The Targeted Management (TEAM) Intervention for Reducing Stroke Risk in African American Men: Rationale and Study Design of a Prospective Randomized Controlled Trial.

Background: African American (AA) male survivors of strokes or transient ischemic attacks (TIA) have the highest risk of recurrent stroke when compared to other racial-ethnic men. However, there is a paucity of evidence-based strategies, including organizational, educational, or behavioral interventions, that targets secondary stroke risk reduction in AA men.

Methods: Targeted Management for Reducing Stroke Risk (TEAM) is an ongoing, 6-month prospective, randomized controlled trial that will determine whether a curriculum-guided self-management approach, using peer dyads (men who had a stroke or TIA and their care partners) will improve post-stroke care in AA men.

Adoption of Health System Innovations: Evidence of Urban-Rural Disparities from the Ohio Primary Care Marketplace.

Background: Accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and the meaningful use of electronic health records (EHRs) generated particular attention during the last decade. Translating these reforms into meaningful increases in population health depends on improving the quality and clinical integration of primary care providers (PCPs). However, if these innovations spread more quickly among PCPs in urban and wealthier areas, then they could potentially worsen existing geographic disparities in health outcomes.

Improving Regional Blood Pressure Control: a Positive Deviance Tiered Intensity Approach.

Background: Accelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities.

Objective: To determine whether a positive deviance approach would improve blood pressure (BP) control across diverse health systems.

Design: Quality improvement study using 1-year cross sections of electronic health record data over 5 years (2013-2017).

"Making Sure We Are All Okay": Healthcare Workers' Strategies for Emotional Connectedness During the COVID-19 Pandemic.

Healthcare workers have been on the front lines throughout the COVID-19 pandemic, treating affected patients and navigating overwhelmed healthcare systems. Emotional connection has been associated with resilient outcomes following collective trauma. This qualitative study examined how healthcare workers define emotional connectedness during the COVID-19 pandemic and their adaptive emotional connection strategies.

The Risk of Acute Myocardial Infarction in Patients With Gastroesophageal Reflux Disease.

Background/aims: A number of inflammatory mediators have been documented to be elevated in gastroesophageal reflux disease (GERD). Similar inflammatory mediators are involved in coronary artery disease. Thus, the aim of the study is to determine if GERD is a risk factor for developing acute myocardial infarction (AMI).

Evaluating the Performance of Driver's License Agencies Using a Standardized Donor Ratio.

Department of Motor Vehicles (DMV) facilities are assessed based on the proportion of patrons who consent to donate. To evaluate the individual characteristics that may influence donation consent, we analyzed the most recent transactions of 9,767,839 patrons of 203 Ohio DMVs between January 1, 2014 and November 17, 2018. Patron age, gender, donor designation, and DMV location were linked via patron zip codes with census tract data on race, ethnicity, income, and education.

Opportunities, Pitfalls, and Alternatives in Adapting Electronic Health Records for Health Services Research.

Electronic health records (EHRs) offer the potential to study large numbers of patients but are designed for clinical practice, not research. Despite the increasing availability of EHR data, their use in research comes with its own set of challenges. In this article, we describe some important considerations and potential solutions for commonly encountered problems when working with large-scale, EHR-derived data for health services and community-relevant health research.

Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization.

Background: Adequacy of prenatal care is associated with fulfillment of postpartum sterilization requests, though it is unclear whether this relationship is indicative of broader social and structural determinants of health or reflects the mandatory Medicaid waiting period required before sterilization can occur. We evaluated the relationship between neighborhood disadvantage (operationalized by the Area Deprivation Index; ADI) and the likelihood of undergoing postpartum sterilization.

Methods: Secondary analysis of a single-center retrospective cohort study examining 8654 postpartum patients from 2012 to 2014, of whom 1332 (15.

Assessment of Physician Priorities in Delivery of Preventive Care.

Importance: Primary care physicians have limited time to discuss preventive care, but it is unknown how they prioritize recommended services.

Objective: To understand primary care physicians' prioritization of preventive services.

Design, Setting, And Participants: This online survey was administered to primary care physicians in a large health care system from March 17 to May 12, 2017.

12-Month Evaluation of an EHR-Supported Staff Role Change for Provision of Tobacco Cessation Care in 8 Primary Care Safety-Net Clinics.

Significance: Guidelines urge primary care practices to routinely provide tobacco cessation care (i.e., assess tobacco use, provide brief cessation advice, and refer to cessation support).

Using Preventive Health Alerts in the Electronic Health Record Improves Hepatitis C Virus Testing Among Infants Perinatally Exposed to Hepatitis C.

Background: Perinatal exposure to hepatitis C virus (HCV) is a major public health issue, and poor testing rates leave many children with infection unidentified. We sought to use the electronic health record (EHR) to promote guideline-directed HCV testing among infants born to mothers with HCV infection in an urban, safety-net hospital system.

Methods: Our study population was identified using our EHR database, Epic.

Primary Care Physician Factors Associated with Inbox Message Volume.

Introduction: The objective of this study was to better understand the relationship between panel size, full-time status, and estimated socioeconomic status of a patient panel with types and number of primary care clinician inbox messages.

