Browsing by Author "Willis, Deanna"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Agile implementation of alcohol screening in primary care
    (Springer Nature, 2024-07-11) Summanwar, Diana; Ropert, Chelan; Barton, James; Hiday, Rachael; Bishop, Dawn; Boustani, Malaz; Willis, Deanna; Medicine, School of Medicine
    Background: Despite the United States Preventive Services Task Force recommendation to screen adults for unhealthy alcohol use, the implementation of alcohol screening in primary care remains suboptimal. Methods: A pre and post-implementation study design that used Agile implementation process to increase screening for unhealthy alcohol use in adult patients from October 2021 to June 2022 at a large primary care clinic serving minority and underprivileged adults in Indianapolis. Results: In comparison to a baseline screening rate of 0%, the agile implementation process increased and sustained screening rates above 80% for alcohol use using the Alcohol Use Disorders Identification Test - Consumption tool (AUDIT-C). Conclusions: Using the agile implementation process, we were able to successfully implement evidence-based recommendations to screen for unhealthy alcohol use in primary care.
  • Thumbnail Image
    Item
    Considerations for widespread implementation of blood-based biomarkers of Alzheimer's disease
    (Wiley, 2024) Mielke, Michelle M.; Anderson, Matthew; Ashford, J. Wesson; Jeromin, Andreas; Lin, Pei-Jung; Rosen, Allyson; Tyrone, Jamie; VandeVrede, Lawren; Willis, Deanna; Hansson, Oskar; Khachaturian, Ara S.; Schindler, Suzanne E.; Weiss, Joan; Batrla, Richard; Bozeat, Sasha; Dwyer, John R.; Holzapfel, Drew; Jones, Daryl Rhys; Murray, James F.; Partrick, Katherine A.; Scholler, Emily; Vradenburg, George; Young, Dylan; Braunstein, Joel B.; Burnham, Samantha C.; de Oliveira, Fabricio Ferreira; Hu, Yan Helen; Mattke, Soeren; Merali, Zul; Monane, Mark; Sabbagh, Marwan Noel; Shobin, Eli; Weiner, Michael W.; Udeh-Momoh , Chinedu T.; Medicine, School of Medicine
    Diagnosing Alzheimer's disease (AD) poses significant challenges to health care, often resulting in delayed or inadequate patient care. The clinical integration of blood-based biomarkers (BBMs) for AD holds promise in enabling early detection of pathology and timely intervention. However, several critical considerations, such as the lack of consistent guidelines for assessing cognition, limited understanding of BBM test characteristics, insufficient evidence on BBM performance across diverse populations, and the ethical management of test results, must be addressed for widespread clinical implementation of BBMs in the United States. The Global CEO Initiative on Alzheimer's Disease BBM Workgroup convened to address these challenges and provide recommendations that underscore the importance of evidence-based guidelines, improved training for health-care professionals, patient empowerment through informed decision making, and the necessity of community-based studies to understand BBM performance in real-world populations. Multi-stakeholder engagement is essential to implement these recommendations and ensure credible guidance and education are accessible to all stakeholders.
  • Thumbnail Image
    Item
    Feasibility and Acceptability of Using Plasma Biomarkers for Diagnosing Alzheimer’s Disease in Primary Care
    (Oxford University Press, 2023-12-21) Fowler, Nicole; Swartzell, Kristen; Hammers, Dustin; Brosch, Jared; Murray, James; Willis, Deanna; Medicine, School of Medicine
    Blood-based biomarkers (Aβ, P-tau, neurofilament light) are clinically available to aid in the diagnosis of Alzheimer’s disease and related dementias (ADRD). However, no research has examined the use of blood biomarkers to aid in the diagnosis of ADRD in primary care (PC). Our study will test feasibility and acceptability of implementing blood-based biomarkers for ADRD in PC. Participants include: all PC patients ≥65 years presenting to one of six PC clinics between 6/1/22 and 5/31/23 who score cognitively impaired on the Linus Health Digital Clock and Recall (DCR™), and PC providers (PCPs) of these patients. Patients will view a decision guide about biomarkers and complete the Concerns about Alzheimer’s Disease Dementia Scale, and the Future Time Perspective Scale and the Impact of Events Scale. These measures and the PHQ-9 and GAD-7 will be repeated within 2 weeks of results disclosure. PCPs will receive training on biomarker disclosure techniques and best practices. To date 9 PCPs have consented to provide the biomarker results disclosure and 11 have declined. Following completion of PCP consent (n=100), a total of 200 patients who failed the DCR are eligible to be approached for consent. By November 2023, we anticipate that 150 patients will have completed biomarker testing, and we will have examined the biomarker results in the context of patient neuropsychological and clinical data, comorbidities, and sociodemographic information. This study will provide information regarding feasibility and utility of ADRD biomarkers in PC and a preliminary analysis of biomarker results compared with the patients’ clinical profiles.
