263 results match your criteria: "Durham Center of Innovation to Accelerate Discovery and Practice Transformation ADAPT[Affiliation]"

In the original version of this paper, an author was misidentified. The corrected author listing appears here, and has been updated in the online version.

View Article and Find Full Text PDF

As the number of Veterans enrolled in the Veterans Health Administration (VHA) and at risk for needing Long Term Services and Supports increases, VHA is shifting from institutional to Home and Community Based Services, such as the Veteran-Directed Care (VDC) program. VDC is a multi-sector program implemented as a collaboration between individual VHA medical centers (VAMCs) and Aging and Disability Network Agencies (ADNAs), entities that sit outside the VHA. Factors that affect establishment of effective multi-sector programs such as VDC are poorly understood, limiting ability to effectively deliver and scale programs.

View Article and Find Full Text PDF

Background: Compared to men, women have lower treatment rates for cardiovascular disease (CVD), are at higher risk for medication non-adherence and have different reasons for being non-adherent. The aim of this study was to synthesize and evaluate gender-specific adherence-promoting interventions for cardiovascular medication and gender-specific effects of gender-neutral interventions.

Methods: A systematic literature search was performed in PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from January 2007 to October 2019.

View Article and Find Full Text PDF

Objective: Compare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness.

Method: Primary trial analysis (n = 135) included patients with advanced cancer, congestive heart failure, or end-stage renal disease; Arm 1 received the Outlook intervention, addressing issues of life completion and preparation, and Arm 2 received relaxation meditation (RM). Primary outcomes at five weeks (primary endpoint) and seven weeks (secondary): completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACIT-Sp) subscales of faith, meaning, and peace.

View Article and Find Full Text PDF

Objectives: To evaluate differences in factors associated with self-reported medication non-adherence to insulin and non-insulin medications in patients with uncontrolled type 2 diabetes.

Methods: In this secondary analysis of a randomized trial in patients with obesity and uncontrolled type 2 diabetes, multivariable logistic regression was used to evaluate associations between several clinical factors (measured with survey questionnaires at study baseline) and self-reported non-adherence to insulin and non-insulin medications.

Results: Among 263 patients, reported non-adherence was 62% (52% for insulin, 55% for non-insulin medications).

View Article and Find Full Text PDF

Background: Medication adherence is essential for improving the health outcomes of patients. Various patient-reported outcome measures (PROMs) have been developed to measure medication adherence in patients. However, no study has summarized the psychometric properties of these PROMs to guide selection for use in clinical practice or research.

View Article and Find Full Text PDF

Background: Medication adherence is important in managing the progression of chronic diseases. A promising approach to reduce cognitive burden when measuring medication adherence lies in the use of computer-adaptive tests (CATs) or in the development of shorter patient-reported outcome measures (PROMs). However, the lack of an item bank currently hampers this progress.

View Article and Find Full Text PDF

Background: The novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopening strategies varied.

Objective: To estimate excess COVID-19 cases and deaths after reopening compared with trends prior to reopening for two groups of states: (1) states with an evidence-based reopening strategy, defined as reopening indoor dining after implementing a statewide mask mandate, and (2) states reopening indoor dining rooms before implementing a statewide mask mandate.

View Article and Find Full Text PDF

Selection Bias in Observational Studies of Palliative Care: Lessons Learned.

J Pain Symptom Manage

May 2021

Margolis Center for Health Policy, Duke University, Durham, North Carolina, USA; Sanford School of Public Policy, Duke University, Durham, North Carolina, USA; Social Science Research Institute, Duke University, Durham, North Carolina, USA.

Context: Palliative care (PC) programs are typically evaluated using observational data, raising concerns about selection bias.

Objectives: To quantify selection bias because of observed and unobserved characteristics in a PC demonstration program.

Methods: Program administrative data and 100% Medicare claims data in two states and a 20% sample in eight states (2013-2017).

View Article and Find Full Text PDF

Background: One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual "Shark Tank" competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support.

View Article and Find Full Text PDF

Background: Medication adherence to immunosuppressants in allogeneic stem cell transplantation (alloSCT) is essential to achieve favorable clinical outcomes (e.g. control of Graft-versus-Host Disease).

View Article and Find Full Text PDF

Efforts to improve cancer care primarily come from two fields: improvement science and implementation science. The two fields have developed independently, yet they have potential for synergy. Leveraging that synergy to enhance alignment could both reduce duplication and, more importantly, enhance the potential of both fields to improve care.

View Article and Find Full Text PDF

Attachment Style, Partner Communication, and Physical Well-Being among Couples Coping with Cancer.

Pers Relatsh

September 2020

Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.

Attachment styles may influence interpersonal strategies used to cope with stress. We examined links between attachment style, communicative behaviors, and physical well-being among 166 couples coping with cancer. Results of actor-partner interdependence mediation models indicated that insecure attachment styles were associated with greater self-report of two different and seemingly contradictory communicative behaviors (disclosure and holding back), which in turn were associated with poorer physical well-being.

