Browsing by Subject "Mass screening"
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Item Accuracy of Electronic Health Record Food Insecurity, Housing Instability, and Financial Strain Screening in Adult Primary Care(American Medical Association, 2023) Harle, Christopher A.; Wu, Wei; Vest, Joshua R.; Psychology, School of ScienceItem Comparing the performance of screening surveys versus predictive models in identifying patients in need of health-related social need services in the emergency department(Public Library of Science, 2024-11-20) Mazurenko, Olena; Hirsh, Adam T.; Harle, Christopher A.; Shen, Joanna; McNamee, Cassidy; Vest, Joshua R.; Health Policy and Management, Richard M. Fairbanks School of Public HealthBackground: Health-related social needs (HRSNs), such as housing instability, food insecurity, and financial strain, are increasingly prevalent among patients. Healthcare organizations must first correctly identify patients with HRSNs to refer them to appropriate services or offer resources to address their HRSNs. Yet, current identification methods are suboptimal, inconsistently applied, and cost prohibitive. Machine learning (ML) predictive modeling applied to existing data sources may be a solution to systematically and effectively identify patients with HRSNs. The performance of ML predictive models using data from electronic health records (EHRs) and other sources has not been compared to other methods of identifying patients needing HRSN services. Methods: A screening questionnaire that included housing instability, food insecurity, transportation barriers, legal issues, and financial strain was administered to adult ED patients at a large safety-net hospital in the mid-Western United States (n = 1,101). We identified those patients likely in need of HRSN-related services within the next 30 days using positive indications from referrals, encounters, scheduling data, orders, or clinical notes. We built an XGBoost classification algorithm using responses from the screening questionnaire to predict HRSN needs (screening questionnaire model). Additionally, we extracted features from the past 12 months of existing EHR, administrative, and health information exchange data for the survey respondents. We built ML predictive models with these EHR data using XGBoost (ML EHR model). Out of concerns of potential bias, we built both the screening question model and the ML EHR model with and without demographic features. Models were assessed on the validation set using sensitivity, specificity, and Area Under the Curve (AUC) values. Models were compared using the Delong test. Results: Almost half (41%) of the patients had a positive indicator for a likely HRSN service need within the next 30 days, as identified through referrals, encounters, scheduling data, orders, or clinical notes. The screening question model had suboptimal performance, with an AUC = 0.580 (95%CI = 0.546, 0.611). Including gender and age resulted in higher performance in the screening question model (AUC = 0.640; 95%CI = 0.609, 0.672). The ML EHR models had higher performance. Without including age and gender, the ML EHR model had an AUC = 0.765 (95%CI = 0.737, 0.792). Adding age and gender did not improve the model (AUC = 0.722; 95%CI = 0.744, 0.800). The screening questionnaire models indicated bias with the highest performance for White non-Hispanic patients. The performance of the ML EHR-based model also differed by race and ethnicity. Conclusion: ML predictive models leveraging several robust EHR data sources outperformed models using screening questions only. Nevertheless, all models indicated biases. Additional work is needed to design predictive models for effectively identifying all patients with HRSNs.Item Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow-up for abnormal colorectal cancer screening test results(Wiley, 2017-09-15) Partin, Melissa R.; Gravely, Amy; Burgess, James F., Jr.; Haggstrom, David; Lillie, Sarah E.; Nelson, David B.; Nugent, Sean; Shaukat, Aasma; Sultan, Shahnaz; Walter, Louise C.; Burgess, Diana J.; Medicine, School of MedicineBACKGROUND: Patient, physician, and environmental factors were identified, and the authors examined the contribution of these factors to demographic and health variation in colonoscopy follow-up after