  • Thumbnail Image
    Item
    Implementation of a Digital Cognitive Screening Program for Dementia in Primary Care
    (Oxford University Press, 2023-12-21) Fowler, Nicole; Mullavey, Judy; Swartzell, Kristen; Hammers, Dustin; Brosch, Jared; Murray, James; Willis, Deanna; Medicine, School of Medicine
    Early identification of Alzheimer’s disease and related dementias (ADRD) has become paramount given the emergence of disease modifying therapies. Integration of rapid, scalable tools to identify early cognitive impairment in primary care is essential because most at-risk individuals have limited access to specialty care. Yet, competing demands on primary care practices can make integration challenging. This demonstration project is being conducted to understand the feasibility, acceptability, and implementation of digital cognitive screening in primary care. Patients ≥65 years presenting to one of six primary care sites between 06/01/2022 and 06/30/2023 are asked to complete the Linus Health Digital Clock and Recall (DCR™) cognitive screening. Data regarding number of screening attempts that were refused, incomplete, or completed was collected. Results of the first completed screening-results were analyzed using descriptive statistics. As of 2/15/23, there are 3,920 screening attempts. DCR™ screenings were completed 40.8% of the time, refused 57.4%, and attempted but incomplete 1.8%. Thirteen-percent of attempts were positive for cognitive impairment, 37% were borderline, 44% were unimpaired, and 6% were unanalyzable. Average patient age is 73.2±6.0 years, 58% female, and 6% report less than high school education. Patients with positive screenings are older, slightly more female, and reported less education. Cognitive screening via DCR™ is ongoing and has been completed in nearly half of those approached, with half scoring cognitively impaired or borderline. This approach appears to have utility in early detection of cognitive impairment in primary care. By November 2023 we will have follow-up data for patients who screened positive.
  • Thumbnail Image
    Item
    Interventions to Promote Colorectal Cancer Screening in Primary Care: Results of a Randomized Trial
    (Office of the Vice Chancellor for Research, 2013-04-05) Rawl, Susan M.; Christy, Shannon M.; Perkins, Susan; Tong, Yan; Krier, Connie; Wang, Hsiao-Lan; Champion, Victoria L.; Myers, Laura Jones; Imperiale, Thomas; Willis, Deanna; Rhyant, Broderick; Springston, Jeffrey; Skinner, Celette Sugg
    Aims: The purpose of this randomized trial was to compare rates of self-reported colorectal cancer (CRC) screening and forward movement in stage of adoption at 6 months post-intervention. African American primary care patients (n=595) who were eligible for CRC screening were randomly assigned to receive a computer-delivered tailored CRC screening intervention (n=286) or a non-tailored screening brochure (n=309) prior to their scheduled visit with their primary care provider. Hypotheses were that differences between groups would be observed in proportions of patients who: 1) completed fecal occult blood tests (FOBT) or colonoscopy; and 2) had moved forward in stages of adoption for these tests. Methods: Participants completed baseline and 6-month telephone interviews; interventions were delivered prior to primary care provider visits. Differences between groups were examined using chi-square tests, predictors of screening were determined using logistic regression models. Results: In the computer-tailored group, the FOBT completion rate was 12.6% compared to 7.8% in the brochure group (p=0.05). The colonoscopy completion rate was 17.5% in the computer group vs. 15.2% in the brochure group (p=0.45). Forward stage movement for FOBT was observed in 28.4% of the computer groups vs. 20.8% in the brochure group (p=0.03). Forward stage movement for colonoscopy was 38.5% in the computer group and 36.8% (p=0.68) in each group, respectively. Conclusions: The computer-tailored intervention was more effective than the brochure at increasing FOBT completion and movement toward action. More research is needed to explain why the tailored intervention was not more effective at increasing colonoscopy completion and to identify moderators of intervention efficacy.