Completed Surveys Research Articles

Improving follow-up survey completion rates through pilot interventions in the All of Us Research Program: Results from a non-randomized intervention study.

Retention to complete follow-up surveys in extensive longitudinal epidemiological cohort studies is vital yet challenging. All of Us developed pilot interventions to improve response rates for follow-up surveys. The pilot interventions occurred from April 27, 2020, to August 3, 2020. The three arms were: (1) telephone appointment [staff members calling participants offering appointments to complete surveys over phone] (2) postal [mail reminder to complete surveys through U.S. Postal Service], and (3) combination of telephone appointment and postal. Controls received digital-only reminders [program-level digital recontact via email or through the participant portal]. Study sites chose their study arm and participants were not randomized. A total of 50 sites piloted interventions with 17,593 participants, while 47,832 participants comprised controls during the same period. Of all participants, 6,828 (10.4%) completed any follow-up surveys (1448: telephone; 522: postal; 486: combination; 4372: controls). Follow-up survey completions were 24% higher in the telephone appointment arm than in controls in bivariate analyses. When controlling for confounders, telephone appointment and combination arms increased rates of completion similarly compared to controls, while the postal arm had no significant effect (odds ratio [95% Confidence Interval], telephone appointment:2.01[1.81-2.23]; combination:1.91[1.66-2.20]; postal:0.92[0.79-1.07]). Although the effects of the telephone appointment and combination arms were similar, differential effects were observed across sub-populations. Telephone appointments appeared to be the most successful intervention in our study. Lessons learned about retention interventions, and improvement in follow-up survey completion rates provide generalizable knowledge for similar cohort studies and demonstrate the potential value of precision reminders and engagement with sub-populations of a cohort.

Activity-based mindfulness: large-scale assessment of an online program on perceived stress and mindfulness.

Mindfulness has emerged as key construct in mental health over past decades. While current mindfulness-based interventions (MBIs) are usually rooted in Asian contemplative traditions, mindfulness practices can equally be found in other knowledge systems, including integrative medicine systems such as anthroposophic medicine (AM). The Activity-Based Stress Release (ABSR) program incorporates the latter as part of an 8-week-long online intervention combining mindfulness exercises, behavioral self-observation, and mindful movement practices derived from this integrative medicine frame. The program could offer additional means for cultivating mindfulness, thereby addressing the necessity for diverse approaches in conjunction with individual differences, diverse clinical demands, or restricted capacities to perform certain mindfulness practices. Using an observational repeated-measures design, the current study aimed to assess a large-scale online implementation of this program in terms of its feasibility, assessing perceived stress and mindfulness. Individuals who enrolled in any of the 37 ABSR program iterations carried out during 2023 and agreed to participate in the study completed online surveys including validated stress and mindfulness scales at the beginning, middle, end, and follow up of the intervention. Linear-mixed models were used for data analysis. A total of 830 individuals took part in the study, of which 53.5% filled in at least 2 surveys. In line with our expectation, mindfulness scores increased significantly over the course of the intervention, while stress scores decreased significantly in this timeframe. We further found differential effects of self-practice frequency and duration on the outcomes. This study provides a first indication of stress reduction in conjunction with the online implementation of this novel MBI. The work further suggests that this AM-based intervention indeed targets mindfulness, as do other MBIs, and that it is adaptable to an online format. However, given the observational single-arm design, controlled studies will be necessary to confirm these results. Nonetheless, the study adds a novel contribution to existent MBIs, which is significant in view of the need for diverse approaches to meet the heterogeneity of individual predispositions and clinical requirements. It remains to established by forthcoming research for which groups of individuals or clinical features this approach could be especially beneficial or less suitable.

Residential wood heat in the US: Results of a survey investigating user behavior and operation of wood heating appliances

Wood is used as a source of primary and secondary heat by millions of people in the US, but many wood stoves emit levels of particulate matter that negatively impact human health and the environment. Modern wood stoves are designed to pass emissions testing required by regulatory bodies and manufacturers may be hindered in their ability to design for the variability of real-world use. User behavior can strongly impact wood heater emissions, and learning about how they are used in real life could inform the future design of cleaner-burning wood heaters. In this study a survey was performed to investigate the habits, needs, and challenges surrounding residential wood heating in the US. Common user characteristics and behaviors are investigated in categories covering heating technology, fuel use and preference, user behavior, and operation. The data collected from 210 completed survey responses can be used to support and refute anecdotal understandings of wood stove use. Results from this study cover wood heater ages and the presence or lack of catalysts. Fuel provenance, type, seasoning, and storage practices are discussed, along with the ways that respondents learned how to use their stoves and their operational practices including reloading, cold start behavior, and use of air controls. The information presented in this paper can be used to inform industry and regulatory groups as to how people use their wood heaters and highlights areas for potential future research.