a positive fecal occult blood test/fecal immunochemical test (FOBT/FIT) screening. METHODS: In total, 76,243 FOBT/FIT-positive patients were identified from 120 Veterans Health Administration (VHA) facilities between August 16, 2009 and March 20, 2011 and were followed for 6 months. Patient demographic (race/ethnicity, sex, age, marital status) and health characteristics (comorbidities), physician characteristics (training level, whether primary care provider) and behaviors (inappropriate FOBT/FIT screening), and environmental factors (geographic access, facility type) were identified from VHA administrative records. Patient behaviors (refusal, private sector colonoscopy use) were estimated with statistical text mining conducted on clinic notes, and follow-up predictors and adjusted rates were estimated using hierarchical logistic regression. RESULTS: Roughly 50% of individuals completed a colonoscopy at a VHA facility within 6 months. Age and comorbidity score were negatively associated with follow-up. Blacks were more likely to receive follow-up than whites. Environmental factors attenuated but did not fully account for these differences. Patient behaviors (refusal, private sector colonoscopy use) and physician behaviors (inappropriate screening) fully accounted for the small reverse race disparity and attenuated variation by age and comorbidity score. Patient behaviors (refusal and private sector colonoscopy use) contributed more to variation in follow-up rates than physician behaviors (inappropriate screening). CONCLUSIONS: In the VHA, blacks are more likely to receive colonoscopy follow-up for positive FOBT/FIT results than whites, and follow-up rates markedly decline with advancing age and comorbidity burden. Patient and physician behaviors explain race variation in follow-up rates and contribute to variation by age and comorbidity burden. Cancer 2017;123:3502-12. Published 2017. This article is a US Government work and is in the public domain in the USA.Item Cost-effectiveness of artificial intelligence for screening colonoscopy: a modelling study(Elsevier, 2022) Areia, Miguel; Mori, Yuichi; Correale, Loredana; Repici, Alessandro; Bretthauer, Michael; Sharma, Prateek; Taveira, Filipe; Spadaccini, Marco; Antonelli, Giulio; Ebigbo, Alanna; Kudo, Shin-ei; Arribas, Julia; Barua, Ishita; Kaminski, Michal F.; Messmann, Helmut; Rex, Douglas K.; Dinis-Ribeiro, Mário; Hassan, Cesare; Medicine, School of MedicineBackground: Artificial intelligence (AI) tools increase detection of precancerous polyps during colonoscopy and might contribute to long-term colorectal cancer prevention. The aim of the study was to investigate the incremental effect of the implementation of AI detection tools in screening colonoscopy on colorectal cancer incidence and mortality, and the cost-effectiveness of such tools. Methods: We conducted Markov model microsimulation of using colonoscopy with and without AI for colorectal cancer screening for individuals at average risk (no personal or family history of colorectal cancer, adenomas, inflammatory bowel disease, or hereditary colorectal cancer syndrome). We ran the microsimulation in a hypothetical cohort of 100 000 individuals in the USA aged 50-100 years. The primary analysis investigated screening colonoscopy with versus without AI every 10 years starting at age 50 years and finishing at age 80 years, with follow-up until age 100 years, assuming 60% screening population uptake. In secondary analyses, we modelled once-in-life screening colonoscopy at age 65 years in adults aged 50-79 years at average risk for colorectal cancer. Post-polypectomy surveillance followed the simplified current guideline. Costs of AI tools and cost for downstream treatment of screening detected disease were estimated with 3% annual discount rates. The main outcome measures included the incremental effect of AI-assisted colonoscopy versus standard (no-AI) colonoscopy on colorectal cancer incidence and mortality, and cost-effectiveness of screening projected for the average risk screening US population. Findings: In the primary analyses, compared with no screening, the relative reduction of colorectal cancer incidence with screening colonoscopy without AI tools was 44·2% and with screening colonoscopy with AI tools was 48·9% (4·8% incremental