Quality Indicators of Primary Care Provider Engagement in Nursing Home Care

The initiative described here aims to identify quality indicators (QIs) germane to the international practice of primary care providers (PCP) in post-acute and long-term care in order to demonstrate the added value of medical providers in nursing homes (NHs). A 7-member international team identified and adapted existing QIs to the AMDA competencies for medical providers. QI sources included the ACOVE 3 Quality Indicators (2007), NH Quality Indicators (2004), NH Residential Care Quality Indicators (2002), and AGS Choosing Wisely (2014). We recruited a technical expert panel (TEP) consisting of 11 panelists from the US, Canada, and the European Union, selected for their knowledge and leadership in post-acute and long-term care. The TEP, using a RAND Modified Delphi approach, provided pre-meeting ratings, discussed items in-person for clarification, and re-rated items following discussion. When panelists rated more than 1 option for a particular QI as valid and feasible, the most stringent option was selected for inclusion in the final candidate set of QIs. Panelists confidentially rated an initial 103 items on validity and feasibility of implementation. During the meeting, panelists added 18 QIs and modified 18. In post-meeting analysis, we eliminated 7 QIs rated not valid and 11 QIs for which a more stringent QI was rated valid and feasible. This resulted in a final set of 95 QIs rated valid and feasible and 8 rated valid but not feasible. This set of QIs for PCPs in the NH identified practices in which provider engagement adds value through expertise in geriatric syndromes, employing evidence-based practice, advocating for residents, delivering person-centered care, facilitating advance care planning, and communicating effectively to coordinate care. Next steps include pilot testing and evaluating the association between adherence to QIs, PCP staffing models, and better outcomes.     

Exploring young women's decisional needs for contraceptive method choice: a qualitative study

Objective

Assisting women with choosing contraceptive methods that meet their needs and preferences is essential to providing patient-centered care, but research to inform interventions supporting method choice is lacking. An assessment of patient decisional needs for contraceptive method choice may provide insight into patient-centered ways to support decision making.

Sensitivity of Claims-Based Algorithms to Ascertain Smoking Status More Than Doubled with Meaningful Use

Background

The “meaningful use of certified electronic health record” policy requires eligible professionals to record smoking status for more than 50% of all individuals aged 13 years or older in 2011 to 2012.

A cross-national comparison of the Twitter feeds of popular alcohol brands in India and Australia

Aims: To evaluate (i) the types of techniques alcohol marketers utilise to facilitate user engagement with content on leading Indian and Australian Twitter alcohol brand pages and (ii) the extent to which users engage with this content in two diverse national contexts.

Methods: The 10 alcohol brands per country with the greatest Twitter presence were identified based on the number of ‘followers’. Number of tweets, photos, and videos were collected and the type of content noted for each brand between 1 January 2016 and 29 February 2016. The data were analysed via an inductive coding approach using NVivo10.

Results: In total, the brands had accumulated up to 150,386 followers (Indian: 110,032; Australian: 40,354). The techniques utilised were a mix of those that differed by country (e.g. India: sexually suggestive content versus Australia: posts related to the brand’s tradition or heritage) and generic approaches (e.g. alcohol sponsorship of sport, music, and fashion; offering consumption suggestions; organising competitions; giveaways; and use of memes).

Conclusions: The flexibility of Twitter, which complements traditional marketing, allows brands to adapt and deliver their online alcohol content in specific national contexts and to capitalise on the cultural meanings users invoke in their interactions with the brands.     

State insurance mandates and off‐label use of chemotherapy

Access to cancer drugs used off‐label is important to cancer patients but may drive up healthcare costs with little evidence of clinical benefit. We hypothesized that state health insurance mandates for private insurers to provide coverage for off‐label use of cancer drugs cause higher rates of off‐label use. We used Truven MarketScan data from 1999 to 2007 on utilization of 35 infused chemotherapy drugs in private health plans in the United States, covering the period when eight states implemented off‐label coverage laws. We studied trends in off‐label use of drugs, distinguishing between appropriate and inappropriate off‐label use according to drug compendia, and estimated difference‐in‐difference regressions of the effect of state laws on off‐label use. We estimate 41% of utilization was off‐label, including 17% of use conservatively defined as inappropriate. Trends show gradual declines in off‐label use over time. We also find no discernable effect of state laws mandating coverage of off‐label use of cancer drugs on utilization patterns under multiple empirical specifications. Our conclusion is that policymakers should consider shifting away from mandating coverage as a way to ensure access to drugs off‐label and towards incentivizing adherence to clinical practice guidelines to improve the quality and value of off‐label use.     

Youth perceptions of alcohol advertising: are current advertising regulations working?

Objectives : We investigated young people’s exposure to alcohol advertising, their intentions to consume and purchase alcohol products following the viewing of advertisements, and whether they perceived the actors in the advertisements as being under the age of 25 years. Methods : Face‐to‐face interviews were completed with 351 risky drinking 16–19‐year‐old Australians, with a sub‐sample (n=68) responding to a range of alcohol advertisements in an in‐depth interview. Results : Participants were exposed to alcohol advertisements from an average of seven specific contexts in the past 12 months, with younger adolescents more likely to recall TV and outdoor billboards (n=351). Positive perception of advertisements was associated with increased intention to use and to purchase advertised products (n=68). A liqueur advertisement actor was perceived by 94% as being under 25 years‐old, and almost 30% thought the advertisement was marketed at people younger than 18 years of age. Conclusions : Young people’s perceptions of alcohol advertising are not necessarily in line with expert/industry assessment; products are sometimes marketed in a way that is highly appealing to young people. Greater appeal was associated with increased intention to consume and to purchase products. Implications for public health : These results indicate deficiencies in the effectiveness of current advertising codes in regard to protecting the health and wellbeing of adolescents.     

