Browsing by Subject "health outcomes"

Now showing 1 - 6 of 6
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    Association Between Medication Adherence and the Outcomes of Heart Failure
    (Wiley, 2018) Hood, Sarah R.; Giazzon, Anthony J.; Seamon, Gwen; Lane, Kathleen A.; Wang, Jane; Eckert, George J.; Tu, Wanzhu; Murray, Michael D.; Biostatistics, School of Public Health
    Background Previous studies of heart failure patients have demonstrated an association between cardiovascular medication adherence and hospitalizations or a composite end point of hospitalization and death. Few studies have assessed the impact of treatment adherence within large general medical populations that distinguish the health outcomes of emergency department visits, hospitalization, and death. Objective To determine the association of incremental cardiovascular medication adherence on emergency department visits, hospitalization, and death in adult heart failure patients in Indiana. Design Retrospective cohort study conducted using electronic health record data from the statewide Indiana Network for Patient Care (INPC) between 2004 and 2009. Methods Patients were at least 18 years of age with a diagnosis of heart failure and prescribed at least one cardiovascular medication for heart failure. Adherence was measured as the proportion of days covered (PDC) using pharmacy transaction data. Clinical end points included emergency department visits, hospital admissions, length of hospital stay, and mortality. Generalized linear models were used to determine the effect of a 10% increase in PDC on clinical end points adjusting for age, sex, race, Charlson comorbidity index, and medications. Results Electronic health records were available for 55,312 patients (mean age ± standard deviation [SD] 68 ± 16 years; 54% women; 65% white). Mean PDC for all heart failure medications was 63% ± 23%. For every 10% increase in PDC, emergency department visits decreased 11% (rate ratio [RR] 0.89; 95% confidence interval [CI] 0.89‐0.89), hospital admissions decreased 6% (RR 0.94; 95% CI 0.94‐0.94), total length of hospital stay decreased 1% (RR 0.99; 95% CI 0.99‐1.00), and all‐cause mortality decreased 9% (odds ratio 0.91; 95% CI 0.90‐0.92). Conclusion Incremental medication adherence was associated with reductions in emergency department visits, hospital admissions, length of hospital stay, and all‐cause mortality.
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    Emergency Department Chief Complaints Among Children With Cancer
    (Wolters Kluwer, 2018-08) Burcham, Megan; Cochrane, Anneli R.; Jacob, Seethal A.; Carroll, Aaron E.; Mueller, Emily L.; Pediatrics, School of Medicine
    Children with cancer have high emergency department (ED) utilization, but little is known about their chief complaints. A retrospective chart review of ED chief complaints for children with cancer (actively receiving therapy) at Riley Hospital for Children from January 2014 to December 2015 was performed. Proportions of visits and disposition for top 5 chief complaints were determined. Multivariate logistic regression analyzed factors associated with admission. There were 598 encounters by 231 children with cancer. About half (49%) had >1 complaint. The 5 most common primary chief complaints were: fever (60.2%), pain (6.5%), nausea/vomiting (5.0%), bleeding (3.9%), and abnormal laboratory values (3.3%). Admission rates varied, with the highest rates being for nausea/vomiting (66.7%). Risk factors for admission were: hospitalization in prior 4 weeks (odds ratio [OR], 2.67; confidence interval [CI], 1.77-4.02), chief complaint of fever (OR, 1.90; CI, 1.16-3.09). For each increase in number of chief complaints, odds increased by 1.45 (CI, 1.14-1.83). Black, non-Hispanic (OR, 0.44; CI, 0.22-0.88) as compared with white, non-Hispanic, younger age (OR, 0.53; CI, 0.29-0.99) or complaint of abnormal laboratory values (OR, 0.20; CI, 0.06-0.68) had lower odds of admission. Children with cancer present to the ED with multiple and varied complaints. Future interventions could aim to improve caregiver anticipatory guidance and ED visit preparedness.
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    Emotion Regulation and Perceptions of Illness Coherence and Controllability on Regimen Adherence and Negative Cardiac Health Events in African American Women With Heart Failure
    (Wolters Kluwer, 2017) Wierenga, Kelly L.; Lehto, Rebecca H.; Given, Barbara; School of Nursing
    Background: African American women with heart failure (HF) have stressors that negatively impact HF self-management adherence and heighten the occurrence of negative cardiac health events. Perceptions of illness coherence and controllability and emotion regulation are known to facilitate self-management in the face of stressors. Objective: The aim of this study was to determine whether difficulties with emotion regulation and negative perceptions of illness coherence and controllability are detrimental to adherence and increase negative cardiac health events in this patient population. Methods: African American women (n = 54) with HF, aged 49 to 84 years, participated in this longitudinal descriptive correlational study. Using convenience sampling, we recruited patients from hospitals and HF clinics. They completed interviews at intake and 30 days, and their medical records were reviewed at 90 days. Linear and logistic regression models were used to assess predictors of general adherence and negative cardiac health events. Results: Of 54 patients who participated in the study, 28 experienced a negative health event during 90 days, and 57% of these events were cardiac related. The only clear predictor of these events was greater New York Heart Association functional classification (β = 1.47, P = .027). No associations were found between predictors (emotion regulation, controllability, coherence, age, education) and general adherence. Conclusions: Emotion regulation showed a possible greater impact on negative cardiac health events than on general adherence. Perceived illness coherence showed less impact on negative cardiac health events than on general adherence.