How much is it about the money? Using facebook to promote a web survey during the COVID-19 pandemic and estimating average response-returns on ad-investments

The use of ads posted on online social networks has become a popular strategy to recruit survey participants. This paper quantifies the returns from ad-investments in terms of the number of responses. We use as a case study a survey about living and working conditions that was promoted in Spain via Facebook from March 2020 to October 2021. Results show that the effect of each additional euro invested in Facebooks ads daily generated between 2 and 2.8 additional completed surveys per day. These results are stable and consistent throughout the period we study. Nonetheless, we find that the number of survey responses tended to be significantly higher when the COVID-19 restrictions imposed were tighter. Our findings are relevant and have practical implications for future survey research.

Does every transgender person want gender affirming surgery? A survey of transgender individuals in the Midwestern United States.

Gender-affirming surgery (GAS) is a highly personalized decision for transgender and gender diverse (TGD) individuals. However, the proportion of TGD individuals who desire GAS is unknown. A questionnaire was created after identifying themes surrounding experiences with gender-affirming medical care by community focus groups. Respondents who reported medically transitioning and who had undergone GAS were compared to those without prior GAS. From 88 completed surveys, 18 (20.5%) individuals did not wish to undergo GAS. Of those medically transitioning and desiring GAS, 15.2% (9/59) desired GAS but had not received it yet, with 6.7% (6/9) identifying as non-binary. Individuals who had not had GAS were more likely to earn under $15,000 annually, compared to $25,000-49,000 in the GAS group (p = 0.01). There was no significant difference in educational level (p = 0.32) or insurance status (p = 0.33). Of TGD individuals who desire GAS, out-of-pocket expenses such as hair removal, opaque insurance policies, lack of social support, and access to gender-affirming providers can hinder the transition process. Understanding barriers and rationales for pursuing GAS can provide targets for improving healthcare delivery to this diverse population.

Cancer-related Fear and Worry in Patients with Low-Risk Thyroid Cancer: A Longitudinal Cohort Study.

Little is known about how patients' emotions impact the choice between hemi- and total thyroidectomy (TT) for low-risk thyroid cancer (LR-TC) and how these emotions change after treatment. To investigate thyroid cancer-specific fear and worry both before and after treatment of LR-TC with hemi- or TT. This prospective cohort study enrolled adults with confirmed or likely LR-TC at 15 institutions. Participants completed measures of thyroid cancer-related fear and worry at the time of their treatment decision and 9-months later. Participants were categorized as having low, medium, or high levels of fear and worry in accordance with the literature. Those choosing hemi-thyroidectomy were compared to those choosing TT. Of 177eligible patients, 125 (70.6%) enrolled and 114 completed both surveys (91.2% retention). Overall, 41 (36.0%) participants chose hemi-thyroidectomy and 73 (64.0%) chose TT. Across all participants, thyroid cancer-related fear and worry both decreased significantly after surgery (fear 25.8±6.4 to 23.1±7.4; worry 8.2±2.4 to 5.4±2.1, p<0.001). The proportion of participants with high fear decreased from 64.9% to 50.9%, while the proportion with high worry decreased from 75.4% to 41.2% (p<0.001 for both). At both time points, no differences existed between those choosing hemi- and TT in levels of worry or fear. Patients with LR-TC report lower levels of fear and worry 9-months after surgery regardless of the extent of surgery, suggesting that both surgeries provide an emotional benefit to some patients. Thyroid cancer-related fear and worry do not appear to influence patients' decisions to undergo hemi- or TT.

Feasibility, acceptability, and fidelity of remote-delivered abbreviated mindfulness-based cognitive therapy interventions for patients with migraine and depressive symptoms.

