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Article ; Online: Variation in multimorbidity by sociodemographics and social drivers of health among patients seen at community-based health centers.

Bensken, Wyatt P / Navale, Suparna M / McGrath, Brenda M / Cook, Nicole / Nishiike, Yui / Mertes, Gretchen / Goueth, Rose / Jones, Matthew / Templeton, Anna / Zyzanski, Stephen J / Koroukian, Siran M / Stange, Kurt C

Journal of multimorbidity and comorbidity

2024 Volume 14, Page(s) 26335565241236410

Abstract: Purpose: Understanding variation in multimorbidity across sociodemographics and social drivers of health is critical to reducing health inequities.: Methods: From the multi-state OCHIN network of community-based health centers (CBHCs), we identified ... ...

Abstract	Purpose: Understanding variation in multimorbidity across sociodemographics and social drivers of health is critical to reducing health inequities. Methods: From the multi-state OCHIN network of community-based health centers (CBHCs), we identified a cross-sectional cohort of adult (> 25 years old) patients who had a visit between 2019-2021. We used generalized linear models to examine the relationship between the Multimorbidity Weighted Index (MWI) and sociodemographics and social drivers of health (Area Deprivation Index [ADI] and social risks [e.g., food insecurity]). Each model included an interaction term between the primary predictor and age to examine if certain groups had a higher MWI at younger ages. Results: Among 642,730 patients, 28.2% were Hispanic/Latino, 42.8% were male, and the median age was 48. The median MWI was 2.05 (IQR: 0.34, 4.87) and was higher for adults over the age of 40 and American Indians and Alaska Natives. The regression model revealed a higher MWI at younger ages for patients living in areas of higher deprivation. Additionally, patients with social risks had a higher MWI (3.16; IQR: 1.33, 6.65) than those without (2.13; IQR: 0.34, 4.89) and the interaction between age and social risk suggested a higher MWI at younger ages. Conclusions: Greater multimorbidity at younger ages and among those with social risks and living in areas of deprivation shows possible mechanisms for the premature aging and disability often seen in community-based health centers and highlights the need for comprehensive approaches to improving the health of vulnerable populations.
Language	English
Publishing date	2024-02-27
Publishing country	England
Document type	Journal Article
ISSN	2633-5565
ISSN (online)	2633-5565
DOI	10.1177/26335565241236410
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Article ; Online: Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022).

Cook, Nicole / McGrath, Brenda M / Navale, Suparna M / Koroukian, Siran M / Templeton, Anna R / Crocker, Laura C / Zyzanski, Stephen J / Bensken, Wyatt P / Stange, Kurt C

Journal of the American Board of Family Medicine : JABFM

2024 Volume 36, Issue 6, Page(s) 916–926

Abstract: Introduction: Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery.: ... ...

Abstract	Introduction: Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery. Objective: To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE). Methods: We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states. Results: There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022. Conclusion: Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time.
MeSH term(s)	Humans ; Child ; COVID-19/epidemiology ; Pandemics ; Delivery of Health Care ; Telemedicine ; Community Health Centers
Language	English
Publishing date	2024-01-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2023.230081R1
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Article ; Online: Performance of the Person Centered Primary Care Measure in Pediatric Continuity Clinic.

Ronis, Sarah D / Westphaln, Kristi K / Kleinman, Lawrence C / Zyzanski, Stephen J / Stange, Kurt C

Academic pediatrics

2020 Volume 21, Issue 6, Page(s) 1077–1083

Abstract: Objective: Improvement efforts in pediatric primary care would benefit from measures that capture families' holistic experience of the practice. We sought to assess the reliability and validity of the new Person-Centered Primary Care Measure (PCPCM) in ... ...

