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Article ; Online: America’s Racial Reckoning Within Perinatal Communication

Maren S.G. Henderson / Meghan M. JaKa / Jennifer M. Dinh / Barbara A. Olson-Bullis / Corinne Brown-Robinson / Thomas E. Kottke / Jeanette Y. Ziegenfuss

Journal of Primary Care & Community Health, Vol

A Rapid Review Using Sociotechnical Systems Theory to Compare Publications Before and After 2020

2023 Volume 14

Abstract: Perinatal communication is one factor driving racial disparities in maternal and infant morbidity. The murder of George Floyd in May 2020, in addition to the disproportionate impacts of the Covid-19 pandemic on communities of color, was a catalyst for ... ...

Abstract	Perinatal communication is one factor driving racial disparities in maternal and infant morbidity. The murder of George Floyd in May 2020, in addition to the disproportionate impacts of the Covid-19 pandemic on communities of color, was a catalyst for American society to address racial injustices with a renewed sense of urgency. Drawing upon sociotechnical systems (STS) theory, this rapid review describes changes in the literature regarding the organizational, social, technical, and external subsystems that affect communication between perinatal providers and their Black patients. The goal of this work is to support health system optimization of health communication initiatives and, as a result, improve patient experience and parent and child outcomes. As part of a multi-year project designed to improve health communications about safe fish consumption during pregnancy, and in response to racial disparities among our health system’s patient population related to receipt of nutrition messages during prenatal visits, we conducted a rapid review of literature on Black parents’ experience of all communication while receiving perinatal care. A search of PubMed identified relevant articles published in English since 2000. Articles were screened to include articles that focused on Black people receiving perinatal care. Article content was then coded using deductive content analysis guided by STS theory to inform healthcare system improvement efforts. Differences in the prevalence of codes pre- and post-2020 are compared using chi-square statistics. The search in PubMed yielded 2419 articles. After screening, 172 articles were included in the rapid review. There was an increased recognition of communication as a key component of quality perinatal care after 2020 ( P = .012) and of the limitations of standardized technical communication ( P = .002) after 2020. Emerging literature suggests improving perinatal health communication and relationships with Black parents would address disparities in perinatal patient and baby ...
Keywords	Computer applications to medicine. Medical informatics ; R858-859.7 ; Public aspects of medicine ; RA1-1270
Subject code	306
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	SAGE Publishing
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: What Outcomes Matter to Patients After Joint or Spine Surgery?

Robin R. Whitebird / Leif I. Solberg / Christine K. Norton / Jeanette Y. Ziegenfuss / Stephen E. Asche / Elizabeth S. Grossman

Journal of Patient-Centered Research and Reviews, Vol 7, Iss 2, Pp 157-

2020 Volume 164

Abstract: Purpose: Patient-reported outcome measures (PROMs) are increasingly used in clinical care, but there have been few studies of what patients identify as the most important outcomes. Methods: Semi-structured interviews were conducted with 65 patients ... ...

Abstract	Purpose: Patient-reported outcome measures (PROMs) are increasingly used in clinical care, but there have been few studies of what patients identify as the most important outcomes. Methods: Semi-structured interviews were conducted with 65 patients undergoing hip or knee replacement, spinal discectomy/laminotomy, or a spinal fusion. Interviews focused on outcomes patients identified as important, perceived usefulness of standardized PROMs measures, and contextual situations important to their care. Data were analyzed using a directed content analysis approach. Results: Patients identified desired outcomes that were unique and important to them. Their preferred outcomes focused in the areas of freedom from pain, getting back to their normal life, and returning to an active lifestyle. Patients cared more about their individual preferred outcomes, which had more meaning for them, than a standardized PROM score. Patients also identified particular contextual situations that their care team was assumed to know about but that may not have been known. Conclusions: Patients identify specific preferred outcomes from these surgical procedures that are important and meaningful to them and that frame whether they see their surgery as a success. They also identified personal factors that they assume their surgeons know about, which affect their care and recovery. These findings underscore the importance of engaging patients in discussions about their preferences and contextual factors both prior to and after surgery.
Keywords	patient-reported outcomes ; proms ; surgery outcomes ; orthopedics ; joint replacement ; spinal fusion ; Medicine ; R
Subject code	616
Language	English
Publishing date	2020-04-01T00:00:00Z
Publisher	Advocate Aurora Health
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Primary care clinicians’ opinions before and after implementation of cancer screening and prevention clinical decision support in a clinic cluster-randomized control trial

