Care coordination programs have traditionally focused on medically complex patients, identifying patients that qualify by analyzing formatted clinical data and claims data. However, not all ...clinically relevant data reside in claims and formatted data. Recently, there has been increasing interest in including patients with complex psychosocial determinants of health in care coordination programs. Psychosocial risk factors, including social determinants of health, mental health disorders, and substance abuse disorders, are less amenable to rapid and systematic data analyses, as these data are often not collected or stored as formatted data, and due to US Health Insurance Portability and Accountability Act (HIPAA) regulations are often not available as claims data.
The objective of our study was to develop a systematic approach using word recognition software to identifying psychosocial risk factors within any part of a patient's electronic health record (EHR).
We used QPID (Queriable Patient Inference Dossier), an ontology-driven word recognition software, to scan adult patients' EHRs to identify terms predicting a high-risk patient suitable to be followed in a care coordination program in Massachusetts, USA. Search terms identified high-risk conditions in patients known to be enrolled in a care coordination program, and were then tested against control patients. We calculated precision, recall, and balanced F-measure for the search terms.
We identified 22 EHR-available search terms to define psychosocial high-risk status; the presence of 9 or more of these terms predicted that a patient would meet inclusion criteria for a care coordination program. Precision was .80, recall .98, and balanced F-measure .88 for the identified terms. For adult patients insured by Medicaid and enrolled in the program, a mean of 14 terms (interquartile range IQR 11-18) were present as identified by the search tool, ranging from 2 to 22 terms. For patients enrolled in the program but not insured by Medicaid, a mean of 6 terms (IQR 3-8) were present as identified by the search tool, ranging from 1 to 21.
Selected informatics tools such as word recognition software can be leveraged to improve health care delivery, such as an EHR-based protocol that identifies psychosocially complex patients eligible for enrollment in a care coordination program.
Chronic health conditions are a growing global health concern and account for over half of all deaths worldwide. Finding ways to decrease the burden of and resources allotted to chronic health ...conditions is of primary importance. Recent advances in technology and insights into modeling techniques offer promising approaches, which if combined, represent a novel direction that would further advance the prevention and treatment of chronic health conditions.
In patients who have chronic heart failure with reduced left ventricular ejection fraction, severe secondary mitral-valve regurgitation is associated with a poor prognosis. Whether percutaneous ...mitral-valve repair improves clinical outcomes in this patient population is unknown.
We randomly assigned patients who had severe secondary mitral regurgitation (defined as an effective regurgitant orifice area of >20 mm
or a regurgitant volume of >30 ml per beat), a left ventricular ejection fraction between 15 and 40%, and symptomatic heart failure, in a 1:1 ratio, to undergo percutaneous mitral-valve repair in addition to receiving medical therapy (intervention group; 152 patients) or to receive medical therapy alone (control group; 152 patients). The primary efficacy outcome was a composite of death from any cause or unplanned hospitalization for heart failure at 12 months.
At 12 months, the rate of the primary outcome was 54.6% (83 of 152 patients) in the intervention group and 51.3% (78 of 152 patients) in the control group (odds ratio, 1.16; 95% confidence interval CI, 0.73 to 1.84; P=0.53). The rate of death from any cause was 24.3% (37 of 152 patients) in the intervention group and 22.4% (34 of 152 patients) in the control group (hazard ratio, 1.11; 95% CI, 0.69 to 1.77). The rate of unplanned hospitalization for heart failure was 48.7% (74 of 152 patients) in the intervention group and 47.4% (72 of 152 patients) in the control group (hazard ratio, 1.13; 95% CI, 0.81 to 1.56).
Among patients with severe secondary mitral regurgitation, the rate of death or unplanned hospitalization for heart failure at 1 year did not differ significantly between patients who underwent percutaneous mitral-valve repair in addition to receiving medical therapy and those who received medical therapy alone. (Funded by the French Ministry of Health and Research National Program and Abbott Vascular; MITRA-FR ClinicalTrials.gov number, NCT01920698 .).