Abstract	Objective: Improvement efforts in pediatric primary care would benefit from measures that capture families' holistic experience of the practice. We sought to assess the reliability and validity of the new Person-Centered Primary Care Measure (PCPCM) in a pediatric resident continuity clinic serving low-income families. Methods: We incorporated the 11-item PCPCM, stems adapted to reflect a parent responding about their child's visit, into a telephone survey of 194 parents presenting for care in October 2019 at a pediatric resident continuity clinic in Cleveland Ohio (64% response rate). We evaluated PCPCM items using factor analysis and Rasch modeling, and assessed associations of the PCPCM with parents' demographics and perceptions of specific elements of their child's care. Results: In this sample of low-income families, the PCPCM had good reliability (Cronbach's alpha 0.85). All items loaded onto a single factor in principal axes factor analysis. Of the 11 aspects of primary care represented in the scale, "shared experience" was most difficult for parents to endorse in Rasch modeling. All 11 items contributed significantly to the total scale score with corrected item-total correlations >0.4. The PCPCM score was independent of socio demographics and was associated with parent's report that their child's clinician spends enough time with them. Conclusions: The PCPCM performs well in a pediatric continuity clinic setting, warranting consideration for its use as a parsimonious parent-reported measure of what patients and clinicians say matters most in pediatric primary care.
MeSH term(s)	Ambulatory Care Facilities ; Child ; Factor Analysis, Statistical ; Humans ; Parents ; Primary Health Care ; Reproducibility of Results
Language	English
Publishing date	2020-12-24
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2483385-X
ISSN	1876-2867 ; 1876-2859
ISSN (online)	1876-2867
ISSN	1876-2859
DOI	10.1016/j.acap.2020.12.006
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Article ; Online: Exploration of the psychometric properties of the Person-Centred Primary Care Measure (PCPCM) in a Chinese primary care population in Hong Kong: a cross-sectional validation study.

Tse, Emily Tsui Yee / Lam, Cindy Lo Kuen / Wong, Carlos King Ho / Chin, Weng Yee / Etz, Rebecca S / Zyzanski, Stephen J / Stange, Kurt C

BMJ open

2021 Volume 11, Issue 9, Page(s) e052655

Abstract: Objectives: To evaluate the validity and psychometric properties of the Chinese Person-Centred Primary Care Measure (PCPCM) in a Chinese-speaking population.: Design: A cross-sectional study.: Setting: A primary care clinic in Hong Kong.: ... ...

Abstract	Objectives: To evaluate the validity and psychometric properties of the Chinese Person-Centred Primary Care Measure (PCPCM) in a Chinese-speaking population. Design: A cross-sectional study. Setting: A primary care clinic in Hong Kong. Participants: 300 Chinese adult patients (150 males and 150 females) were recruited from a primary care clinic to complete a questionnaire containing the PCPCM, Consultation and Relational Empathy (CARE), Patient Enablement Index (PEI) and Adult (short version) Primary Care Assessment Tool (PCAT). The Chinese PCPCM was readministered to 118 participants after 14 days for test-retest reliability. Outcome measures: The construct validity, reliability and sensitivity of the Chinese PCPCM. Results: The Chinese PCPCM was identified to have a one-factor construct, with good item fit and unidimensionality on Rasch analysis. Internal reliability was high (Cronbach's alpha >0.8) with moderate test-retest reliability (intraclass correlation coefficient=0.622, p<0.001). Significant correlations (0.58, 0.42, 0.48) between the PCPCM and CARE, PEI and Adult (short version) PCAT scores supported good convergent construct validity. PCPCM scores were higher among patients who had known their doctors for a longer period or who were more likely to be able to see the same doctor at every visit, and among those who self-reported to have 'better health' rather than 'worse health'. Conclusion: The Chinese PCPCM appears to be a valid, reliable and sensitive instrument for evaluating the quality of person-centred care among primary care patients in Hong Kong. Further studies are needed to confirm the utility of this instrument in other Chinese-speaking populations around the world.
MeSH term(s)	Adult ; China ; Cross-Sectional Studies ; Female ; Hong Kong ; Humans ; Male ; Primary Health Care ; Psychometrics ; Reproducibility of Results ; Surveys and Questionnaires
Language	English
Publishing date	2021-09-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-052655
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Article ; Online: Measuring Primary Care Across 35 OECD Countries.

