scholarly journals Nonresponse adjustment using clinical and perioperative patient characteristics is critical for understanding post-discharge opioid consumption

2021 ◽  
Author(s):  
Chris J. Kennedy ◽  
Jayson S. Marwaha ◽  
P. Nina Scalise ◽  
Kortney A. Robinson ◽  
Brandon Booth ◽  
...  
Keyword(s):  
Telephone Survey ◽  
Preoperative Assessment ◽  
Patient Characteristics ◽  
Opioid Consumption ◽  
Survey Response ◽  
Nonresponse Bias ◽  
Web Survey ◽  
Post Discharge ◽  
Bias Adjustment ◽  
Response Characteristics

Background: Post-discharge opioid consumption is an important source of data in guiding appropriate opioid prescribing guidelines, but its collection is tedious and requires significant resources. Furthermore, the reliability of post-discharge opioid consumption surveys is unclear. Our group developed an automated short messaging service (SMS)-to-web survey for collecting this data from patients. In this study, we assessed its effectiveness in estimating opioid consumption by performing causal adjustment and comparison to a phone-based survey as reference. Methods: Patients who underwent surgical procedures at our institution from 2019-2020 were sent an SMS message with a link to a secure web survey to quantify opioids consumed after discharge. Several patient factors extracted from the EHR were tested for association with survey response. Following targeted learning (TL) nonresponse adjustment using these EHR-based factors, opioid consumption survey results were compared to a prior telephone-based survey at our institution as a reference. Results: 6,553 patients were included. Opioid consumption was measured in 2,883 (44%), including 1,342 (20.5%) through survey response. Characteristics associated with inability to measure opioid consumption included age, length of stay, race, tobacco use, and missing preoperative assessment. Among the top 10 procedures by volume, EHR-based TL nonresponse bias adjustment corrected the median opioid consumption reported by an average of 57%, and corrected the 75th percentile of reported consumption by an average of 11%. This brought median estimates for 6/10 procedures closer to telephone survey-based consumption estimates, and 75th percentile estimates for 3/10 procedures closer to telephone survey-based consumption estimates. Conclusion: We found that applying electronic health record (EHR)-based machine learning nonresponse bias adjustment is essential for debiased opioid consumption estimates from patient surveys. After adjustment, post-discharge surveys can generate reliable opioid consumption estimates. Clinical factors from the EHR combined with TL adjustment appropriately capture differences between responders and nonresponders and should be used prior to generalizing or applying opioid consumption estimates to patient care.

scholarly journals A Nonresponse-adjusted Text Message-to-Web Survey Provides Sustainable Post-discharge Opioid Consumption Data From Surgical Patients

2021 ◽  
Vol 233 (5) ◽  
pp. e95
Author(s):  
Chris J. Kennedy ◽  
Jayson S. Marwaha ◽  
Pamela Scalise ◽  
Kortney Robinson ◽  
Brandon Booth ◽  
...  
Keyword(s):  
Text Message ◽  
Opioid Consumption ◽  
Surgical Patients ◽  
Web Survey ◽  
Post Discharge ◽  
Consumption Data

scholarly journals Cerebral oxygenation in 45-degree trendelenburg position for robot-assisted radical prostatectomy: a single-center, open, controlled pilot study

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Clemens Wiesinger ◽  
Dominik Stefan Schoeb ◽  
Mathias Stockhammer ◽  
Emir Mirtezani ◽  
Lukas Mitterschiffthaler ◽  
...  
Keyword(s):  
Pilot Study ◽  
Cerebral Oxygenation ◽  
Preoperative Assessment ◽  
Patient Characteristics ◽  
Rank Test ◽  
Control Group ◽  
Robot Assisted ◽  
Clinical Trial Registry ◽  
Trendelenburg Position ◽  
Signed Rank Test

