The Dietary Approaches to Stop Hypertension (“DASH diet”) has been proven in research settings to... more The Dietary Approaches to Stop Hypertension (“DASH diet”) has been proven in research settings to lower blood pressure, but its implementation is untested among seniors in congregate meals settings. We report the planning, implementation, impact of COVID-19, and results of an Administration of Community Living-funded study to test whether two evidence-based interventions - DASH-alignment of congregate meals, and home blood pressure self-monitoring, can lower systolic blood pressure and increase blood pressure control among community-dwelling seniors.. Congregate meal menus were aligned with the DASH eating plan, through collaboration of Bionutrition professionals on the research team, CBN food services leadership, and the NYC Department for the Aging. Seniors provided feedback on the DASH-modified meal options. The intervention began on October 15, 2019 (Site 1) and February 3, 2020 (Site 2). The study was interrupted by the COVID-19 pandemic in March 2020, when congregate meals cea...
Background: Patient engagement is the foundation for improving health care, particularly for peop... more Background: Patient engagement is the foundation for improving health care, particularly for people living with HIV (PLWH). The Patient Activation Measure (PAM) is a widely used and validated metric for assessing patients' engagement and self-management empowerment. Patient activation is associated with improved adherence, better health outcomes, and lower costs. There is a dearth of scientific data on how to improve patient activation-particularly among individuals with the lowest activation, who are often disproportionately minority, lowerincome, older, and less educated than those with higher levels of activation. The Research team used a community-based participatory research approach involving PLWH, HIV clinicians, community-based organizations, and researchers to develop a patient activation program for PLWH. Get Ready and Empowered About Treatment (GREAT) uses a smart, web-enabled device (Apple iPod) with an electronic Personal Health Record (ePHR). Objectives: Our primary aim was to assess the impact of the GREAT program on patient activation (using PAM) among PLWH. Secondary outcomes included improvements in eHealth literacy (eHEALS), decision-making self-efficacy (DSES), patient involvement in care (Perceived Involvement in Care Scale [PICS]), patient-reported adherence to antiretroviral therapy (ART) and viral load suppression, health status/quality of life (SF-12), receipt of evidence-based care, and reductions in patient activation disparities.
Journal of the American Medical Informatics Association, 2014
The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedent... more The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedented collaboration across diverse healthcare institutions including private, county, and state hospitals and health systems, a consortium of Federally Qualified Health Centers, and two Department of Veterans Affairs hospitals. CAPriCORN builds on the strengths of our institutions to develop a cross-cutting infrastructure for sustainable and patient-centered comparative effectiveness research in Chicago. Unique aspects include collaboration with the University HealthSystem Consortium to aggregate data across sites, a centralized communication center to integrate patient recruitment with the data infrastructure, and a centralized institutional review board to ensure a strong and efficient human subject protection program. With coordination by the Chicago Community Trust and the Illinois Medical District Commission, CAPriCORN will model how healthcare institutions can overcome barriers of data integration, marketplace competition, and care fragmentation to develop, test, and implement strategies to improve care for diverse populations and reduce health disparities.
Background-Staphylococcus aureus is the most common cause of Skin and Soft Tissue Infections (SST... more Background-Staphylococcus aureus is the most common cause of Skin and Soft Tissue Infections (SSTIs) in the community in the United States of America. Community Health Centers (CHC) serve as primary care providers for thousands of immigrants in New York. Methods-As part of a research collaborative, 6 New York City-area CHCs recruited patients with SSTIs. Characterization was performed in all S. aureus isolates from wounds and nasal swabs collected from patients. Statistical analysis examined the differences in wound and nasal cultures among immigrant compared to native-born patients. Results-Wound and nasal specimens were recovered from 129 patients and tested for antibiotic susceptibility. 40 patients were immigrants from 15 different countries. Although not statistically
Despite the numerous benefits of physical activity, older adults continue to be more sedentary th... more Despite the numerous benefits of physical activity, older adults continue to be more sedentary than their younger counterparts, and sedentary behavior is more prevalent among older racial and ethnic minorities than among Whites. This study used the nominal group technique (NGT) to examine participants’ perceptions of what neighborhood environmental changes would encourage greater physical activity for older African American and Hispanic women. Participants age 50–75 years were recruited from 2 urban community health clinics. Nine NGT sessions (45 participants) were conducted. The women were asked what changes in their neighborhood environment would encourage them to become more physically active. Responses to the research question were tabulated, and qualitative analysis was used to identify themes and categories. Major categories were physical environment changes, safety, and activities/social support. Although the physical environment received the greatest number of points, concer...
Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. Howeve... more Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH. Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examin...
Background-Staphylococcus aureus is the most common cause of Skin and Soft Tissue Infections (SST... more Background-Staphylococcus aureus is the most common cause of Skin and Soft Tissue Infections (SSTIs) in the community in the United States of America. Community Health Centers (CHC) serve as primary care providers for thousands of immigrants in New York. Methods-As part of a research collaborative, 6 New York City-area CHCs recruited patients with SSTIs. Characterization was performed in all S. aureus isolates from wounds and nasal swabs collected from patients. Statistical analysis examined the differences in wound and nasal cultures among immigrant compared to native-born patients. Results-Wound and nasal specimens were recovered from 129 patients and tested for antibiotic susceptibility. 40 patients were immigrants from 15 different countries. Although not statistically
Despite the numerous benefits of physical activity, older adults continue to be more sedentary th... more Despite the numerous benefits of physical activity, older adults continue to be more sedentary than their younger counterparts, and sedentary behavior is more prevalent among older racial and ethnic minorities than among Whites. This study used the nominal group technique (NGT) to examine participants’ perceptions of what neighborhood environmental changes would encourage greater physical activity for older African American and Hispanic women. Participants age 50–75 years were recruited from 2 urban community health clinics. Nine NGT sessions (45 participants) were conducted. The women were asked what changes in their neighborhood environment would encourage them to become more physically active. Responses to the research question were tabulated, and qualitative analysis was used to identify themes and categories. Major categories were physical environment changes, safety, and activities/social support. Although the physical environment received the greatest number of points, concer...
Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. Howeve... more Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH. Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examin...
We describe the staff time required by the Prevention Care Manager tailored telephone support int... more We describe the staff time required by the Prevention Care Manager tailored telephone support intervention, which significantly increased breast, cervical and colorectal cancer screening rates among female patients of Community Health Centers in New York City. For a sample of 38 women whose intervention was timed, Prevention Care Managers spent an average of 99 minutes per woman on the phone and on related follow-up tasks over 18 months, or 248 minutes for each additional cancer screening test. Potential modifications to decrease the time required include automation of common tasks and the use of administrative data to further tailor outreach calls. Keywords Cancer screening; patient care management; telephone counseling Every year in New York City, over 700 women die of colorectal cancer, 1100 die of breast cancer, and 150 die of cervical cancer.1 The cancer death rate in New York City is 1.3 times higher in low-income neighborhoods than in high-income neighborhoods.2 Lower cancer screening rates among low-income and minority women may contribute to their higher rates of cancer morbidity and mortality.3 , 4 Low screening rates affect the health of individuals,
Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. Howeve... more Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH. Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examin...
We describe the staff time required by the Prevention Care Manager tailored telephone support int... more We describe the staff time required by the Prevention Care Manager tailored telephone support intervention, which significantly increased breast, cervical and colorectal cancer screening rates among female patients of Community Health Centers in New York City. For a sample of 38 women whose intervention was timed, Prevention Care Managers spent an average of 99 minutes per woman on the phone and on related follow-up tasks over 18 months, or 248 minutes for each additional cancer screening test. Potential modifications to decrease the time required include automation of common tasks and the use of administrative data to further tailor outreach calls. Keywords Cancer screening; patient care management; telephone counseling Every year in New York City, over 700 women die of colorectal cancer, 1100 die of breast cancer, and 150 die of cervical cancer.1 The cancer death rate in New York City is 1.3 times higher in low-income neighborhoods than in high-income neighborhoods.2 Lower cancer screening rates among low-income and minority women may contribute to their higher rates of cancer morbidity and mortality.3 , 4 Low screening rates affect the health of individuals,
The Dietary Approaches to Stop Hypertension (“DASH diet”) has been proven in research settings to... more The Dietary Approaches to Stop Hypertension (“DASH diet”) has been proven in research settings to lower blood pressure, but its implementation is untested among seniors in congregate meals settings. We report the planning, implementation, impact of COVID-19, and results of an Administration of Community Living-funded study to test whether two evidence-based interventions - DASH-alignment of congregate meals, and home blood pressure self-monitoring, can lower systolic blood pressure and increase blood pressure control among community-dwelling seniors.. Congregate meal menus were aligned with the DASH eating plan, through collaboration of Bionutrition professionals on the research team, CBN food services leadership, and the NYC Department for the Aging. Seniors provided feedback on the DASH-modified meal options. The intervention began on October 15, 2019 (Site 1) and February 3, 2020 (Site 2). The study was interrupted by the COVID-19 pandemic in March 2020, when congregate meals cea...