View Article and Find Full Text PDF

Objective: To characterize operative care for cleft lip and/or palate (CL/P) based on location (ie, from American Cleft Palate Craniofacial Association [ACPA]-approved multidisciplinary teams or from community providers).

Design: Cross-sectional analysis of Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery & Services Database databases for North Carolina from 2012 to 2015.

Setting/patients And Main Outcome Measures: Clinical encounters for children with CL/P undergoing operative procedures were identified, classified by location as "Team" versus "Community," and characterized by demographic, geographic, clinical, and procedural factors.

View Article and Find Full Text PDF

Aims: Type 2 diabetes (T2D) accelerates progression of chronic liver disease to cirrhosis, yet the effects of most glucose-lowering drugs (GLDs) on cirrhosis risk in T2D are unknown. To address this gap, we compared cirrhosis risk following initiation of newer second-line GLDs vs. thiazolidinediones (TZDs), which improve histology in non-alcoholic fatty liver disease.

View Article and Find Full Text PDF

Background: The CAregiver Perceptions About CommunIcaTion with Clinical Team members (CAPACITY) instrument measures how care partners perceive themselves to be supported by the patient's health care team and their experiences communicating with the team.

Objectives: The objective of this study was to assess the measurement properties (ie, structural validity of the construct and internal consistency) of the CAPACITY instrument in care partners of patients with cognitive impairment, and to examine whether care partner health literacy and patient cognitive impairment are associated with a higher or lower CAPACITY score.

Research Design: This was a retrospective cohort study.

View Article and Find Full Text PDF

Background/objectives: To describe the caregiving experiences and physical and emotional needs of family members and friends who provide care to veterans with mental, physical, and cognitive comorbidities.

Design: Cross-sectional study.

Setting: National telephone surveys administered from 2017 to 2019.

View Article and Find Full Text PDF

Impact of bystander-focused public health interventions on cardiopulmonary resuscitation and survival: a cohort study.

Lancet Public Health

August 2020

Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore.

Background: Bystander cardiopulmonary resuscitation (CPR) increases an individual's chance of survival from out-of-hospital cardiac arrest (OHCA), but the frequency of bystander CPR is low in many communities. We aimed to assess the cumulative effect of CPR-targeted public health interventions in Singapore, which were incrementally introduced between 2012 and 2016.

Methods: We did a secondary analysis of a prospective cohort study of adult, non-traumatic OHCAs, through the Singapore registry.

View Article and Find Full Text PDF

Purpose: The purpose of this study was to examine the prevalences of CVD, CVD risk factors. and health behaviors among cancer survivor-spouse dyads, assess how these prevalences differ by role (survivor vs spouse) and gender, and report congruences in health behaviors between survivors and their spouses.

Methods: We identified 1026 survivor-spouse dyads from the 2010-2015 Medical Expenditure Panel Survey.

View Article and Find Full Text PDF

Background: Patients with dementia and multiple chronic conditions (MCC) frequently experience polypharmacy, increasing their risk of adverse drug events.

Objectives: To elucidate patient, family, and physician perspectives on medication discontinuation and recommended language for deprescribing discussions in order to inform an intervention to increase awareness of deprescribing among individuals with dementia and MCC, family caregivers and primary care physicians. We also explored participant views on culturally competent approaches to deprescribing.

View Article and Find Full Text PDF

Cancer incidence and treatment utilization patterns at a regional cancer center in Tanzania from 2008-2016: Initial report of 2,772 cases.

Cancer Epidemiol

August 2020

Bugando Medical Centre, Mwanza, Tanzania; Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Pediatric Hematology/Oncology, Duke University, Durham, NC, USA. Electronic address:

Purpose: To describe cancer incidence and treatment utilization patterns at the regional cancer referral center for the Lake Zone of northwestern Tanzania from 2008 to 2016.

Methods: This descriptive, retrospective study reviewed all cancer cases recorded in the Bugando Cancer Registry (BCR), a clinical and pathology based registry at the only cancer referral hospital in the region. Primary tumor site, method of diagnosis, HIV status, and cancer treatment were reported.

View Article and Find Full Text PDF

Objectives: To examine the effect of the Department of Veterans Affairs' (VA) Program of Comprehensive Assistance for Caregivers (PCAFC) on total VA health care costs for Veterans.

Data Sources: VA claims.

Study Design: Using a pre-post cohort design with nonequivalent control group, we estimated the effect of PCAFC on total VA costs up through 6 years.

View Article and Find Full Text PDF

Objective: To understand the experiences of veterans with disabilities and caregiving needs who use Department of Veterans Affairs (VA) vocational and education services, including Supported Employment, the Post-9/11 GI Bill, and Vocational Rehabilitation and Employment.

Method: We conducted 26 joint semistructured interviews with post-9/11 veterans who had used at least one of three vocational and education services, and their family members who were enrolled in a VA Caregiver Support Program.

Results: VA vocational and education services helped veterans with disabilities transition from the military into civilian life by providing skills and incremental exposure to engaging in everyday life tasks.

View Article and Find Full Text PDF