This study was an open-label single-arm clinical trial evaluating the fidelity, feasibility, acceptability, and clinical signal of abbreviated mindfulness-based cognitive therapy (MBCT-brief) delivered either via telephone (MBCT-T) or by video conferencing (MBCT-V) for people with migraine and comorbid depressive symptoms. Migraine is commonly comorbid with elevated depressive symptoms. MBCT reduces depressive symptoms and shows promise to reduce migraine-related disability. An abbreviated and remotely delivered version of MBCT could increase access to care. People with migraine and elevated depressive symptoms were recruited from a large urban health system. Participants were assigned in blocks of eight to receive an evidence-based MBCT-brief treatment, including eight weekly group classes and home practice delivered via telephone (MBCT-T) or video (MBCT-V); MBCT-T was randomly selected for the first block. Sessions were recorded and coded for treatment fidelity. Feasibility was assessed via session attendance (primary), homework completion, recruitment rate, and survey completion rate. Acceptability was assessed via the eight-item Client Satisfaction Questionnaire (CSQ-8; primary), the Credibility/Expectancy Questionnaire (CEQ), the System Usability Scale (SUS), and items assessing survey acceptability. Participants completed the Headache Disability Inventory (HDI) and Quick Inventory of Depressive Symptomatology-Self Report 16-item (QIDS-SR16) at baseline, mid-treatment, and post-treatment. Feasibility and acceptability rates were compared to a priori benchmarks. Participants (n = 16) were all female with a mean (standard deviation [SD]) age of 45 (13) years, the majority of whom identified as White (13/16, 81%) and non-Hispanic (14/16, 88%). The intervention met the a priori criteria set for therapist fidelity to treatment protocol (mean [SD] MBCT-Treatment Acceptability and Competence Scale Adherence score 2.9 [0.2]), feasibility (mean [SD] session attendance was 7.9/8 [0.3]), and acceptability (mean [SD] CSQ-8 score 28.8 [3.3]) for the entire sample and for each treatment arm. The usability of the remote-delivery system was high across study participants (mean [SD] SUS score 84.8 [11.0]). Survey procedures were broadly deemed acceptable, with at least 80% participants either endorsing "Agree" or "Strongly Agree" across all items. Using Wilcoxon tests, we observed significant reductions in both the HDI (pre-treatment median [interquartile range] score 63 [40, 70] vs. post-treatment 36 [26, 54], p = 0.004) and the QIDS-SR16 (pre-treatment median [interquartile range] score 8 [5, 13] vs. post-treatment 4 [3, 6], p = 0.003). We found that remotely delivered MBCT-brief for migraine and depressive symptoms was feasible and acceptable to patients in both the telephone and video modalities. Intervention was associated with significant post-treatment reductions in headache-related disability and depressive symptomatology, findings that must be interpreted cautiously in the absence of a control group.

Health information, what do people search and where? a cross-sectional online survey study in the adult Swiss population.

Health promotion and disease prevention are crucial for improving public health and alleviating the burden of illness in the population. This study aimed to investigate, the sources of health information most used and trusted, and the health topics most searched, by means of a nationwide cross-sectional online survey of a representative sample of the adult Swiss general population. Overall, complete surveys of 2020 participants were analysed (mean age 47 years old, 51% male, and matching the Swiss population regarding age, sex, and language-speaking region). Sources' use were calculated with descriptive statistics per sex and age groups. The most frequently used sources were general practitioners (min: 46% to max: 73%), government websites (40% to 55%), family and friends (37% to 63%), pharmacy (33% to 46%), and television (21% to 57%). The most trusted sources were specialised physicians (94% to 98%) general practitioners (90% to 96%), and pharmacies (81% to 89%). Based on multivariable controlled regression, age (per five years increase) was associated with increased odds of using television (Odds Ratio (OR): 1.19, 95% Confidence Interval (CI): 1.12 to 1.21), print media (OR: 1.15, 95% CI: 1.10 to 1.19), radio (OR: 1.15, 95%CI: 1.10 to 1.20), and the general practitioner (OR: 1.11, 95% CI: 1.07 to 1.15), and decreased odds of using news websites (OR: 0.94, 95% CI:0.9 to 0.98), family and friends (OR: 0.93, 95% CI: 0.9 to 0.98), foreign authorities websites (OR: 0.91, 95%CI: 0.86 to 0.97), and social media (OR: 0.88, 95% CI: 0.84 to 0.92). Women were more likely to seek health information in the pharmacy (OR: 1.39, 95% CI: 1.15 to 1.68), specialised physicians (OR: 1.39, 95% CI:1.13 to 1.72), television (OR: 1.41, 95% CI: 1.16 to 1.72), and books (OR: 1.9, 95% CI: 1.44 to 2.5). The most searched health topics, based on the International Classification of Primary Care, 2nd edition (ICPC2), were general and unspecified symptoms (20.9%) and musculoskeletal issues (19.4%). The use of these findings by policymakers and health care providers could potentially enhance the effectiveness of health-related education strategies, by aligning communication efforts with the populations' preferences and content needs, and allocating resources where they are most commonly accessed and trusted, namely in the general practice.

