Faculty Bibliography
Searched for:
school:SOM
Department/Unit:Population Health
Total Results:
12799
Ninety-Day Readmissions of Bundled Valve Patients: Implications for Healthcare Policy
OBJECTIVE:Medicare's Bundle Payment for Care Improvement(BPCI) Model 2 groups reimbursement for valve surgery into 90-day episodes of care(EOC) which include operative costs, inpatient stay, physician fees, post-acute care, and readmissions up to 90 days post-procedure. We analyzed our BPCI patients' 90-day outcomes to understand the late financial risks and implications of the bundle payment system for valve patients. METHODS:All BPCI valve patients from 10/2013 (start of risk-sharing phase) through 12/2015 were included. Readmissions were categorized as early (≤30 days) or late (31-90 days). Data were collected from institutional databases as well as Medicare claims. RESULTS:Analysis included 376 BPCI valve patients: 202 open and 174 transcatheter aortic valves (TAVR). TAVR patients were older (83.6 vs 73.8 years; p=0.001) and had higher STS predicted risk (7.1% vs 2.8%; p=0.001). Overall, 18.6% of patients (70/376) had one-or-more 90-day readmission, and total claims was on average 51% greater for these patients. Overall readmissions were more common among TAVR patients (22.4%(39/174) vs 15.3%(31/202),p=0.052) as was late readmission. TAVR patients had significantly higher late readmission claims, and early readmission was predictive of late readmission for TAVR patients only (p=0.04). CONCLUSION/CONCLUSIONS:Bundled claims for a 90-day episode of care are significantly increased in patients with readmissions. TAVR patients represent a high-risk group for late readmission, possibly a reflection of their chronic disease processes. Being able to identify patients at highest risk for 90-day readmission and the associated claims will be valuable as we enter into risk-bearing EOC agreements with Medicare.
PMID: 30102970
ISSN: 1532-9488
CID: 3236652
Early termination of cardiac rehabilitation in older adults [Meeting Abstract]
Background: Among older adults with cardiovascular disease (CVD), cardiac rehabilitation (CR) has multiple benefits including improved quality of life and reduced mortality. Despite the known benefits of CR, early termination (ET) by patients (attending <12/36 recommended sessions) may attenuate these benefits. Our aim was to determine the incidence of ET in our older adult patient population, as well as risk factors associated with this outcome.
Method(s): We reviewed records from 792 consecutive older adult patients (>= 65 years old) enrolled in the NYU Langone Rusk CR program (2013-2017). Sessions attended, demographics, comor-bidities, and primary referral diagnosis were abstracted. We analyzed the overall rate of ET (defined as attending <12 sessions). Categorical variables were described with percentages and continuous variables with mean values. Multivariable logistic regression was subsequently used to analyze predictors of ET, considering age, race, ethnicity, sex, body mass index, diabetes, chronic lung disease, coronary artery disease, heart failure, and stroke.
Result(s): In our total study population, mean age was 74 +/- 7 years, mean BMI was 26 +/- 5, 38% were female, and 18% were nonwhite. Most patients (65%) were referred to CR due to ischemic heart disease (chronic stable angina, post-myocardial infarction, CABG, or elective PCI), with an additional 23% referred for valvular heart disease, 9% for systolic heart failure, and 3% for congenital heart disease. Early termination occurred in 129 patients (16.3%). Patients who terminated early were significantly older (75.6 vs. 73.9, p=0.005) and less likely to have coronary artery disease (13.6% vs. 19.5%, p=0.03). After multivariable logistic regression, the independent risk factors for ET were age (adjusted OR 1.04, 95% CI 1.01-1.07) and Hispanic ethnicity (adjusted OR 2.32, 95% CI 1.01-5.33).
Conclusion(s): Nearly 1 in 6 older adults terminated CR within 1 month (<12/36 sessions), potentially limiting the benefits of CR within this subgroup. Among factors we analyzed, age and Hispanic ethnicity were risk factors for ET, but the overall strength of associ-ation was weak. Further research is necessary to identify novel risk factors for ET in order to better target prevention efforts
Method(s): We reviewed records from 792 consecutive older adult patients (>= 65 years old) enrolled in the NYU Langone Rusk CR program (2013-2017). Sessions attended, demographics, comor-bidities, and primary referral diagnosis were abstracted. We analyzed the overall rate of ET (defined as attending <12 sessions). Categorical variables were described with percentages and continuous variables with mean values. Multivariable logistic regression was subsequently used to analyze predictors of ET, considering age, race, ethnicity, sex, body mass index, diabetes, chronic lung disease, coronary artery disease, heart failure, and stroke.