Abstract Background Within the last decade, robotically-assisted laparoscopic prostatectomy (RALP) has become the standard for treating localized prostate cancer, causing a revival of the 45° Trendelenburg position. In this pilot study we investigated effects of Trendelenburg position on hemodynamics and cerebral oxygenation in patients undergoing RALP. Methods We enrolled 58 patients undergoing RALP and 22 patients undergoing robot-assisted partial nephrectomy (RAPN) (control group) in our study. Demographic patient data and intraoperative parameters including cerebral oxygenation and cerebral hemodynamics were recorded for all patients. Cerebral function was also assessed pre- and postoperatively via the Mini Mental Status (MMS) exam. Changes in parameters during surgery were modelled by a mixed effects model; changes in the MMS result were evaluated using the Wilcoxon signed rank test. Results Preoperative assessment of patient characteristics, standard blood values and vital parameters revealed no difference between the two groups. Conclusions Applying a 45° Trendelenburg position causes no difference in postoperative brain function, and does not alter cerebral oxygenation during a surgical procedure lasting up to 5 h. Further studies in larger patient cohorts will have to confirm these findings. Trial registration German Clinical Trial Registry; DRKS00005094; Registered 12th December 2013—Retrospectively registered; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005094.

scholarly journals Paper, E-mail, or Both? Effects of Contact Mode on Participation in a Web Survey of Establishments

2018 ◽  
Vol 37 (6) ◽  
pp. 750-765 ◽  
Author(s):  
Joseph W. Sakshaug ◽  
Basha Vicari ◽  
Mick P. Couper
Keyword(s):  
Response Rate ◽  
Population Based ◽  
High Response Rate ◽  
Nonresponse Bias ◽  
Web Survey ◽  
Participation Rates ◽  
Web Surveys ◽  
Contact Mode ◽  
Mail Address ◽  
E Mail

Identifying strategies that maximize participation rates in population-based web surveys is of critical interest to survey researchers. While much of this interest has focused on surveys of persons and households, there is a growing interest in surveys of establishments. However, there is a lack of experimental evidence on strategies for optimizing participation rates in web surveys of establishments. To address this research gap, we conducted a contact mode experiment in which establishments selected to participate in a web survey were randomized to receive the survey invitation with login details and subsequent reminder using a fully crossed sequence of paper and e-mail contacts. We find that a paper invitation followed by a paper reminder achieves the highest response rate and smallest aggregate nonresponse bias across all-possible paper/e-mail contact sequences, but a close runner-up was the e-mail invitation and paper reminder sequence which achieved a similarly high response rate and low aggregate nonresponse bias at about half the per-respondent cost. Following up undeliverable e-mail invitations with supplementary paper contacts yielded further reductions in nonresponse bias and costs. Finally, for establishments without an available e-mail address, we show that enclosing an e-mail address request form with a prenotification letter is not effective from a response rate, nonresponse bias, and cost perspective.

scholarly journals Evaluation of a Systems-Based Tobacco Cessation Program Using Bedside Volunteers

2018 ◽  
Vol 22 (3) ◽  
pp. 440-445 ◽  
Author(s):  
Denise S Taylor ◽  
Dominique Medaglio ◽  
Claudine T Jurkovitz ◽  
Freda Patterson ◽  
Zugui Zhang ◽  
...  
Keyword(s):  
Tobacco Cessation ◽  
Patient Characteristics ◽  
Post Discharge ◽  
Cessation Treatment ◽  
Opt Out ◽  
Artery Disease ◽  
Intent To Treat ◽  
The Cost ◽  
Referral Completion ◽  
Future Work

