IU Indianapolis ScholarWorks :: Browsing by Author "Comer, Amber R."

Browsing by Author "Comer, Amber R."

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Assessment of Discordance Between Surrogate Care Goals and Medical Treatment Provided to Older Adults With Serious Illness
(JAMA Network, 2020-05) Comer, Amber R.; Hickman, Susan E.; Slaven, James E.; Monahan, Patrick O.; Sachs, Greg A.; Wocial, Lucia D.; Burke, Emily S.; Torke, Alexia M.; Health Sciences, School of Health and Human Sciences
Importance: An important aspect of high-quality care is ensuring that treatments are in alignment with patient or surrogate decision-maker goals. Treatment discordant with patient goals has been shown to increase medical costs and prolong end-of-life difficulties. Objectives: To evaluate discordance between surrogate decision-maker goals of care and medical orders and treatments provided to hospitalized, incapacitated older patients. Design, setting, and participants: This prospective cohort study included 363 patient-surrogate dyads. Patients were 65 years or older and faced at least 1 major medical decision in the medical and medical intensive care unit services in 3 tertiary care hospitals in an urban Midwestern area. Data were collected from April 27, 2012, through July 10, 2015, and analyzed from October 5, 2018, to December 5, 2019. Main outcomes and measures: Each surrogate's preferred goal of care was determined via interview during initial hospitalization and 6 to 8 weeks after discharge. Surrogates were asked to select the goal of care for the patient from 3 options: comfort-focused care, life-sustaining treatment, or an intermediate option. To assess discordance, the preferred goal of care as determined by the surrogate was compared with data from medical record review outlining the medical treatment received during the target hospitalization. Results: A total of 363 dyads consisting of patients (223 women [61.4%]; mean [SD] age, 81.8 [8.3] years) and their surrogates (257 women [70.8%]; mean [SD] age, 58.3 [11.2] years) were included in the analysis. One hundred sixty-nine patients (46.6%) received at least 1 medical treatment discordant from their surrogate's identified goals of care. The most common type of discordance involved full-code orders for patients with a goal of comfort (n = 41) or an intermediate option (n = 93). More frequent in-person contact between surrogate and patient (adjusted odds ratio [AOR], 0.43; 95% CI, 0.23-0.82), patient residence in an institution (AOR, 0.44; 95% CI, 0.23-0.82), and surrogate-rated quality of communication (AOR, 0.98; 95% CI, 0.96-0.99) were associated with lower discordance. Surrogate marital status (AOR for single vs married, 1.92; 95% CI, 1.01-3.66), number of family members involved in decisions (AOR for ≥2 vs 0-1, 1.84; 95% CI, 1.05-3.21), and religious affiliation (AOR for none vs any, 4.87; 95% CI, 1.12-21.09) were associated with higher discordance. Conclusions and relevance: This study found that discordance between surrogate goals of care and medical treatments for hospitalized, incapacitated patients was common. Communication quality is a modifiable factor associated with discordance that may be an avenue for future interventions.
Barriers to guideline-concordant antibiotic use among inpatient physicians: A case vignette qualitative study
(Wiley, 2016-03) Livorsi, D.; Comer, Amber R.; Matthias, Marianne S.; Perencevich, E.N.; Bair, M.J.; Department of Communication Studies, School of Liberal Arts
BACKGROUND: Greater adherence to antibiotic-prescribing guidelines may promote more judicious antibiotic use, which could benefit individual patients and society at large. OBJECTIVE: To assess physician knowledge and acceptance of antibiotic-prescribing guidelines through the use of case vignettes. DESIGN: We conducted semistructured interviews with 30 inpatient physicians. Participants were asked to respond to 3 hypothetical case vignettes: (1) a skin and soft tissue infection (SSTI), (2) suspected hospital-acquired pneumonia (HAP), and (3) asymptomatic bacteriuria (ASB). All participants received feedback according to guidelines from the Infectious Diseases Society of America (IDSA) and were asked to discuss their level of comfort with following these guidelines. SETTING: Two acute care teaching hospitals for adult patients. INTERVENTION: None. MEASUREMENTS: Data from transcribed interviews were analyzed using emergent thematic analysis. RESULTS: Participants were receptive to guidelines and believed they were useful. However, participants' responses to the case vignettes demonstrated that IDSA guideline recommendations were not routinely followed for SSTI, HAP, and ASB. We identified 3 barriers to guideline-concordant care: (1) physicians' lack of awareness of specific guideline recommendations; (2) tension between adhering to guidelines and the desire to individualize patient care; and (3) skepticism of certain guideline recommendations. CONCLUSIONS: Case vignettes may be useful tools to assess physician knowledge and acceptance of antibiotic-prescribing guidelines. Using case vignettes, we identified 3 barriers to following IDSA guidelines. Efforts to improve guideline-concordant antibiotic prescribing should focus on reducing such barriers at the local level.