Background: Patient engagement is the foundation for improving health care, particularly for peop... more Background: Patient engagement is the foundation for improving health care, particularly for people living with HIV (PLWH). The Patient Activation Measure (PAM) is a widely used and validated metric for assessing patients' engagement and self-management empowerment. Patient activation is associated with improved adherence, better health outcomes, and lower costs. There is a dearth of scientific data on how to improve patient activation-particularly among individuals with the lowest activation, who are often disproportionately minority, lowerincome, older, and less educated than those with higher levels of activation. The Research team used a community-based participatory research approach involving PLWH, HIV clinicians, community-based organizations, and researchers to develop a patient activation program for PLWH. Get Ready and Empowered About Treatment (GREAT) uses a smart, web-enabled device (Apple iPod) with an electronic Personal Health Record (ePHR). Objectives: Our primary aim was to assess the impact of the GREAT program on patient activation (using PAM) among PLWH. Secondary outcomes included improvements in eHealth literacy (eHEALS), decision-making self-efficacy (DSES), patient involvement in care (Perceived Involvement in Care Scale [PICS]), patient-reported adherence to antiretroviral therapy (ART) and viral load suppression, health status/quality of life (SF-12), receipt of evidence-based care, and reductions in patient activation disparities.
Journal of the American Medical Informatics Association, 2014
The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedent... more The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedented collaboration across diverse healthcare institutions including private, county, and state hospitals and health systems, a consortium of Federally Qualified Health Centers, and two Department of Veterans Affairs hospitals. CAPriCORN builds on the strengths of our institutions to develop a cross-cutting infrastructure for sustainable and patient-centered comparative effectiveness research in Chicago. Unique aspects include collaboration with the University HealthSystem Consortium to aggregate data across sites, a centralized communication center to integrate patient recruitment with the data infrastructure, and a centralized institutional review board to ensure a strong and efficient human subject protection program. With coordination by the Chicago Community Trust and the Illinois Medical District Commission, CAPriCORN will model how healthcare institutions can overcome barriers of data integration, marketplace competition, and care fragmentation to develop, test, and implement strategies to improve care for diverse populations and reduce health disparities.
Background-Staphylococcus aureus is the most common cause of Skin and Soft Tissue Infections (SST... more Background-Staphylococcus aureus is the most common cause of Skin and Soft Tissue Infections (SSTIs) in the community in the United States of America. Community Health Centers (CHC) serve as primary care providers for thousands of immigrants in New York. Methods-As part of a research collaborative, 6 New York City-area CHCs recruited patients with SSTIs. Characterization was performed in all S. aureus isolates from wounds and nasal swabs collected from patients. Statistical analysis examined the differences in wound and nasal cultures among immigrant compared to native-born patients. Results-Wound and nasal specimens were recovered from 129 patients and tested for antibiotic susceptibility. 40 patients were immigrants from 15 different countries. Although not statistically
Despite the numerous benefits of physical activity, older adults continue to be more sedentary th... more Despite the numerous benefits of physical activity, older adults continue to be more sedentary than their younger counterparts, and sedentary behavior is more prevalent among older racial and ethnic minorities than among Whites. This study used the nominal group technique (NGT) to examine participants’ perceptions of what neighborhood environmental changes would encourage greater physical activity for older African American and Hispanic women. Participants age 50–75 years were recruited from 2 urban community health clinics. Nine NGT sessions (45 participants) were conducted. The women were asked what changes in their neighborhood environment would encourage them to become more physically active. Responses to the research question were tabulated, and qualitative analysis was used to identify themes and categories. Major categories were physical environment changes, safety, and activities/social support. Although the physical environment received the greatest number of points, concer...
Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. Howeve... more Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH. Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examin...