Using gas chromatography and mass spectrometry to determine 25-hydroxyvitamin D levels for clinical assessment of vitamin D deficiency

Vitamin D is responsible for multiple metabolic functions in humans. Rickets are the most common disease caused by vitamin D deficiency. It is caused by poor calcium intake resulting in poor serum-ionized calcium. The purpose of this study is to develop a rapid, sensitive, and feasible method to determine the 25-hydroxy-vitamin D3 (25(OH)D3) levels in blood samples for clinical assessment. In this study, gas chromatography coupled mass spectrometry with trimethylsilyl derivatization (TMS-GC-MS) is the most suitable protocol for quantitative analyses of 25(OH)D3. Performance of method was evaluated and compared with liquid chromatography and immunoassay. Method validation has been carried out with plasma specimens. The limit of quantitation of TMS-GC-MS method is 1.5 ppb with good linear correlation. Furthermore, the dietary intake and nutritional status of vegetarian and non-vegetarians in Taiwan were assessed by our validated method. As a result, this vitamin D nutrition survey demonstrates that most Taiwanese people have insufficient vitamin D. Due to dietary habits; the male vegans may have the highest risk of vitamin D deficiency.     

Maternal use of nicotine replacement therapy during pregnancy and offspring birthweight: a study within the Danish National Birth Cohort

Lassen TH, Madsen M, Skovgaard LT, Strandberg‐Larsen K, Olsen J, Andersen A‐MN. Maternal use of nicotine replacement therapy during pregnancy and offspring birthweight: a study within the Danish National Birth Cohort. Paediatric and Perinatal Epidemiology 2010; 24: 272–281. Smoking is a well‐established risk factor for fetal growth restriction and other adverse pregnancy outcomes, and nicotine may be one of the chemical compounds that drive these associations. Nicotine replacement therapy (NRT) is a smoking cessation aid, which can facilitate smoking cessation. It is, however, unknown whether NRT used during pregnancy impairs fetal growth. The aim of this study was to estimate the association between the use of NRT during pregnancy and offspring birthweight. The study population consisted of 72 761 women enrolled in the Danish National Birth Cohort between 1996 and 2002. Information on NRT and potential confounders was obtained from two computer‐assisted telephone interviews conducted in the second and third trimesters, respectively. Multiple linear regression in a multilevel model was used to estimate the association between NRT use and birthweight adjusted for gestational age and potential confounders. The adjusted analyses showed no significant association between the duration of NRT use and birthweight (b = 0.25 g per week of NRT use [95% CI ?2.31, 2.81]) and neither was the type of NRT product (patch, gum, inhaler) associated with reduced birthweight. However, simultaneous use of more than one NRT product was associated with reduced birthweight (b = ?10.73 g per week of NRT use [95% CI ?26.51, 5.05]), although the association was not statistically significant. The results of this study suggest that maternal use of NRT in pregnancy does not seriously affect birthweight, but there could be a negative effect on birthweight associated with simultaneous use of more than one type of NRT product.     

Complete hydatidiform mole in Hawaii: an epidemiological study

An analysis of hydatidiform moles occurring in Hawaii over a 14-year period (1968-1981) was undertaken. The pathology of all 278 reported molar pregnancies was reviewed and showed 69.4% to be complete, 24.5% to be partial, and 6.1% to be nonmolar. A case-control epidemiological investigation of the complete moles showed maternal age and race to be important, moles being significantly more prevalent in women under 20 and over 40 yr of age and also in women of Japanese, Filipino, and other Oriental ancestry. However no difference was seen in the prevalence of moles between Oriental women born in the Orient and those born and raised in Hawaii. No significant difference was found in paternal age, paternal race, socioeconomic status, or reproductive history, suggesting that these factors do not play an important role in the etiology of complete hydatidiform mole. Incidence rates for complete moles were calculated taking age and race into consideration and ranged from a high of 1 in 150 to a low of 1 in 2,000 naturally terminating pregnancies.     

Dietary protein source and butyrylated high-amylose maize starch included in a high-protein diet determines the urinary metabolome of rats

Intake of red and processed meat increases the risk of colorectal cancer (CRC), whereas dairy product consumption and the intake of dietary fibre are negatively associated with this risk. We investigated the effect of (i) low-protein diets with either whey or cooked meat (beef) as the protein source and (ii) high-protein diets with cooked meat (beef) either without or with the inclusion of 10% butyrylated high-amylose maize starch (HAMSB), on the urinary metabolome of rats. Urine samples from rats were analysed using untargeted LC-MS metabolomics. The level and source of the dietary protein affected the urinary excretion of numerous metabolites indicating that several metabolic pathways were changed. The inclusion of HAMSB in a high-protein diet caused significant alterations in the excretion of several metabolites. HAMSB reduced urinary excretion of potentially harmful metabolites resulting from a high level of meat consumption.