A5064502502- Primary Care and Health Outcomes
- Global Cancer Incidence and Screening
- Health Policy Implementation Science
- Patient-Provider Communication in Healthcare
- Patient Satisfaction in Healthcare
- Lung Cancer Diagnosis and Treatment
- Healthcare Policy and Management
- Health Systems, Economic Evaluations, Quality of Life
- Palliative Care and End-of-Life Issues
- Peripheral Artery Disease Management
- Lung Cancer Treatments and Mutations
- Economic and Financial Impacts of Cancer
- Clinical practice guidelines implementation
- Health Promotion and Cardiovascular Prevention
- Racial and Ethnic Identity Research
- Global Health Workforce Issues
- Healthcare Systems and Technology
- Ethics in Clinical Research
- Bone health and osteoporosis research
- Cardiac Health and Mental Health
- Cancer survivorship and care
- Health Literacy and Information Accessibility
- Clinical Reasoning and Diagnostic Skills
- Electronic Health Records Systems
- Vaccine Coverage and Hesitancy
University of North Carolina at Chapel Hill
2016-2025
Cone Health
1999-2022
UNC Lineberger Comprehensive Cancer Center
2019-2022
Public Health Department
2022
General Department of Preventive Medicine
2022
HealthPartners
2021
Kaiser Permanente Washington Health Research Institute
2021
Northwestern University
2021
New York University
2021
Virginia Commonwealth University
2021
Lung cancer is the leading cause of death in United States. Surgical resection for stage I or II non-small cell remains only reliable treatment cure. Patients who do not undergo surgery have a median survival less than 1 year. Despite disadvantage, many patients with early-stage disease receive surgical care and rates are even lower black patients.
Timely lung cancer surgery is a metric of high-quality care and improves survival for early-stage non-small-cell cancer. Historically, Black patients experience longer delays to than White have lower rates. Antiracism interventions shown benefits in reducing racial disparities treatment.
Importance Implicit bias may influence physician treatment decisions and contribute to Black-White health disparities. There are limited data linking implicit with actual care delivery outcomes. Objective To determine whether racial is associated potentially harmful surgical selection for a cohort of patients peripheral artery disease–related claudication. Design, Setting, Participants This survey study, linked observational registry data, included eligible clinicians who participate in the...
Abstract Background Advances in early diagnosis and curative treatment have reduced high mortality rates associated with non‐small cell lung cancer. However, racial disparity survival persists partly because Black patients receive less than White patients. Methods We performed a 5‐year pragmatic, trial at five cancer centers using system‐based intervention. Patients diagnosed stage cancer, aged 18‐85 were eligible. Intervention components included: (1) real‐time warning system derived from...
Background Racial and ethnic disparities in outcomes following lower limb revascularization for peripheral artery disease have been ascribed to severity at presentation surgery. Methods Results We calculated 1‐year risk of major adverse events (MALEs), amputation, death patients undergoing elective claudication or chronic limb‐threatening ischemia the Vascular Quality Initiative data (2011–2018). report hazard ratios according race ethnicity using Cox (death) Fine Gray subdistribution...
Little is known about how internal medicine residents train for and practice telephone management. To address this deficiency, a national survey of program directors at accredited training sites was conducted to evaluate residents' medicine.A 43-item questionnaire mailed in December 1993 all the 416 United States. A limited questionnaire, regarding most essential questions, non-responders.The response rate 60% (250) full questionnaire. Only 15 (6%) programs offered formal management their...
Abstract Objective We aimed to investigate bias in applying machine learning predict real-world individual treatment effects. Materials and Methods Using a virtual patient cohort, we simulated healthcare data applied random forest gradient boosting classifiers develop prediction models. Treatment effect was estimated as the difference between predicted outcomes of control. evaluated impact predictors (ie, [X1], confounders [X2], effects modifiers [X3], other outcome risk factors [X4]) with...
