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Lepore S.J.,Temple University | Wolf R.L.,Columbia University | Basch C.E.,Columbia University | Godfrey M.,Temple University | And 5 more authors.
Annals of Behavioral Medicine | Year: 2012

Background: Decision support interventions have been developed to help men clarify their values and make informed decisions about prostate cancer testing, but they seldom target high-risk black and immigrant men. Purpose: This study evaluated the efficacy of a decision support intervention focused on prostate cancer testing in a sample of predominantly immigrant black men. Methods: Black men (N = 490) were randomized to tailored telephone education about prostate cancer testing or a control condition. Results: Post-intervention, the intervention group had significantly greater knowledge, lower decision conflict, and greater likelihood of talking with their physician about prostate cancer testing than the control group. There were no significant intervention effects on prostate specific antigen testing, congruence between testing intention and behavior, or anxiety. Conclusions: A tailored telephone decision support intervention can promote informed decision making about prostate cancer testing in black and predominantly immigrant men without increasing testing or anxiety. © The Society of Behavioral Medicine 2012.


Charlson M.,New York Medical College | Wells M.T.,Cornell University | Ullman R.,1199SEIU Benefit and Pension Funds | King F.,1199SEIU Benefit and Pension Funds | Shmukler C.,1199SEIU Benefit and Pension Funds
PLoS ONE | Year: 2014

Background: Reducing health care costs requires the ability to identify patients most likely to incur high costs. Our objective was to evaluate the ability of the Charlson comorbidity score to predict the individuals who would incur high costs in the subsequent year and to contrast its predictive ability with other commonly used predictors.Methods: We contrasted the prior year Charlson comorbidity index, costs, Diagnostic Cost Group (DCG) and hospitalization as predictors of subsequent year costs from claims data of fund that provides comprehensive health benefits to a large union of health care workers. Total costs in the subsequent year was the principal outcome.Results: Of the 181,764 predominantly Black and Latino beneficiaries, 70% were adults (mean age 45.7 years; 62% women). As the comorbidity index increased, total yearly costs increased significantly (P<.001). At lower comorbidity, the costs were similar across different chronic diseases. Using regression to predict total costs, top 5th and 10th percentile of costs, the comorbidity index, prior costs and DCG achieved almost identical explained variance in both adults and children.Conclusions and Relevance: The comorbidity index predicted health costs in the subsequent year, performing as well as prior cost and DCG in identifying those in the top 5% or 10%. The comorbidity index can be used prospectively to identify patients who are likely to incur high costs. © 2014 Charlson et al.


PubMed | 1199SEIU Benefit and Pension Funds, Cornell University and New York Medical College
Type: Clinical Trial | Journal: PloS one | Year: 2014

Reducing health care costs requires the ability to identify patients most likely to incur high costs. Our objective was to evaluate the ability of the Charlson comorbidity score to predict the individuals who would incur high costs in the subsequent year and to contrast its predictive ability with other commonly used predictors.We contrasted the prior year Charlson comorbidity index, costs, Diagnostic Cost Group (DCG) and hospitalization as predictors of subsequent year costs from claims data of fund that provides comprehensive health benefits to a large union of health care workers. Total costs in the subsequent year was the principal outcome.Of the 181,764 predominantly Black and Latino beneficiaries, 70% were adults (mean age 45.7 years; 62% women). As the comorbidity index increased, total yearly costs increased significantly (P<.001). At lower comorbidity, the costs were similar across different chronic diseases. Using regression to predict total costs, top 5th and 10th percentile of costs, the comorbidity index, prior costs and DCG achieved almost identical explained variance in both adults and children.The comorbidity index predicted health costs in the subsequent year, performing as well as prior cost and DCG in identifying those in the top 5% or 10%. The comorbidity index can be used prospectively to identify patients who are likely to incur high costs.ClinicalTrials.gov NCT01761253.


Walker E.A.,Yeshiva University | Shmukler C.,1199SEIU Benefit and Pension Funds | Ullman R.,1199SEIU Benefit and Pension Funds | Blanco E.,Yeshiva University | And 2 more authors.
Diabetes Care | Year: 2011

OBJECTIVE - To compare the effectiveness of a telephonic and a print intervention over 1 year to improve diabetes control in low-income urban adults. RESEARCH DESIGN AND METHODS - A randomized trial in Spanish and English comparing a telephonic intervention implemented by health educators with a print intervention. Participants (N=526) had an A1C≥7.5% and were prescribed one or more oral agents. All were members of a union/employer jointly sponsored health benefit plan. Health coverage included medications. Primary outcomes were A1C and pharmacy claims data; secondary outcomes included self-report of two medication adherence measures and other self-care behaviors. RESULTS - Participants were 62% black and 23% Hispanic; 77% were foreign born, and 42% had annual family incomes <$30 thousand. Baseline median A1C was 8.6% (interquartile range 8.0-10.0). Insulin was also prescribed for 24% of participants. The telephone group had mean ± SE decline in A1C of 0.23 ± 0.11% over 1 year compared with a rise of 0.13 ± 0.13% for the print group (P = 0.04). After adjusting for baseline A1C, sex, age, and insulin use, the difference in A1C was 0.40% (95% CI 0.10-0.70, P = 0.009). Change in medication adherence measured by claims data, but not by self-report measures, was significantly associated with change in A1C (P = 0.01). Improvement in medication adherence was associated (P = 0.005) with the telephonic intervention, but only among those not taking insulin. No diabetes self-care activities were significantly correlated with the change in A1C. CONCLUSIONS - A 1-year tailored telephonic intervention implemented by health educators was successful in significantly, albeit modestly, improving diabetes control compared with a print intervention in a low-income, insured, minority population. © 2011 by the American Diabetes Association.


