Aurora Health Care Inc

NCI COMMUNITY ONCOLOGY RESEARCH PROGRAM (NCORP) - COMMUNITY SITES

THE IMPACT OF ELECTRONIC KNOWLEDGE-BASED NURSING CONTENT AND DECISION-SUPPORT ON NURSING-SENSITIVE PATIENT OUTCOMES

MITOCHONDRIAL DYSFUNCTION AND SUSCEPTIBILITY TO ATRIAL FIBRILLATION IN THE ELDERL

LEVERAGING PREGNANT PEOPLE-INFANT LINKAGES FROM ELECTRONIC HEALTH RECORDS IN THE LARGEST INTEGRATED MIDWESTERN HEALTHCARE SYSTEM TO IMPROVE LONG-TERM SURVEILLANCE OF PUBLIC HEALTH THREATS

HUMAN SENESCENCE AND CARDIOPROTECTION

A NOVEL, SEMI-AUTOMATED SELF-MONITORING FEEDBACK SYSTEM FOR HEALTH PROMOTION IN COMMUNITY SETTINGS - PROJECT SUMMARY WEIGHT MANAGEMENT INTERVENTIONS DELIVERED IN COMMUNITY SETTINGS DEMONSTRATE WEIGHT LOSSES OF ~4% OF BASELINE WEIGHT, SMALLER THAN THE 8-10% OBSERVED IN EFFECTIVENESS TRIALS. THE PROVISION OF WEEKLY FEEDBACK RELATED TO SELF-MONITORING OF DIETARY INTAKE, PHYSICAL ACTIVITY, AND WEIGHT IMPROVES WEIGHT LOSS OUTCOMES IN ADULTS WITH OBESITY; HOWEVER, THIS FEEDBACK IS OFTEN NOT PROVIDED IN INTERVENTIONS DELIVERED IN COMMUNITY SETTINGS DUE TO LACK OF TRAINING AND TIME. TO SUPPORT EFFECTIVE FEEDBACK PROVISION IN COMMUNITY INTERVENTIONS, WE PROPOSE TO DEVELOP A SEMI-AUTOMATED SELF-MONITORING FEEDBACK SYSTEM THAT CAN BE INTEGRATED INTO A RANGE OF COMMUNITY SETTINGS. FIRST, TO ADDRESS THE LACK OF EMPIRICAL EVIDENCE REGARDING OPTIMAL FEEDBACK CONSTRUCTION, AIM 1 WILL FOCUS ON OPTIMIZING THE EFFICACY OF FEEDBACK MESSAGES (INCLUDING DEVELOPMENT OF A FEEDBACK LIBRARY AND AN OPTIMIZED ALGORITHM FOR FEEDBACK PROVISION). IN STUDY 1, WE PROPOSE TO USE A HIGHLY EFFICIENT MICRO- RANDOMIZED FACTORIAL TRIAL DESIGN TO EVALUATE THE IMPACT OF DIFFERENT TYPES (IN RELATION TO BEHAVIORAL TARGET AND INTERACTIVITY) AND AMOUNT OF FEEDBACK ON WEIGHT CHANGE IN 300 ADULTS WITH OVERWEIGHT OR OBESITY. PARTICIPANTS IN THIS STUDY WILL RECEIVE A CORE WEIGHT LOSS 101 SESSION AND WILL BE ASKED TO SELF-MONITOR DIETARY INTAKE, PHYSICAL ACTIVITY, AND WEIGHT DAILY USING STUDY-PROVIDED TOOLS (A FITBIT ACTIVITY MONITOR, FITBIT E-SCALE, AND THE FITBIT SMARTPHONE APP). EACH WEEK FOR 16 WEEKS PARTICIPANTS WILL RECEIVE BASIC FEEDBACK ON THE FREQUENCY OF THEIR SELF-MONITORING OF DIETARY INTAKE, PHYSICAL ACTIVITY, AND WEIGHT AND THEIR WEIGHT TRAJECTORY, AND WILL BE RANDOMLY ASSIGNED TO RECEIVE (OR NOT RECEIVE) EACH OF FOUR ADDITIONAL FEEDBACK COMPONENTS (CALORIE GOAL ATTAINMENT, DIET QUALITY, PHYSICAL ACTIVITY GOAL ATTAINMENT, AND PROMPTED GOAL SETTING). WE WILL USE MIXED-EFFECTS MODELS TO INVESTIGATE THE IMPACT OF EACH FEEDBACK COMPONENT ON WEIGHT CHANGE (PRIMARY OUTCOME) AND ON PROPOSED MECHANISMS (ADHERENCE TO SELF-MONITORING AND TO CALORIC INTAKE AND PHYSICAL ACTIVITY GOALS) DURING THE WEEK AFTER IT IS RECEIVED. WE WILL ALSO INVESTIGATE THE IMPACT OF THE NUMBER OF FEEDBACK COMPONENTS RECEIVED, POTENTIAL MODERATORS OF FEEDBACK EFFICACY (E.G., AGE, SEX/GENDER, RACE/ETHNICITY, SOCIOECONOMIC STATUS, SOCIAL SUPPORT, FOOD SECURITY) AND WHETHER DIFFERENT COMBINATIONS OF FEEDBACK ARE MORE EFFECTIVE WHEN INDIVIDUALS ARE DOING WELL IN THE PROGRAM (I.E., MEETING PROGRAM GOALS) VERSUS WHEN THEY ARE NOT DOING WELL, ALLOWING US TO DEVELOP PERSONALIZED ALGORITHMS FOR FEEDBACK PROVISION. FOR AIM 2, WE WILL EMPLOY USER-CENTERED DESIGN METHODS TO DEVELOP, REFINE (VIA ITERATIVE DEVELOPMENT/TESTING CYCLES IN STUDY 2), AND CONDUCT “REAL WORLD” USABILITY TESTING WITH COMMUNITY INTERVENTION FACILITATORS (STUDY 3) OF A SEMI-AUTOMATED SELF-MONITORING FEEDBACK SYSTEM THAT AIMS TO COMBINE THE EFFICIENCY OF COMPUTER AUTOMATION WITH THE EXPERTISE OF TARGET USERS. COMMUNITY INTERVENTION FACILITATORS WILL BE ABLE TO USE THIS SYSTEM TO QUICKLY DEVELOP EFFECTIVE SELF-MONITORING FEEDBACK FOR DELIVERY OF THIS ESSENTIAL TREATMENT COMPONENT ACROSS A RANGE OF COMMUNITY INTERVENTION SETTINGS, BROADLY IMPROVING ACCESS TO EFFECTIVE TREATMENT FOR ADULT OVERWEIGHT AND OBESITY.

