Faculty Bibliography

Rigorous evidence about the broad range of harms that might be experienced by a patient in the course of testing and treatment is sparse. We aimed to generate recommendations for how researchers might more comprehensively evaluate potential harms of healthcare interventions, to allow clinicians and patients to better include this evidence in clinical decision-making. We propose seven domains of harms of tests and treatments that are relevant to patients: (1) physical impairment, (2) psychological distress, (3) social disruption, (4) disruption in connection to healthcare, (5) labeling, (6) financial impact, and (7) treatment burden. These domains will include a range of severity of harms and variation in timing after testing or treatment, attributable to the service itself or a resulting care cascade. Although some new measures may be needed, diverse data and tools are available to allow the assessment of harms comprehensively across these domains. We encourage researchers to evaluate harms in sub-populations, since the harms experienced may differ importantly by demographics, social determinants, presence of comorbid illness, psychological state, and other characteristics. Regulators, funders, and editors might require either assessment or reporting of harms in each domain or require justification for inclusion and exclusion of different domains.

Objective/UNASSIGNED:The widespread deployment of electronic health records (EHRs) has introduced new sources of error and inefficiencies to the process of ordering medications in the hospital setting. Existing work identifies orders that require pharmacy intervention by comparing them to a patient's medical records. In this work, we develop a machine learning model for identifying medication orders requiring intervention using only provider behavior and other contextual features that may reflect these new sources of inefficiencies. Materials and Methods/UNASSIGNED:Data on providers' actions in the EHR system and pharmacy orders were collected over a 2-week period in a major metropolitan hospital system. A classification model was then built to identify orders requiring pharmacist intervention. We tune the model to the context in which it would be deployed and evaluate global and local feature importance. Results/UNASSIGNED:The resultant model had an area under the receiver-operator characteristic curve of 0.91 and an area under the precision-recall curve of 0.44. Conclusions/UNASSIGNED:Providers' actions can serve as useful predictors in identifying medication orders that require pharmacy intervention. Careful model tuning for the clinical context in which the model is deployed can help to create an effective tool for improving health outcomes without using sensitive patient data.

OBJECTIVE:To establish the reliability and validity of a self-report measure designed to assess self-efficacy for hypertension treatment adherence. METHODS:This investigation was embedded within a six-month randomized clinical trial (RCT), which demonstrated that a tailored, stage-matched intervention was more effective at improving hypertension control than usual care among individuals (n = 533) with repeated uncontrolled hypertension. The instrument used to assess self-efficacy for hypertension treatment adherence (SE-HTA) comprised three subscales that assessed diet self-efficacy (DSE), exercise self-efficacy (ESE), and medication self-efficacy (MSE). To determine SE-HTA validity and reliability, we assessed internal consistency using Cronbach's α coefficients, conducted exploratory factor analysis, and evaluated convergent and discriminant validity, as well as test-retest reliability using Spearman's ρ correlation coefficients. RESULTS:Cronbach's α (internal consistency) values for DSE, ESE, and MSE were 0.81, 0.82 and 0.74. Factor analysis and the scree plot demonstrated three distinct factors, which correspond to the three subscales contained in the SE-HTA instrument. SE-HTA possessed good convergent and discriminant validity, and moderate test-retest reliability. CONCLUSION/CONCLUSIONS:The SE-HTA instrument containing diet, exercise, and medication adherence subscales is valid and reliable in adults with uncontrolled hypertension. PRACTICE IMPLICATIONS/CONCLUSIONS:This SE-HTA instrument measures self-efficacy and could help facilitate behavior change in hypertension.

Proton pump inhibitors (PPIs) are among the most commonly used medications in the world; however, these drugs carry the risk of patient harm, including acute and chronic kidney disease, Clostridium difficile infection, hypomagnesemia, and fractures. In the hospital setting, PPIs are overused for stress ulcer prophylaxis and gastrointestinal bleeding, and PPI use often continues after discharge. Numerous multifaceted interventions have demonstrated safe and effective reduction of PPI use in the inpatient setting. This narrative review and the resulting implementation guide summarize published interventions to reduce inappropriate PPI use and provide a strategy for quality improvement teams.

OBJECTIVE:To identify school garden attributes and practices that most strongly contribute to garden use and sustainability and translate them into recommendations for improving garden-based nutrition education. DESIGN:Surveys were developed and administered to school stakeholders to assess the barriers, strategies, and resources for successful school garden-based nutrition education. A panel of school garden experts identified thriving school gardens. Logistic regression was used to identify which attributes predicted thriving school garden programs. SETTING:Approximately 109 schools across Greater Austin, TX. PARTICIPANTS:A total of 523 school teachers and 174 administrators. OUTCOMES:Barriers, strategies, and resources relevant to successful school gardening nutrition programs. RESULTS:Thriving school gardens were 3-fold more likely to have funding and community partner use (P = 0.022 and P = 0.024), 4 times more likely to have active garden committees (P = 0.021), available garden curriculum (P = 0.003), teacher training (P = 0.045), ≥ 100 students who used the garden annually (P = 0.047), and 12 times more likely to have adequate district and administrator support (P = 0.018). CONCLUSIONS AND IMPLICATIONS:Adequate administrative and district support is fundamental when implementing a school garden. Schools may benefit from finding additional funding, providing teacher garden training, providing garden curriculum, forming garden leadership committees, and partnering with local community organizations to improve garden-based nutrition education.