The Southern Center for Maternal Health Equity (SCMHE): a multisector multifaceted community-based approach to reduce disparities in maternal morbidity and mortality in the Gulf South.

Introduction: The maternal mortality crisis in the United States disproportionately affects women who are Black, especially those living in the Gulf South. These disparities result from a confluence of healthcare, policy, and social factors that systematically place Black women at greater risk of maternal morbidities and mortality. This study protocol describes the Southern Center for Maternal Health Equity (SCMHE), a research center funded by the National Institutes of Health in 2023 to reduce preventable causes of maternal morbidity and mortality while improving health equity.

Stakeholder perspectives on facilitators and barriers to implementing a zero-dollar copay program for chronic conditions study.

Background: Type 2 diabetes mellitus (T2D) remains a pressing public health concern. Despite advancements in antidiabetic medications, suboptimal medication adherence persists among many individuals with T2D, often due to the high cost of medications. To combat this issue, Blue Cross and Blue Shield of Louisiana (Blue Cross) introduced the $0 Drug Copay (ZDC) program, providing $0 copays for select drugs.

Ensuring safety and optimization in total joint arthroplasty of cancer patients: A comprehensive analysis of complication risks and modifiable risk factors.

Aims & Objectives: The primary objective of this study is to determine whether an active cancer diagnosis results in an increased risk of perioperative TJA complications and postoperative mortality. The secondary objective is to analyze the effects of demographic factors on perioperative complication rates in cancer patients undergoing TJA.

Materials & Methods: Patients with active cancer diagnoses undergoing total joint arthroplasty from 2014 to 2020 were included in this retrospective analysis.

Characteristics and healthcare utilization of patients with myasthenia gravis exacerbation.

Purpose: This retrospective cohort study describes the characteristics of patients with myasthenia gravis (MG) who developed exacerbations (MG-E) and compares their healthcare utilization (HRU) to patients who did not experience exacerbations (MG-O).

Method: De-identified data from patients who had ≥2 MG-related diagnostic code submissions were extracted from the National Veterans Affairs Health Care Network electronic health records between 1999 and 2022. Descriptive statistics, Kaplan-Meier analysis, and per-patient per-year (PPPY) HRU were used to compare the two patient groups.

Overall Survival in Real-World Patients with Unresectable Hepatocellular Carcinoma Receiving Atezolizumab Plus Bevacizumab Versus Sorafenib or Lenvatinib as First-Line Therapy: Findings from the National Veterans Health Administration Database.

This study evaluated comparative overall survival (OS) of United States veterans with unresectable hepatocellular carcinoma (uHCC) receiving first-line (1L) atezolizumab plus bevacizumab vs. sorafenib or lenvatinib, overall and across racial and ethnic groups. In this retrospective study, patients with uHCC who initiated atezolizumab plus bevacizumab (post-2020) or sorafenib or lenvatinib (post-2018) were identified from the Veterans Health Administration National Corporate Data Warehouse (1 January 2017-31 December 2022).

Treatment Journey and Healthcare Resource Use Among Patients With Alcohol Use Disorder Who Initiated Extended-Release Naltrexone: An Analysis of Veterans Affairs Data.

Background: The US Department of Veterans Affairs, Department of Defense (VA/DoD) clinical guidelines recommend extended-release naltrexone (XR-NTX) as a treatment option for moderate-to-severe alcohol use disorder (AUD); however, contemporary real-world outcomes related to this guideline are lacking. This retrospective, observational, descriptive study examined treatment patterns and healthcare resource use (HCRU) among veterans with an AUD diagnosis who initiated XR-NTX.

Methods: Veterans with incident AUD who initiated XR-NTX between 8/2014 and 11/2018 were identified.

Sodium-glucose cotransporter 2 inhibitors and the risk of Parkinson disease in real-world patients with type 2 diabetes.

Importance: Diabetes increases the risk of Parkinson disease (PD). Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a new glucose-lowering therapeutic class, have shown neuroprotective effects in mechanistic studies. However, the association between SGLT2 inhibitors and PD risk in real-world populations with type 2 diabetes (T2D) remains unclear.

Decision Support and Behavioral Health for Reducing High-Dose Opioids in Comorbid Chronic Pain, Depression and Anxiety: Stepped-Wedge Cluster Randomized Trial.

Background: High prevalence of depression or anxiety with opioid use for chronic pain complicates co-management and may influence prescribing behaviors.

Objective: Compare clinical effectiveness of electronic medical record clinical decision support (EMR-CDS) versus additional behavioral health (BH) care management for reducing rates of high-dose opioid prescriptions.

Design: Type 2 effectiveness-implementation hybrid stepped-wedge cluster randomized trial in 35 primary care clinics within a health system in LA, USA.

Cost-effectiveness analysis of a digital diabetes-prevention programme versus an in-person diabetes-prevention programme in people with prediabetes in the United States.

Aim: To assess the cost-effectiveness of a digital diabetes prevention programme (d-DPP) compared with a diabetes prevention programme (DPP) for preventing type 2 diabetes (T2D) in individuals with prediabetes in the United States.

Methods: A Markov cohort model was constructed, simulating a 10-year period starting at the age of 45 years, with a societal and healthcare sector perspective. The effectiveness of the d-DPP intervention was evaluated using a meta-analysis, with that of the DPP as the comparator.

Renal function as an effect modifier of intensive glucose control in delaying cognitive function decline among individuals with type 2 diabetes: A revisit to the ACCORD MIND trial.

Aim: Dysglycaemia accelerates cognitive decline. Intensive glucose control may help delay or prevent cognitive function decline (CFD). We aimed to determine how patient characteristics influence the effect of intensive glucose control [glycated haemoglobin (HbA1c) <6.