Concussion Health Improvement Program (CHIP): study protocol for a randomized controlled optimization trial for youth with persistent post-concussive symptoms

BackgroundUp to 1.9 million youth in the USA sustain a concussion each year, and up to 30% experience persistent post-concussive symptoms (PPCS) lasting 1 month or more. PPCS can substantially interfere with social, emotional, and academic functioning. Despite these concerns, few evidence-based treatments are available for youth with PPCS. We previously found effectiveness in treating youth with concussion using a collaborative care intervention that integrates mental health care into a medical model, with improvements in concussive symptoms and quality of life at 1 year. Using the multiphase optimization strategy (MOST) framework, we now aim to assess the contribution of each of the three components that were part of collaborative care: concussion-focused cognitive behavioral therapy (cf-CBT), parenting skills training (PST), and care management (CM).MethodsThe MOST factorial design examines all three intervention components with two levels of each (present or absent), resulting in 8 possible treatment combinations. We will recruit 368 youth with PPCS from 2 geographic locations (Seattle and Dallas), randomizing them to 1 of 8 treatment groups. Youth and/or parents will attend treatment sessions via video conferencing software over 3 months, and complete surveys regarding primary outcomes (concussive symptoms and health-related quality of life) and secondary outcomes (sleep, pain, mood, and parental distress) at 6 weeks and 3, 6, and 12 months. We will also assess potential mediators and moderators to allow for future tailoring and refinement.DiscussionThe overarching goal of this investigation is to determine which collaborative care components (delivered individually or in combination) are most effective in treating PPCS in concussion-exposed youth. The investigation will inform mental health screening, intervention, and referral procedures for youth and families following concussion. At the completion of this study, we will have an optimized and refined intervention for youth with PPCS ready for large-scale implementation and dissemination.Trial registrationClinicalTrials.gov NCT06036147. Registered on September 13, 2023.

Self-rated health is an independent predictor of subsequent late mortality after blood or marrow transplantation: A Blood or Marrow Transplant Survivor Study report.

The prevalence of suboptimal self-rated health (SRH) and its association with subsequent all-cause and cause-specific mortality after blood or marrow transplantation (BMT) were examined. Study participants were drawn from the multicenter Blood or Marrow Transplant Survivor Study, and included patients who were transplanted between 1974 and 2014 and had survived ≥2 years after BMT. Participants (aged ≥18 years) completed a survey at a median of 9 years from BMT, and were followed for a median of 5.6 years after survey completion. Survivors provided information on sociodemographic factors, chronic health conditions, health behaviors, and SRH (a single-item measure rated as excellent, very good, good, fair, or poor; excellent, very good, and good SRH were classified as good SRH, and fair and poor were classified as suboptimal SRH). The National Death Index Plus and Accurint databases and medical records provided vital status through December 2021. Of 3739 participants, 784 died after survey completion (21%). Overall, 879 BMT survivors (23.5%) reported suboptimal SRH. Pain, low socioeconomic status, psychological distress, lack of exercise, severe/life-threatening chronic health conditions, post-BMT relapse, obesity, smoking, and male sex were associated with suboptimal SRH. BMT survivors who reported suboptimal SRH had a 1.9-fold increased risk of all-cause mortality (95% confidence interval [CI],1.6-2.3), 1.8-fold increased risk of recurrence-related mortality (95% CI,1.4-2.5), and 1.9-fold increased risk of non-recurrence-related mortality (95% CI, 1.4-2.4) compared to those who reported good SRH. This single-item measure could help identify vulnerable subpopulations who could benefit from interventions to mitigate the risk for subsequent mortality.

Use of mobile applications and mental health services among veterans who received internet-connected tablets.