A clear disconnection exists between theory and research that postulates that affect and coping are embodied in a process that unfolds over time and are likely to be characterized by change and ...co-occurrence in changes. The use of a 2-wave cross-lagged panel investigation within a naturalistic achievement-related demanding situation allowed us to shed light on the issue of temporal ordering between affect and coping. A total of 601 participants completed a series of self-report questionnaires designed to assess affective states and coping strategies used by athletes within a naturalistic achievement-related demanding situation (sport competition) characterized by an anticipatory stage and a performance stage (just before and during competition, respectively). Structural equation modeling results showed that a lagged model in which affect predicted coping at a later time point fitted to the data better than did the simultaneous models (coping predicted affect within single stages or affect predicted coping within single stages), another lagged model (coping predicted affect at later time point), and the cross-lagged model (reciprocal relationship between coping and affect over time). In line with recent theoretical frameworks that have suggested that affect could be conceptualized as an antecedent of coping, our results highlighted that a lagged model in which affect influences coping emerged as the most parsimonious representation of the temporal ordering between affect and coping.
Previous studies exploring athletes' affective experience within competition neglected the multivariate nature of the construct of affective states. The purposes of the current study were to: (a) ...identify affective profiles before and during competition; (b) examine if key theoretical covariates from a transactional perspective of affective states (i.e., perceived control and stress) predict membership of affective profiles; (c) explore the issue of consistency or change of affective profiles for the same individual over time (transition probabilities); and (d) examine whether precompetitive perceived control and stress impact transition probabilities. Two-hundred and 96 competitive athletes filled out self-report measures of perceived stress, perceived control, intensity and direction of positive affect (PA) and negative Affect (NA). Latent profile transition analysis revealed 5 affective profiles as a whole: low PA and NA debilitators (T1 only), high PA moderate NA facilitators, low PA high NA debilitators (T1 only), moderate PA and NA neutrals (T2 only), low PA moderate NA debilitators (T2 only). Athletes exhibited changes of affective profiles over time. High PA moderate NA facilitators reported the best psychological adjustment, as indicated by the effects of covariates (i.e., perceived control and stress) on affective profiles. Precompetitive perceived control and stress significantly predicted transition probabilities (i.e., athletes' change of affective profiles from before to during competition). As a whole, an affective profile approach may prove useful in understanding affective states as a dynamic system and have implications for intervention.
This study investigated the dynamics of stress and recovery responses and their relationships with perceived environmental mastery during one-year of polar winter-over expeditioners in distinct ...environmental conditions of sub-Antarctic and Antarctic polar station. The findings of multilevel analysis suggested that the several stress and recovery responses experienced by the winterers were characterized by diverse dynamics according to the severity of the environment. Furthermore, perceived environmental mastery impacted differently the dynamics of these responses. This multidimensional study highlights the complex evolution of stress and recovery in these extreme situations and the central role of environmental mastery on the temporal patterns of these psychological dimensions with potential salutogenic effects. Practical recommendations for improving environmental mastery at the different stages of the mission including psychoeducation, monitoring and psychological preparation are proposed.
•Stress and recovery have been recognized as key issue in psychology.•Stress and recovery provide insight into the multidimensional associations that can exist between persons and environments.•Stress and recovery dimensions evolve differently according to the environmental conditions.•Environmental mastery influences the trajectories of these dimensions.•These understandings might assist selection, training and support of persons to better adapt to their specific environment.
Psychological adaptation to isolated, confined and extreme (ICE) environments is a complex and multidimensional theoretical construct that requires an appropriate method to capture inter-individual ...and intra-individual differences dynamics across time. As such, we adopted a person-centred approach to address several objectives to identify: (a) winterers' profiles and trajectories of the four dimensions in adaptation (social, emotional, physical, and occupational), (b) temporal dynamics of these profiles, (c) consistency of these profiles over the wintering period, and (d) to examine whether adaptation profiles are associated with a theoretical covariate of interest (optimism). To address these objectives, 133 winterers from sub-Antarctic and Antarctic stations participated in this study. Latent class growth analysis and latent profile transition analysis highlighted distinct adaptation profiles and trajectories. Winterers’ from distinct adaptation trajectories reported significant different scores of dispositional optimism. These results bring elements of answers to better understand psychological adaptation to extreme environment.
•The Big four of the PAP evolve differently during a wintering.•Multidimensionality and temporality are considered as key elements of the PAP in extreme environments.•Several adaptation and trajectories profiles are revealed in wintering.•Optimism differs significantly from distinct adaptation trajectories.
PDF