Code status orders in hospitalized patients with COVID-19
(Elsevier, 2023-08-23) Comer, Amber R.; Fettig, Lyle; Bartlett, Stephanie; Sinha, Shilpee; D’Cruz, Lynn; Odgers, Aubrey; Waite, Carly; Slaven, James E.; White, Ryan; Schmidt, Amanda; Petras, Laura; Torke, Alexia M.; Medicine, School of Medicine
Background: The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19. Methods: A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest. DNACPR code status orders including, DNI orders, demographics, labs, COVID-19 treatments, clinical interventions during hospitalization, and outcome measures including mortality, discharge disposition, and hospice utilization were collected. Patients were divided into two time periods (early and late) by timing of hospitalization during the first wave of the pandemic (March-October 2020). Results: Among 1375 hospitalized patients with COVID-19, 19% (n = 258) of all patients had a documented DNACPR and/or DNI order. In multivariable analysis, age (older) p =< 0.01, OR 1.12 and hospitalization early in the pandemic p = 0.01, OR 2.08, were associated with having a DNACPR order. Median day from DNACPR order to death varied between cohorts p => 0.01 (early cohort 5 days versus late cohort 2 days). In-hospital mortality did not differ between cohorts among patients with DNACPR orders, p = 0.80. Conclusions: There was a higher prevalence of DNACPR and/or DNI orders and these orders were written earlier in the hospital course for patients hospitalized early in the pandemic versus later despite similarities in clinical characteristics and medical interventions. Changes in clinical care between cohorts may be due to fear of resource shortages and changes in knowledge about COVID-19.
Determinants of Telerehabilitation Acceptance among Patients Attending Pulmonary Rehabilitation Programs in the United States
(Wolters Kluwer, 2021) Almojaibel, Abdullah A.; Munk, Niki; Goodfellow, Lynda T.; Fisher, Thomas F.; Miller, Kristine K.; Comer, Amber R.; Bakas, Tamilyn; Justiss, Michael D.; Health Sciences, School of Health and Human Sciences
Background: Pulmonary rehabilitation (PR) is an interdisciplinary intervention designed to improve the physical status and the psychological condition of people with chronic respiratory diseases. To improve patients' participation in PR programs, telerehabilitation has been introduced. Objective: This study aimed to identify factors that could influence the intention to use telerehabilitation among patients attending traditional PR programs. Methods: This cross-sectional study recruited subjects attending the PR centers in the hospitals of the Indiana State University, United States of America, between January and May 2017. Data were collected using self-administered Tele-Pulmonary Rehabilitation Acceptance Scale (TPRAS). TPRAS had two subscales: perceived usefulness and perceived ease of use. Behavioral intention (BI) was the dependent variable, and all responses were dichotomized into positive and negative intention to use. Multiple logistic regressions were performed to assess the influence of variables on the intention to use telerehabilitation. Results: A total of 134 respondents were included in this study, of which 61.2% indicated positive intention to use telerehabilitation. Perceived usefulness was a significant predictor of the positive intentions to use of telerehabilitation. Duration of respiratory disease was negatively associated with the use of telerehabilitation. Conclusion: Perceived usefulness was a significant predictor of using telerehabilitation. The findings of this study may be useful for health-care organizations in improving the adoption of telerehabilitation or in its implementation. Future telerehabilitation acceptance studies could explore the effects of additional factors including computer literacy and culture on the intention to use telerehabilitation.
