Biostatistics and Health Data Science Works

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https://hdl.handle.net/1805/7162

Works authored by scholars from the Department of Biostatistics and Health Data Science, a dual department of the Richard M. Fairbanks School of Public Health and the IU School of Medicine.

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Now showing 1 - 10 of 599

Systematic review of the impact of medication synchronization on healthcare utilization, economic, clinical, and humanistic outcomes
(Wiley, 2023-06) Waghmare, Prajakta H.; Lindsey, Rachel; Reed, Jason B.; Gao, Sujuan; Zillich, Alan J.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
Medication synchronization (med-sync) or appointment-based medication synchronization (ABMS) programs allow patients to have their chronic medication refills aligned to one pickup day. For patients on multiple chronic medications, it provides a more manageable way of picking up those medications. The objective of the study was to systematically characterize literature describing economic and healthcare utilization, clinical, and humanistic outcomes for patients enrolled in med-sync. A literature search was conducted on PubMed, International Pharmaceutical Abstracts (Ovid), CINAHL (EBSCO), EMBASE (Elsevier), and Cochrane Library. Studies were included if they were conducted at a pharmacy in the United States, between January 2008 and October 2022, and evaluated the impact of med-sync on at least one of the four outcomes of interest (utilization, economic, clinical, and humanistic). The title and abstracts were screened, followed by a full-text review and final data extraction by two researchers. A data extraction template and Cochrane risk of bias tool were used for data collection and quality assessments, respectively. The search resulted in 1617 studies and finally, 27 studies were included in the systematic review. All studies included patients enrolled in either ABMS, med-sync, or in conjunction with other pharmacy services. Across all studies evaluating medication adherence, proportion of days covered (PDC) increased. All studies that administered patient surveys showed a majority of patients were satisfied with their med-sync program. One study showed a reduction in healthcare utilization and costs, while another study indicated no change. Med-sync programs have shown clinical outcomes, specifically to improve adherence in patients taking chronic medications. In terms of humanistic outcomes, patient surveys have shown high rates of satisfaction with med-sync programs. Additional studies are needed to determine if med-sync can lead to improvements in healthcare utilization and cost outcomes.
Increase in blood pressure precedes clinical depression in elderly primary care patients
(Wiley, 2013) Gao, Sujuan; Hendrie, Hugh C.; Yang, Lili; Stump, Timothy E.; Stewart, Jesse C.; Kesterson, Joe; Clark, Daniel O.; Callahan, Christopher M.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
A practical approach for incorporating dependence among fields in probabilistic record linkage
(Springer Nature, 2013-08-30) Daggy, Joanne K.; Xu, Huiping; Hui, Siu L.; Gamache, Roland E.; Grannis, Shaun J.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
Background: Methods for linking real-world healthcare data often use a latent class model, where the latent, or unknown, class is the true match status of candidate record-pairs. This commonly used model assumes that agreement patterns among multiple fields within a latent class are independent. When this assumption is violated, various approaches, including the most commonly proposed loglinear models, have been suggested to account for conditional dependence. Methods: We present a step-by-step guide to identify important dependencies between fields through a correlation residual plot and demonstrate how they can be incorporated into loglinear models for record linkage. This method is applied to healthcare data from the patient registry for a large county health department. Results: Our method could be readily implemented using standard software (with code supplied) to produce an overall better model fit as measured by BIC and deviance. Finding the most parsimonious model is known to reduce bias in parameter estimates. Conclusions: This novel approach identifies and accommodates conditional dependence in the context of record linkage. The conditional dependence model is recommended for routine use due to its flexibility for incorporating conditional dependence and easy implementation using existing software.