Evolving availability and standardization of patient attributes for matching.

Variation in availability, format, and standardization of patient attributes across health care organizations impacts patient-matching performance. We report on the changing nature of patient-matching features available from 2010-2020 across diverse care settings. We asked 38 health care provider organizations about their current patient attribute data-collection practices.

Defining Meaningful Change in Antihypertensive Medication Adherence in Adults with Established Hypertension: Implications for Clinical Practice.

Uncontrolled hypertension and low antihypertensive medication adherence remain significant clinical challenges. There is a critical need to detect meaningful change in adherence in clinical settings. The authors determined that a ≥2-point change in the 4-item Krousel-Wood Medication Adherence Scale score represents meaningful change in antihypertensive medication adherence.

An exploratory analysis of the cost-effectiveness of insulin glargine 300 units/mL versus insulin glargine 100 units/mL over a lifetime horizon using the BRAVO diabetes model.

Background: This analysis assessed the cost-effectiveness of insulin glargine 300 units/mL (Gla-300) versus insulin glargine 100 units/mL (Gla-100) in insulin-naïve adults with type 2 diabetes (T2D) inadequately controlled with oral antidiabetic drugs (OADs).

Methods: Costs and outcomes for Gla-300 versus Gla-100 from a US healthcare payer perspective were assessed using the BRAVO diabetes model. Baseline clinical data were derived from EDITION-3, a 12-month randomized controlled trial comparing Gla-300 with Gla-100 in insulin-naïve adults with inadequately controlled T2D on OADs.

Effects of Non-Face-to-Face Chronic Care Management on Service Utilization and Outcomes Among US Medicare Beneficiaries with Diabetes.

Background: Type 2 diabetes mellitus (T2DM) results in heavy economic and disease burdens in Louisiana. The Centers for Medicare and Medicaid Services has reimbursed non-face-to-face chronic care management (NFFCCM) for patients with two or more chronic conditions since 2015.

Objective: To assess the impacts of NFFCCM on healthcare utilization and health outcomes.

Some patients with type 2 diabetes may benefit from intensive glycaemic and blood pressure control: A post-hoc machine learning analysis of ACCORD trial data.

Aim: The action to control cardiovascular risk in diabetes (ACCORD) trial showed a neutral average treatment effect of intensive blood glucose and blood pressure (BP) controls in preventing major adverse cardiovascular events (MACE) in individuals with type 2 diabetes. Yet, treatment effects across patient subgroups have not been well understood. We aimed to identify patient subgroups that might benefit from intensive glucose or BP controls for preventing MACE.

Mortality among US veterans with a physician-documented diagnosis of pyruvate kinase deficiency.

Real-world studies of pyruvate kinase (PK) deficiency and estimates of mortality are lacking. This retrospective observational study aimed to identify patients with PK deficiency and compare their overall survival (OS) to that of a matched cohort without PK deficiency. Patients with ≥1 diagnosis code related to PK deficiency were selected from the US Veterans Health Administration (VHA) database (01/1995-07/2019); patients with a physician-documented diagnosis were included (PK deficiency cohort; index: date of first diagnosis code related to PK deficiency).

Optimizing Telehealth for Diabetes Management in the Deep South of the United States: Qualitative Study of Barriers and Facilitators on the Patient and Clinician Journey.

Background: The Deep South of the United States, and Louisiana in particular, bears a greater burden of obesity, diabetes, and heart disease compared with other regions in the United States. Throughout the COVID-19 pandemic, there has been a substantial increase in telehealth visits for diabetes management to protect the safety of patients. Although there have been significant advancements in telehealth and chronic disease management, little is known about patient and provider perspectives on the challenges and benefits of telehealth visits among people living with diabetes and providers who care for patients with diabetes in Louisiana.

Telehealth Use and Healthcare Utilization Among Individuals with Type 2 Diabetes During the COVID-19 Pandemic: Evidence From Louisiana Medicaid Claims.

Introduction: The impact of telehealth use on healthcare utilization is limited, especially among Medicaid beneficiaries with type 2 diabetes. Considering the rapid adoption of telehealth during the COVID-19 pandemic, this study examined associations between telehealth use and healthcare utilization among Medicaid beneficiaries with type 2 diabetes.

Methods: Using Louisiana Medicaid claims data from March 2019 to August 2021, the associations were examined using a difference-in-difference model with propensity score weighting.

5-Year simulation of diabetes-related complications in people treated with tirzepatide or semaglutide versus insulin glargine.

Aim: This study compared the 5-year incidence rate of macrovascular and microvascular complications for tirzepatide, semaglutide and insulin glargine in individuals with type 2 diabetes, using the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes simulation model.

Research Design And Methods: This study was a 5-year SURPASS-2 trial extrapolation, with an insulin glargine arm added as an additional comparator. The 1-year treatment effects of tirzepatide (5, 10 or 15 mg), semaglutide (1 mg) and insulin glargine on glycated haemoglobin, systolic blood pressure, low-density lipoprotein and body weights were obtained from the SUSTAIN-4 and SURPASS-2 trials.

Telehealth use and its impact on clinical outcomes in patients with type 2 diabetes during the COVID-19 pandemic.

Aim: To evaluate the impact of telehealth use during the COVID-19 pandemic on glycaemic control and other clinical outcomes among patients with type 2 diabetes.

Methods: We used electronic health records from the Research Action for Health Network (REACHnet) database for patients with type 2 diabetes who had telehealth visits and those who only received in-person care during the pandemic. A quasi-experimental method of difference-in-difference with propensity-score weighting was implemented to mitigate selection bias and to control for observed factors related to telehealth use.