Among Veterans Health Administration (VHA) patients receiving internet-connected tablets, we examined (1) app usage, (2) clusters of commonly used apps and patient characteristics across clusters, and (3) the relationship between app clusters and mental health services. A survey was distributed to a national sample of VHA patients (n = 5449) within 6 months of tablet receipt. Self-reported app use was clustered with agglomerative hierarchical clustering. Survey data were combined with electronic health record data that included sociodemographics and mental health care utilization during the 6 months following survey completion. Differences in patient characteristics by cluster were examined using chi-square tests. A multivariable model assessed prediction of mental health services across app clusters. Among 1664 patients with complete survey and health care utilization data, the majority (74%) reported using at least 1 app. The most used apps were for video visits (60%) and VA's patient portal (53%). Cluster analysis revealed 5 distinct groups reflecting app usage: Patient Portal (n = 685, 41%), Video Connection (n = 319, 19%), Treatment Companion (n = 166, 10%), Self-Management (n = 85, 5%), and Non-App Group (n = 409, 25%). Cluster characteristics varied, and those in the Patient Portal Group (adjusted odds ratio = 1.64; 95% CI = 1.15-2.32) and Video Connection Group (adjusted odds ratio = 1.52; 95% CI = 1.02-2.26) were more likely to have a mental health visit in the 6 months after survey completion when compared to the Non-App Group (P < .05). Tablet provision supports opportunities to use apps for multiple health management tasks, and app use clusters vary across patient characteristics and health care utilization. Patients most commonly used apps to connect with their care team, and use of some apps and app combinations may improve engagement with mental health services.

Pre-cluster symptoms in a Taiwanese cohort of cluster headache: symptom profiles and clinical predictions

BackgroundPre-cluster symptoms (PCSs) are symptoms preceding cluster bouts and might have implications for the treatment of cluster headache (CH). This study investigated the prevalence of PCSs, and their utility in predicting upcoming bouts as well as the associations with therapeutic efficacy.MethodsWe prospectively collected data from patients with CH. Each patient received a structured interview and completed questionnaire surveys during CH bouts. In sub-study 1, we cross-sectionally analyzed the prevalence, symptomatology, and predictability of upcoming bouts. Overall, 34 PCSs, divided into seven categories, were queried, including head and neck pain, cranial autonomic symptoms, restlessness, fatigue or mood changes, sleep alterations, constitutional symptoms, and generalized pain. In sub-study 2, we recorded the weekly frequency of CH attacks after the initiation of verapamil concurrently with a 14-day transitional therapy based on the patients’ headache diary. A responder to verapamil was defined as a patient who have a reduction from baseline of at least 50% in the weekly frequency of CH attacks 4 weeks after the initiation of verapamil.ResultsA total of 168 CH patients (women/men: 39/129) completed the study. In sub-study 1, we found 149 (88.7%) experienced PCSs, with a median of 24 (IQR 18 to 72) hours before the bouts. Up to 57.7% of patients with PCS reported that they could predict upcoming bouts. Among the seven categories of PCSs, head and neck pain was the most common (81.0%) and was associated with a higher predictability of upcoming bouts (odds ratio [OR] = 4.0; 95% confidence interval [CI] 1.7–9.6). In sub-study 2, we found two categories of PCSs were associated with the response to verapamil: sleep alteration (OR = 2.5 [95% CI = 1.3–4.8], p = 0.004) and ≥ 1 cranial autonomic symptoms (OR = 2.7 [95% CI = 1.4–5.1], p = 0.003).ConclusionPCSs were very common in CH and could be used to predict upcoming bouts. Different symptom categories of PCSs may have different clinical implications.

Occupational performance patterns in children with paediatric acute-onset neuropsychiatric syndrome.

Paediatric acute-onset neuropsychiatric syndrome (PANS) is a neuroimmune condition characterised by episodic exacerbations and remissions. This study investigates the impact of PANS on children's occupational performance during these phases, using the Vineland Adaptive Behaviour Scale (VABS). Understanding these variations is crucial for developing tailored interventions and managing the condition effectively. A two-period bidirectional case-crossover design was employed to assess occupational performance in children with PANS at exacerbation (T-E) and remission (T-R) phases. Parents of children aged 4.6-13.1years with PANS were recruited globally, with data collected via online surveys and monthly updates. The VABS evaluated occupational performance, with analysis using linear mixed models and Least Squares Means (LSMeans) for accurate representation. Data from 27 participants showed significantly lower scores in the Adaptive Behaviour Composite and socialisation domain of the VABS at T-E compared with T-R, indicating a decline in occupational performance and social skills during exacerbations. During remission, participants demonstrated typical performance across all domains. The study highlights a marked decline in occupational performance and socialisation during PANS exacerbations, with improvements to typical levels during remission. These findings emphasise the need for targeted interventions to address occupational and social challenges in children with PANS during exacerbations, underscoring the episodic nature of the condition and the risk of misinterpreting behaviours if assessed during exacerbations. Multidisciplinary allied health support may benefit children with PANS. Although there was no direct consumer and community involvement, two researchers on our team have family members with PANS. Their personal experiences provided vital insights into the challenges faced by children with PANS, deeply influencing our study's design, focus, and interpretation, ensuring it reflects the realities of those affected. Our study looked at how PANS affects the things children do in their daily lives. We asked parents of children ages 4.6-13.1years old to complete surveys measuring this at two times: once during a symptom flare-up and once during a period of wellness. Our results showed that during symptom flare-ups, children's social skills and general ability to do daily tasks were much lower compared with periods of wellness. When children were well, their abilities were similar to those of typically developing children of the same age. This highlights the need for occupational therapy during flare-ups to help improve the lives of children with PANS.