gain). Compared with no screening, the relative reduction in colorectal cancer mortality with screening colonoscopy with no AI was 48·7% and with screening colonoscopy with AI was 52·3% (3·6% incremental gain). AI detection tools decreased the discounted costs per screened individual from $3400 to $3343 (a saving of $57 per individual). Results were similar in the secondary analyses modelling once-in-life colonoscopy. At the US population level, the implementation of AI detection during screening colonoscopy resulted in yearly additional prevention of 7194 colorectal cancer cases and 2089 related deaths, and a yearly saving of US$290 million. Interpretation: Our findings suggest that implementation of AI detection tools in screening colonoscopy is a cost-saving strategy to further prevent colorectal cancer incidence and mortality.Item Evaluation of a National Quality Improvement Collaborative for Improving Cancer Screening(American Medical Association, 2022-11-01) Joung, Rachel Hae-Soo; Mullett, Timothy W.; Kurtzman, Scott H.; Shafir, Sarah; Harris, James B.; Yao, Katharine A.; Bilimoria, Karl Y.; Cance, William G.; Nelson, Heidi; Return-to-Screening Quality Improvement Collaborative; Surgery, School of MedicineImportance: Cancer screening deficits during the first year of the COVID-19 pandemic were found to persist into 2021. Cancer-related deaths over the next decade are projected to increase if these deficits are not addressed. Objective: To assess whether participation in a nationwide quality improvement (QI) collaborative, Return-to-Screening, was associated with restoration of cancer screening. Design, setting, and participants: Accredited cancer programs electively enrolled in this QI study. Project-specific targets were established on the basis of differences in mean monthly screening test volumes (MTVs) between representative prepandemic (September 2019 and January 2020) and pandemic (September 2020 and January 2021) periods to restore prepandemic volumes and achieve a minimum of 10% increase in MTV. Local QI teams implemented evidence-based screening interventions from June to November 2021 (intervention period), iteratively adjusting interventions according to their MTVs and target. Interrupted time series analyses was used to identify the intervention effect. Data analysis was performed from January to April 2022. Exposures: Collaborative QI support included provision of a Return-to-Screening plan-do-study-act protocol, evidence-based screening interventions, QI education, programmatic coordination, and calculation of screening deficits and targets. Main outcomes and measures: The primary outcome was the proportion of QI projects reaching target MTV and counterfactual differences in the aggregate number of screening tests across time periods. Results: Of 859 cancer screening QI projects (452 for breast cancer, 134 for colorectal cancer, 244 for lung cancer, and 29 for cervical cancer) conducted by 786 accredited cancer programs, 676 projects (79%) reached their target MTV. There were no hospital characteristics associated with increased likelihood of reaching target MTV except for disease site (lung vs breast, odds ratio, 2.8; 95% CI, 1.7 to 4.7). During the preintervention period (April to May 2021), there was a decrease in the mean MTV (slope, -13.1 tests per month; 95% CI, -23.1 to -3.2 tests per month). Interventions were associated with a significant immediate (slope, 101.0 tests per month; 95% CI, 49.1 to 153.0 tests per month) and sustained (slope, 36.3 tests per month; 95% CI, 5.3 to 67.3 tests per month) increase in MTVs relative to the preintervention trends. Additional screening tests were performed during the intervention period compared with the prepandemic period (170 748 tests), the pandemic period (210 450 tests), and the preintervention period (722 427 tests). Conclusions and relevance: In this QI study, participation in a national Return-to-Screening collaborative with a multifaceted QI intervention was associated with improvements in cancer screening. Future collaborative QI endeavors leveraging accreditation infrastructure may help address other gaps in cancer care.Item Factors Associated with Screening Baby Boomers for Hepatitis C Virus Infection Among Primary Care Providers: a Retrospective Analysis(Springer, 