Scope and Outcomes of Surrogate Decision Making Among Hospitalized Older Adults
(American Medical Association, 2014) Torke, Alexia M.; Sachs, Greg A.; Helft, Paul R.; Montz, Kianna; Hui, Siu L.; Slaven, James E.; Callahan, Christopher M.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
Importance: Hospitalized older adults often lack decisional capacity, but outside of the intensive care unit and end-of-life care settings, little is known about the frequency of decision making by family members or other surrogates or its implications for hospital care. Objective: To describe the scope of surrogate decision making, the hospital course, and outcomes for older adults. Design, setting, and participants: Prospective, observational study conducted in medicine and medical intensive care unit services of 2 hospitals in 1 Midwestern city in 1083 hospitalized older adults identified by their physicians as requiring major medical decisions. Main outcomes and measures: Clinical characteristics, hospital outcomes, nature of major medical decisions, and surrogate involvement. Results: According to physician reports, at 48 hours of hospitalization, 47.4% (95% CI, 44.4%-50.4%) of older adults required at least some surrogate involvement, including 23.0% (20.6%-25.6%) with all decisions made by a surrogate. Among patients who required a surrogate for at least 1 decision within 48 hours, 57.2% required decisions about life-sustaining care (mostly addressing code status), 48.6% about procedures and operations, and 46.9% about discharge planning. Patients who needed a surrogate experienced a more complex hospital course with greater use of ventilators (2.5% of patients who made decisions and 13.2% of patients who required any surrogate decisions; P < .001), artificial nutrition (1.7% of patients and 14.4% of surrogates; P < .001), and length of stay (median, 6 days for patients and 7 days for surrogates; P < .001). They were more likely to be discharged to an extended-care facility (21.2% with patient decisions and 40.9% with surrogate decisions; P < .001) and had higher hospital mortality (0.0% patients and 5.9% surrogates; P < .001). Most surrogates were daughters (58.9%), sons (25.0%), or spouses (20.6%). Overall, only 7.4% had a living will and 25.0% had a health care representative document in the medical record. Conclusions and relevance: Surrogate decision making occurs for nearly half of hospitalized older adults and includes both complete decision making by the surrogate and joint decision making by the patient and surrogate. Surrogates commonly face a broad range of decisions in the intensive care unit and the hospital ward setting. Hospital functions should be redesigned to account for the large and growing role of surrogates, supporting them as they make health care decisions.
Bayesian mixed model inference for genetic association under related samples with brain network phenotype
(Oxford University Press, 2024) Tian, Xinyuan; Wang, Yiting; Wang, Selena; Zhao, Yi; Zhao, Yize; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
Genetic association studies for brain connectivity phenotypes have gained prominence due to advances in noninvasive imaging techniques and quantitative genetics. Brain connectivity traits, characterized by network configurations and unique biological structures, present distinct challenges compared to other quantitative phenotypes. Furthermore, the presence of sample relatedness in the most imaging genetics studies limits the feasibility of adopting existing network-response modeling. In this article, we fill this gap by proposing a Bayesian network-response mixed-effect model that considers a network-variate phenotype and incorporates population structures including pedigrees and unknown sample relatedness. To accommodate the inherent topological architecture associated with the genetic contributions to the phenotype, we model the effect components via a set of effect network configurations and impose an inter-network sparsity and intra-network shrinkage to dissect the phenotypic network configurations affected by the risk genetic variant. A Markov chain Monte Carlo (MCMC) algorithm is further developed to facilitate uncertainty quantification. We evaluate the performance of our model through extensive simulations. By further applying the method to study, the genetic bases for brain structural connectivity using data from the Human Connectome Project with excessive family structures, we obtain plausible and interpretable results. Beyond brain connectivity genetic studies, our proposed model also provides a general linear mixed-effect regression framework for network-variate outcomes.