Are Cooked Nutritious School Lunches Associated with Improved Attendance? Findings from the 2022-2023 Tasmanian School Lunch Project.

Background/Objectives: During 2022-2023, the School Lunch Project (SLP) provided free nutritious cooked lunches 1-4 days per week to Kinder to Grade 10 students attending 30 schools in areas of high disadvantage in Tasmania, Australia. This analysis examined if the SLP was associated with student attendance. Methods: Staff (teachers, support staff, and principals) from 12 schools completed an online survey and/or participated in focus groups/interviews. Government-held, objectively measured, grade-level attendance data were provided for 17 SLP and 11 matched comparison schools for 2018-2023. Linear mixed models compared attendance on school lunch and non-school lunch days in SLP schools. Difference-in-difference regression compared attendance between SLP and comparison schools. Qualitative data were analysed thematically. Results: Sixty-five staff completed surveys, where 22% reported that increased attendance was a benefit of the SLP. Similar findings were observed in the staff focus groups/interviews (N = 51). Mean attendance was similar on school lunch and non-school lunch days among the SLP schools during 2022 (difference: 0.04, 95% CI: -0.5, 0.6) and 2023 (difference 0.1, 95% CI: -0.2, 0.4) and similar between SLP and comparison schools (average treatment effect in the treated: 1.2, 95% CI: -0.7, 3.0). Conclusions: The SLP was perceived by some staff to improve attendance but was not associated with objectively measured attendance examined at the grade level.

Retrospective Cohort Study Demonstrates Tolerance and Adherence to Pea-Based Complete Enteral Formula When Transitioned from a Previous Hypoallergenic Product.

Plant-based formulas have become increasingly popular due to their health benefits, environmental concerns, cultural beliefs, improved palatability, and decreased cost. A retrospective chart review of medically stable children transitioning from a hypoallergenic formula to a yellow pea protein plant-based formula (PPPBF) was included. This study aimed to assess gastrointestinal tolerance, weight changes, and adherence to receiving a unique PPPBF. Healthcare providers (HCPs) from pediatric clinics across the United States who requested increased PPPBF samples between the dates of 1 November 2021and 31 January 2022 and again from 1 February 2022 to 15 April 2022 inputted survey data. The HCPs selected participants based on the inclusion criteria. Seventy-three completed patient surveys were included of children (ages 1-18 years old, 41% females, 59% males). After the transition to PPPBF, 38.4% experienced improvement in GI tolerance, 56.2% experienced no change, and 5.5% reported worsening GI tolerance. There was a 95% adherence rate, and 98.9% reported no adverse reactions or allergic manifestations after formula transition. Transitioning from a hypoallergenic formula to a PPPBF showed a trend toward stable GI tolerance, weight gain or stability, and adherence. A PPPBF offers a first-choice option for children who are on hypoallergenic formulas due to intolerance.

Emergency Department Patient Satisfaction Scores Are Lower for Patients Who Arrive During the Night Shift