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    Emotion Regulation in Chronic Disease Populations: An Integrative Review
    (Springer, 2017) Wierenga, Kelly L.; Lehto, Rebecca H.; Given, Barbara; School of Nursing
    Background and Purpose: Emotion regulation, the experiencing, processing, and modulating of emotional response, is necessary to manage the emotional stressors common in patients with chronic illness. Overwhelming emotional demands deplete the resources needed for everyday self-care management of chronic disease, contributing to poor health outcomes. Emotion regulation is shown to impact behaviors in healthy individuals; yet, a review of literature examining evidence of associations in chronically ill populations is lacking. The purpose of this article is to examine the state of the science relative to the impact of emotion regulation on health outcomes in chronic illness populations. Methods: Articles were reviewed (N = 14) that focused on emotion regulation and outcomes of patients with chronic illness. Results: Indicate that most of the studies focused on these concepts are cross-sectional and measure emotion regulation using various surveys. Potential relationships exist with increased age, male gender, higher education, decreased stress, depressive, and anxiety symptoms being associated with more adaptive emotion regulation. Of primary importance to patients with chronic illnesses is the potential link between greater difficulties with emotion regulation and the presence of chronic disease as well as poorer physical function. Implications for Practice: Care should include attention to affective regulation as well as physiologic responses of chronic illness.
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    The Impact of Health Workers' Strikes on Health Outcomes and Health Service Utilization in Low-and Middle-Income Countries: A Systematic Review
    (Social Science Research Network, 2019) Scanlon, Michael L.; Maldonado, Lauren Y.; Ruhl, Laura J.; Atwoli, Lukoye; Medicine, School of Medicine
    Background The impact of strikes by health workers in low- and middle-income countries (LMIC) is not well described. We systematically reviewed articles on the impact of health workers’ strikes on health outcomes or health service utilization in LMIC. Methods We searched PubMed, SCOPUS, Web of Science, and Google Scholar databases on May 27, 2019. To be included for review, articles met the following criteria: (1) reported on a strike that involved at least one cadre of health worker; (2) reported on a strike in a LMIC; (3) included at least one outcome related to patient or population health or health service utilization; and, (4) included a reference group or time period. There were no date or language restrictions. We modified the Newcastle-Ottawa Tool to appraise study quality. The review is registered with PROSPERO (CRD42019124989). Findings Among 5,123 articles, eleven articles met inclusion criteria. Studies examined 20 strikes in LMIC from 1991 to 2017 (average strike length of 32·9 days), with five studies from Kenya, two each from India and Nigeria, and one each from Malawi and South Africa. The majority of studies reported hospital admissions or inpatient mortality. Generally, health service utilization decreased during strike periods, but changes in patient mortality and other health outcomes varied. Study quality was heterogenous with most studies reporting from a single facility or medical department. Interpretation Compared to high-income settings, our study suggests a more complex picture of the effect of strikes by health workers on health and health service utilization outcomes in LMIC.
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    Outcomes from a single-intervention trial to improve interprofessional practice behaviors at a student-led free clinic
    (Elsevier, 2019-12) Horbal, Steven R.; Grice, Brian A.; Evans, Alexandra; Kaplan, Kyle W.; Wright, Lauren; Bidulescu, Aurelian; Pfeifle, Andrea L.; Family Medicine, School of Medicine
    Background Interprofessional collaboration (IPC) is the practice of two or more healthcare professionals working together and learning from one another to improve health outcomes. IPC is important for quality training, typically improving individual and group level outcomes. Students value the opportunity for leadership and teamwork development when IPC is offered in their curriculum. The Indiana University Student Outreach Clinic (IUSOC) is a student run clinic that provides free primary care services to underserved residents residing in Indianapolis, Indiana. The IUSOC partner leaders identified a need to enhance knowledge about partner roles, scope of practice, and professional training with the hopes of improving quality of care through IPC and utilization of clinic resources. Methods A cluster randomized design consisted of education session days and control days. Participants had an equal selection probability. Student partners from ten different disciplines were involved. Two survey instruments were used for data collection: 1) The Interprofessional Socialization and Valuing Scale and 2) The Professional Consciousness Raising Questionnaire. The former measured the attitudes and beliefs that underlie interprofessional socialization, while the latter assessed pre/post student knowledge of the roles and responsibilities of each partner. Results The control arm of the study was composed of 167 student participants and the intervention arm had 170 participants. Participants in the intervention arm had greater scores for “ability to work with others”, “value in working with others”, and “comfort in working with others.” The intervention arm also had significantly increased odds of correctly identifying the roles responsibilities of the nursing, law, dental, and global health disciplines. Conclusions Results of this study demonstrate that administering a short interprofessional education exercise to healthcare professional students leads to improved IPC through increased interprofessional knowledge about other professions and change in beliefs and values toward the value of interprofessional collaboration among healthcare professionals.