Decreasing trend of gastroschisis prevalence in the United States from 2014 through 2022: Is attributed to declining birth rates in young, high-risk gravidae
(Elsevier, 2025-02-12) Mustafa, Hiba J.; Zargarzadeh, Nikan; Moss, Kevin L.; Abiad, May; Gray, Brian; Aagaard, Kjersti M.; Buchmiller, Terry L.; Perrone, Erin E.; Shamshirsaz, Alireza A.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
Objectives: To investigate the prevalence trend of gastroschisis in the United States between 2014 and 2022. Methods: A cross-sectional retrospective analysis of the Centers for the United States live births between 2014 and 2022. Pregnancies and neonatal singleton live births with documented isolated gastroschisis were included. Neonates with other major congenital anomalies and known chromosomal abnormalities were excluded. Prevalence per 10,000 live births along with 95 % confidence intervals was estimated. Results: Among 32,088,301 singleton live births, 6804 cases of isolated gastroschisis were identified (Point prevalence: 2 in 10,000 live births). A significant decline in gastroschisis prevalence was observed, decreasing from 2.86 per 10,000 live births in 2014-1.55 per 10,000 live births in 2022 (P < 0.001). The risk of gastroschisis was significantly higher in teen and nulliparous gravidae, with prepregnancy tobacco use, and among socially vulnerable populations (underweight, < 12th-grade education, Medicaid, non-Hispanic Indigenous Americans). The drop in gastroschisis births from 2014 to 2022, compared to non-gastroschisis births, is more significant in maternal age < 20 years, nulliparous, BMI < 18.5, and in smokers prior to pregnancy than in the overall population (P = 0.02, 0.0008, <0.0001, <0.0001, and 0.01 respectively). All of the associated maternal factors had a significant decline in prevalence (P < 0.001), which may influence the decreasing trend of gastroschisis. There was no perceived considerable impact of the COVID-19 pandemic on gastroschisis trends. Conclusions: The study highlights a notable decline in gastroschisis prevalence mostly attributable to a declining birth rate in the highest at-risk strata, suggesting recent increases in birth rates among these at-risk gravidae may reverse the trend of declining gastroschisis disease prevalence. These findings support the need for ongoing further research to understand effective means of sustaining this decreasing trend.
From marginal gains to clinical utility: machine learning-based percutaneous coronary intervention risk prediction models
(Oxford University Press, 2025-01-16) Qadir, Muhammad Ibtsaam; Hira, Ravi S.; Kolbinger, Fiona R.; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
A pilot study protocol of a relational coordination training intervention among healthcare professionals in an Army medical center
(Springer Nature, 2025-03-04) House, Sherita; Perkins, Susan M.; Miller, Melissa; Taylor‑Clark, Tanekkia; Newhouse, Robin; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
Background: As patient care becomes more complex, high-quality communication and relationships among healthcare professionals are critical to coordinating care. Relational coordination (RC), a process of high-quality communication supported by shared goals, shared knowledge, and mutual respect, is positively associated with better patient (e.g., quality of care) and staff (e.g., job satisfaction, and retention) outcomes. A few researchers have found that communication skills training improves RC in civilian hospitals. However, researchers have not tested the feasibility of conducting communication skills training based on the RC framework among healthcare professionals in military hospitals. To address this gap, we propose conducting an RC training intervention in a military hospital. The primary aim of the proposed pilot study is to determine the feasibility (e.g., recruitment, retention, and completion rates) of conducting an RC training intervention in an Army medical center. The secondary aim is to explore the acceptability and usability of the RC training intervention. We will also explore changes in RC, quality of care, job satisfaction, and intent to stay among participants following the RC training intervention. Methods: A single-group feasibility study will be conducted among nurses and physicians from three units (intensive care unit, medical-surgical, and labor and delivery unit). A convenience sample of licensed practical nurses (LPNs), registered nurses (RNs), resident physicians, and physicians from the participating units will be invited to complete a 1-h RC training intervention once a month for 3 months. Participants will complete RC, quality of care, job satisfaction, and intent to stay measures at baseline and 2 weeks after each RC training intervention session. To assess the feasibility of conducting an RC training intervention, we will examine recruitment/retention rates, intervention session completion rates, and survey measure completion rates. Acceptability will be assessed qualitatively through focus group interviews, and results will be used to refine the intervention and determine if the selected measures align with participant experiences. For our secondary aim, we will explore the acceptability of the RC training intervention through focus group interviews. We will also explore changes in outcome measures using descriptive statistics with 95% confidence intervals. Discussion: Findings will establish the feasibility and acceptability of conducting an RC intervention in a military hospital and inform refinement of the intervention and study procedures prior to conducting a larger randomized controlled trial to establish efficacy.