Zyzanski, Stephen J / Gonzalez, Martha M / O'Neal, Jonathan P / Etz, Rebecca S / Reves, Sarah R / Stange, Kurt C

Annals of family medicine

2021 Volume 19, Issue 6, Page(s) 547–552

Abstract: Purpose: To examine the psychometric properties and scores of the Person-Centered Primary Care Measure (PCPCM) in 28 languages and 35 Organisation for Economic Co-operation and Development (OECD) countries.: Methods: Using a paid online sampling ... ...

Abstract	Purpose: To examine the psychometric properties and scores of the Person-Centered Primary Care Measure (PCPCM) in 28 languages and 35 Organisation for Economic Co-operation and Development (OECD) countries. Methods: Using a paid online sampling service, we requested age- and sex-representative samples of 360 adults in each country. We administered the Person-Centered Primary Care Measure-a previously validated 11-item, patient-reported measure that was developed using what patients and clinicians said is most important about primary care. We also assessed construct validity through associations with demographics, the Patient-Enablement Instrument, number of years the person had been with their primary care physician and practice, whether the patient thought the doctor knowing the results would improve their care, and whether it was hard to complete the survey. We assessed the psychometric properties of the PCPCM in each country and report the summative and item-specific PCPCM scores for each country. Results: The PCPCM exhibited solid psychometric properties across all languages and countries, with Cronbach's alphas ranging from 0.88 to 0.95, and corrected item-total correlations ranging from 0.47 to 0.81, with the vast majority of countries ranging from the low 0.50s to the high 0.70s. Multiple analyses showed strong evidence of concurrent validity. With a potential range from a low of 1 to a high of 4, the overall mean score was 2.74, with a standard deviation of 0.19. Mean PCPCM scores ranged from the lowest in Sweden (2.28) to the highest in Turkey (3.08), with Germany ranking second (3.01), and the United States third (2.99). Conclusion: The internal consistency and concurrent validity of the PCPCM across multiple countries provides strong evidence of the coherence of the breadth of primary care functions that patients and clinicians say are important. The diversity of total and item-specific scores across countries provokes interesting hypotheses about the influence of each different country's policies, practices, demographics, and culture on primary care, and provides a strong impetus for further ecological and individual data analyses using the Person-Centered Primary Care Measure.
MeSH term(s)	Adult ; Humans ; Organisation for Economic Co-Operation and Development ; Primary Health Care ; Psychometrics ; Reproducibility of Results ; Surveys and Questionnaires
Language	English
Publishing date	2021-07-30
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2171425-3
ISSN	1544-1717 ; 1544-1709
ISSN (online)	1544-1717
ISSN	1544-1709
DOI	10.1370/afm.2697
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Article ; Online: Exploration of the psychometric properties of the Person-Centred Primary Care Measure (PCPCM) in a Chinese primary care population in Hong Kong

Cindy Lo Kuen Lam / Emily Tsui Yee Tse / Weng Yee Chin / Rebecca S Etz / Stephen J Zyzanski / Kurt C Stange

BMJ Open, Vol 11, Iss

a cross-sectional validation study

2021 Volume 9

Keywords	Medicine ; R
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cultural adaptation and content validity of a Chinese translation of the 'Person-Centered Primary Care Measure': findings from cognitive debriefing.

Tse, Emily Tsui Yee / Lam, Cindy Lo Kuen / Wong, Carlos King Ho / Chin, Weng Yee / Etz, Rebecca S / Zyzanski, Stephen J / Stange, Kurt C

Family medicine and community health

2020 Volume 8, Issue 4

Abstract: Objectives: To develop an equivalent Chinese translation of the Person-Centered Primary Care Measure (PCPCM) and to establish its cultural adaptability and content validity through cognitive debriefing.: Design: The original English PCPCM was first ... ...