Abstract Introduction Hospitalization and post-discharge provide an opportune time for tobacco cessation. This study tested the feasibility, uptake, and cessation outcomes of a hospital-based tobacco cessation program, delivered by volunteers to the bedside with post-discharge referral to Quitline services. Patient characteristics associated with Quitline uptake and cessation were assessed. Methods Between February and November 2016, trained hospital volunteers approached inpatient tobacco users on six pilot units. Volunteers shared a cessation brochure and used the ASK-ADVISE-CONNECT model to connect ready to quit patients to the Delaware Quitline via fax-referral. Volunteers administered a follow-up survey to all admitted tobacco users via telephone or email at 3-months post-discharge. Results Of the 743 admitted tobacco users, 531 (72%) were visited by a volunteer, and 97% (531/547) of those approached, accepted the visit. Over one-third (201/531; 38%) were ready to quit and fax-referred to the Quitline, and 36% of those referred accepted Quitline services. At 3 months post-discharge, 37% (135/368) reported not using tobacco in the last 30 days; intent-to-treat cessation rate was 18% (135/743). In a multivariable regression model of Quitline fax-referral completion, receiving nicotine replacement therapy (NRT) during hospitalization was the strongest predictor (odds ratios [OR] = 1.97; 95% confidence interval [CI] = 1.34 to 2.90). In a model of 3-month cessation, receiving Quitline services (OR = 3.21, 95% CI = 1.35 to 7.68) and having coronary artery disease (OR = 2.28; 95% CI = 1.11 to 4.68) were associated with tobacco cessation, but a volunteer visit was not. Conclusions An “opt-out” tobacco cessation service using trained volunteers is feasible for connecting patients to Quitline services. Implications This study demonstrates the feasibility of a systems-based approach to link inpatients to evidence-based treatment for tobacco use. This model used trained bedside volunteers to connect inpatients to a state-funded Quitline after discharge that offers free cessation treatment of telephone coaching and cessation medications. Receiving NRT during hospitalization positively impacted Quitline referral, and engagement with Quitline resources was critical to tobacco abstinence post-discharge. Future work is needed to evaluate the cost-effectiveness and sustainability of this volunteer model.

Using Response Propensity Modeling to Allocate Noncontingent Incentives in an Address-Based Sample: Evidence from a National Experiment

2019 ◽  
Vol 8 (2) ◽  
pp. 385-411
Author(s):  
Michael T Jackson ◽  
Cameron B McPhee ◽  
Paul J Lavrakas
Keyword(s):  
Response Rate ◽  
Survey Response ◽  
Nonresponse Bias ◽  
Monetary Incentives ◽  
Entire Sample ◽  
Ethical Concerns ◽  
Response Propensity ◽  
Using Data ◽  
National Household Education Survey ◽  
Probability Of Response

Abstract Monetary incentives are frequently used to improve survey response rates. While it is common to use a single incentive amount for an entire sample, allowing the incentive to vary inversely with the expected probability of response may help to mitigate nonresponse and/or nonresponse bias. Using data from the 2016 National Household Education Survey (NHES:2016), an address-based sample (ABS) of US households, this article evaluates an experiment in which the noncontingent incentive amount was determined by a household’s predicted response propensity (RP). Households with the lowest RP received $10, those with the highest received $2 or $0, and those in between received the standard NHES incentive of $5. Relative to a uniform $5 protocol, this “tailored” incentive protocol slightly reduced the response rate and had no impact on observable nonresponse bias. These results serve as an important caution to researchers considering the targeting of incentives or other interventions based on predicted RP. While preferable in theory to “one-size-fits-all” approaches, such differential designs may not improve recruitment outcomes without a dramatic increase in the resources devoted to low RP cases. If budget and/or ethical concerns limit the resources that can be devoted to such cases, RP-based targeting could have little practical benefit.

