Publications by authors named "David O Meltzer"

Background: Length of stay (LOS) is an important measure of hospital quality and may be impacted by patient participation. However, concepts of patient participation, like health confidence, have received little examination in hospitalized patients' LOS, especially in diverse populations.

Objective: To determine if the Health Confidence Score (HCS) is associated with hospital LOS and readmission in a socioeconomically diverse population.

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Clopidogrel, an anti-platelet drug, used to prevent thrombosis after percutaneous coronary intervention. Clopidogrel resistance results in recurring ischemic episodes, with African Americans suffering disproportionately. The aim of this study was to identify biomarkers of clopidogrel resistance in African American patients.

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Background: Cost-related medication nonadherence (CRN) is an important patient-centered outcome measure. Longitudinal follow-up of CRN is rare.

Objective: We propose to develop a novel integrated dataset to study CRN longitudinally.

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Article Synopsis
  • - The first Lancet Oncology Commission on Global Cancer Surgery, published in 2015, emphasized the global burden of cancer and the critical role of surgical care, while highlighting existing gaps in providing safe and accessible cancer surgery.
  • - The new Commission builds on the previous work by proposing actionable solutions aimed at enhancing access to cancer surgery globally, involving expertise from international leaders in the field.
  • - It outlines solution frameworks across nine domains tailored to the six WHO regions, with eight specific actions designed to improve cancer surgical capacity and promote equity, affordability, and safety for all patients.
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Objective: To study cost-related medication non-adherence (CRN) for a 30-month period before and during the COVID-19 pandemic using a sample of Medicare patients at high risk of hospitalization.

Design: A novel data set of quarterly surveys of CRN was used to evaluate CRN before and during the COVID-19 pandemic. Generalized Estimating Equation (GEE) analyses were conducted to evaluate the adjusted coefficients of change in CRN behaviors controlling for socio-demographic and health characteristics.

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Article Synopsis
  • - The study investigates how adults with insufficient vision access and use technology compared to those with normal vision, emphasizing the growing importance of eHealth in managing chronic diseases.
  • - Conducted at an academic urban hospital, the research utilized surveys to measure patients' technology access, willingness to use eHealth, and overall eHealth literacy, while also assessing visual acuity and demographic characteristics.
  • - Out of 59 participants, the majority were Black women with at least some college education, and most owned technology and used the internet, indicating potential for integrating eHealth into their post-discharge self-management despite vision challenges.
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Objective: To examine the quality and costs of care for patients evaluated for hematuria by urologic advanced practice providers (APPs) and urologists. The roles of APPs in urology are growing, but their clinical and financial outcomes compared to urologists are not well understood.

Methods: We conducted a retrospective cohort study of commercially insured patients using data from 2014 to 2020.

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Background: Medicare coverage for audio-only telehealth is slated to end this year after the public health emergency concludes. When the time comes, many patients may be unable to make the transition from audio-only to video telehealth due to digital inexperience. This study explores the second digital divide within video telehealth use, which is primarily characterized by skills and capabilities rather than access, by measuring eHealth literacy (eHL) and video capabilities in hospitalized patients.

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Article Synopsis
  • Pharmacogenomics plays a vital role in personalized medicine but is rarely implemented in hospitals, prompting a collaborative project in Chicago to integrate it into inpatient care.
  • The study focused on enrolling African American adult patients for preemptive genotyping to predict drug responses or toxicity across three hospitals.
  • Challenges faced included engaging hospital staff and adapting workflows, with strategies like streamlined information delivery and leveraging champions among healthcare providers to enhance adoption of pharmacogenomic practices.
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Background: Throughout the COVID-19 pandemic, patient portals have become more widely used tools of patient care delivery. However, not all individuals have equivalent access or ability to use patient portals.

Objective: The aim of this study is to evaluate the relationships between eHealth literacy (eHL) and patient portal awareness, use, and attitudes among hospitalized patients.

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Vitamin D deficiency has long been associated with reduced immune function that can lead to viral infection. Several studies have shown that Vitamin D deficiency is associated with increases the risk of infection with COVID-19. However, it is unknown if treatment with Vitamin D can reduce the associated risk of COVID-19 infection, which is the focus of this study.

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Purpose: Longitudinal patient-partnered experiences may promote medical student empathy, but evaluation of such programs is limited. The aim of this study was to compare areas of learning among first-year medical students randomized to a patient-centered track (PCT) or traditional track (TT) longitudinal clinical experience.

