition and physical activity of county employees and promote weight loss.

Design: Random assignment to begin the program when first offered or after 3 months ("wait control" group).

Setting: Worksite.

The effect of media attention on concern for and medical management of methicillin-resistant Staphylococcus aureus: a multimethod study.

Background: Reports of an increase in the incidence and severity of methicillin-resistant Staphylococcus aureus (MRSA) infections provoked widespread media attention in October 2007. This study attempted to determine whether this widespread media attention led to changes in physician practices related to skin infections.

Design: Data collection via LexisNexis, Central New York (CNY) microbiologic laboratory records, publicly available data on Internet search activity, and a survey of CNY healthcare providers allowed for examination of concurrent trends in media attention, public information-seeking behavior, and physician response.

Appraising outbreak investigation skills in a public health emergency: an examination based on an actual event.

The purpose of this article is to provide a method of appraising skills in surveillance, assessment, and public health emergency investigation by using an examination based on an actual outbreak occurrence. This article presents an examination that uses a problem-based approach that works sequentially through the steps of an outbreak investigation to assess the investigation skills of individual students. Designed for graduate public heath students enrolled in a course in infectious disease epidemiology at East Carolina University, the examination can be used to appraise the outbreak investigation skills of medical students or practitioners.

A case exercise in public health preparedness: a community outbreak of influenza-like illness.

Public health emergency preparedness has been a priority of local and state health departments as well as other community partners for several years. This article provides a tool for teaching a wide audience of learners the essential steps in training for a disease outbreak. This teaching case involves an investigation of and the community's response to an outbreak of influenza-like illness.

Determining local colorectal cancer screening utilization patterns.

Appropriate screening for colorectal cancer saves lives, yet many Americans at average risk for this disease are not being screened. This article presents the results of an inexpensive, manageable telephone survey that can be used by health departments to determine point prevalence estimates for colorectal cancer screening in their community and to determine local barriers to screening. In Onondaga County, this survey demonstrated that only 17% of the eligible population had been screened with annual fecal occult blood test and a flexible sigmoidoscopy.

Future applications of case-based teaching in population-based prevention.

The Case-Based Series in Population-Oriented Prevention (C-POP) introduced in this supplement to the American Journal of Preventive Medicine provides a set of tools to integrate clinical- and community-based prevention into interactive teaching cases. These cases, which address recommended core competencies in prevention education, have been taught to both medical students and preventive medicine residents. Initial experience with the cases indicates that this method is a promising tool to enhance prevention education in medical schools and primary care residencies.

Bicycle helmet effectiveness in preventing injury and death.

This case--bicycle helmet effectiveness--is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine.