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Article ; Online: The health IT special issue: enduring barriers to adoption and innovative predictive methods.

Graetz, Ilana

2020 Volume 26, Issue 1, Page(s) 19

Abstract: Electronic health record systems have the potential to significantly improve care coordination and, ultimately, clinical care delivery. Still, it is clear that these systems are not silver bullets that will automatically result in better coordination of ... ...

Abstract	Electronic health record systems have the potential to significantly improve care coordination and, ultimately, clinical care delivery. Still, it is clear that these systems are not silver bullets that will automatically result in better coordination of care and quality.
MeSH term(s)	American Recovery and Reinvestment Act ; Electronic Health Records ; Humans ; Medical Informatics ; Periodicals as Topic ; United States
Language	English
Publishing date	2020-01-17
Publishing country	United States
Document type	Editorial ; Introductory Journal Article
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
DOI	10.37765/ajmc.2020.42140
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Article ; Online: Capsule Commentary on Richman et al., Colorectal Cancer Screening in the Era of the Affordable Care Act.

Graetz, Ilana

Journal of general internal medicine

2016 Volume 31, Issue 3, Page(s) 325

MeSH term(s)	Colorectal Neoplasms/diagnosis ; Early Detection of Cancer ; Humans ; Patient Protection and Affordable Care Act
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-015-3519-8
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Article ; Online: Vertical integration of oncologists and cancer outcomes and costs in metastatic castration-resistant prostate cancer.

Hu, Xin / Lipscomb, Joseph / Jiang, Changchuan / Graetz, Ilana

Journal of the National Cancer Institute

2022 Volume 115, Issue 3, Page(s) 268–278

Abstract: Background: The share of oncology practices owned by hospitals (ie, vertically integrated) nearly doubled from 2007 to 2017. We examined how integration between hospitals and oncologists affected care quality, outcomes, and spending among metastatic ... ...

Abstract	Background: The share of oncology practices owned by hospitals (ie, vertically integrated) nearly doubled from 2007 to 2017. We examined how integration between hospitals and oncologists affected care quality, outcomes, and spending among metastatic castration-resistant prostate cancer (mCRPC) patients. Methods: Using Surveillance, Epidemiology, and End Results-Medicare linked data and the Medicare Data on Provider Practice and Specialty, we identified Medicare beneficiaries who initiated systemic therapy for mCRPC between 2008 and 2017 (n = 9172). Primary outcomes included 1) bone-modifying agents (BMA) use, 2) time on systemic therapy, 3) survival, and 4) Medicare spending for the first 3 months following therapy initiation. We used a differences-in-differences approach to estimate the impact of vertical integration on outcomes, adjusting for patient and provider characteristics. Results: The proportion of patients treated by integrated oncologists increased from 28% to 55% from 2008 to 2017. Vertical integration was associated with an 11.7 percentage point (95% confidence interval [CI] = 4.2 to 19.1) increased likelihood of BMA use. There were no satistically significant changes in time on systemic therapy, survival, or total per-patient Medicare spending. Further decomposition showed an increase in outpatient payment ($5190, 95% CI = $1451 to $8930) and decrease in professional service payment (-$4757, 95% CI = -$7644 to -$1870) but no statistically significant changes for other service types (eg, inpatient and prescription drugs). Conclusions: Vertical integration was associated with statistically significant increased BMA use but not with other cancer outcomes among mCRPC patients. For oncologists who switched service billing from physician offices to outpatient departments, there was no statistically significant change in overall Medicare spending in the first 3 months of therapy initiation. Future studies should extend the investigation to other cancer types and patient outcomes.
MeSH term(s)	Aged ; Male ; Humans ; United States/epidemiology ; Prostatic Neoplasms, Castration-Resistant/drug therapy ; Medicare ; Oncologists ; Medical Oncology ; Quality of Health Care
Language	English
Publishing date	2022-12-27
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2992-0
ISSN	1460-2105 ; 0027-8874 ; 0198-0157
ISSN (online)	1460-2105
ISSN	0027-8874 ; 0198-0157
DOI	10.1093/jnci/djac233
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Article ; Online: The effect of cancer exemption in mandatory-access prescription drug monitoring programs among oncologists.

Graetz, Ilana / Hu, Xin / Ji, Xu / Wetzel, Martha / Yarbrough, Courtney R

JNCI cancer spectrum

2023 Volume 7, Issue 2

Abstract: To address the opioid epidemic, some states mandate that prescribers review a state-run prescription drug monitoring program (PDMP) database before prescribing opioids. We used Medicare Part D prescriber data from 2013 (baseline) to 2019 to examine the ... ...