Background: Increasingly, patient satisfaction scores are being used to assess emergency physicians. We sought to determine whether the patient satisfaction scores collected by our hospital system are lower for patients who are treated in the emergency department (ED) on night shifts as compared to those treated on day shifts. Methods: We performed a cross-sectional analysis of patient satisfaction scores from three EDs in Florida. We obtained satisfaction data from NRC Health (the company that provides our surveys) using a random sample of 1,000 completed surveys from patients treated in 2022; we also performed manual chart review to obtain clinical data. The satisfaction surveys asked patients how likely they would be to recommend the facility (from 0–10). Patients who provided a score of 9 or 10 were considered “promoters.” For our primary analysis, we compared the percentage of promoters for the day shift encounters (7 AM to 7 PM) to the night shift encounters (7 PM to 7 AM). We also performed a multivariable logistic regression analysis using several demographic and clinical variables to further assess the association between night shift arrival and satisfaction scores. Results: Of the 1,000 surveys analyzed, 66.3% of patients arrived during the day shift, and 33.7%arrived during the night shift. Of those who arrived during the day shift, 525 (79.2%) were promoters compared to 228 (67.7%) of those who arrived during the night shift, a difference of 11.5% (95%confidence interval [CI] 5.7–17.4%), P &amp;lt; 0.001. On multivariable analysis, night shift arrival was associated with a lower chance of a patient being a promoter, with adjusted odds ratio 0.60 (95% CI 0.43–0.84), P = 0.003. Conclusion: Patients who presented to the ED during the night shift were less likely to be promoters than patients who arrived during the day shift. Assessments of patient satisfaction data should account for time of visit and other facility-related and operational characteristics.

Academic hospitalist perspectives on the benefits and challenges of secure messaging: A mixed methods analysis.

Hospitals and patients rely on effective clinician communication. Asynchronous electronic secure messaging (SM) systems are a common way for hospitalists to communicate, but few studies have evaluated how hospitalists are navigating the adoption of SM and the benefits and challenges they are encountering. The objective of this study is to assess academic hospitalist perspectives on SM to guide future research and quality improvement initiatives. This was a mixed methods study utilizing an embedded REDCap survey and six virtual semistructured focus groups. It took place during a Hospital Medicine ReEngineering Network Zoom meeting on October 13, 2023. Rapid qualitative methods were used to define major themes. There were 28 hospitalists and one patient representative across 24 separate academic institutions. There was a 71% survey completion rate (N = 20). SM was felt to be an effective and efficient communication modality but was associated with a large amount of multitasking and interruptions. Perspectives around SM clustered around three main themes: SM has been widely but variably adopted; there is a lack of institutional guidance about how to best engage with SM; and SM is changing the landscape of hospitalist work by increasing ease but decreasing depth of communication, increasing cognitive load, and changing interpersonal relationships. Recommendations for SM improvements included the need for institutions to work with frontline workers to develop and implement clear usage guidelines. SM is likely contributing to both positive and negative effects for clinicians and patients. Understanding hospitalist perspectives on SM will help guide future research and quality improvement initiatives.

Understanding health literacy's moderating role in remote monitoring for adjuvant endocrine therapy: Findings from a randomized clinical trial.

45 Background: Despite the efficacy of oral adjuvant endocrine therapy (AET) for improving survival among women with hormone receptor-positive early-stage breast cancer, adherence rates remain low. Our THRIVE study (NCT03592771) investigated the effectiveness of a mobile health remote monitoring app with and without tailored educational messages on AET adherence among women with breast cancer and found no statistically significant treatment effects on 1-year AET adherence overall. Health literacy contributes to patients’ understanding of their treatment plans. We conducted a post hoc analysis of the THRIVE study to examine if health literacy moderates the effectiveness of this intervention. Methods: This non-blinded randomized controlled trial included women with early-stage breast cancer prescribed AET at a large cancer center with 14 clinics across three states. Participants used a pillbox to electronically monitor AET adherence for 1 year and completed surveys at enrollment. Consented participants were randomized into (1) “App”, receiving access to the study adherence and symptom monitoring app for 6 months, with increasing/severe symptoms and missed doses reported in the app triggering follow-ups from the oncology team; (2) “App+Feedback”, receiving additional weekly text messages about managing symptoms, adherence, and communication for 6 months; or (3) “Enhanced Usual Care (EUC).” The primary outcome was 1-year AET adherence captured with the pillbox (≥80% Proportion of Days Covered [PDC] vs. &lt; 80%). The enrollment survey captured participant’s sociodemographic characteristics, including race and ethnicity, education, household income, and health literacy. We used a linear probability model to measure the interaction between the study arm and health literacy on AET adherence. Results: Among 304 women randomized (104 EUC, 98 App, and 102 App+Feedback), the 12-month follow-up retention rate was 88% (n = 266) and 19.4% reported low health literacy at enrollment. Low health literacy was more prevalent among Black (29.4%) vs. White (13.4%) participants (p &lt; 0.001), those with incomes below the federal poverty level (34.4% vs. 17.2% of those with higher incomes, p = 0.02), and those with only a high school degree or lower education (31.7%) vs. with those with some college or higher education (16.4%, p &lt; 0.01). In the low health literacy group, 80.0% of App+Feedback were AET adherent vs. 42.1% of EUC, a 37.9 percentage point (ppt) difference (95% CI: 4.1 to 71.7, p = 0.03); in higher literacy group adherence, 47.1% of App+Feedback vs. 59.0% of EUC were adherent, a -11.8 ppt difference (95% CI: -27.9 to 4.3, p = 0.15). Conclusions: A remote monitoring app with tailored educational text messages led to higher 1-year AET adherence among participants with low health literacy, but not for those with high health literacy. Clinical trial information: NCT03592771 .