Result(s): In our total study population, mean age was 74 +/- 7 years, mean BMI was 26 +/- 5, 38% were female, and 18% were nonwhite. Most patients (65%) were referred to CR due to ischemic heart disease (chronic stable angina, post-myocardial infarction, CABG, or elective PCI), with an additional 23% referred for valvular heart disease, 9% for systolic heart failure, and 3% for congenital heart disease. Early termination occurred in 129 patients (16.3%). Patients who terminated early were significantly older (75.6 vs. 73.9, p=0.005) and less likely to have coronary artery disease (13.6% vs. 19.5%, p=0.03). After multivariable logistic regression, the independent risk factors for ET were age (adjusted OR 1.04, 95% CI 1.01-1.07) and Hispanic ethnicity (adjusted OR 2.32, 95% CI 1.01-5.33).
Conclusion(s): Nearly 1 in 6 older adults terminated CR within 1 month (<12/36 sessions), potentially limiting the benefits of CR within this subgroup. Among factors we analyzed, age and Hispanic ethnicity were risk factors for ET, but the overall strength of associ-ation was weak. Further research is necessary to identify novel risk factors for ET in order to better target prevention efforts
EMBASE:627352655
ISSN: 1532-5415
CID: 3831812
Facilitated Peer Mentorship to Support Aging Research: A RE-AIM Evaluation of the CoMPAdRE Program
BACKGROUND:The need for mentorship in aging research among postdoctoral trainees and junior faculty across medical disciplines and subspecialties is increasing, yet senior personnel with expertise in aging are lacking to fulfill the traditional dyadic mentorship role. Facilitated peer mentorship is grounded in collaborative work among peers with the guidance of a senior mentor. METHODS AND RESULTS/RESULTS:We evaluated the Columbia University Mentor Peer Aging Research (CoMPAdRE) program, an interprofessional facilitated peer mentorship program for early stage investigators, using the Reach Effectiveness Adoption Implementation and Maintenance framework (RE-AIM). Reach: A total of 15 participants, of which 20% were women, from five states and across six medical specialties participated. Effectiveness: Participants published 183 papers, of which more than 20% were collaborative papers between CoMPAdRE mentees or mentees-mentor. Participants reported developing skills in negotiation, navigating the academic role, organizing a seminar, management, and leadership over the course of the program. According to the qualitative findings, the most important components of the program included alignment around the aging, learning from national leaders, developing leadership skills and career networking. Adoption: Individual-level factors included selecting participants with a research track record, willingness to sign a compact of commitment and involvement in shaping the program. An institutional-level factor that facilitated program adoption included strong commitment from department leaders. IMPLEMENTATION/METHODS:The program cost $3,259 per participant. Maintenance: CoMPAdRE is being maintained and currently incorporating a second cohort of mentees. CONCLUSION/CONCLUSIONS:This RE-AIM evaluation provides lessons learned and strategies for future adoption, implementation, and maintenance of an aging-focused facilitated peer mentorship program.
