Browsing by Subject "Mass screening"
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Item Accuracy of Alternative PHQ-9 Scoring Algorithms to Screen for Depression in People Living With HIV in Sub-Saharan Africa(Wolters Kluwer, 2025) Bernard, Charlotte; Font, Hélène; Zotova, Natalia; Wools-Kaloustian, Kara; Goodrich, Suzanne; Kamaru Kwobah, Edith; Rogers Awoh, Ajeh; Nko'o Mbongo'o, Guy Calvin; Nsonde, Dominique Mahambu; Gandou, Paul; Minga, Albert; Tine, Judicaël Malick; Ndiaye, Ibrahima; Dabis, François; Seydi, Moussa; de Rekeneire, Nathalie; Yotebieng, Marcel; Jaquet, Antoine; IeDEA Cohort Collaboration; Medicine, School of MedicineBackground: Screening for depression remains a priority for people living with HIV (PLWH) accessing care. The 9-item Patient Health Questionnaire (PHQ-9) is a widely used depression screening tool, but has limited accuracy when applied across various cultural contexts. We aimed to evaluate the performance of alternative PHQ-9 scoring algorithms in sub-Saharan African PLWH. Setting: Five HIV programs in Cameroon, Côte d'Ivoire, Kenya, Senegal, and the Republic of Congo. Methods: Adult PLWH were screened for depression during the 2018-2022 period. Diagnosis confirmation was done by psychiatrist blinded clinical evaluation (gold standard). Diagnostic performances, including sensitivity and area under the curve (AUC) of the traditional PHQ-9 scoring (positive screening - score ≥ 10), were compared to alternative scoring algorithms including (1) the presence of ≥1 mood symptom (PHQ-9 items 1 and 2) combined with ≥2 other symptoms listed in the PHQ-9, and (2) a simplified recoding of each 4-response item into 2 categories (absence/presence). Results: A total of 735 participants were included [54% women, median age 42 years (interquartile range 34-50)]. Depression was diagnosed by a psychiatrist in 95 (13%) participants. Alternative scoring sensitivities (0.59-0.74) were higher than that of the traditional score's (0.39). Compared to traditional scoring, AUC was significantly higher for PHQ-9 alternative scoring. Across settings, alternative scoring algorithms increased sensitivity and reduced variability. Conclusions: As a primary screening test, new scoring algorithms seemed to improve the PHQ-9 sensitivity in identifying depression and reducing heterogeneity across settings. This alternative might be considered to identify PLWH in need of referral for further diagnostic evaluations.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 Dementia Screening in Primary Care: Not Too Fast!(Wiley, 2013) Boustani, Malaz; Medicine, School of MedicineItem Emergency Department Food Insecurity Screening, Food Voucher Distribution and Utilization: A Prospective Cohort Study(University of California, 2024) Ulintz, Alexander J.; Patel, Seema S.; Anderson, Katherine; Walters, Kevin; Stepsis, Tyler J.; Lyons, Michael S.; Pang, Peter S.; Emergency Medicine, School of MedicineObjective: Food insecurity is a prevalent social risk among emergency department (ED) patients. Patients who may benefit from food insecurity resources may be identified via ED-based screening; however, many patients experience difficulty accessing resources after discharge. Co-locating resources in or near the ED may improve utilization by patients, but this approach remains largely unstudied. This study characterized the acceptance and use of a food voucher redeemable at a hospital food market for patients who screened positive for food insecurity during their ED visit. Methods: This prospective cohort study, conducted at a single county-funded ED, included consecutive adult patients who presented on weekdays between 8 AM-8 PM from July-October 2022 and consented to research participation. We excluded patients who required resuscitation on arrival or could not provide written informed consent in English. Study participants completed a paper version of the two-question Hunger Vital Sign screening tool, administered by research staff. Participants who screened positive received a uniquely numbered $30 food voucher redeemable at the hospital's co-located food market. Voucher redemption was quantified through regular evaluation of market receipt records at 30-day intervals. The primary outcome was the proportion of redeemed vouchers. Secondary outcomes included the proportion of participants screening positive for food insecurity, proportion of participants accepting vouchers, and associated descriptive statistics. Results: Of the 396 eligible individuals approached, 377 (95.2%) consented and completed food insecurity screening. Most were middle-aged (median 53 years, interquartile range 30-58 years), 191 were female (50.4%), 242 were Black (63.9%), and 343 were non-Hispanic (91.0%). Of the participants, 228 (60.2%) screened positive for food insecurity and 224 received vouchers (98.2%), of which 86 were redeemed (38.4%) a median of nine days after the ED visit. Conclusion: A high proportion of participants screened positive for food insecurity and accepted food vouchers; however, less than half of all vouchers were redeemed at the co-located food market. These results imply ED food voucher distribution for food insecurity is feasible, but co-location of resources alone may be insufficient in addressing the social risk and alludes to a limited understanding of facilitators and barriers to resource utilization following ED-based social needs screening.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 Medicine