Alleviating the emotional burden on families during organ donation requests in neurologic patients declared with brain death: the role of timing and circumstances of death
(Springer Nature, 2025-03-11) Powla, Plamena P.; Turaka, Deekshitha; Fakhri, Farima; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
Organ donation requests to families often occur during moments of profound grief and create an emotional burden that is compounded by the varying emotional responses to circumstances surrounding death. These responses, in turn, interact with the timing of the request to influence authorization decisions. Understanding the interplay between timing and circumstances of death is crucial for improving authorization rates and addressing the organ donor shortage. The Organ Retrieval and Collection of Health Information for Donation database was used to identify 3,289 potential donors with neurologic mechanisms of brain death. Multivariate logistic regression with interaction between timing and circumstance was used to estimate authorization rates. Results show no significant differences in authorization for requests made within 12 h of death, regardless of circumstance. However, significant differences in authorization were observed between requests made at the time of brain death and those made 12 or more hours later for natural causes, as well as those at 24 or more hours for homicide, motor vehicle accidents, and non-motor vehicle accidents. These findings indicate that the optimal timing for organ donation requests may depend on the emotional intensity of the situation. While quicker requests may be more effective in less emotionally charged cases, extending the time for families to grieve in highly distressing circumstances does not appear to negatively impact authorization rates. Tailoring the timing of donation requests to the circumstances of death, balancing sensitivity with the need for prompt decision-making, could reduce families' emotional burden, ease pressure in decision-making, and help address the shortage of organ donors.
Impact of Fecal Microbiota Transplant Formulations, Storage Conditions, and Duration on Bacterial Viability, Functionality, and Clinical Outcomes in Patients with Recurrent Clostridioides difficile Infection
(MDPI, 2025-03-04) Shaheen, Mohamed; McDougall, Chelsea; Chan, Leona; Franz, Rose; Wong, Karen; Giebelhaus, Ryland T.; Nguyen, Gwen; Nam, Seo Lin; de la Mata, A. Paulina; Yeo, Sam; Harynuk, James J.; Pakpour, Sepideh; Xu, Huiping; Kao, Dina; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
Fecal microbiota transplantation (FMT) is the most effective therapy for preventing recurrent Clostridioides difficile infection (rCDI). However, the impact of FMT formulations and storage conditions on bacterial viability, community structure, functionality, and clinical efficacy remains under-investigated. We studied the effect of different storage conditions on the bacterial viability (live/dead staining and cell sorting), community structure (16S rDNA analysis), and metabolic functionality (fermentation) of frozen and lyophilized FMT formulations. The clinical success rates of rCDI patients were correlated retrospectively with FMT formulations, storage durations, and host factors using the Edmonton FMT program database. Bacterial viability remained at 10-20% across various storage conditions and formulations and was comparable to that of fresh FMT. Live and dead bacterial fractions in both frozen and lyophilized FMT preparations exhibited distinct community structures. Storage durations, but not temperatures, negatively affected bacterial diversity. More short-chain fatty acids were found in the metabolomic profiling of in vitro fermentation products using lyophilized than frozen FMT. Clinical success rates in 537 rCDI patients receiving a single dose of FMT were not significantly different among the three formulations. However, longer storage durations and advanced recipient age negatively impacted clinical efficacy. Together, our findings suggest that FMT formulations and storage durations should be considered when establishing guidelines for product shelf life for optimal treatment outcomes.

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