PMID: 30693950
ISSN: 1532-5415
CID: 3626542
Searching for origins of sex differences that underlie mental health disorders: are sex differences in brain connectivity evident in humans before birth? [Meeting Abstract]
Background and aims.- Prevalence of psychiatric disorders differs in males and females, and neurological studies suggest that sex-linked variation in the brain may underlie this dissociation. However, the origin of this difference, and how early in human life sexual dimorphism in brain function emerges is a topic that requires further investigation. Here, we address this gap by assessing brain resting-state functional connectivity (RSFC) between and within brain networks as it relates to fetal sex and gestational age (GA). Methods.- We examined 118 typical human fetuses (70 male; 48 female) between 25.9 and 39.6 weeks GA. Infomap was used to derive 16 separable fetal neural networks distributed across cortical, subcortical, and cerebellar regions. Using enrichment analysis, we identified network pairs revealing distinct patterns of GArelated change in males and females. Results.- Sex-dependent variation of between- and within- network RSFC-GA associations was observed: while females exhibited GA-related variation in connectivity between posterior cingulate and temporal pole regions, and between pre-frontal and cerebellar regions, males demonstrated increased intracerebellar RSFC with advancing age. Conclusions.- Such observations confirm that sex-related differences in functional brain development are present before birth. An important next step in this line of research will be to follow children across early development and discover how sex-related variation in network development relates to future health outcomes
EMBASE:639494994
ISSN: 1778-3585
CID: 5366512
The Role of Emotion Understanding in the Development of Aggression and Callous-Unemotional Features across Early Childhood
Although prior research suggests that children show rapid change in socioemotional functioning and aggression throughout early childhood, little is known about how these factors may be associated with the development of callous-unemotional (CU) features. This study investigated the parallel development of, and reciprocal relationships between, emotion understanding (EU) and aggression across early childhood, as well as how they play a role in the development of CU features. Parallel latent growth curve modeling was used to examine longitudinal reciprocal relationships between EU and aggression in a sample of 498 primarily Black (i.e., African-American or Afro-Caribbean) preschoolers (49.5% male, 89.2% Black, Mage = 4.1), followed with six waves over a 45-month period from pre-kindergarten through grade 2. CU features were included as a baseline covariate, as well as an outcome, of EU and aggression growth factors. Children with lower levels of EU at age 4 displayed higher linear increases in aggression over time. EU at age 4 had a significant indirect effect on CU features at age 8 via its association with linear increases in aggression. Findings suggest that EU is influential in the early development of aggression, which may in turn influence the development or exacerbation of CU features. Children's EU in early childhood, especially concerning others' distress, may be an important component of preventive intervention efforts for young children at risk for serious antisocial behavior.
PMID: 30155686
ISSN: 1573-2835
CID: 3255962
Epidemiology of paediatric trauma presenting to US emergency departments: 2006-2012
BACKGROUND: Traumatic injury is the leading cause of paediatric morbidity and mortality in the USA. We present updated national data on emergency department (ED) discharges for traumatic injury for a recent 7-year period. METHODS: We conducted a descriptive epidemiological analysis of the Nationwide Emergency Department Sample Survey, the largest and most comprehensive database in the USA, for 2006-2012. Among children and adolescents, we tracked changes in injury mechanism and severity, cost of care, injury intent and the role of trauma centres. RESULTS: There was an 8.3% (95% CI 7.7 to 8.9) decrease in the annual number of ED visits for traumatic injury in children and adolescents over the study period, from 8 557 904 (SE=5861) in 2006 to 7 846 912 (SE=5191) in 2012. The case-fatality rate was 0.04% for all injuries and 3.2% for severely injured children. Children and adolescents with high-mortality injury mechanisms were more than three times more likely to be treated at a level 1 trauma centre (OR=3.5, 95% CI 3.3 to 3.7), but were more no more likely to die (OR=0.96, 95% CI 0.93 to 1.00). Traumatic brain injury diagnoses increased 22.2% (95% CI 20.6 to 23.9) during the study period. Intentional assault accounted for 3% (SE=0.1) of all child and adolescent ED injury discharges and 7.2% (SE=0.3) of discharges among 15-19 year-olds. There was an 11.3% (95% CI 10.0 to 12.6) decline in motor vehicle injuries from 2009 to 2012. The total cost of care was $23 billion (SE=0.01), a 78% increase from 2006 to 2012. CONCLUSIONS: This analysis presents a recent portrait of paediatric trauma across the USA. These analyses indicate the important role and value of trauma centre care for injured children and adolescents, and that the most common causes and mechanisms of injury are preventable.