Methods: The study used data from the Epic Signal database to examine inbox volume and types of messages for 86 primary care clinicians at 19 primary care sites. We measured correlations and performed multiple regression analysis to understand the relationship between inbox volume and types of messages and 3 factors: panel size, full-time status, and estimated socioeconomic status of patient panels.

Outcome measures in pediatric polypharmacy research: a scoping review.

Introduction: Various methods have been used to interpret the reports of pediatric polypharmacy across the literature. This is the first scoping review that explores outcome measures in pediatric polypharmacy research.

Objectives: The aim of our study was to describe outcome measures assessed in pediatric polypharmacy research.

Higher dose weekly fluoxetine in hemodialysis patients: A case series report.

Objective: The antidepressant medication fluoxetine at 90 mg dosed weekly is as effective and safe as standard formulation fluoxetine 20 mg dosed daily in patients with major depressive disorder. Weekly fluoxetine has not been well studied in hemodialysis patients, and doses beyond 90 mg/week have not been described in this population. This case series, derived from a larger study on depression in hemodialysis patients, describes the use of weekly fluoxetine at dosages beyond 90 mg/week.

Pre-diagnosis Multidisciplinary Tumor Board and Time to Staging in Lung Cancer: The Case Western MetroHealth Experience.

Introduction National guidelines support the discussion of cancer patients by multidisciplinary tumor boards (MTB). We researched whether early pre-diagnosis multidisciplinary tumor board discussions are associated with shorter times to staging in lung cancer. Methods We reviewed our institution's lung cancer and MTB registries to retrospectively study if an early discussion at pre-diagnostic MTB (pd-MTB) influenced the timeliness of diagnostic evaluation.

Neighborhood Disadvantage and Lung Cancer Incidence in Ever-Smokers at a Safety Net Health-Care System: A Retrospective Study.

Background: Neighborhood circumstances have an influence on multiple health outcomes, but the association between neighborhood conditions and lung cancer incidence has not been studied in sufficient detail. The goal of this study was to understand whether neighborhood conditions are independently associated with lung cancer incidence in ever-smokers after adjusting for individual smoking exposure and other risk factors.

Methods: A cohort of ever-smokers aged ≥ 55 years was assembled from 19 years of electronic health record data from our academic community health-care system.

A Scoping Review of Medications Studied in Pediatric Polypharmacy Research.

Purpose: The purpose of this study is to describe medications most commonly studied in pediatric polypharmacy research by pharmacologic classes and disease using a scoping review methodology.

Methods: A search of electronic databases was conducted in July 2019 that included Ovid Medline, PubMed, Elsevier Embase, and EBSCO CINAHL. Primary observational studies were selected if they evaluated polypharmacy as an aim, outcome, predictor, or covariate in children 0-21 years of age.

Low Awareness of and Access to Pre-exposure Prophylaxis But High Interest Among Heterosexual Women in Cleveland, Ohio.

Women received <5% of all US pre-exposure prophylaxis (PrEP) prescriptions in 2016. Among 351 heterosexual women surveyed in Cleveland, Ohio, 14.5% were aware of PrEP, 20.

"The coupons and stuff just made it possible": economic constraints and patient experiences of a produce prescription program.

Although produce prescription (PRx) programs have been shown to improve fruit and vegetable (FV) consumption, few studies have examined how economic constraints influence participant experience. We conducted a qualitative study of patient experience of a 3-month PRx program for hypertension (PRxHTN) including 3 safety-net clinics and 20 farmers' markets (FMs). We interviewed 23 PRxHTN participants using semistructured guides to understand their program experiences.

Meta-analysis and systematic review for the treatment of perpetrators of intimate partner violence.

Aim of this study is to investigate the effectiveness of different batterer intervention programs in reducing violence for male IPV perpetrators. The Cochrane Handbook for Systemic Reviews of Interventions guidelines for the process of conducting systematic reviews and meta-analysis were followed. Pooled together, overall these various intervention programs are effective in reducing violence for male perpetrators of IPV comparing post to pre-intervention [(pooled estimate = -0.

Clinician dashboard views and improvement in preventative health outcome measures: a retrospective analysis.

Background: Measuring and reporting outcome data is fundamental for health care systems to drive improvement. Our electronic health record built a dashboard that allows each primary care provider (PCP) to view real-time population health quality data of their patient panel and use that information to identify care gaps. We hypothesized that the number of dashboard views would be positively associated with clinical quality improvement.

Erythrocytosis is associated with intradialytic hypotension: a case series.

Background: For patients with end stage renal disease undergoing hemodialysis, erythrocytosis occurs rarely. Erythrocytosis increases the risk of thrombosis, which is a common complication in hemodialysis patients. The risk of thrombosis may also be increased by hypotension.

Primary Care Practice Workplace Social Capital: A Potential Secret Sauce for Improved Staff Well-Being and Patient Experience.

Patient experiences with the health-care system are increasingly seen as a vital measure of health-care quality. This study examined whether workplace social capital and employee outcomes are associated with patients' perceptions of care quality across multiple clinic sites in a diverse, urban safety net care setting. Data from clinic staff were collected using paper and pencil surveys and data from patients were collected via a telephone survey.