Abstract	Objectives: To develop an equivalent Chinese translation of the Person-Centered Primary Care Measure (PCPCM) and to establish its cultural adaptability and content validity through cognitive debriefing. Design: The original English PCPCM was first translated into Chinese by double forward-translation by professional translators. The reconciliated Chinese version was then doubly back-translated into English by two other professional translators blinded to the forward-translation. On affirmation on its linguistic equivalence with the developers of the original English PCPCM, the reconciliated Chinese PCPCM was sent for cognitive debriefing with 20 Chinese-speaking primary care subjects by a trained interviewer using structured probing questions to collect their opinions on the clarity, comprehensibility and relevance of each item and response option in the Measure. Setting: Subjects were invited from a primary care clinic in Hong Kong to undergo the cognitive debriefing interviews. The interviews were divided into four groups chronologically to allow revision of the items to be made in between. Participants: Ten males and 10 females above the age of 18 completed the cognitive interviews. They were all Cantonese-speaking Chinese recruited by convenience sampling. Subjects with cognitive impairment, could not read Chinese, too old or too sick to complete the interviews were excluded from the study. Results: An average of 3.3 min (range 3-4 min) was required for the subjects to self-complete the Measure. All items were generally perceived to be easily understood and relevant. Modifications were made to items with the content validity index (CVI) on clarity or understanding <0.8 in each round of the interviews or if a majority of the subjects suggested rewording. Revisions were made to two items in the Chinese PCPCM throughout the whole cognitive debriefing process before the final version was confirmed. The average CVI on clarity of the Chinese PCPCM items ranged from 0.75 to 1. The average CVI on understanding ranged from 0.7 to 1. The average CVI on relevance ranged from 0.55 to 1. Conclusions: The content validity of the PCPCM was ascertained in terms of its clarity, understandability and relevance to allow further testing of its psychometric properties in a larger Chinese population.
MeSH term(s)	China/ethnology ; Cultural Competency ; Female ; Humans ; Male ; Middle Aged ; Patient-Centered Care ; Primary Health Care ; Psychometrics/instrumentation ; Psychometrics/standards ; Reproducibility of Results ; Surveys and Questionnaires/standards ; Translations
Language	English
Publishing date	2020-09-19
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2986753-8
ISSN	2009-8774 ; 2305-6983
ISSN (online)	2009-8774
ISSN	2305-6983
DOI	10.1136/fmch-2020-000621
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Preventing Sudden Cardiac Death: Automated External Defibrillators in Ohio High Schools.

Lear, Aaron / Hoang, Minh-Ha / Zyzanski, Stephen J

Journal of athletic training

2015 Volume 50, Issue 10, Page(s) 1054–1058

Abstract: Context: Ohio passed legislation in 2004 for optional public funding of automated external defibrillators (AEDs) in all Ohio high schools.: Objective: To report occurrences of sudden cardiac arrest in which AEDs were used in Ohio high schools and to ... ...

Abstract	Context: Ohio passed legislation in 2004 for optional public funding of automated external defibrillators (AEDs) in all Ohio high schools. Objective: To report occurrences of sudden cardiac arrest in which AEDs were used in Ohio high schools and to evaluate the adherence of Ohio high schools with AEDs to state law and published guidelines on AEDs and emergency action plans (EAPs) in schools. Design: Cross-sectional survey. Setting: Web-based survey. Patients or other participants: A total of 264 of 827 schools that were members of the Ohio High School Athletic Association. Main outcome measure(s): We surveyed schools on AED use, AED maintenance, and EAPs. Results: Twenty-five episodes of AED deployment at 22 schools over an 11-year period were reported; 8 (32%) involved students and 17 (68%) involved adults. The reported survival rate was 60% (n = 15). Most events (n = 20, 80%) in both students and adults occurred at or near athletic facilities. The annual use rate of AEDs was 0.7%. Fifty-three percent (n = 140) of schools reported having an EAP in place for episodes of cardiac arrest. Of the schools with EAPs, 57% (n = 80) reported having rehearsed them. Conclusions: Our data supported the placement of AEDs in high schools given the frequency of use for sudden cardiac arrest and the survival rate reported. They also suggested the need for increased awareness of recommendations for EAPs and the need to formulate and practice EAPs. School EAPs should emphasize planning for events in the vicinity of athletic facilities.
MeSH term(s)	Adult ; Cross-Sectional Studies ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/etiology ; Death, Sudden, Cardiac/prevention & control ; Defibrillators/utilization ; Female ; First Aid/instrumentation ; First Aid/methods ; First Aid/statistics & numerical data ; Humans ; Male ; Ohio/epidemiology ; Schools/statistics & numerical data ; Sports/statistics & numerical data ; Students ; Surveys and Questionnaires
Language	English
Publishing date	2015-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2070051-9
ISSN	1938-162X ; 1062-6050
ISSN (online)	1938-162X
ISSN	1062-6050
DOI	10.4085/1062-6050-50.8.01
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The effect of a college pen incentive on survey response rate among recent college graduates.