Background-Staphylococcus aureus is the most common cause of Skin and Soft Tissue Infections (SST... more Background-Staphylococcus aureus is the most common cause of Skin and Soft Tissue Infections (SSTIs) in the community in the United States of America. Community Health Centers (CHC) serve as primary care providers for thousands of immigrants in New York. Methods-As part of a research collaborative, 6 New York City-area CHCs recruited patients with SSTIs. Characterization was performed in all S. aureus isolates from wounds and nasal swabs collected from patients. Statistical analysis examined the differences in wound and nasal cultures among immigrant compared to native-born patients. Results-Wound and nasal specimens were recovered from 129 patients and tested for antibiotic susceptibility. 40 patients were immigrants from 15 different countries. Although not statistically
Despite the numerous benefits of physical activity, older adults continue to be more sedentary th... more Despite the numerous benefits of physical activity, older adults continue to be more sedentary than their younger counterparts, and sedentary behavior is more prevalent among older racial and ethnic minorities than among Whites. This study used the nominal group technique (NGT) to examine participants’ perceptions of what neighborhood environmental changes would encourage greater physical activity for older African American and Hispanic women. Participants age 50–75 years were recruited from 2 urban community health clinics. Nine NGT sessions (45 participants) were conducted. The women were asked what changes in their neighborhood environment would encourage them to become more physically active. Responses to the research question were tabulated, and qualitative analysis was used to identify themes and categories. Major categories were physical environment changes, safety, and activities/social support. Although the physical environment received the greatest number of points, concer...
Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. Howeve... more Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH. Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examin...
We describe the staff time required by the Prevention Care Manager tailored telephone support int... more We describe the staff time required by the Prevention Care Manager tailored telephone support intervention, which significantly increased breast, cervical and colorectal cancer screening rates among female patients of Community Health Centers in New York City. For a sample of 38 women whose intervention was timed, Prevention Care Managers spent an average of 99 minutes per woman on the phone and on related follow-up tasks over 18 months, or 248 minutes for each additional cancer screening test. Potential modifications to decrease the time required include automation of common tasks and the use of administrative data to further tailor outreach calls. Keywords Cancer screening; patient care management; telephone counseling Every year in New York City, over 700 women die of colorectal cancer, 1100 die of breast cancer, and 150 die of cervical cancer.1 The cancer death rate in New York City is 1.3 times higher in low-income neighborhoods than in high-income neighborhoods.2 Lower cancer screening rates among low-income and minority women may contribute to their higher rates of cancer morbidity and mortality.3 , 4 Low screening rates affect the health of individuals,
Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. Howeve... more Masked hypertension (MH) is a risk factor for cardiovascular and cerebrovascular diseases. However, little is known about the effect of psychosocial stressors on MH. Daily interpersonal conflict was examined as a predictor of elevated ambulatory blood pressure (ABP) in a community sample of 240 unmedicated black and Latino(a) adults (63% women; mean age 36 years) who had optimal office blood pressure (BP) readings (≤120/80 mm Hg). Electronic diaries were used to assess daily interpersonal conflict (i.e., perceptions of being treated unfairly/harassed during social interactions). Participants rated the degree to which they experienced each interaction as unfair or harassing on a scale of 1-100. Systolic and diastolic ABP (SysABP and DiaABP, respectively) were collected using a validated 24-h ABP monitor. Participants were classified as having marked MH (MMH) if the average of all readings obtained yielded SysABP: ≥135 mm Hg or DiaABP: ≥85 mm Hg. Logistic regression was used to examin...
We describe the staff time required by the Prevention Care Manager tailored telephone support int... more We describe the staff time required by the Prevention Care Manager tailored telephone support intervention, which significantly increased breast, cervical and colorectal cancer screening rates among female patients of Community Health Centers in New York City. For a sample of 38 women whose intervention was timed, Prevention Care Managers spent an average of 99 minutes per woman on the phone and on related follow-up tasks over 18 months, or 248 minutes for each additional cancer screening test. Potential modifications to decrease the time required include automation of common tasks and the use of administrative data to further tailor outreach calls. Keywords Cancer screening; patient care management; telephone counseling Every year in New York City, over 700 women die of colorectal cancer, 1100 die of breast cancer, and 150 die of cervical cancer.1 The cancer death rate in New York City is 1.3 times higher in low-income neighborhoods than in high-income neighborhoods.2 Lower cancer screening rates among low-income and minority women may contribute to their higher rates of cancer morbidity and mortality.3 , 4 Low screening rates affect the health of individuals,
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Papers by Jonathan Tobin