Faculty Bibliography
Searched for:
in-biosketch:yes
person:aab221
Total Results:
179
Limb Volume Changes and Activities of Daily Living: A Prospective Study
PMID: 33185515
ISSN: 1557-8585
CID: 4676342
Development and protocol for a nurse-led telephonic palliative care program
BACKGROUND:The COVID-19 pandemic has resulted in a profound transformation of health care delivery toward telemedicine models. PURPOSE/OBJECTIVE:We present the structure of a nurse-led telephonic palliative program and operational metrics to influence further development of tele-palliative programs. METHODS:The nurses engage with seriously ill patients for 6 months with the goal of discussing advance care planning (ACP) and addressing self-identified issues related to their illness. FINDINGS/RESULTS:Of the first 100 program graduates, 78% were actively engaged and 51% named a health care agent and/or engaged in ACP. Of the 18 patients who died during the study, 13 (72%) were enrolled in hospice services. DISCUSSION/CONCLUSIONS:Our preliminary results indicate that seriously ill patients are willing to engage with nurses and to participate with discussions on ACP. CONCLUSION/CONCLUSIONS:Given the gaps in health care exposed by the COVID-19 pandemic, this innovative program serves as an important model for bringing palliative care directly to patients.
PMID: 33485590
ISSN: 1528-3968
CID: 4799522
Disruptions in Care and Support for Homebound Adults in Home-Based Primary Care in New York City During the COVID-19 Pandemic
Homebound older adults are a highly vulnerable population, yet little is known about their experiences with healthcare during the COVID-19 pandemic. We interviewed patients in home-based primary care (HBPC) in New York City by telephone in May and June of 2020. Interviews covered social supports, household activities, self-care, and medical care, and asked participants to compare current with prepandemic experiences. Among 70 participants, 37% were Black and 32% were Hispanic. Disruptions in the home included greater difficulty accessing paid caregivers (13.9%) and food (35.3%) than before the pandemic, and unaddressed household chores (laundry, 81.4%; food preparation, 11.4%). Black study participants were more likely than White and Hispanic participants to report disruptions in accessing medical care (13 [50.0%] vs. 3 [14.3%] vs. 6 [27.3%], respectively, p = 0.02), as well as food preparation and medication taking. Black patients in HBPC are at risk of disparities in healthcare and social support during the COVID-19 pandemic.
PMCID:8345896
PMID: 34190705
ISSN: 2374-4537
CID: 5079862
Journal of the American Medical Directors Association. 2021:22(5):974-976.DOI: 10.1016/j.jamda.2021.02.010
Environmental Noise in New York City Long-Term Care Facilities: A Window into the COVID-19 Pandemic [Letter]
PMCID:7885630
PMID: 33722568
ISSN: 1538-9375
CID: 4817532
"At Home, with Care": Lessons from New York City Home-based Primary Care Practices Managing COVID-19
BACKGROUND/OBJECTIVES/OBJECTIVE:COVID-19 required rapid innovation throughout the healthcare system. Home-based primary care (HBPC) practices faced unique challenges maintaining services for medically complex older populations for whom they needed to adapt a traditionally hands-on, model of care to accommodate restrictions on in-person contact. Our aim was to determine strategies used by New York City (NYC)-area HBPC practices to provide patient care during the first wave of the COVID-19 pandemic with the goal of informing planning and preparation for home-based practices nationwide. DESIGN/METHODS:Cross-sectional qualitative design using semi-structured interviews. SETTING/METHODS:HBPC practices in the NYC metro area during spring 2020. PARTICIPANTS/METHODS:HBPC leadership including clinical/medical directors, program managers, nurse practitioners/nursing coordinators, and social workers/social work coordinators (n = 13) at 6 NYC-area practices. MEASUREMENTS/METHODS:Semi-structured interviews explored HBPC practices' COVID-19 care delivery challenges, adaptations, and advice for providers. Interviewers probed patient care, end-of-life care, telehealth, community-based services and staffing. Interviews were recorded and transcribed. Data were analyzed through a combined inductive and deductive thematic approach. RESULTS:Participants described care delivery and operational adaptations similar to those universally adopted across healthcare settings during COVID-19, such as patient outreach and telehealth. HBPC-specific adaptations included mental health services for patients experiencing depression and isolation, using multiple modalities of patient interactions to balance virtual care with necessary in-person contact, strategies to maintain patient trust, and supporting team connection of staff through daily huddles and emotional support during the surge of deaths among long-standing patients. CONCLUSION/CONCLUSIONS:NYC-area HBPC providers adapted care delivery and operations rapidly during the height of the COVID-19 pandemic. Keeping older, medically complex patients safe in their homes required considerable flexibility, transparency, teamwork, and partnerships with outside providers. As the pandemic continues to surge around the United States, HBPC providers may apply these lessons and consider resources needed to prepare for future challenges.