Abstract	To address the opioid epidemic, some states mandate that prescribers review a state-run prescription drug monitoring program (PDMP) database before prescribing opioids. We used Medicare Part D prescriber data from 2013 (baseline) to 2019 to examine the association between state mandatory-access PDMPs, with and without a cancer exemption, and changes in the percent of oncologists' patients with any opioid fill per year, stratified by oncologists' baseline prescribing volume. Among 9746 medical or hematologic oncologists, the proportion of patients prescribed opioids declined after states implemented mandatory-access PDMPs without a cancer exemption overall (-0.49 percentage point, 95% confidence interval = -0.78 to -0.20 percentage point) and among those with above-median baseline prescribing, but not in states with a cancer exemption (-0.16 percentage point, 95% confidence interval = -0.50 to 0.18 percentage point) or with below-median baseline prescribing. Carefully designed mandatory-access PDMPs with cancer exemptions minimize unnecessary reductions in prescription opioid treatments among oncology patients in need of pain management.
MeSH term(s)	Aged ; Humans ; United States ; Prescription Drug Monitoring Programs ; Analgesics, Opioid ; Medicare ; Practice Patterns, Physicians' ; Oncologists ; Neoplasms
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-02-08
Publishing country	England
Document type	Journal Article
ISSN	2515-5091
ISSN (online)	2515-5091
DOI	10.1093/jncics/pkad006
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Article ; Online: Primary care video and telephone telemedicine during the COVID-19 pandemic: treatment and follow-up health care utilization.

Huang, Jie / Gopalan, Anjali / Muelly, Emilie / Hsueh, Loretta / Millman, Andrea / Graetz, Ilana / Reed, Mary

The American journal of managed care

2023 Volume 29, Issue 1, Page(s) e13–e17

Abstract: Objectives: Telemedicine use expanded greatly during the COVID-19 pandemic, and broad use of telemedicine is expected to persist beyond the pandemic. More evidence on the efficiency and safety of different telemedicine modalities is needed to inform ... ...

Abstract	Objectives: Telemedicine use expanded greatly during the COVID-19 pandemic, and broad use of telemedicine is expected to persist beyond the pandemic. More evidence on the efficiency and safety of different telemedicine modalities is needed to inform clinical and policy decisions around telemedicine use. To evaluate the efficiency and safety of telemedicine, we compared treatment and follow-up care between video and telephone visits during the COVID-19 pandemic. Study design: Observational study of patient-scheduled telemedicine visits for primary care. Methods: We used multivariate logistic regression to compare treatment (medication prescribing, laboratory/imaging orders) and 7-day follow-up care (in-person office visits, emergency department visits, and hospitalizations) between video and telephone visits, adjusted for patient characteristics. Results: Among 734,442 telemedicine visits, 58.4% were telephone visits. Adjusted rates of medication prescribing and laboratory/imaging orders were higher in video visits than telephone visits, with differences of 3.5% (95% CI, 3.3%-3.8%) and 3.9% (95% CI, 3.6%-4.1%), respectively. Adjusted rates of 7-day follow-up in-person office visits, emergency department visits, and hospitalizations were lower after video than telephone visits, with differences of 0.7% (95% CI, 0.5%-0.9%), 0.3% (95% CI, 0.2%-0.3%), and 0.04% (95% CI, 0.02%-0.06%), respectively. Conclusions: Among telemedicine visits with primary care clinicians, return visits were not common and downstream emergency events were rare. Adjusted rates of treatment measures were higher and adjusted rates of follow-up care were lower for video visits than telephone visits. Although video visits were marginally more efficient than telephone visits, telephone visits may offer an accessible option to address patient primary care needs without raising safety concerns.
MeSH term(s)	Humans ; Pandemics ; Follow-Up Studies ; COVID-19 ; Patient Acceptance of Health Care ; Telemedicine ; Primary Health Care ; Telephone
Language	English
Publishing date	2023-01-01
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
DOI	10.37765/ajmc.2023.89307
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Article ; Online: Implementing a COVID-19 Virtual Observation Unit in Emergency Medicine: Frontline Clinician and Staff Experiences.

Jung, Olivia S / Graetz, Ilana / Dorner, Stephen C / Hayden, Emily M

Medical care research and review : MCRR

2022 Volume 80, Issue 1, Page(s) 79–91

Abstract: The COVID-19 pandemic pushed hospitals to deliver care outside of their four walls. To successfully scale virtual care delivery, it is important to understand how its implementation affects frontline workers, including their teamwork and patient-provider ...