2021) Kasting, Monica L.; Giuliano, Anna R.; Reich, Richard R.; Rathwell, Julie; Roetzheim, Richard G.; Vadaparampil, Susan T.; Medicine, School of MedicineItem Improving Care for Adolescents with Substance Use Disorder: More than Screening(Springer Nature, 2021) Adams, Zachary W.; Denne, Scott C.; Pediatric Policy Council; Psychiatry, School of MedicineItem Low Rates of Lung and Colorectal Cancer Screening Uptake Among a Safety-net Emergency Department Population(Department of Emergency Medicine, School of Medicine, University of California, Irvine, 2022-08-11) Pettit, Nicholas; Ceppa, DuyKhanh; Monahan, Patrick; Emergency Medicine, School of MedicineIntroduction: A suspected diagnosis of cancer through an emergency department (ED) visit is associated with poor clinical outcomes. The purpose of this study was to explore the rate at which ED patients attend cancer screenings for lung, colorectal (CRC), and breast cancers based on national guidelines set forth by the United States Preventive Services Task Force (USPSTF). Methods: This was a prospective cohort study. Patients were randomly approached in the Eskenazi Hospital ED between August 2019-February 2020 and were surveyed to determine whether they would be eligible and had attended lung, CRC, and breast cancer screenings, as well as their awareness of lung cancer screening with low-dose computed tomography (LDCT). Patients who were English-speaking and ≥18 years old, and who were not critically ill or intoxicated or being seen for acute decompensated psychiatric illness were offered enrollment. Enrolled subjects were surveyed to determine eligibility for lung, colorectal, and breast cancer screenings based on guidelines set by the USPSTF. No cancer screenings were actually done during the ED visit. Results: A total of 500 patients were enrolled in this study. More participants were female (54.4%), and a majority were Black (53.0%). Most participants had both insurance (80.2%) and access to primary care (62.8%). Among the entire cohort, 63.0% identified as smokers, and 62.2% (140/225) of the 50- to 80-year-old participants qualified for lung cancer screening. No patients were screened for lung cancer in this cohort (0/225). Only 0.6% (3/500) were aware that LDCT was the preferred method for screening. Based on pack years, 35.5% (32/90) of the patients who were 40-49 years old and 6.7% (6/90) of those 30-39 years old would eventually qualify for screening. Regarding CRC screening, 43.6% (218/500) of the entire cohort was eligible. However, of those patients only 54% (118/218) had been screened. Comparatively, 77.7% (87/112) of the eligible females had been screened for breast cancer, but only 54.5% (61/112) had been screened in the prior two years. Conclusion: Many ED patients are not screened for lung/colorectal/breast cancers even though many are eligible and have reported access to primary care. This study demonstrates an opportunity and a need to address cancer screening in the ED.Item Perinatal Outcomes of Two Screening Strategies for Gestational Diabetes Mellitus: A Randomized Controlled Trial(Wolters Kluwer, 2021) Davis, Esa M.; Abebe, Kaleab Z.; Simhan, Hyagriv N.; Catalano, Patrick; Costacou, Tina; Comer, Diane; Orris, Steven; Ly, Kathleen; Decker, Alison; Mendez, Dara; Day, Nancy; Scifres, Christina M.; Obstetrics and Gynecology, School of MedicineObjective: To evaluate differences in short-term perinatal outcomes between the two prominent screening strategies for gestational diabetes mellitus, the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and Carpenter-Coustan. Methods: In this single-site, blinded, randomized, comparative effectiveness trial, participants received a nonfasting 50-g oral glucose tolerance test and, if less than 200 mg/dL (less than 11.1 mmol/L), were randomized to further screening with either IADPSG or Carpenter-Coustan criteria. Gestational diabetes treatment occurred per routine clinical care. The primary outcome was incidence of large-for-gestational-age (LGA) neonates. Prespecified secondary outcomes included small-for-gestational-age (SGA) neonates, cesarean birth, and neonatal and maternal composites of adverse perinatal outcomes. Assuming a 15% incidence of LGA neonates in the Carpenter-Coustan group, 782 participants provided more than 