PMID: 33179761
ISSN: 1532-5415
CID: 4734592
An Exploratory Qualitative Study of Patient and Caregiver Perspectives of Ambulatory Kidney Palliative Care
OBJECTIVES/UNASSIGNED:The ideal clinical model to deliver palliative care to patients with advanced kidney disease is currently unknown. Internationally, ambulatory kidney palliative care clinics have emerged with positive outcomes, yet there is limited data from the United States (US). In this exploratory study we report perceptions of a US-based ambulatory kidney palliative care clinic from the perspective of patient and caregiver attendees. The objective of this study was to inform further improvement of our clinical program. METHODS/UNASSIGNED:Semi-structured interviews were conducted to elicit the patient and caregiver experience. Eleven interviews (8 patients with chronic kidney disease stage IV or V and 3 caregivers) were analyzed using qualitative description design. RESULTS/UNASSIGNED:We identified 2 themes: "Communication addressing the emotional and physical aspects of disease" and "Filling gaps in care"; Subthemes include perceived value in symptom management, assistance with coping with disease, engagement in advance care planning, program satisfaction and patient activation. SIGNIFICANCE OF RESULTS/UNASSIGNED:Qualitative analysis showed that attendees of an ambulatory kidney palliative care clinic found the clinic enhanced the management of their kidney disease and provided services that filled current gaps in their care. Shared experiences highlight the significant challenges of life with kidney disease and the possible benefits of palliative care for this population. Further study to determine the optimal model of care for kidney palliative care is needed. Inclusion of the patient and caregiver perspective will be essential in this development.
PMID: 33438435
ISSN: 1938-2715
CID: 4746812
The Effect of Body Mass Index on Brain Volume and Cognitive Function in Relapsing-Remitting Multiple sclerosis: A CombiRx Secondary Analysis
Background/UNASSIGNED:Multiple sclerosis (MS) is an autoimmune disease leading to physical, emotional and cognitive disability. High body mass index (BMI) may impact cognitive function and brain volume in MS. Yet, there is paucity of evidence addressing the impact of BMI on cognitive function and brain volume in MS. Objectives/UNASSIGNED:The purpose of this study was to examine the effects of BMI on normal appearing brain volume and cognitive function in patients with relapsing-remitting MS. Methods/UNASSIGNED:A secondary data analysis of the NIH CombiRx study was conducted. Multivariate regression and mixed model analyses were executed to analyze the effect of BMI on brain volume and cognitive function. Results/UNASSIGNED:(SD = 6.7). The multivariate regression and mixed model analyses failed to show a clinical effect of BMI on brain volume and cognitive function. Conclusion/UNASSIGNED:BMI did not show an effect on cognitive function and brain volume among MS patients. Although there is increased interest in the effects of modifiable factors on the course of MS, the effects of BMI on brain volume and cognitive function are debatable and warrant further research.ClinicalTrials.gov NCT00211887.
PMCID:8573693
PMID: 34759712
ISSN: 1179-5735
CID: 5066222
Hospice Saves Costs for Families: Evidence from 16 Years of Medicare Survey Data [Meeting Abstract]
ISI:000695816000005
ISSN: 0017-9124
CID: 5016822
EXPLORING THE INTERSECTION OF CHRONIC DISEASE, FUNCTION, AND SOCIAL CARE IN ADULT DAY CARE CLIENTS WITH DEMENTIA [Meeting Abstract]
ISI:000842009900321
ISSN: 2399-5300
CID: 5388222
DOCUMENTING THE NEED FOR PATIENT-CENTERED RELEVANT OUTCOMES IN ADULT DAY SERVICES [Meeting Abstract]
ISI:000842009900324
ISSN: 2399-5300
CID: 5388232