Basch C.E.,Columbia University | Zybert P.,Columbia University | Wolf R.L.,Columbia University | Basch C.H.,William Paterson University | And 5 more authors.
Journal of Community Health | Year: 2015

This randomized controlled trial assessed different educational approaches for increasing colorectal cancer screening uptake in a sample of primarily non-US born urban minority individuals, over aged 50, with health insurance, and out of compliance with screening guidelines. In one group, participants were mailed printed educational material (n = 180); in a second, participants’ primary care physicians received academic detailing to improve screening referral and follow-up practices (n = 185); in a third, physicians received academic detailing and participants received tailored telephone education (n = 199). Overall, 21.5 % of participants (n = 121) received appropriate screening within one year of randomization. There were no statistically significant pairwise differences between groups in screening rate. Among those 60 years of age or older, however, the detailing plus telephone education group had a higher screening rate than the print group (27.3 vs. 7.7 %, p = .02). Different kinds of interventions will be required to increase colorectal cancer screening among the increasingly small population segment that remains unscreened. ClinicalTrials.gov Identifier: NCT02392143. © 2015, Springer Science+Business Media New York.


Cohen H.W.,Yeshiva University | Shmukler C.,1199SEIU Benefit and Pension Funds | Ullman R.,1199SEIU Benefit and Pension Funds | Rivera C.M.,Montefiore Medical Center | Walker E.A.,Yeshiva University
Diabetic Medicine | Year: 2010

Aims To assess pharmacy claims and self-report data as measures of medication adherence and to describe baseline characteristics of subjects in the Improving Diabetes Outcomes Study. Methods Multi-ethnic, lower-income, insured adults (n = 526) in New York City with Type 2 diabetes were enrolled in a randomized, controlled, behavioural intervention study delivered by telephone. Baseline data were examined, including glycated haemoglobin (HbA1c), objective measures of diabetes medication adherence [claims data medication possession ratio (MPR)], and two self-report measures [Morisky Medication-taking Scale and the medication-taking item of the Summary of Diabetes Self-Care Activities (SDSCA)]. Associations of highest tertile HbA1c (≥ 9.3%) with lowest tertile MPR (< 42%) were assessed with logistic regression models adjusting for potential confounders. Subset analyses were performed based on assessment of potential interaction. Results Participants (mean ± sd age 56 ± 7 years) had median (interquartile range) HbA1c 8.6% (8.0-10.0). Correlations of baseline MPR with Morisky score and SDSCA medication-taking item were strongly significant (both ρ = 0.21, P < 0.001). Lowest MPR was significantly (P = 0.008) associated with highest HbA1c in the group as a whole and among the subset taking two or more oral glucose-lowering agents (OGLA) (P = 0.002), but not among the subset taking only one (P = 0.83). Self-report adherence measures were not significantly associated with HbA1c in either the whole group or either subset. Conclusions These results support the validity of MPR as an adherence measure for OGLA among insured diabetes patients with poorly controlled HbA1c, especially those taking two or more OGLA. © 2010 Diabetes UK.


Lepore S.J.,Temple University | Nair R.G.,Temple University | Davis S.N.,H. Lee Moffitt Cancer Center and Research Institute | Wolf R.L.,Columbia University | And 4 more authors.
Journal of Immigrant and Minority Health | Year: 2016

Medical guidelines do not recommend prostate cancer screening, particularly without informed and shared decision making. This study investigates undisclosed opportunistic screening using prostate specific antigen (PSA) testing in black immigrant and African American men. Participants (N = 142) were insured urban men, 45- to 70-years old. Patients’ reports of testing were compared with medical claims to assess undisclosed PSA testing. Most (94.4 %) men preferred to share in screening decisions, but few (46.5 %) were aware PSA testing was performed. Four factors predicted being unaware of testing: low formal education, low knowledge about prostate cancer, no intention to screen, and no physician recommendation (all p’s < .05). Undisclosed PSA testing was common. Both patient and provider factors increased risk of being uninformed about prostate cancer screening. Interventions combining patient education and physician engagement in shared decision making may better align practice with current prostate cancer screening guidelines. © 2016 Springer Science+Business Media New York


Schechter C.B.,Yeshiva University | Cohen H.W.,Yeshiva University | Shmukler C.,1199SEIU Benefit and Pension Funds | Walker E.A.,Yeshiva University
Diabetes Care | Year: 2012

OBJECTIVE - To characterize the costs and cost-effectiveness of a telephonic behavioral intervention to promote glycemic control in the Improving Diabetes Outcomes study. RESEARCH DESIGN AND METHODS - Using the provider perspective and a time horizon to the end of the 1-year intervention, we calculate the costs of a telephonic intervention by health educators compared with an active control (print) intervention to improve glycemic control in adults with type 2 diabetes. We calculate the cost-effectiveness ratios for a reduction of one percentage point in hemoglobin A1c (A1C), as well as for one participant to achieve an A1C <7%. Base-case and sensitivity analysis results are presented. RESULTS - The intervention cost $176.61 per person randomized to the telephone group to achieve a mean 0.36 percentage point of A1C improvement. The incremental cost-effectiveness ratio was $490.58 per incremental percentage point of A1C improvement and $2,617.35 per person over a 1-year intervention in achieving the A1C goal. In probabilistic sensitivity analysis, the median (interquartile range) of per capita cost, cost per percentage point reduction in A1C, and cost per person achieving the A1C goal of <7% are $175.82 (147.32-203.56), $487.75 (356.50-718.32), and $2,312.88 (1,785.58- 3,220.78), respectively. CONCLUSIONS - The costs of a telephonic intervention for diabetes self-management support are moderate and commensurate to the modest associated improvement in glycemic control. © 2012 by the American Diabetes Association.

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