Abstract	The COVID-19 pandemic pushed hospitals to deliver care outside of their four walls. To successfully scale virtual care delivery, it is important to understand how its implementation affects frontline workers, including their teamwork and patient-provider interactions. We conducted in-depth interviews of 17 clinicians and staff involved with the COVID-19 Virtual Observation Unit (CVOU) in the emergency department (ED) of an academic hospital. The program leveraged remote patient monitoring and mobile integrated health care. In the CVOU (vs. the ED), participants observed increases in interactions among clinicians and staff, patient participation in care delivery, attention to nonmedical factors, and involvement of coordinators and paramedics in patient care. These changes were associated with unintended, positive consequences for staff, namely, feeling heard, experience of meaningfulness, and positive attitudes toward virtual care. This study advances research on reconfiguration of roles following implementation of new practices using digital tools, virtual work interactions, and at-home care delivery.
MeSH term(s)	Humans ; COVID-19 ; Pandemics ; Clinical Observation Units ; Emergency Service, Hospital ; Emergency Medicine
Language	English
Publishing date	2022-07-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1232314-7
ISSN	1552-6801 ; 1077-5587
ISSN (online)	1552-6801
ISSN	1077-5587
DOI	10.1177/10775587221108750
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Article ; Online: Therapists' perspectives on access to telemental health among Medicaid-enrolled youth.

Cummings, Janet R / Kalk, Terah / Trello, Sarah / Walker, Elizabeth Reisinger / Graetz, Ilana

The American journal of managed care

2023 Volume 29, Issue 11, Page(s) e339–e347

Abstract: Objective: The COVID-19 pandemic exacerbated risk for poor mental health (MH) outcomes among youth from low-income families and propelled a shift to telemental health. Yet, little is known about barriers to and facilitators of MH care access when ... ...

Abstract	Objective: The COVID-19 pandemic exacerbated risk for poor mental health (MH) outcomes among youth from low-income families and propelled a shift to telemental health. Yet, little is known about barriers to and facilitators of MH care access when services are delivered via synchronous telehealth to Medicaid-enrolled youth. Study design: Between December 2020 and March 2021, we conducted in-depth interviews with 19 therapists from a large safety-net organization who served Medicaid-enrolled youth (< 18 years of age) to elucidate their perspectives on barriers to and facilitators of access to telemental health services among this population. Methods: We conducted a thematic content analysis, guided by the 5 dimensions of health care access identified by Fortney and colleagues: geographical, temporal, digital, cultural (including acceptability of services), and financial access. Results: Therapists noted that when components of digital access are met (ie, access to hardware and software, connectivity, and technological literacy), then telehealth could facilitate temporal access and eliminate geographic barriers; elimination of these barriers was particularly beneficial for youth in rural and hard-to-reach communities. Notably, many families depended on smartphones for telemental health access, and many youth depended on their caregiver's smartphone. When considering acceptability of services, some youth preferred in-person services, whereas other youth (especially some teenagers with high technological literacy) had a preference for telemental health. Conclusions: Our results highlight the need for flexibility in reimbursement policies that allows providers to optimize MH care access by offering telehealth delivered via telephone and video as well as in-person services, depending on the needs and preferences of youth and families.
MeSH term(s)	United States ; Humans ; Adolescent ; Medicaid ; Pandemics ; Allied Health Personnel ; COVID-19/epidemiology ; Geography
Language	English
Publishing date	2023-11-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
DOI	10.37765/ajmc.2023.89430
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Article ; Online: "I don't just say, Hi! I'm gay": Sexual Orientation Disclosures in Oncology Clinic Settings Among Sexual Minority Women Treated for Breast Cancer in the U.S. South.

Anderson, Janeane N / Paladino, Andrew J / Robles, Andrew / Krukowski, Rebecca A / Graetz, Ilana

Seminars in oncology nursing

2023 Volume 39, Issue 4, Page(s) 151452

Abstract: Objectives: Few studies examine sexual orientation disclosures (SODs) among women with breast cancer; fewer examine the impact of culture and geography on disclosure processes. This study explores how sexual minority women (SMW) in the Southern United ... ...