Stange, Jonathan P / Zyzanski, Stephen J

Evaluation review

2011 Volume 35, Issue 1, Page(s) 93–99

Abstract: Incentives have shown a variable effect in improving survey response rates, but the effect of a pen from an organization to which the respondent has loyalty has not been studied. Recent college graduates were randomized to receive or not receive a ... ...

Abstract	Incentives have shown a variable effect in improving survey response rates, but the effect of a pen from an organization to which the respondent has loyalty has not been studied. Recent college graduates were randomized to receive or not receive a college logo pen accompanying an initial survey mailing. Among 119 total respondents, there were no differences in response rate to the initial mailing, to a second mailing to nonrespondents who did not receive a pen in the initial mailing, or in total response rate. Investigators may save money by not including a pen incentive or may consider stronger incentives.
MeSH term(s)	Chi-Square Distribution ; Data Collection/economics ; Data Collection/methods ; Data Collection/statistics & numerical data ; Female ; Handwriting ; Humans ; Male ; Motivation ; Research Design ; Students/psychology ; Surveys and Questionnaires ; United States ; Universities ; Young Adult
Language	English
Publishing date	2011-02
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1500138-6
ISSN	1552-3926 ; 0193-841X ; 0145-4692
ISSN (online)	1552-3926
ISSN	0193-841X ; 0145-4692
DOI	10.1177/0193841X11400707
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Article ; Online: The impact of educational interventions on COVID-19 and vaccination attitudes among patients in Michigan: A prospective study.

Takagi, Maya Asami / Hess, Samantha / Smith, Zachary / Gawronski, Karissa / Kumar, Ayushi / Horsley, Jacob / Haddad, Nicholas / Noveloso, Bernard / Zyzanski, Stephen / Ragina, Neli

Frontiers in public health

2023 Volume 11, Page(s) 1144659

Abstract: Background: Mass vaccination serves as an effective strategy to combat the COVID-19 pandemic. Vaccine hesitancy is a recognized impediment to achieving a vaccination rate necessary to protect communities. However, solutions and interventions to address ... ...

Abstract	Background: Mass vaccination serves as an effective strategy to combat the COVID-19 pandemic. Vaccine hesitancy is a recognized impediment to achieving a vaccination rate necessary to protect communities. However, solutions and interventions to address this issue are limited by a lack of prior research. Methods: Over 200 patients from 18 Michigan counties participated in this study. Each participant received an initial survey, including demographical questions and knowledge and opinion questions regarding COVID-19 and vaccines. Participants were randomly assigned an educational intervention in either video or infographic format. Patients received a post-survey to assess changes in knowledge and attitudes. Paired sample Results: Patients showed increased knowledge after the educational intervention in six out of seven COVID-19 topics ( Conclusion: The findings illustrate that educational interventions improved COVID-19 and vaccine knowledge among patients and that the knowledge was retained. Educational interventions serve as powerful tools to increase knowledge within communities and address negative views on vaccination. Interventions should be continually utilized to reinforce information within communities to improve vaccination rates.
MeSH term(s)	Humans ; Prospective Studies ; Michigan ; Pandemics ; COVID-19/prevention & control ; Vaccination
Language	English
Publishing date	2023-04-03
Publishing country	Switzerland
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1144659
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