Melissa L. Harry / Ella A. Chrenka / Laura A. Freitag / Daniel M. Saman / Clayton I. Allen / Stephen E. Asche / Anjali R. Truitt / Heidi L. Ekstrom / Patrick J. O’Connor / Jo Ann M. Sperl-Hillen / Jeanette Y. Ziegenfuss / Thomas E. Elliott

BMC Health Services Research, Vol 22, Iss 1, Pp 1-

a survey research study

2022 Volume 14

Abstract: Abstract Background Electronic health record (EHR)-linked clinical decision support (CDS) may impact primary care clinicians’ (PCCs’) clinical care opinions. As part of a clinic cluster-randomized control trial (RCT) testing a cancer prevention and ... ...

Abstract	Abstract Background Electronic health record (EHR)-linked clinical decision support (CDS) may impact primary care clinicians’ (PCCs’) clinical care opinions. As part of a clinic cluster-randomized control trial (RCT) testing a cancer prevention and screening CDS system with patient and PCC printouts (with or without shared decision-making tools [SDMT]) for patients due for breast, cervical, colorectal, and lung cancer screening and/or human papillomavirus (HPV) vaccination compared to usual care (UC), we surveyed PCCs at study clinics pre- and post-CDS implementation. Our primary aim was to learn if PCCs' opinions changed over time within study arms. Secondary aims including examining whether PCCs' opinions in study arms differed both pre- and post-implementation, and gauging PCCs’ opinions on the CDS in the two intervention arms. Methods This study was conducted within a healthcare system serving an upper Midwestern population. We administered pre-implementation (11/2/2017–1/24/2018) and post-implementation (2/2/2020–4/9/2020) cross-sectional electronic surveys to PCCs practicing within a RCT arm: UC; CDS; or CDS + SDMT. Bivariate analyses compared responses between study arms at both time periods and longitudinally within study arms. Results Pre-implementation (53%, n = 166) and post-implementation (57%, n = 172) response rates were similar. No significant differences in PCC responses were seen between study arms on cancer prevention and screening questions pre-implementation, with few significant differences found between study arms post-implementation. However, significantly fewer intervention arm clinic PCCs reported being very comfortable with discussing breast cancer screening options with patients compared to UC post-implementation, as well as compared to the same intervention arms pre-implementation. Other significant differences were noted within arms longitudinally. For intervention arms, these differences related to CDS areas like EHR alerts, risk calculators, and ordering screening. Most ...
Keywords	Cancer prevention ; Cancer screening ; Clinical decision support ; Electronic health record ; Primary care provide ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Pragmatic Evaluation of a Health System-Based Employee Weight Management Program

Meghan M. JaKa / Jennifer M. Dinh / Rachael L. Rivard / Stephen D. Herrmann / Joel Spoonheim / Nicolaas P. Pronk / Jeanette Y. Ziegenfuss

International Journal of Environmental Research and Public Health, Vol 18, Iss 5901, p

2021 Volume 5901

Abstract: Objective : We aimed to evaluate the fidelity and estimate the effectiveness of a novel health system employee weight-management program. Methods: Employees participating in a weight loss program consisting of self-monitoring, health coaching and meal ... ...

Abstract	Objective : We aimed to evaluate the fidelity and estimate the effectiveness of a novel health system employee weight-management program. Methods: Employees participating in a weight loss program consisting of self-monitoring, health coaching and meal replacements optionally enrolled in the 12-month study. Longitudinal, single-arm analyses were conducted evaluating change over time via survey, claims and programmatic data. Token participation incentives were offered for survey completion. Results : In total, 140 participants enrolled (51.2 ± 9.8 years; BMI = 33.2 ± 6.5 kg/m 2 89.3% female). During 1 year, participants attended 18.0 ± 12.2 coaching appointments and self-reported significant improvements in weight (−8.2 ± 10.5% body weight), BMI (−3.9 ± 6.5 kg/m 2 ), fruit/vegetable intake, home food preparation, added sugar, sugar sweetened beverages and life satisfaction (all p < 0.05). No significant changes were reported in physical activity, weight-related social support, self-efficacy or healthcare utilization (all p > 0.05). Conclusions : The findings from this evaluation establish implementation fidelity. Clinically significant self-reported weight loss, coupled with improvements in many weight-related behaviors, suggest the program is an effective weight management tool when offered as an employee well-being program.
Keywords	population health ; health care ; health coaching ; worksite wellness ; weight loss ; obesity prevention ; Medicine ; R
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Personalized outcomes for hip and knee replacement