Methods: PCT students (n=24) were paired with 2 patients and a physician to participate in their patients' care across multiple settings.

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The present study builds on our prior work that demonstrated an association between pharmacogenetic interactions and 90-day readmission. In a substantially larger, more diverse study population of 19,999 adults tracked from 2010 through 2020 who underwent testing with a 13-gene pharmacogenetic panel, we included additional covariates to evaluate aggregate contribution of social determinants and medical comorbidity with the presence of identified gene-x-drug interactions to moderate 90-day hospital readmission (primary outcome). Univariate logistic regression analyses demonstrated that strongest associations with 90 day hospital readmissions were the number of medications prescribed within 30 days of a first hospital admission that had Clinical Pharmacogenomics Implementation Consortium (CPIC) guidance (CPIC medications) (5+ CPIC medications, odds ratio (OR) = 7.

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Background: Pharmacogenomics, which offers a potential means by which to inform prescribing and avoid adverse drug reactions, has gained increasing consideration in other medical settings but has not been broadly evaluated during perioperative care.

Methods: The Implementation of Pharmacogenomic Decision Support in Surgery (ImPreSS) Trial is a prospective, single-center study consisting of a prerandomization pilot and a subsequent randomized phase. We describe findings from the pilot period.

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Article Synopsis
  • The study investigates the effects of cannabidiol (CBD) on SARS-CoV-2 infection, revealing that CBD inhibits the virus's replication in both cells and mice while not being effective like other cannabinoids such as THC.
  • CBD works by acting after the virus enters host cells, blocking viral gene expression and positively influencing host gene responses, particularly enhancing the IRE1α RNase ER stress response and interferon signaling pathways.
  • In human patient data, a significant negative relationship was found between CBD use and positive COVID-19 test results, suggesting potential for CBD as a preventative measure; however, the authors advise against using non-medical forms of CBD for treatment at this time.
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Coding variation distorts performance/outcome statistics not eliminated by risk adjustment. Among 1596 community-acquired pneumonia patients hospitalized from 1998 to 2012 identified using an evidence-based algorithm, the authors measured the association of principal diagnosis (PD) with 30-day readmission, stratified by Pneumonia Severity Index risk class. The 152 readmitted patients were more ill (Pneumonia Severity Index class V 38.

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Known disparities exist in the availability of pharmacogenomic information for minority populations, amplifying uncertainty around clinical utility for these groups. We conducted a multi-site inpatient pharmacogenomic implementation program among self-identified African-Americans (AA; = 135) with numerous rehospitalizations ( = 341) from 2017 to 2020 (NIH-funded ACCOuNT project/clinicaltrials.gov#NCT03225820).

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Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines exist for many medications commonly prescribed prior to hospital discharge, yet there are limited data regarding the contribution of gene-x-drug interactions to hospital readmissions. The present study evaluated the relationship between prescription of CPIC medications prescribed within 30 days of hospital admission and 90-day hospital readmission from 2010 to 2020 in a study population (N = 10,104) who underwent sequencing with a 14-gene pharmacogenetic panel. The presence of at least one pharmacogenetic indicator for a medication prescribed within 30 days of hospital admission was considered a gene-x-drug interaction.

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Objective: To explore frequently hospitalised patients' experiences and preferences related to primary care physician (PCP) involvement during hospitalisation across two care models.

Design: Qualitative study embedded within a randomised controlled trial. Semistructured interviews were conducted with patients.

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Within an institutional pharmacogenomics implementation program, we surveyed 463 outpatients completing preemptive pharmacogenomic testing whose genetic results were available to providers for guiding medication treatment. We compared views and experiences from self-reported White and Black patients, including education level as a covariate across analyses. Black patients were less confident about whether their providers made personalized treatment decisions, and overwhelmingly wanted a greater role for their genetic information in clinical care.

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Objectives: Integration of pharmacogenomics into clinical care is being studied in multiple disciplines. We hypothesized that understanding attitudes and perceptions of anesthesiologists, critical care and pain medicine providers would uncover unique considerations for future implementation within perioperative care.

Methods: A survey (multiple choice and Likert-scale) was administered to providers within our Department of Anesthesia and Critical Care prior to initiation of a department-wide prospective pharmacogenomics implementation program.

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