End-of-Life Orders, Resource Utilization, and Costs Among Injured Older Adults Requiring Emergency Services

2020 ◽  
Author(s):  
Amber L Lin ◽  
Craig Newgard ◽  
Aaron B Caughey ◽  
Susan Malveau ◽  
Abby Dotson ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Resource Utilization ◽  
Emergency Services ◽  
Patient Characteristics ◽  
Vital Statistics ◽  
Fee For Service ◽  
Post Discharge ◽  
Index Event ◽  
Hospice Use

Abstract Background: Portable Orders for Life-Sustaining Treatment (POLST) are increasingly utilized to assist patients approaching the end of life in documenting goals of care. We evaluated the association of POLST, resource utilization, and costs to 1 year among injured older adults requiring emergency services.Methods: This was a retrospective cohort of injured older adults ≥65 years with continuous Medicare fee-for-service coverage transported by emergency medical services (EMS) in 2011 across 4 counties in Oregon. Data sources included EMS, Medicare claims, vital statistics, and state POLST, inpatient and trauma registries. Outcomes included hospital admission, receipt of aggressive medical interventions, costs, and hospice use. We matched patients on patient characteristics and comorbidities to control for bias.Results: We included 2116 patients of which 484 (22.9%) had a POLST form prior to 911 contact. Of POLST patients, 136 (28.1%) had orders for full treatment, 194 (40.1%) for limited interventions, and 154 (31.8%) for comfort measures. There were no significant associations for care during the index event. However, in the year after the index event, patients with care limitations had higher adjusted hospice use (limited interventions OR 1.7 [95% CI: 1.2–2.6]; comfort OR, 2.0 [95% CI: 1.3–3.0]) and lower adjusted post-discharge costs (no POLST, $32,399 [95% CI: 30,041–34,756]; limited interventions, $18,729 [95% CI: 12,913–24,545]; and comfort $15,593 [95% CI: 12,091–19,095]). There were no significant associations for all other outcomes.Conclusions: Care limitations specified in POLST forms among injured older adults transported by EMS are associated with increased use of hospice and decreased costs to 1 year.

Data quality comparison between computers and smartphones in different web survey modes and question formats

2020 ◽  
Vol 30 (6) ◽  
pp. 1763-1781
Author(s):  
Louisa Ha ◽  
Chenjie Zhang ◽  
Weiwei Jiang
Keyword(s):  
Survey Response ◽  
Computer Assisted ◽  
Web Survey ◽  
Web Surveys ◽  
Online Surveys ◽  
Response Quality ◽  
Content Type ◽  
Survey Modes ◽  
Question Formats

PurposeLow response rates in web surveys and the use of different devices in entering web survey responses are the two main challenges to response quality of web surveys. The purpose of this study is to compare the effects of using interviewers to recruit participants in computer-assisted self-administered interviews (CASI) vs computer-assisted personal interviews (CAPI) and smartphones vs computers on participation rate and web survey response quality.Design/methodology/approachTwo field experiments using two similar media use studies on US college students were conducted to compare response quality in different survey modes and response devices.FindingsResponse quality of computer entry was better than smartphone entry in both studies for open-ended and closed-ended question formats. Device effect was only significant on overall completion rate when interviewers were present.Practical implicationsSurvey researchers are given guidance how to conduct online surveys using different devices and choice of question format to maximize survey response quality. The benefits and limitations of using an interviewer to recruit participants and smartphones as web survey response devices are discussed.Social implicationsIt shows how computer-assisted self-interviews and smartphones can improve response quality and participation for underprivileged groups.Originality/valueThis is the first study to compare response quality in different question formats between CASI, e-mailed delivered online surveys and CAPI. It demonstrates the importance of human factor in creating sense of obligation to improve response quality.

A Rapid Desensitization Program Is a Viable Therapeutic Option in the Management of Immunomodulating Agent-Related Hypersensitivity Reactions in Patients with Plasma Cell Disorders

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2411-2411
Author(s):  
Jack T Seki ◽  
Naoko Sakurai ◽  
Wallace Lam ◽  
Vesna Lukaroska ◽  
Anna Granic ◽  
...  
Keyword(s):  
Research Funding ◽  
Adverse Reactions ◽  
Patient Characteristics ◽  
Urgent Care ◽  
Initial Reaction ◽  
Allergic Reactions ◽  
Hypersensitivity Reactions ◽  
Target Dose ◽  
Post Discharge ◽  
Temporal Area

