Take a deeper look into all the publications produced by researchers at The Dartmouth Institute.

Knutzen KE, Sacks OA, Brody-Bizar OC, Murray GF, Jain RH, Holdcroft LA, Alam SS, Liu MA, Pollak KI, Tulsky JA, Barnato AE

2021 Jun 1;4(6):e2113193doi: 10.1001/jamanetworkopen.2021.13193

Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month before death, despite most patients desiring information earlier.

JAMA Netw Open|2021 Jun 1

Chelen JSC, White DB, Zaza S, Perry AN, Feifer DS, Crawford ML, Barnato AE

2021 Jun 9;doi: 10.1089/hs.2020.0166

Before the predicted March 2020 surge of COVID-19, US healthcare organizations were charged with developing resource allocation policies. We assessed policy preparedness and substantive triage criteria within existing policies using a cross-sectional survey distributed to public health personnel and healthcare providers between March 23 and April 23, 2020. Personnel and providers from 68 organizations from 34 US states responded. While half of the organizations did not yet have formal allocation policies, all but 4 were in the process of developing policies. Using manual abstraction and natural language processing, we summarize the origins and features of the policies. Most policies included objective triage criteria, specified inapplicable criteria, separated triage and clinical decision making, detailed reassessment plans, offered an appeals process, and addressed palliative care. All but 1 policy referenced a sequential organ failure assessment score as a triage criterion, and 10 policies categorically excluded patients. Six policies were almost identical, tracing their origins to influenza planning. This sample of policies reflects organizational strategies of exemplar-based policy development and the use of objective criteria in triage decisions, either before or instead of clinical judgment, to support ethical distribution of resources. Future guidance is warranted on how to adapt policies across disease type, choose objective criteria, and specify processes that rely on clinical judgments.

Health Secur|2021 Jun 9

Schott SL, Berkowitz J, Dodge SE, Petersen CL, Saunders CH, Sobti NK, Xu K, Coylewright M

2021 Jun 10;:CIRCOUTCOMES120007329doi: 10.1161/CIRCOUTCOMES.120.007329

Shared decision-making in cardiology is increasingly recommended to improve patient-centeredness of care. Decision aids can improve patient knowledge and decisional quality but are infrequently used in real-world practice. This mixed-methods study tests the efficacy and acceptability of a decision aid integrated into the electronic health record (Integrated Decision Aid [IDeA]) and delivered by clinicians for patients with atrial fibrillation considering options to reduce stroke risk. We aimed to determine whether the IDeA improves patient knowledge, reduces decisional conflict, and is seen as acceptable by clinicians and patients.

Circ Cardiovasc Qual Outcomes|2021 Jun 10

Gilstrap L, Austin AM, O'Malley AJ, Gladders B, Barnato AE, Tosteson A, Skinner J

2021 Jun 7;doi: 10.1007/s11606-021-06901-7

The demographics of heart failure are changing. The rate of growth of the "older" heart failure population, specifically those ≥ 75, has outpaced that of any other age group. These older patients were underrepresented in the early beta-blocker trials. There are several reasons, including a decreased potential for mortality benefit and increased risk of side effects, why the risk/benefit tradeoff may be different in this population.

J Gen Intern Med|2021 Jun 7

Selby K, Cardinaux R, Metry B, de Rougemont S, Chabloz J, Meier-Herrmann V, Stoller J, Durand MA, Auer R

2021 Jun 5;7(1):37doi: 10.1186/s40900-021-00283-0

Guidelines for patient decision aids (DA) recommend target population involvement throughout the development process, but developers may struggle because of limited resources. We sought to develop a feasible means of getting repeated feedback from users.

Res Involv Engagem|2021 Jun 5

Tosteson ANA, Tapp S, Titus LJ, Nelson HD, Longton GM, Bronson M, Pepe M, Carney PA, Onega T, Piepkorn MW, Knezevich SR, Barnhill R, Weinstock MA, Elder DE, Elmore JG

2021 Jun 2;doi: 10.1001/jamadermatol.2021.1779

Diagnostic variation among pathologists interpreting cutaneous melanocytic lesions could lead to suboptimal care.

JAMA Dermatol|2021 Jun 2

Gerjevic KA, Ahmad S, Strohbehn K, Riblet N

2021 May 28;doi: 10.1097/SPV.0000000000001074

We summarized the evidence evaluating the cost-effectiveness of sacral neuromodulation (SNM) versus onabotulinumtoxinA (BONT/A) in the treatment of refractory overactive bladder (OAB) among women.

Female Pelvic Med Reconstr Surg|2021 May 28

Green CM, Leyenaar JK, Nuncio B, Leslie LK

2021 May 28;pii: S1876-2859(21)00235-7. doi: 10.1016/j.acap.2021.04.015

This national study identified the rotations in which pediatric residents received training in the assessment and treatment of behavioral/mental health (B/MH) problems, and examined associations between learning B/MH skills during multiple clinical rotations and resident-reported interest in B/MH issues.

Acad Pediatr|2021 May 28

McLaren JL, Barnett ER, Acquilano SC, Concepcion Zayas MT, Drake RE, Leyenaar JK

2021 May 31;doi: 10.1007/s10597-021-00845-2

We examined caregiver's knowledge, attitudes, and concerns about their child's psychotropic medication regimen and the potential side effects, describe how they seek information regarding treatment, and ascertain their perspectives toward deprescribing.

Community Ment Health J|2021 May 31

Young MN, Kearing S, Malenka D, Goodney PP, Skinner J, Iribarne A

2021 May 31;:e019588doi: 10.1161/JAHA.120.019588

Background Transcatheter aortic valve replacement (TAVR) has transformed the management of aortic valve stenosis. However, little national data are available characterizing the geographic and demographic dispersion of this disruptive technology relative to surgical aortic valve replacement (SAVR). Methods and Results In this US claims-based study, we analyzed a 100% sample of fee-for-service Medicare beneficiaries from 2012 to 2017 and examined national rates of TAVR versus SAVR. Procedure rates were compared across years as a function of age, sex, race, and geography for TAVR and SAVR beneficiaries. There was significant growth in TAVR from 15.4 beneficiaries/100 000 enrollees in 2012 to 90.6 in 2017 (<0.001). SAVR rates declined from 92.8 beneficiaries/100 000 enrollees in 2012 to 63.5 in 2017 (<0.001). The growth of TAVR varied as a function of age (<0.0001). While TAVR was the dominant strategy among beneficiaries ≥85 and 75 to 84 years old, SAVR was more common among beneficiaries 65 to 74 years old. TAVR was also used more frequently than SAVR among women (<0.001). While TAVR increased among all races, it was less commonly used among non-White beneficiaries (<0.001). Contemporary use of TAVR relative to SAVR varied significantly by geographic location, with a TAVR:SAVR ratio in 2017 of 1.24 in the Midwest and 1.68 in the Northeast (<0.001). Conclusions In 2017, the number of Medicare beneficiaries receiving TAVR exceeded SAVR for the first time in the United States. There is significant variation, however, in the geographic expansion of TAVR and in patient demographics relative to SAVR.

J Am Heart Assoc|2021 May 31


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