Development and Validation of the Tele-Pulmonary Rehabilitation Acceptance Scale
(Daedalus, 2019) Almojaibel, Abdullah A.; Munk, Niki; Goodfellow, Lynda T.; Fisher, Thomas F.; Miller, Kristine K.; Comer, Amber R.; Bakas, Tamilyn; Justiss, Michael D.; Health Sciences, School of Health and Rehabilitation Sciences
BACKGROUND: Using telehealth in pulmonary rehabilitation (telerehabilitation) is a new field of health-care practice. To successfully implement a telerehabilitation program, measures of acceptance of this new type of program need to be assessed among potential users. The purpose of this study was to develop a scale to measure acceptance of using telerehabilitation by health-care practitioners and patients. METHODS: Three objectives were met (a) constructing a modified scale of the technology acceptance model, (b) judging the items for content validity, and (c) judging the scale for face validity. Nine experts agreed to participate and evaluate item relevance to theoretical definitions of domains. To establish face validity, 7 health-care practitioners and 5 patients were interviewed to provide feedback about the scale's clarity and ease of reading. RESULTS: The final items were divided into 2 scales that reflected the health-care practitioner and patient responses. Each scale included 3 subscales: perceived usefulness, perceived ease of use, and behavioral intention. CONCLUSIONS: The 2 scales, each with 3 subscales, exhibited evidence of content validity and face validity. The 17-item telerehabilitation acceptance scale for health-care practitioners and the 13-item telerehabilitation acceptance scale among patients warrant further psychometric testing as valuable measures for pulmonary rehabilitation programs.
Documentation of advance care planning forms in patients with amyotrophic lateral sclerosis
(Wiley, 2022-02) Takacs, Sara M.; Comer, Amber R.; Neurology, School of Medicine
Introduction/Aims Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by progressive weakness. Survival is typically only a few years from symptom onset. The often-predictable disease course creates opportunities to complete advance care planning (ACP) forms. The Physician Orders for Life-Sustaining Treatment (POLST) is a broadly used ACP paradigm to communicate end-of-life wishes but has not been well-studied in the ALS population. Methods In this retrospective chart review study, patients diagnosed with ALS seen between 2014 and 2018 at an academic ALS center were identified. Demographic information, clinical characteristics, and ACP data were collected. Results Of 513 patients identified, 30% had an ACP document. POLST forms were competed in 16.6% of patients with 73.8% of forms signed by a neurologist. Only 5.1% of patients saw a palliative care physician. Palliative care consultation was associated with having an POLST on file (P < .001). Patients with completed POLST forms were significantly more likely to have been seen in clinic more frequently (P < .001) and have a lower ALS Functional Rating Scale—Revised score on last visit (P = .005). Discussion Less than one third of patients with ALS completed an ACP document, and only a small percentage completed POLST forms. The data suggest a need for greater documentation of goals of care in the ALS population.
An educational video improves physician knowledge of a public health care law that affects patient care during hospital clinical practice
(Sage, 2021-05-31) Comer, Amber R.; Salven, James; Torke, Alexia; Medicine, School of Medicine
When public health laws are passed that affect clinical practice within hospitals, it is important to educate physicians about best practices in implementing these laws into routine patient care in hospitals. An educational video was developed to inform physicians about a new state public health care law. This study sought to determine whether an educational video about a new state public health care law improves physicians' knowledge of the law and how to implement the law during clinical practice. A total of n=33 internal medicine physicians participated in this study. This study found that an educational video was successful in increasing physician knowledge about a new public health care law that affects clinical practice. The utilization of validated educational videos may provide a useful resource when attempting to provide education about new public health laws that effect the provision of medical care.