Robin R. Whitebird / Leif I. Solberg / Jeanette Y. Ziegenfuss / Stephen E. Asche / Christine K. Norton / Marc F. Swiontkowski / Steven P. Dehmer / Elizabeth S. Grossman

Journal of Patient-Reported Outcomes, Vol 5, Iss 1, Pp 1-

the patients point of view

2021 Volume 10

Abstract: Abstract Background Patient reported outcome measures (PROMs) are increasingly being incorporated into clinical and surgical care for assessing outcomes. This study examined outcomes important to patients in their decision to have hip or knee replacement ...

Abstract	Abstract Background Patient reported outcome measures (PROMs) are increasingly being incorporated into clinical and surgical care for assessing outcomes. This study examined outcomes important to patients in their decision to have hip or knee replacement surgery, their perspectives on PROMs and shared decision-making, and factors they considered important for postoperative care. Methods A cross-sectional study employing survey methods with a stratified random sample of adult orthopedic patients who were scheduled for or recently had hip or knee replacement surgery. Results In a representative sample of 226 respondents, patients identified personalized outcomes important to them that they wanted from their surgery including the ability to walk without pain/discomfort, pain relief, and returning to an active lifestyle. They preferred a personalized outcome (54%) that they identified, compared to a PROM score, for tracking progress in their care and thought it important that their surgeon know their personal outcomes (63%). Patients also wanted to engage in shared decision-making (79%) about their post-surgical care and identified personal factors important to their aftercare, such as living alone and caring for pets. Conclusions Patients identified unique personalized outcomes they desired from their care and that they wanted their orthopedic surgeons to know about. Asking patients to identify their personalized outcomes could add value for both patients and surgeons in clinical care, facilitating more robust patient involvement in shared decision-making.
Keywords	Patient reported outcomes (PRO) ; Performance measurement ; Orthopedic surgery ; Clinical care ; Patient perspective ; Shared decision-making ; Public aspects of medicine ; RA1-1270
Subject code	616
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	SpringerOpen
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The impact of personalized clinical decision support on primary care patients’ views of cancer prevention and screening

Daniel M. Saman / Ella A. Chrenka / Melissa L. Harry / Clayton I. Allen / Laura A. Freitag / Stephen E. Asche / Anjali R. Truitt / Heidi L. Ekstrom / Patrick J. O’Connor / JoAnn M. Sperl-Hillen / Jeanette Y. Ziegenfuss / Thomas E. Elliott

BMC Health Services Research, Vol 21, Iss 1, Pp 1-

a cross-sectional survey

2021 Volume 11

Abstract: Abstract Background Few studies have assessed the impact of clinical decision support (CDS), with or without shared decision-making tools (SDMTs), on patients’ perceptions of cancer screening or prevention in primary care settings. This cross-sectional ... ...

Abstract	Abstract Background Few studies have assessed the impact of clinical decision support (CDS), with or without shared decision-making tools (SDMTs), on patients’ perceptions of cancer screening or prevention in primary care settings. This cross-sectional survey was conducted to understand primary care patient’s perceptions on cancer screening or prevention. Methods We mailed surveys (10/2018–1/2019) to 749 patients aged 18 to 75 years within 15 days after an index clinical encounter at 36 primary care clinics participating in a clinic-randomized control trial of a CDS system for cancer prevention. All patients were overdue for cancer screening or human papillomavirus vaccination. The survey compared respondents’ answers by study arm: usual care; CDS; or CDS + SDMT. Results Of 387 respondents (52% response rate), 73% reported having enough time to discuss cancer prevention options with their primary care provider (PCP), 64% reported their PCP explained the benefits of the cancer screening choice very well, and 32% of obese patients reported discussing weight management, with two-thirds reporting selecting a weight management intervention. Usual care respondents were significantly more likely to decide on colorectal cancer screening than CDS respondents (p < 0.01), and on tobacco cessation than CDS + SDMT respondents (p = 0.02) and both CDS and CDS + SDMT respondents (p < 0.001). Conclusions Most patients reported discussing cancer prevention needs with PCPs, with few significant differences between the three study arms in patient-reported cancer prevention care. Upcoming research will assess differences in screening and vaccination rates between study arms during the post-intervention follow-up period. Trial registration clinicaltrials.gov , NCT02986230 , December 6, 2016.
Keywords	Cancer prevention ; Cancer screening ; Clinical decision support ; Decision aid ; Electronic health record ; Patient survey ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Piquing their “Pinterest”

