BackgroundMotivational interviewing (MI) may improve HIV outcomes in adolescents and emerging adults, but competence in delivering MI is critical. Although providers may receive introductory exposure to MI through workshops or didactic sessions, achieving competence requires more rigorous, structured training. Tailored Motivational Interviewing (TMI), is a set of targeted implementation strategies integrated into MI training to tailor it for adolescent HIV care providers and improve competence.MethodsUsing a retrospective analysis of program training, personnel, and performance records, the cost to train beyond beginner MI competency was calculated using a practice perspective, and tested by sensitivity analysis.ResultsThe cost of training a staff member to intermediate or expert MI competence was estimated at $6,286 for the base model.ConclusionsTMI had per-provider costs comparable to other MI training models, supporting feasibility and sustainability for youth HIV clinic implementation.Trial registrationThe main study is registered at clinicaltrials.gov in the National Library of Medicine with the ID NCT03681912. (Registration date: 2018-09-07).

Asthma medication adherence, measured by the asthma medication ratio (AMR), has been shown to be a reliable predictor of exacerbations among children with asthma. We developed a Markov model to estimate healthcare use, costs, and utility-associated outcomes across AMR-defined asthma states among children with asthma. We constructed an asthma Markov model using claims for a cohort of Medicaid beneficiaries aged 2-17 years (n = 214,452) using 2013‐2014 MarketScan® data who had at least one claim for an inhaled corticosteroid. We calculated 3‐month AMRs as the basis of transition estimates in the model. The AMRs data were transformed to reflect a one‐month Markov cycle length. Our model included five states: controlled, sub-optimally controlled, inactive, IP admission, and ED. The Markov model used an overall 2‐year time horizon for 10,000 beneficiaries. Patients entered the model in one of the five states as observed in the Medicaid data. Costs were based on 2017 Medicaid claims inflation adjusted to reflect 2020 costs. Medication-related costs were based on mean observed payments for controller and rescue medications, whereas costs for ED visits and inpatient admissions were based on median observed payments for those acute events. Utilities for each state were based on existing literature. Monthly costs for children with asthma were 235 for controlled,35 for suboptimally controlled (attributable to fewer medication fills), 364 for months with ED visit, and6,229 with admission. Over a 2-year period, we estimated the 2‐year direct medical costs of asthma among Medicaid insured children to average 4,552 per child. Children are on average 1.6 months more in controlled state at a cost of0.89 more per child per month accounting for medication cost less the cost of ED visits and hospitalizations. In addition to the saved side effects of oral steroids and time hospitalized, there is one increased quality month per 13 months. This Markov model populated with Medicaid population exacerbation, ED, hospital and medication use and payment data provides a framework to estimate the potential clinical and economic impact of existing and novel targeted interventions aimed at improving medication adherence and reducing acute care use.

Background: Ulnar collateral ligament (UCL) reconstruction has historically been considered the gold standard treatment for severe UCL tears. With the advent of suture-spanning repair techniques, some studies suggest that UCL repair is being performed with increasing frequency. This study provides a large analysis of UCL reconstruction versus repair trends in the United States following the introduction of suture-spanning repair techniques. Purpose: To compare the prevalence and complication rates of UCL reconstruction versus repair over a 5-year span following the introduction of suture spanning repair techniques. We also sought to determine if there was an age-related preference for reconstruction versus repair and whether the addition of an ulnar nerve transposition (UNT) affected short-term complication rates. Study Design: Cohort study; Level of evidence, 3. Methods: Using the Merative MarketScan research databases, which contain deidentified patient national claims information, we retrospectively identified patients aged 14 to 30 years who underwent UCL reconstruction or repair between 2016 and 2021, with or without UNT. Patients with a fracture diagnosis at the time of surgery were excluded. Demographic information including age, sex, and geographic region was collected. The number of patients who experienced infection, ulnar neuropathy, device-related complications, and unspecified complications were obtained for each procedure. Results: A total of 1191 reconstruction patients and 696 repair patients were identified. 36.8% of patients who underwent either reconstruction or repair had a concomitant UNT. UCL reconstruction patients were approximately 3 years older than repair patients on average ( P < .001). Male patients accounted for 89.5% of reconstruction patients and 77.7% of repair patients. From 2016 to 2021, the number of reconstructions declined 32.0% and the number of repairs increased 81.6%. There were no differences in the rate of infection ( P = .36) and ulnar neuropathy ( P = .73) between reconstruction and repair. The overall risk of developing any complication was higher for repair patients (1.58%) than reconstruction patients (0.67%); however, this difference was not significant ( P = .09). Conclusion: Between 2016 and 2021, following the introduction of suture spanning UCL repair techniques, the number of UCL repairs increased and the number of reconstructions decreased. There was no difference in complication rates between UCL repair and UCL reconstruction and the rate of complication for either surgery remains low.

Abstract INTRODUCTION Home health clinicians require practical tools to assess complex care needs, particularly for people living with dementia. Existing measures are time‐consuming and not well aligned with clinical workflows. METHODS We utilized 2019 national Medicare data, including the Outcome and Assessment Information Set (OASIS), to develop and validate a multidimensional care needs scale through exploratory factor analysis and standardized scores. Results were confirmed in the validation cohort. RESULTS Six domains were identified: self‐care and mobility (dominant), cognitive and behavioral supervision, complex ambulation, memory and decision‐making, hospitalization risk, and challenging behaviors. The Care Needs Scale showed strong gradients in impairment across the cohort, with people living with dementia disproportionately represented in moderate and high care‐need categories. CONCLUSION This scale leverages routinely collected data to characterize care needs across home health populations, with particular relevance to people living with dementia. Its design supports integration into existing documentation systems and facilitates individualized care planning, research, and policy evaluation in home health settings.