Abstract Introduction Immunomodulatory drugs (IMiDs) such as the newer-generation agents lenalidomide and pomalidomide have become essential treatment backbones for myeloma, but some patients may experience skin and other toxicity resulting in discontinuation of these life-prolonging drugs. The optimal management of moderately severe cutaneous and other potentially life-threatening allergic reactions (including angioedema and anaphylaxis), has not been defined. Beginning in 2011, we developed a rapid desensitization program (RDP) for patients who developed significant cutaneous/allergic reactions (Grade 3 CTCAE 4.03 hypersensitivity reactions [HSRs]) felt to contraindicate re-exposure to an IMiD by the treating physician. Patients who had Grade 2 or less cutaneous HSRs were not eligible for RDP. Our primary objective of the RDP was to safely restore treatment with these key agents. Methodology Patients with only mild or grade 1/2 (CTCAE 4.03) HSRs to prior IMiDs were excluded. After obtaining informed consent, patients who had experienced more severe reactions were admitted to a step-down nursing facility with an anaphylaxis kit at bedside. As per protocol, a 10-14 step RDP process took on average 3.5-5 hours to complete (Seki J, et al. ClinLymphoma Myeloma Leuk 2013; 13: 162-5 and Seki J, et al. J Clin Med Res 2015; 7:807-811 2015). Capsules of the target IMiDs were emptied and dissolved into an Erlenmeyer flask or beaker containing either saline solution (in the case of lenalidomide), or an institution-developed suspension (for pomalidomide), from which 3 or 4 different concentrations of stock solutions were prepared; the desired strengths produced were dependent on the target dose for a given patient. The RDP protocol also contained monitoring guidelines for frequent vital signs and rescue medications in case of breakthrough reactions. Post-RDP, patients were observed and monitored overnight. If no problems were encountered, patients were re-challenged with the IMiD full target dose the next morning. Patients were discharged if no active issues developed in the following 4 hours. Longitudinal follow-up by phone at one-, two- and four weeks post-discharge continued to ensure safety and efficacy of RDP. Post-assessment, patients were instructed to report worsening of adverse reactions to the myeloma triage nurse by phone and/or seek urgent care when needed. Results No one developed irreversible or serious adverse reactions during the procedures. One (1/12) patient developed a recurrent mild rash around her forehead and temporal area which migrated to the back of her neck a few hours post-RDP which lasted into the next day. The rash waxed and waned but resolved at the end of the day without intervention. Two (2/12) patients had systolic and diastolic blood pressure (BP) fluctuations during the procedure, especially at the early stages of the desensitization. BPs normalized in both patients before completing the RDP. Patients tolerated the contents of the oral syringes containing the two different IMiDs formulation well. A second RDP was offered to two patients. One, who had developed milder forms of HSR following the first procedure compared to the initial reaction (but still at least Grade 2), underwent a second RDP but developed recurrent hives 3 weeks post-discharge that could not be controlled with antihistamines; the second had developed angioedema and rash after the first RDP and was premedicated with prednisone, antihistamines and montelukast before the second. Subsequently, this patient was able to continue lenalidomide until disease progression. No other patients were premedicated prior to commencing RDP. Conclusion Our RDP was a safe and effective means to manage IMiD-related HSRs that were moderately severe in nature. In total our RDP protocol allowed eleven of twelve patients (92%) with significant HSRs, felt to preclude further IMiD treatment, to proceed with such therapy without IMiD-related toxicity. Given the critical need for IMiD treatment in myeloma and amyloidosis, we feel this program improved patients' outcomes with minimum risk. Table 1 Patient characteristics Table 1. Patient characteristics Table 2 Results of RDP Table 2. Results of RDP Disclosures Trudel: Celgene: Honoraria; Glaxo Smith Kline: Honoraria, Research Funding; Novartis: Honoraria; Oncoethix: Research Funding. Reece:Otsuka: Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; Merck: Consultancy, Honoraria, Research Funding; BMS: Honoraria, Research Funding; Novartis: Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding.

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