Jennifer Renner / Amy B. LaFrance / Ruth Taswell / Jeanne Mettner / Abigail S. Katz / Patricia McCann / Thomas E. Kottke / Lisa Harvey / Jeanette Y. Ziegenfuss

Cogent Social Sciences, Vol 4, Iss

A qualitative study to format and deliver complex fish consumption guidelines to women who are or could become pregnant

2018 Volume 1

Abstract: The topic of safe fish consumption among women is complex both in its audience (women who are or could become pregnant) and its message (it is important to eat fish for its many nutritional benefits but because mercury levels vary by species, it is ... ...

Abstract	The topic of safe fish consumption among women is complex both in its audience (women who are or could become pregnant) and its message (it is important to eat fish for its many nutritional benefits but because mercury levels vary by species, it is important to make informed choices about which species to eat). These complexities have led to confusion and fish avoidance in this population. Ideal messages about fish consumption have been suggested in the literature, but a more nuanced approach to message delivery that addresses subtleties, such as style and format of information, is needed for women to optimally use the materials. To explore how to package and deliver messages that describe and promote safe fish consumption, we conducted focus groups among women in our target population. Findings were used to design a visually appealing brochure and interactive, mobile-responsive website with recipes and a format that echoes and links to Pinterest. By delivering complex messages using a mode (easily accessible), style (photo-centric) and format (interactive, with recipes similar to Pinterest) desired by women, we have created an opportunity for repeated exposure to appealing fish images and recipes. Ideally, such exposure also piques curiosity and encourages women to seek out more complex fish information and consume safe fish during pregnancy.
Keywords	fish ; diet ; pregnancy ; health promotion ; health communication ; qualitative research ; focus groups ; mercury ; health systems ; social media ; Social Sciences ; H
Subject code	360
Language	English
Publishing date	2018-01-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Patient-Centered Outcomes Measurement

Leif I. Solberg / Stephen E. Asche / John Butler / David Carrell / Christine K. Norton / Jeffrey G. Jarvik / Rebecca Smith-Bindman / Juliana O. Tillema / Robin R. Whitebird / Ann M. Werner / Jeanette Y. Ziegenfuss

Journal of Patient-Centered Research and Reviews, Vol 4, Iss 4, Pp 221-

Does It Require Information From Patients?

2017 Volume 229

Abstract: Purpose: Since collecting outcome measure data from patients can be expensive, time-consuming, and subject to memory and nonresponse bias, we sought to learn whether outcomes important to patients can be obtained from data in the electronic health record ...

Abstract	Purpose: Since collecting outcome measure data from patients can be expensive, time-consuming, and subject to memory and nonresponse bias, we sought to learn whether outcomes important to patients can be obtained from data in the electronic health record (EHR) or health insurance claims. Methods: We previously identified 21 outcomes rated important by patients who had advanced imaging tests for back or abdominal pain. Telephone surveys about experiencing those outcomes 1 year after their test from 321 people consenting to use of their medical record and claims data were compared with audits of the participants’ EHR progress notes over the time period between the imaging test and survey completion. We also compared survey data with algorithmically extracted data from claims files for outcomes for which data might be available from that source. Results: Of the 16 outcomes for which patients’ survey responses were considered to be the best information source, only 2 outcomes for back pain and 3 for abdominal pain had kappa scores above a very modest level of ≥ 0.2 for chart audit of EHR data and none for algorithmically obtained EHR/claims data. Of the other 5 outcomes for which claims data were considered to be the best information source, only 2 outcomes from patient surveys and 3 outcomes from chart audits had kappa scores ≥ 0.2. Conclusions: For the types of outcomes studied here, medical record or claims data do not provide an adequate source of information except for a few outcomes where patient reports may be less accurate.
Keywords	electronic health records ; patient-reported outcomes ; patient-centered care ; Medicine ; R
Subject code	310
Language	English
Publishing date	2017-11-01T00:00:00Z
Publisher	Advocate Aurora Health
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Understanding primary care providers’ perceptions of cancer prevention and screening in a predominantly rural healthcare system in the upper Midwest