<h3>PURPOSE</h3> Despite the growing popularity of stepped-wedge cluster randomized trials (SW-CRTs) for practice-based research, design's advantages and challenges are not well documented. The objective this study was to identify SW-CRT design large-scale intervention implementations in primary care settings. <h3>METHODS</h3> EvidenceNOW: Advancing Heart Health initiative, funded by Agency Healthcare Research Quality, included a large collection SW-CRTs. We conducted qualitative interviews...
In Brief Following decades of research demonstrating the efficacy patient navigation on clinical and patient-reported outcomes, Centers for Medicare & Medicaid Services (CMS) issued a final rule that pays navigation-related services effective January 1, 2024. This article reviews new codes to reimburse principal illness (PIN) services, social determinants health (SDOH) assessment, community integration, PIN-Peer Support (PIN-PS). A description codes, how use them, who can perform next...
Perceived quality of lung cancer communication is strongly associated with receiving potentially curative surgery for early-stage disease. The patient characteristics poor in the setting new diagnosis are not known, although race may be a contributing factor. Using data from prospective study decision making non–small cell patients five academic and community medical centers (N = 386), authors used logistic regression techniques to identify patient-level correlated scoring lowest quartile...
Abstract Objective To assess the effect of dissemination and implementation an intervention consisting practice facilitation a risk‐stratified, population management dashboard on cardiovascular risk reduction for patients at high in small, primary care practices. Study Setting A total 219 small practices (≤10 clinicians per site) across North Carolina with data collection from electronic health records (EHRs) fourth quarter 2015 through second 2018. Design We performed stepped‐wedge,...
In Brief OBJECTIVE: Given the potential side effects and an uncertain survival benefit, decisions about tamoxifen treatment for primary prevention of breast cancer remain complex. Primary care providers, including gynecologists, will need to counsel patients regarding this form preventive care. report, we update cost-effectiveness calculations chemoprevention establish reasonable parameters clinicians’ use. METHODS: We performed a analysis that compared women aged 50 years who were treated...
<i>Aims:</i> Although recent advances in pharmacogenomics are making possible the use of genetic testing to determine best medication for patients, little is known about how patients view such procedures. The aims this study that were developed collaboratively as part a community-academic partnership are: (1) What attitudes and perceptions prescription drug consumers concerning personalized medicine compatibility do they differ between African American white patients? (2)...
Abstract Background Community Health Workers (CHW) are recommended for delivery of interventions to prevent cardiovascular disease, but there is insufficient evidence guide implementation CHW in rural, medically underserved areas. Methods Using a hybrid implementation-effectiveness design, we evaluated the and effectiveness an adapted, evidence-based disease risk reduction intervention among rural high-risk adults. CHWs at community health center local department recruited, enrolled...
Patients express risk aversion toward surgery, particularly if surgery can lead to lifelong debility and loss of independence. When faced with a guarantee progressive lung cancer no alternatives for cure, however, patients are willing take extremely high risks postoperative complications surgery-related death. This result occurs because unrelenting death supersedes patients' attitudes almost all other health states. By adding conditions such as misunderstanding prognosis, diagnostic...
The objective of Heart Health NOW (HHN) is to determine if primary care practice support—a comprehensive evidence-based quality improvement strategy involving facilitation, academic detailing, technology support, and regional learning collaboratives—accelerates widespread dissemination implementation guidelines for cardiovascular disease (CVD) prevention in small- medium-sized practices and, additionally, increases practices’ capacity incorporate other clinical the future. HHN a stepped...
**BACKGROUND** The effect of practice facilitation that provides onsite quality improvement (QI) and electronic health record (EHR) coaching on chronic care outcomes is unclear. This study evaluates the effectiveness such a program---similar to an agricultural extension center model---that these services. **METHODS** Through Health Information Technology for Economic Clinical (HITECH) portion American Recovery Reinvestment Act, North Carolina Area Education Centers program became Regional...