80% power to detect a 7% absolute risk reduction with the use of IADPSG; planned recruitment was 920 for anticipated attrition. Results: From June 2015 to February 2019, 1,016 participants were enrolled and 921 were randomized to IADPSG (n=461) or Carpenter-Coustan (n=460) groups. Gestational diabetes incidence (14.4% vs 4.5%, P<.001) and diabetes medication use (9.3% vs 2.4%; P<.001) were more common in the IADPSG group; there were no differences in LGA neonates, either overall (risk reduction 0.90, 97.5% CI 0.53-1.52) or among women without gestational diabetes (risk reduction 0.85, 97.5% CI 0.49-1.48). Those screened with IADPSG had higher rates of neonatal morbidity but fewer study-related adverse events. Rates of SGA neonates, cesarean birth, and maternal morbidity composite did not differ significantly between study groups. Conclusions: The IADPSG screening criteria resulted in more women diagnosed and treated for gestational diabetes than Carpenter-Coustan without reducing the incidence of LGA birth weight or maternal or neonatal morbidity.Item Prospective multicenter assessment of patient preferences for properties of gadolinium-based contrast media and their potential socioeconomic impact in a screening breast MRI setting(Springer, 2021-12) Woolen, Sean A.; Troost, Jonathan P.; Khalatbari, Shokoufeh; Pujara, Akshat C.; McDonald, Jennifer S.; McDonald, Robert J.; Shankar, Prasad; Lewin, Alana A.; Melsaether, Amy N.; Westphal, Steven M.; Patterson, Katherine H.; Nettles, Ashley; Welby, John P.; Patel, Parth Pradip; Kiros, Neud; Piccoli, Lisa; Davenport, Matthew S.; Radiology and Imaging Sciences, School of MedicineObjective: It is unknown how patients prioritize gadolinium-based contrast media (GBCM) benefits (detection sensitivity) and risks (reactions, gadolinium retention, cost). The purpose of this study is to measure preferences for properties of GBCM in women at intermediate or high risk of breast cancer undergoing annual screening MRI. Methods: An institutional reviewed board-approved prospective discrete choice conjoint survey was administered to patients at intermediate or high risk for breast cancer undergoing screening MRI at 4 institutions (July 2018-March 2020). Participants were given 15 tasks and asked to choose which of two hypothetical GBCM they would prefer. GBCMs varied by the following attributes: sensitivity for cancer detection (80-95%), intracranial gadolinium retention (1-100 molecules per 100 million administered), severe allergic-like reaction rate (1-19 per 100,000 administrations), mild allergic-like reaction rate (10-1000 per 100,000 administrations), out-of-pocket cost ($25-$100). Attribute levels were based on published values of existing GBCMs. Hierarchical Bayesian analysis was used to derive attribute "importance." Preference shares were determined by simulation. Results: Response (87% [247/284]) and completion (96% [236/247]) rates were excellent. Sensitivity (importance = 44.3%, 95% confidence interval = 42.0-46.7%) was valued more than GBCM-related risks (mild allergic-like reaction risk (19.5%, 17.9-21.1%), severe allergic-like reaction risk (17.0%, 15.8-18.1%), intracranial gadolinium retention (11.6%, 10.5-12.7%), out-of-pocket expense (7.5%, 6.8-8.3%)). Lower income participants placed more importance on cost and less on sensitivity (p < 0.01). A simulator is provided that models GBCM preference shares by GBCM attributes and competition. Conclusions: Patients at intermediate or high risk for breast cancer undergoing MRI screening prioritize cancer detection over GBCM-related risks, and prioritize reaction risks over gadolinium retention. Key points: • Among women undergoing annual breast MRI screening, cancer detection sensitivity (attribute "importance," 44.3%) was valued more than GBCM-related risks (mild allergic reaction risk 19.5%, severe allergic reaction risk 17.0%, intracranial gadolinium retention 11.6%, out-of-pocket expense 7.5%). • Prospective four-center patient preference data have been incorporated into a GBCM choice simulator that allows users to input GBCM properties and calculate patient preference shares for competitor GBCMs. • Lower-income women placed more importance on out-of-pocket cost and less importance on cancer detection (p < 0.01) when prioritizing GBCM properties.