The effect of a state health care consent law on patient care in hospitals: A survey of physicians
(Sciedu Press, 2018-03-05) Comer, Amber R.; Gaffney, Margaret; Stone, Cynthia; Torke, Alexia; Physical Therapy, School of Health and Human Sciences
Objective: When a patient cannot make medical decisions for him or herself, and has not appointed a healthcare representative, default state healthcare consent laws determine who is able to make healthcare decisions for the patient. The narrow construction of some state laws leaves many patients in situations where the closest person to the patient does not qualify as a representative under the law, or where the patient has too many representatives and a consensus cannot be reached on the patient’s medical care. Methods: In order to determine how state healthcare consent laws affect patient care in hospitals, a survey of 412 Indiana physicians was conducted. Results: The data shows 53.8% of physicians experienced a delay in patient care because they were unable to identify a legally appropriate health care representative. Almost half (46.01%) of physicians experienced delay of patient care due to the inability to identify a ﬁnal decision maker when disputes arose between multiple legal representatives. Conclusions: The results of this study have important implications for hospital administrators as a delay in patient care can be costly and unnecessarily utilizes hospital resources. Additionally, the results of this study have important implications for the status of state surrogate decision making laws. Amending state laws to include more potential surrogates, has the potential to minimize delays in patient care and ensure that appropriate surrogates are making medical care decisions for patients without the undue burden of court intervention.
Electric Scooters (e-scooters): Assessing the Threat to Public Health and Safety in Setting Policies: Assessing e-scooter policies
(Society of Practitioners of Health Impact Assessment, 2020-11) Comer, Amber R.; Apathy, Nate; Waite, Carly; Bestmann, Zoe; Bradshaw, Jacob; Burchfield, Emily; Harmon, Brittany; Legg, Rebekah; Meyer, Star; O'Brien, Patrick; Sabec, Micha; Sayeed, Jami; Weaver, Alexis; D'Cruz, Lynn; Bartlett, Stephanie; Marchand, McKenzi; Zepeda, Isabel; Endri, Katelyn; Finnell, John T.; Grannis, Shaun; Silverman, Ross D.; Embi, Peter J.; Health Sciences, School of Health and Human Sciences
Objective: To determine self-reported incidences of health and safety hazards among persons who ride rentable electric scooters (e-scooters), knowledge of e-scooter laws, and attitudes and perceptions of the health and safety of e-scooter usage. Methods: A cross-sectional survey of n= 561 e-scooter riders and non-riders was conducted during June of 2019. Results: Almost half of respondents (44%) report that e-scooters pose a threat to the health and safety of riders. Riders and non-riders disagree regarding the hazards that e-scooters pose to pedestrians. Among riders, 15% report crashing or falling off an e-scooter. Only 2.5% of e-scooter riders self-report that they always wear a helmet while riding. Conclusions: E-scooter riders report substantial rates of harmful behavior and injuries. Knowledge of e-scooter laws is limited, and e-scooters introduce threats to the health and safety of riders, pedestrians on sidewalks, and automobile drivers. Enhanced public health interventions are needed to educate about potential health risks and laws associated with e-scooter use and to ensure health in all policies. Additionally, greater consideration should be given to public health, safety, and injury prevention when passing relevant state and local e-scooter laws.
The Ethical Allocation of Remdesivir Within Hospitals
(2021) Comer, Amber R.; Health Sciences, School of Health and Human Sciences
Recent evidence has shown that remdesivir may shorten length of hospital stay and recovery in COVID-19 patients. Many hospitals are experiencing shortages of remdesivir and are being forced to determine systems for the ethical allocation of this drug. Ethical allocation of remdesivir is imperative for upholding principles of justice during public health crisis.2 Currently, there is no consensus on the ethical distribution of remdesivir to patients within hospitals. This article discusses places of consensus, variance, and limitations of hospital level remdesivir allocation policies throughout the US during the COVID-19 pandemic.

Browsing by Author "Comer, Amber R."

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