Faculty Bibliography

Introduction Esophageal cancer is one of the leading causes of death in males in the United States (US). Previous studies have analyzed incidence rates of esophageal cancer in the US using the data from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program. However, given its limited patient population, certain groups and regions in the US are underrepresented. Our study utilizes the United States Cancer Statistics (USCS) database, which combines the SEER database with the Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) to cover all 50 states to examine the incidence of esophageal cancer. Methods The USCS registry was used to obtain data for esophageal cancer from 2001 to 2015. Incidence analysis was stratified based on sex, race, stage, histology, and US regional location/histology. Results The overall incidence of esophageal cancer from 2001-2015 was 4.7 per 100,000 people per year. Overall incidence rates were greatest for each stratification in males, blacks, distant disease, adenocarcinoma, and those in the Midwest with adenocarcinoma. Blacks, compared to other races, had the greatest statistically significant decrease in incidence between 2001-2015 (annual percent change (APC) -4.55). The incidence rate is also increasing the most rapidly in those with adenocarcinoma in the Northeast from 2011 to 2015 (APC 2.16). Conclusion In our study, we were able to determine the incidence of esophageal cancer using data from all 50 states in the US. Our findings of decreasing incidence in blacks and increasing incidence of adenocarcinoma in the Midwest and Northeast help elucidate the at-risk populations. Moreover, our findings help bring to light risk factors that may be contributing to the development of esophageal cancer and how diagnosis and surveillance can be improved based on these risk factors.

We integrated and optimized patient-reported outcome measures into the electronic health record to provide quantitative, objective data regarding patients' health status, which is important for patient care, payer contracts, and research. With a multidisciplinary team from information technology, clinical informatics, population health, and physician champions, we used formal human-computer interaction techniques and user-centered design to integrate several technology platforms and computerized adaptive testing for the National Institutes of Health Patient-Reported Outcomes Measurement Information System. The patient-reported outcome measure system leverages software frequently used by health systems and provides data for research and clinical care via a mobile-responsive web application using Symfony, with REDCap for configuring assessments and de-identified data storage. The system incorporates Oracle databases and Epic flowsheets. Patients complete patient-reported outcome measures, with data viewable in MyChart and Epic Synopsis Reports. Researchers can access data portals. The highly usable, successful patient-reported outcome measures platform is acceptable to patients and clinicians and achieved 73 percent overall completion rates.

BACKGROUND: A small subset of patients account for a substantial proportion of hospital readmissions. Programs to reduce utilization among this subset of frequently hospitalized patients have the potential to improve health and reduce unnecessary spending.

Many integrated health systems and accountable care organizations have turned to intensive primary care programs to improve quality of care and reduce costs for high-need high-cost patients. How best to implement such programs remains an active area of discussion. In 2014, the Veterans Health Administration (VHA) implemented five distinct intensive primary care programs as part of a demonstration project that targeted Veterans at the highest risk for hospitalization. We found that programs evolved over time, eventually converging on the implementation of the following elements: 1) an interdisciplinary care team, 2) chronic disease management, 3) comprehensive patient assessment and evaluation, 4) care and case management, 5) transitional care support, 6) preventive home visits, 7) pharmaceutical services, 8) chronic disease self-management, 9) caregiver support services, 10) health coaching, and 11) advanced care planning. The teams also found that including social workers and mental health providers on the interdisciplinary teams was critical to effectively address psychosocial needs of these complex patients. Having a central implementation coordinator facilitated the convergence of these program features across diverse demonstration sites. In future iterations of these programs, VHA intends to standardize staffing and key features to develop a scalable program that can be disseminated throughout the system.

Companion animals are likely relevant in the transmission of antimicrobial resistant bacteria in the community. Enterobacter xiangfangensis ST171, a clone that has been implicated in clusters of infections in humans, was isolated from two dogs with clinical disease in Ohio, U.S. The canine isolates contained IncHI2 plasmids encoding bla_KPC-4 Whole genome sequencing was used to put the canine isolates in phylogenetic context with available human ST171 sequences, as well as characterize their bla_KPC-4 plasmids.