EXAMINING THE IMPACT OF WEATHER-RELATED BARRIERS ON PRIMARY CARE UTILIZATION IN OLDER ADULTS WITH CHRONIC CONDITIONS - PROJECT ABSTRACT NATIONALLY, MISSED VISITS ARE A WIDESPREAD AND COSTLY ISSUE, WITH NO-SHOW RATES RANGING FROM 4% TO 55% AND COSTING THE HEALTHCARE SYSTEM OVER $150 BILLION ANNUALLY. MISSED PRIMARY CARE VISITS ALSO POSE A SIGNIFICANT THREAT TO THE HEALTH OF ELDERLY PATIENTS AND THE EFFICIENCY OF THE HEALTHCARE SYSTEM. WITH 80% OF OLDER ADULTS IN THE U.S. HAVING AT LEAST ONE CHRONIC CONDITION, CONSISTENT PRIMARY CARE IS VITAL FOR DISEASE MONITORING AND TREAT- MENT—ESPECIALLY FOR COMMON CONDITIONS SUCH AS DIABETES, HYPERTENSION, CHRONIC OBSTRUCTIVE PULMONARY DIS- EASE, CONGESTIVE HEART FAILURE, AND ALZHEIMER’S DISEASE AND OTHER NEUROCOGNITIVE DISORDERS. HOWEVER, MISSED VISITS DISRUPT THIS CONTINUITY OF CARE, CONTRIBUTING TO POOR HEALTH OUTCOMES, INCLUDING INCREASED MORTALITY RISK, DELAYED FOLLOW-UP, AND GREATER PATIENT ATTRITION. THESE DISRUPTIONS ARE ESPECIALLY PROBLEMATIC FOR OLDER ADULTS WITH CHRONIC CONDITIONS WHO ARE MORE LIKELY TO MISS VISITS. ONE UNDERSTUDIED BARRIER TO PRIMARY CARE ACCESS IS INCLEMENT WEATHER, SUCH AS EXTREME TEMPERATURES, HIGH HEAT INDEX, AND HEAVY PRECIPITATION. WHILE SOME RE- SEARCH SHOWS A LINK BETWEEN SPECIFIC WEATHER EVENTS AND MISSED VISITS, FINDINGS VARY BY REGION, AND MOST STUD- IES HAVE NOT FOCUSED ON ELDERLY PATIENTS OR THOSE WITH CHRONIC CONDITIONS. THERE REMAINS A CRITICAL GAP IN UNDER- STANDING WHO IS MOST AT RISK AND HOW MUCH PRIMARY CARE IS AFFECTED. TELEMEDICINE OFFERS A PROMISING SOLUTION, HAVING PROVEN EFFECTIVE IN REDUCING MISSED VISITS DURING THE COVID-19 PANDEMIC. BOTH PATIENTS AND CLINICIANS REPORTED SATISFACTION WITH TELEMEDICINE, PARTICULARLY WHEN IN-PERSON VISITS WERE NOT FEASIBLE DUE TO WEATHER. THIS STUDY AIMS TO QUANTIFY HOW INCLEMENT WEATHER CONTRIBUTES TO MISSED PRIMARY CARE VISITS AMONG ELDERLY ADULTS WITH CHRONIC CONDITIONS AND EVALUATE WHETHER TELEMEDICINE CAN MITIGATE THESE EFFECTS BY PROVIDING AN ACCESSIBLE ALTERNATIVE DURING INCLEMENT WEATHER. USING ELECTRONIC HEALTH RECORD DATA FROM 2022–2025 LINKED WITH DETAILED WEATHER INFORMATION, WE WILL ASSESS THE IMPACTS OF INCLEMENT WEATHER ON PATTERNS OF MISSED VISITS, TIME INTERVALS BETWEEN APPOINTMENTS, AND SUBSEQUENT EMERGENCY OR HOSPITAL USE WITHIN A LARGE, DIVERSE POPU- LATION OF ELDERLY PATIENTS ACROSS ILLINOIS AND WISCONSIN. ULTIMATELY, THIS RESEARCH WILL PROVIDE CRITICAL INSIGHTS TO GUIDE FUTURE INTERVENTIONS, SUCH AS PROACTIVELY SCHEDULING TELEMEDICINE VISITS AHEAD OF FORECASTED INCLEMENT WEATHER, THAT HEALTHCARE SYSTEMS CAN ADOPT TO MAINTAIN ACCESS, CONTINUITY, AND HEALTH FOR ALL PATIENTS.