Daniel M. Saman / Kayla M. Walton / Melissa L. Harry / Stephen E. Asche / Anjali R. Truitt / Hillary A. Henzler-Buckingham / Clayton I. Allen / Heidi L. Ekstrom / Patrick J. O’Connor / JoAnn M. Sperl-Hillen / Jeanette Y. Ziegenfuss / Joseph A. Bianco / Thomas E. Elliott

BMC Health Services Research, Vol 19, Iss 1, Pp 1-

2019 Volume 7

Abstract: Abstract Background Cancer is the leading cause of death in the United States, with the burden expected to rise in the coming decades, increasing the need for effective cancer prevention and screening options. The United States Preventive Services Task ... ...

Abstract	Abstract Background Cancer is the leading cause of death in the United States, with the burden expected to rise in the coming decades, increasing the need for effective cancer prevention and screening options. The United States Preventive Services Task Force has suggested that a shared decision-making process be used when clinicians and patients discuss cancer screening. The electronic medical record (EMR) often provides only reminders or alerts to primary care providers (PCPs) when screenings are due, a strategy with limited efficacy. Methods We administered a cross-sectional electronic survey to PCPs (n = 165, 53% response rate) at 36 Essentia Health primary care clinics participating in a large, National Cancer Institute-funded study on a cancer prevention clinical decision support (CDS) tool. The survey assessed PCP demographics, perceptions of the EMR’s ability to help assess and manage patients’ cancer risk, and experience and comfort level discussing cancer screening and prevention with patients. Results In these predominantly rural clinics, only 49% of PCPs thought the EMR was well integrated to help assess and manage cancer risk. Both advanced care practitioners and physicians agreed that cancer screening and informed discussion of cancer risks are important; however, only 53% reported their patients gave cancer screening a high priority relative to other health issues. Conclusions The impact of EMR-linked CDS delivered to both patients and PCPs may improve cancer screening, but only if it is easy to use and saves PCPs time.
Keywords	Cancer prevention ; Cancer screening ; Clinical decision support ; Electronic medical record ; Primary care provider ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2019-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Attitudes toward and uptake of H1N1 vaccine among health care workers during the 2009 H1N1 pandemic.

Joan M Henriksen Hellyer / Aaron S DeVries / Sarah M Jenkins / Kandace A Lackore / Katherine M James / Jeanette Y Ziegenfuss / Gregory A Poland / Jon C Tilburt

PLoS ONE, Vol 6, Iss 12, p e

2011 Volume 29478

Abstract: BACKGROUND: Though recommended by many and mandated by some, influenza vaccination rates among health care workers, even in pandemics, remain below optimal levels. The objective of this study was to assess vaccination uptake, attitudes, and ... ...

Abstract	BACKGROUND: Though recommended by many and mandated by some, influenza vaccination rates among health care workers, even in pandemics, remain below optimal levels. The objective of this study was to assess vaccination uptake, attitudes, and distinguishing characteristics (including doctor-nurse differences) of health care workers who did and did not receive the pandemic H1N1 influenza vaccine in late 2009. METHODOLOGY/PRINCIPAL FINDINGS: In early 2010 we mailed a self-administered survey to 800 physicians and 800 nurses currently licensed and practicing in Minnesota. 1,073 individuals responded (cooperation rate: 69%). 85% and 62% of Minnesota physicians and nurses, respectively, reported being vaccinated. Accurately estimating the risk of vaccine side effects (OR 2.0; 95% CI 1.5-2.7), agreeing with a professional obligation to be vaccinated (OR 10.1; 95% CI 7.1-14.2), an ethical obligation to follow public health authorities' recommendations (OR 9.9; 95% CI 6.6-14.9), and laws mandating pandemic vaccination (OR 3.1; 95% CI 2.3-4.1) were all independently associated with receiving the H1N1 influenza vaccine. CONCLUSIONS/SIGNIFICANCE: While a majority of health care workers in one midwestern state reported receiving the pandemic H1N1 vaccine, physicians and nurses differed significantly in vaccination uptake. Several key attitudes and perceptions may influence health care workers' decisions regarding vaccination. These data inform how states might optimally enlist health care workers' support in achieving vaccination goals during a pandemic.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2011-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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