Browsing by Author "Rivera, Rebecca L."

Now showing 1 - 6 of 6
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    Changes in Health Information Exchange Use Behavior After Introduction of a Fast Healthcare Interoperability Resources (FHIR) Application
    (American Medical Informatics Association, 2025-05-22) Kampman, Haleigh M.; Rivera, Rebecca L.; Park, Seho; Schaffer, Jason T.; Hancock, Amy; Rahurkar, Saurabh; Musey, Paul; Kuhn, Diane; Vest, Joshua R.; Schleyer, Titus K.; Health Policy and Management, Richard M. Fairbanks School of Public Health
    The aim of our study was to characterize emergency department clinicians' health information exchange (HIE) use patterns after the implementation of a Fast Healthcare Interoperability Resources (FHIR) application. Using longitudinal electronic health record log data, we categorized HIE use behavior as: no HIE use (0), Web-based viewer use only (1), FHIR application use only (2), or Web-based viewer and FHIR application use (3). We sequenced HIE use behavior from September 2019 to February 2023, then employed hierarchical agglomerative clustering to identify clinician characteristics associated with each HIE use pattern. Our results showed four usage patterns representing (1) clinicians who "lagged" in HIE use and continued as sporadic HIE users (n=66, 46.1%), (2) "late adopters" who had more consistent usage over time (n=32, 22.4%), (3) "legacy users" whose preferred modality was the Web-based viewer (n=25, 17.5%), and (4) "mixed modality users" who displayed frequent changes in HIE access modality (n=20, 14.0%).
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    Delivering Food Resources and Kitchen Skills (FoRKS) to Adults with Food Insecurity and Hypertension: A Pilot Study
    (MDPI, 2023-03-17) Rivera, Rebecca L.; Adams, Mariah; Dawkins, Emily; Carter, Amy; Zhang, Xuan; Tu, Wanzhu; Peña, Armando; Holden, Richard J.; Clark, Daniel O.; Medicine, School of Medicine
    Food insecurity affects nearly 50 million Americans and is linked to cardiovascular disease risk factors and health disparities. The purpose of this single-arm pilot study was to determine the feasibility of a 16-week dietitian-led lifestyle intervention to concurrently address food access, nutrition literacy, cooking skills, and hypertension among safety-net primary care adult patients. The Food Resources and Kitchen Skills (FoRKS) intervention provided nutrition education and support for hypertension self-management, group kitchen skills and cooking classes from a health center teaching kitchen, medically tailored home-delivered meals and meal kits, and a kitchen toolkit. Feasibility and process measures included class attendance rates and satisfaction and social support and self-efficacy toward healthy food behaviors. Outcome measures included food security, blood pressure, diet quality, and weight. Participants (n = 13) were on average {mean (SD)} aged 58.9 ± 4.5 years, 10 were female, and 12 were Black or African American. Attendance averaged 19 of 22 (87.1%) classes and satisfaction was rated as high. Food self-efficacy and food security improved, and blood pressure and weight declined. FoRKS is a promising intervention that warrants further evaluation for its potential to reduce cardiovascular disease risk factors among adults with food insecurity and hypertension.
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    Dietary Quality and Usual Intake of Underconsumed Nutrients and Related Food Groups Differ by Food Security Status for Rural, Midwestern Food Pantry Clients
    (Elsevier, 2020) Wright, Breanne N.; Tooze, Janet A.; Bailey, Regan L.; Liu, Yibin; Rivera, Rebecca L.; McCormack, Lacey; Stluka, Suzanne; Franzen-Castle, Lisa; Henne, Becky; Mehrle, Donna; Remley, Dan; Eicher-Miller, Heather A.; Medicine, School of Medicine
    Background: Food pantry users represent a predominantly food insecure population, yet dietary intake may differ among food secure (FS), low FS, and very low FS clients. Usual intake of food groups and nutrients by food security status has not previously been compared among food pantry clients. Objective: This study aimed to estimate the usual intakes of underconsumed nutrients (ie, potassium; dietary fiber; choline; magnesium; calcium; vitamins A, D, E, and C; and iron) and related food groups (ie, vegetables, fruits, whole grains, and dairy) and dietary quality, and to evaluate their relationship with food security status. Design: This cross-sectional, secondary analysis used baseline data from a prior intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected. Participants/setting: This community-based study included a convenience sample of adult, midwestern food pantry clients (N=579) recruited from August to November 2014. Main outcome measures: Main outcomes evaluated were Healthy Eating Index-2010 scores and usual intakes of underconsumed nutrients and related food groups. Statistical analyses performed: Linear regression models and the National Cancer Institute method, adjusting for confounders, were used to estimate associations of food security with diet quality and usual intake, respectively. Results: Being FS was associated with a higher whole grains HEI-2010 score and higher mean usual intake of whole grains compared with being low FS. Being FS was associated with higher usual intakes of iron and dairy compared with being very low FS. Being FS was associated with a higher mean usual intake of dark green vegetables compared with being low FS and very low FS. Usual intakes were below federal guidance for all subgroups of food security. Conclusions: Although food security status may differentiate dietary intake among food pantry clients, improvements are needed among all clients.