Enhancing Sensory Experiences for Infants Born Preterm: A Quality Improvement Project

ObjectiveTo enhance neonatal sensory experiences for infants born preterm: a quality improvement project. DesignThis was a time-interruption quality improvement project. The time-interruption lasted four weeks with an eight-week data collection period before and after. Baseline data were collected on current program use for eight weeks prior to the time-interruption. The NICU occupational therapist provided staff education, training, and modeling of SENSE during the time-interruption. Data were collected for eight weeks following the time-interruption to track improvements. ParticipantsTwenty infants and their families participated as well as NICU nurses who provided positive sensory experiences and completed surveys. Main Outcome MeasuresData related to delivery of, education on, and adherence to SENSE were collected before, during, and after the time-interruption. Staff surveys were completed pre- and post- education, training, and modeling to gather perspectives on program usage. ResultsOn average, parents delivered 43.88 minutes of positive sensory input per day before the time-interruption and increased to 92.7 minutes per day after the time-interruption. Positive tactile recommendations were met, on average, 19% of the time before the time-interruption and 47% of the time after the time-interruption. After education, training and modeling, nursing staff unanimously supported the program according to surveys. ConclusionsWhile a higher percentage of infants received the recommended dosage of positive tactile input after intervention, opportunities still exist to improve and expand implementation.

Financial hardship and healthcare utilization among older cancer survivors with comorbidities.

349 Background: Financial burden among older cancer survivors (65y+) is understudied, particularly with regard to how comorbidities may affect financial burden and healthcare utilization despite Medicare eligibility. We assessed the relationship between financial hardship (FH), healthcare utilization, and comorbidities among cancer survivors. Methods: The University of Alabama at Birmingham tumor registry was used to identify patients diagnosed at ≥65y with lymphoma, breast, colorectal, prostate, or lung cancer types and received curative-intent treatment from 2000 to 2019. Patients were surveyed on FH, healthcare utilization, and comorbid conditions. FH was defined as having answered ‘Yes’ to experiencing material, psychological, or behavioral hardship in the past year. Visits to a primary care physician (PCP), oncologist, non-oncology specialist, or emergency department (ED) in the past 2 years were self-reported. A modified Common Terminology Criteria for Adverse Events (CTCAE) grading system captured 45 self-reported comorbidities. A CTCAE of 3 or 4 was considered severe. Multivariable models were used to determine the differences in risk of any FH between severe vs. non-severe CTCAE and to determine differences in healthcare utilization. All models were adjusted for age at survey completion, years from diagnosis to survey, sex, race, income, stage, distance travelled to medical center. Results: Among the 759 survivors included, median age was 77 (IQR=73-82), a majority identified as White (82%), half were female (53%) and a third reported annual income of less than 20,000 (32%). Breast (33%) was the most common cancer type followed by prostate (26%), lung (17%), colorectal (15%), and lymph (9%). Moderate or Severe comorbidities were reported by 46% of participants. FH was most commonly associated with coronary heart disease (18-47%), chronic obstructive pulmonary disease (20-57%), and myocardial infarction (25-60%) across all cancer types. Overall, patients with severe comorbidities had a higher risk of any FH (RR, 1.50; 95%CI, 1.15, 1.97), ED visits (IRR, 2.20; 95%CI, 1.22, 3.95), specialists (IRR, 1.52; 95%CI, 1.25, 1.87), and PCP (IRR 1.15; 95%CI, 1.01, 1.30). Those with severe comorbidities and financial hardship had higher utilization of PCP (p &lt; 0.003), but not other types of utilization. Conclusions: Older patients with severe comorbidities were at increased risk of financial hardship while also utilizing healthcare facilities at a higher rate than those with fewer comorbidities. While those with severe comorbidities and financial hardship utilized their PCP more often, they did not utilize all healthcare facilities more than those with fewer comorbidities. Financial burden and high healthcare utilization remain after entering into cancer survivorship but is exacerbated by additional comorbid conditions.