Abstract	Objectives: Few studies examine sexual orientation disclosures (SODs) among women with breast cancer; fewer examine the impact of culture and geography on disclosure processes. This study explores how sexual minority women (SMW) in the Southern United States engage in SODs with oncology clinicians. Data sources: We conducted in-depth interviews with SMW (eg, lesbian, bisexual) treated for early-stage (stages I-III), hormone receptor-positive breast cancer (N = 12), using a semistructured interview guide. Participants completed an online survey prior to the 60-minute interview. Data was analyzed using an adapted pile sorting approach and thematic analysis conventions. Conclusion: Average age of participants was 49.5 years (range: 30-69), all self-identified as cisgender; 83.3% as lesbian, 58.3% were married, 91.7% had completed a 4-year college degree or higher, 66.7% identified as non-Hispanic White, 16.7% as Black, and 16.7% as Hispanic/Latina. Half of the sample had not engaged in SODs with an oncology clinician. Key themes were: (1) religious and political conservatism in the South create SOD barriers; (2) oncologist-specific barriers to SODs; (3) "straight passing" as a discrimination mitigation strategy; and (4) SOD facilitators in oncology settings (ie, strategic disclosures, medical privilege, and lesbian, gay, bisexual, and transgender-friendly branding of oncology centers). Implications for nursing practice: SMW with breast cancer living in the U.S. South navigate unique interpersonal barriers to SODs in oncology settings. Clinicians could encourage SODs by fostering inclusive environments via nonheteronormative language, inclusive intake forms, and respect for SMW's SOD navigation processes. Oncology clinicians require culturally relevant, geographic-specific communication training to facilitate SODs among SMW.
MeSH term(s)	Humans ; Female ; Male ; United States ; Adult ; Middle Aged ; Aged ; Breast Neoplasms/therapy ; Disclosure ; Sexual Behavior ; Sexual and Gender Minorities ; Superoxide Dismutase
Chemical Substances	Superoxide Dismutase (EC 1.15.1.1)
Language	English
Publishing date	2023-06-17
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	632682-1
ISSN	1878-3449 ; 0749-2081
ISSN (online)	1878-3449
ISSN	0749-2081
DOI	10.1016/j.soncn.2023.151452
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Article ; Online: Association of Medical Assistant Virtual Rooming with Vital Signs Documentation and Health Behavior Screening in Patients with Diabetes.

Somers, Madeline / Hsueh, Loretta / Huang, Jie / Gopalan, Anjali / Mulley, Emilie / Graetz, Ilana / Reed, Mary

Journal of general internal medicine

2023 Volume 38, Issue 15, Page(s) 3445–3447

MeSH term(s)	Humans ; Vital Signs ; Patients ; Health Behavior ; Documentation ; Diabetes Mellitus ; Telemedicine
Language	English
Publishing date	2023-08-24
Publishing country	United States
Document type	Letter
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-023-08372-4
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Article ; Online: Hospital adoption of interoperability functions.

Thompson, Michael P / Graetz, Ilana

Healthcare (Amsterdam, Netherlands)

2018 Volume 7, Issue 3, Page(s) 100347

Abstract: Background: The seamless transmission of patient health information across health care settings, commonly referred to as interoperability, is a focal point of federal electronic health record (EHR) incentive programs. The objective of this study was to ... ...

Abstract	Background: The seamless transmission of patient health information across health care settings, commonly referred to as interoperability, is a focal point of federal electronic health record (EHR) incentive programs. The objective of this study was to examine the extent to which interoperability functions outlined in Promoting Interoperability Stage 3 (PI3) requirements have been adopted by US hospitals, and barriers to interoperability. Methods: We conducted a cross-sectional analysis of 2781 non-federal, acute-care hospitals responding to the 2015 American Hospital Association Information Technology (IT) Supplement survey. We described the percentage of hospitals that adopted PI3 functionalities, identified hospital characteristics associated with adoption, and compared barriers to interoperability between hospitals that have and have not adopted PI3 functionalities. Results: Only 16.7% of hospitals had adopted all six core functionalities required to meet PI3 objectives. Over 70% of hospitals had implemented at least four of six functionalities, while 1.8% implemented none. Major teaching (adjusted odds ratio [aOR]=1.66), system affiliated (aOR=1.63), and regional health information exchange participating hospitals (aOR=1.86) were more likely to adopt PI3 functionalities, while for-profit hospitals (OR=0.11) were less likely. Hospitals that adopted PI3 functionalities more frequently reported experiencing barriers to interoperability, including the receiving provider's ability and interest to send/receive data. Conclusions: While only a small proportion of hospitals had implemented all six PI3 functionalities at the time the requirements were finalized, the vast majority had already implemented most of the required functionalities. Still, several barriers stand in the way of achieving seamless interoperability, many of which lie outside hospitals' control.
MeSH term(s)	Access to Information ; American Hospital Association ; Cross-Sectional Studies ; Delivery of Health Care/organization & administration ; Diffusion of Innovation ; Electronic Health Records/statistics & numerical data ; Health Care Surveys ; Humans ; Information Dissemination ; Interinstitutional Relations ; United States
Language	English
Publishing date	2018-12-27
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2724773-9
ISSN	2213-0772 ; 2213-0764 ; 2213-0772
ISSN (online)	2213-0772 ; 2213-0764
ISSN	2213-0772
DOI	10.1016/j.hjdsi.2018.12.001
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