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    Directly Integrating Health Information Exchange (HIE) Data with the Electronic Health Record Increases HIE Use by Emergency Department Clinicians
    (Thieme, 2023) Rivera, Rebecca L.; Hosler, Heidi; Jang, Jeong Hoon; Schaffer, Jason T.; Price, John; Vest, Joshua R.; Schleyer, Titus K.; Medicine, School of Medicine
    Objectives: This article (1) develops a Fast Healthcare Interoperability Resources app, Health Dart, that integrates information from Indiana's community health information exchange (HIE), the Indiana Network for Patient Care (INPC), directly with Cerner, an electronic health record (EHR), and (2) evaluates the effect of Health Dart's implementation on HIE use. Methods: Health Dart was implemented in 14 Indiana University Health emergency departments (EDs) using a stepped-wedge study design. We analyzed rates of INPC use in 286,175 ED encounters between October 1, 2019 and December 31, 2020. Logistic regression was used to model the probability of INPC use given the implementation context, such as user interface (UI) enhancements and the coronavirus disease 2019 pandemic. Results: INPC use increased by 131% across all encounters (from 3.6 to 8.3%; p < 0.001) after Health Dart implementation. INPC use increased by 144% (from 3.6 to 8.8%; p < 0.001) more than 2 months postimplementation. After UI enhancements, postimplementation INPC use increased by 123% (from 3.5 to 7.8%) compared to 181% (from 3.6 to 10.1%; p < 0.001) in postimplementation encounters that occurred before UI enhancements. During the pandemic, postimplementation INPC use increased by 135% (from 3.4 to 8.0%; p < 0.001) compared to 178% (from 3.6 to 10%; p < 0.001) in postimplementation encounters that occurred before the pandemic. Statistical significance was determined using 95% confidence intervals (α = 0.05). Conclusion: Direct integration of HIE information into an EHR substantially increased frequency of HIE use, but the effect was weakened by the UI enhancements and pandemic. HIE information integrated into EHRs in the form of problem-oriented dashboards can potentially make information retrieval more efficient and effective for clinicians.
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    Supplemental Nutrition Assistance Program-Education Improves Food Security Independent of Food Assistance and Program Characteristics
    (MDPI, 2020-08-29) Eicher-Miller, Heather A.; Rivera, Rebecca L.; Sun, Hanxi; Zhang, Yumin; Maulding, Melissa K.; Abbott, Angela R.; Medicine, School of Medicine
    The purpose of this project was to determine whether consistent food assistance program participation or changes in participation over time mediated or moderated the effect of federal nutrition education through the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) on food security and determine the associations of SNAP-Ed program delivery characteristics with change in food security. This secondary analysis used data from a randomized controlled trial from September 2013 through April 2015. SNAP-Ed-eligible participants (n = 328; ≥18 years) in households with children were recruited from 39 counties in Indiana, USA. The dependent variable was one year change in household food security score measured using the United States Household Food Security Survey Module. Assessment of mediation used Barron-Kenny analysis and moderation used interactions of food assistance program use and changes over time with treatment group in general linear regression modeling. Program delivery characteristics were investigated using mixed linear regression modeling. Results showed that neither consistent participation nor changes in food assistance program participation over time mediated nor moderated the effect of SNAP-Ed on food security and neither were SNAP-Ed program delivery characteristics associated with change in food security over the one year study period. SNAP-Ed directly improved food security among SNAP-Ed-eligible Indiana households with children regardless of food assistance program participation and changes over time or varying program delivery characteristics.
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    The Food Resources and Kitchen Skills intervention: Protocol of a randomized controlled trial
    (Public Library of Science, 2025-02-06) Peña, Armando; Dawkins, Emily; Adams, Mariah; Moser, Lyndsi R.; Carter, Amy; Rivera, Rebecca L.; Reinoso, Deanna; Tu, Wanzhu; Holden, Richard J.; Clark, Daniel O.; Psychiatry, School of Medicine
    Introduction: Individuals with food insecurity are disproportionately burdened by hypertension (HTN) and type 2 diabetes and face greater barriers to self-managing these conditions. Methods: Food Resources and Kitchen Skills (FoRKS) is an ongoing 2-arm parallel randomized controlled trial (RCT) that will enroll 200 adults (35-75 y) with food insecurity and elevated systolic blood pressure (≥120 mmHg) at a large federally qualified health center (FQHC) network in Central Indiana. Blood pressure is measured using an ambulatory blood pressure monitoring (ABPM) device. The (FoRKS, N = 100) intervention integrates hypertension self-management education and support (SMES) with a home-delivered ingredient kit and cooking skills program (16 weeks). Enhanced Usual Care (EUC, N = 100) includes usual care services by the FQHC network, SMES classes (separate from FoRKS), and grocery assistance. This paper describes the protocol for this RCT that will: 1) test the efficacy of FoRKS compared to EUC for reducing systolic blood pressure using an intention to treat protocol, 2) identify behavior change levers (e.g., engagement, social support) and their associations with change in food insecurity, diet quality, and systolic blood pressure, 3) examine the maintenance of outcomes, and 4) assess cost-effectiveness. Conclusions: Establishing that a food insecurity and SMES intervention, compared to usual care services, is feasible in FQHCs and efficacious for improving blood pressure and related outcomes would have important public health implications. Understanding the behavior change levers of FoRKS that are associated with changes in health outcomes, whether these outcomes are maintained, and its cost-effectiveness will inform future efforts to address health disparities.