Browsing by Author "Larkin, Angela"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Correction to: The “State of Implementation” Progress Report (SIPREP): a pilot demonstration of a navigation system for implementation
    (BMC, 2020-12-03) Miech, Edward J.; Larkin, Angela; Lowery, Julie C.; Butler, Andrew J.; Pettey, Kristin M.; Rattray, Nicholas A.; Penney, Lauren S.; Myers, Jennifer; Damush, Teresa M.; Regenstrief Institute, IU School of Medicine
    Following publication of the original article [1], it was reported that the incorrect version of a reviewer’s comments were published. The correct version has now been uploaded and the original article has been corrected.
  • Thumbnail Image
    Item
    A Method to Quantify Mean Hypertension Treatment Daily Dose Intensity Using Health Care System Data
    (American Medical Association, 2021-01-04) Min, Lillian; Ha, Jin-Kyung; Aubert, Carole E.; Hofer, Timothy P.; Sussman, Jeremy B.; Langa, Kenneth M.; Tinetti, Mary; Hyungjin Myra, Kim; Maciejewski, Matthew L.; Gillon, Leah; Larkin, Angela; Chan, Chiao-Li; Kerr, Eve A.; Bravata, Dawn; Cushman, William C.; Medicine, School of Medicine
    Importance: Simple measures of hypertension treatment, such as achievement of blood pressure (BP) targets, ignore the intensity of treatment once the BP target is met. High-intensity treatment involves increased treatment burden and can be associated with potential adverse effects in older adults. A method was previously developed to identify older patients receiving intense hypertension treatment by low BP and number of BP medications using national Veterans Health Administration and Medicare Part D administrative pharmacy data to evaluate which BP medications a patient is likely taking on any given day. Objective: To further develop and validate a method to more precisely quantify dose intensity of hypertension treatment using only health system administrative pharmacy fill data. Design, setting, and participants: Observational, cross-sectional study of 319 randomly selected older veterans in the national Veterans Health Administration health care system who were taking multiple BP-lowering medications and had a total of 3625 ambulatory care visits from July 1, 2011, to June 30, 2013. Measure development and medical record review occurred January 1, 2017, through November 30, 2018, and data analysis was conducted from December 1, 2019, to August 31, 2020. Main outcomes and measures: For each BP-lowering medication, a moderate hypertension daily dose (HDD) was defined as half the maximum dose above which no further clinical benefit has been demonstrated by that medication in hypertension trials. Patients' total HDD was calculated using pharmacy data (pharmacy HDDs), accounting for substantial delays in refills (>30 days) when a patient's pill supply was stretched (eg, cutting existing pills in half). As an external comparison, the pharmacy HDDs were correlated with doses manually extracted from clinicians' visit notes (clinically noted HDDs). How well the pharmacy HDDs correlated with clinically noted HDDs was calculated (using C statistics). To facilitate interpretation, HDDs were described in association with the number of medications. Results: A total of 316 patients (99.1%) were male; the mean (SD) age was 75.6 (7.2) years. Pharmacy HDDs were highly correlated (r = 0.92) with clinically noted HDDs, with a mean (SD) of 2.7 (1.8) for pharmacy HDDs and 2.8 (1.8) for clinically noted HDDs. Pharmacy HDDs correlated with high-intensity, clinically noted HDDs ranging from a C statistic of 92.8% (95% CI, 92.0%-93.7%) for 2 or more clinically noted HDDs to 88.1% (95% CI, 85.5%-90.6%) for 6 or more clinically noted HDDs. Conclusions and relevance: This study suggests that health system pharmacy data may be used to accurately quantify hypertension regimen dose intensity. Together with clinic-measured BP, this tool can be used in future health system-based research or quality improvement efforts to fine-tune, manage, and optimize hypertension treatment in older adults.
  • Thumbnail Image
    Item
    The "State of Implementation" Progress Report (SIPREP): a pilot demonstration of a navigation system for implementation
    (BMC, 2020-11-05) Miech, Edward J.; Larkin, Angela; Lowery, Julie C.; Butler, Andrew J.; Pettey, Kristin M.; Rattray, Nicholas A.; Penney, Lauren S.; Myers, Jennifer; Damush, Teresa M.; Regenstrief Institute, IU School of Medicine
    BACKGROUND: Implementation of new clinical programs across diverse facilities in national healthcare systems like the Veterans Health Administration (VHA) can be extraordinarily complex. Implementation is a dynamic process, influenced heavily by local organizational context and the individual staff at each medical center. It is not always clear in the midst of implementation what issues are most important to whom or how to address them. In recognition of these challenges, implementation researchers within VHA developed a new systemic approach to map the implementation work required at different stages and provide ongoing, detailed, and nuanced feedback about implementation progress. METHODS: This observational pilot demonstration project details how a novel approach to monitoring implementation progress was applied across two different national VHA initiatives. Stage-specific grids organized the implementation work into columns, rows, and cells, identifying specific implementation activities at the site level to be completed along with who was responsible for completing each implementation activity. As implementation advanced, item-level checkboxes were crossed off and cells changed colors, offering a visual representation of implementation progress within and across sites across the various stages of implementation. RESULTS: Applied across two different national initiatives, the SIPREP provided a novel navigation system to guide and inform ongoing implementation within and across facilities. The SIPREP addressed different needs of different audiences, both described and explained how to implement the program, made ample use of visualizations, and revealed both what was happening and not happening within and across sites. The final SIPREP product spanned distinct stages of implementation. CONCLUSIONS: The SIPREP made the work of implementation explicit at the facility level (i.e., who does what, and when) and provided a new common way for all stakeholders to monitor implementation progress and to help keep implementation moving forward. This approach could be adapted to a wide range of settings and interventions and is planned to be integrated into the national deployment of two additional VHA initiatives within the next 12 months.