PMID: 29056586
ISSN: 1475-5785
CID: 2757522
Human Papillomavirus Vaccination and Infection in Young Sexual Minority Men: The P18 Cohort Study
We examined the prevalence of infection with human papillomavirus (HPV) and HIV in a cohort of young gay, bisexual, and other men who have sex with men [sexual minority men (SMM)]. HPV vaccination uptake was assessed; HIV antibody testing was performed and genetic testing for oral and anal HPV infection was undertaken. We examined both HPV vaccination and infection in relation to key demographic and structural variables. Participants (n = 486) were on average 23 years old; 70% identified as a member of a racial/ethnic minority group, and 7% identified as transgender females. Only 18.1% of the participants indicated having received the full dosage of HPV vaccination and 45.1% were unvaccinated. Slightly over half the participants (58.6%) were infected with HPV, with 58.1% testing positive for anal infection and 8.8% for oral infection. HIV seropositivity was associated with infection to oral HPV [adjusted odds ratio (AOR) = 4.03] and vaccine-preventable HPV, whereas both neighborhood-level poverty (AOR = 1.68) and HIV infection (AOR = 31.13) were associated with anal infection to HPV (AOR = 1.68). Prevalence of HPV infection is high among unvaccinated young SMM, despite the availability and eligibility for vaccination. HPV infection adds further health burden to these populations and is particularly concerning for those who are HIV positive as HIV infection increases the risk of developing HPV-related cancers. These findings underscore a missed prevention opportunity for an at-risk and underserved population and suggest the need for active strategies to increase HPV vaccination uptake in young SMM before the onset of sexual behavior.
PMID: 30932696
ISSN: 1557-7449
CID: 3783482
Multi-ancestry genome-wide gene-smoking interaction study of 387,272 individuals identifies new loci associated with serum lipids
The concentrations of high- and low-density-lipoprotein cholesterol and triglycerides are influenced by smoking, but it is unknown whether genetic associations with lipids may be modified by smoking. We conducted a multi-ancestry genome-wide gene-smoking interaction study in 133,805 individuals with follow-up in an additional 253,467 individuals. Combined meta-analyses identified 13 new loci associated with lipids, some of which were detected only because association differed by smoking status. Additionally, we demonstrate the importance of including diverse populations, particularly in studies of interactions with lifestyle factors, where genomic and lifestyle differences by ancestry may contribute to novel findings.
PMCID:6467258
PMID: 30926973
ISSN: 1546-1718
CID: 4094682
City of love: group sex is associated with risks for HIV and other sexually transmissible infections among gay and bisexual men in Paris, France
Objective:This study explored the relationships between participation in group sex and risk for HIV and other sexually transmissible infections (STIs). Methods: An anonymous online survey collected data from 580 gay and bisexual men using a mobile sex and dating application in Paris, France. Logistic regression analyses were conducted, which controlled for HIV status, HIV pre-exposure prophylaxis (PrEP) use and participants' sociodemographic characteristics. Results: Compared with men with no recent group sex experience, those reporting group sex in the 3 months before the survey (30.7% of the sample) were more likely to have had condomless receptive anal sex at least once in the same period [adjusted odds ratio (aOR)=1.6, 95% confidence interval (CI)=1.1-2.4, P = 0.02], condomless insertive anal sex (aOR=2.0, 95%CI: 2.4-8.7, P < 0.001) and substance use before or during sex (aOR=1.6, 95%CI: 1.1-2.3, P = 0.02). Even when controlling for condom use, men involved with group sex were more likely to be have been diagnosed with a bacterial STI in the previous year (aOR=2.1, 95%CI: 1.3-3.3, P = 0.002). Conclusions: Group sex remains a useful marker of risk among gay and bisexual men, but research is needed that moves beyond individual practice in order to assess the epidemiological networks comprising group sex and the risks they pose relevant to HIV and other STIs.
PMID: 30819325
ISSN: 1448-5028
CID: 3752032
Condomless Group Sex Is Associated With HIV Pre-Exposure Prophylaxis Knowledge and Interest Uptake: A Cross-Sectional Study of Gay and Bisexual Men in Paris, France
As a prevention strategy, HIV pre-exposure prophylaxis (PrEP) may benefit men who participate in group sex, but little is known about PrEP among this group internationally and virtually nothing is known of the European context. This study used an online survey of gay men living in Paris, France to assess associations between group sex and awareness of, use and interest in PrEP in its once-daily, episodic, injectable, and microbicidal forms. Men reporting recent (within 3 months) condomless group sex were much more likely to report once-daily PrEP use than men with no group sex experience (41.5% vs 7.7%, p < .001). Uptake was similarly low among men who had group sex with condoms (8.0%) and those with less-recent experience (6.43%). Overall, willingness to use PrEP-including its non-daily forms-was high among men reporting group sex, suggesting opportunities for outreach and implementation.
PMID: 30917015
ISSN: 1943-2755
CID: 3778882