BACKGROUND: Corticosteroids increasingly are recommended as adjunctive treatments in critical illness syndromes; however, the existing literature supporting their benefit remains uncertain. Ventilator-dependent respiratory failure (VDRF) is a critical illness syndrome with low-acuity and high-acuity subphenotypes identifiable with electronic health record (EHR) data. RESEARCH QUESTION: Do conditional average treatment effects (CATEs) from corticosteroids with respect to hospital mortality differ by clinical subphenotypes in VDRF? STUDY DESIGN AND METHODS: In this multicenter, retrospective observational cohort, we measured CATE by clinical subphenotype among patients > 18 years of age receiving > 48 hours of mechanical ventilation with adjusted doubly robust estimator models using EHR data from the first 24 hours after initiation of mechanical ventilation. RESULTS: Low-acuity and high-acuity subphenotypes from the Medical University of South Carolina (MUSC) and Medical Information Mart for Intensive Care III (MIMIC-III) cohorts showed heterogeneous CATEs on mortality resulting from corticosteroid treatments (low-acuity MUSC, -4.1%; low-acuity MIMIC-III, -5.2%; high-acuity MUSC, 9.3%; and high-acuity MIMIC-III, 4.5%) with mean differences of 13.4% (95% CI, 11.8%-14.9%) and 9.7% (95% CI, 9.3%-10.1%), respectively. Protective effects in the low-acuity subphenotype were attenuated among patients with ARDS, pneumonia, or sepsis identified by administrative diagnosis codes; however, the risk of harm was consistent for the high-acuity subphenotype. INTERPRETATION: Our results show that clinical subphenotypes in VDRF can identify heterogeneous treatment effects from corticosteroids. These findings support the usefulness of clinically derived subphenotypes and may inform enrichment strategies for future prospective clinical trials. CHEST Critical Care 2026; 4(3):100258

OBJECTIVE:Describe Medicaid payments for a subset of home- and community-based services (HCBS) for continuously enrolled children by complexity level. METHODS:A cohort study of 21,838 children in South Carolina (1,744,294 claims, 2019-2022). Outcomes include mean annual payments for selected HCBS (eg, home nursing, personal care, rehabilitation). Descriptive statistics, an adjusted gamma-distributed generalized linear model with a log link, and Tukey-adjusted post hoc tests examined associations between children's characteristics, payments, and the effect of South Carolina's Medically Complex Children's Waiver (MCCW) enrollment within each complexity level. RESULTS:Payments increased with complexity (P<.001). Annually, children with C-CD had mean payments of $1496 (IQR: $296-$1733), followed by children with NC-CD (M=$426, IQR: $124-$428) and no CD (M=$265, IQR: $63-$261). Adjusted mean annual payments increased with complexity for children not enrolled in MCCW, from $273 (95% CI: [$256, $292]) for children with no CD, to $427 (95% CI: [$396, $460]) for children with NC-CD, and $1178 (95% CI: [$1071, $1296]) for children with C-CD (P<.001). Among those enrolled in MCCW, adjusted mean annual payments were $2571 (95% CI: [$1426, $4.637]) for children with no CD, $3335 (95% CI: [$1794, $6200]) for children with NC-CD, and $4460 (95% CI: [$3348, $5942]) for children with C-CD. CONCLUSIONS:A small cohort of children enrolled in MCCW account for a high concentration of Medicaid payments, reflecting the resource-intensive nature of hospital-level care delivered at home. Health policymaking should consider that restricting HCBS and waiver access may exponentially increase long-term state spending through avoidable institutional care.

BackgroundAdministrative data is widely used to identify Alzheimer's disease and related dementias (ADRD), yet commonly applied algorithms (e.g., the Chronic Conditions Warehouse [CCW] algorithm) rely on binary classification that may obscure heterogeneity in likelihood and care needs.ObjectiveTo examine whether a tiered ADRD classification algorithm using Medicare home health data yields cohorts with more clearly distinguishable clinical and sociodemographic characteristics compared with the CCW-27 algorithm.MethodsWe conducted a retrospective cohort study of 2,252,040 Medicare Fee-for-Service beneficiaries with home health encounters. The novel algorithm applied episode-level and individual-level criteria to classify individuals into one of three mutually exclusive groups (ADRD-highly likely, ADRD-possible, ADRD-unlikely). Using descriptive statistics, we compared socio-demographic characteristics and OASIS-based cognitive and functional measures across groups defined by the novel algorithm and the CCW-27 algorithm.ResultsThe CCW-27 algorithm classified 34.3% of individuals as ADRD-positive, whereas the novel algorithm classified 7.6% as ADRD-highly likely, 29.3% as ADRD-possible, and 63.1% as ADRD-unlikely. The ADRD-highly likely group demonstrated greater cognitive and functional impairment than the CCW-27 ADRD-positive group. Discordant classifications revealed important sociodemographic differences: individuals classified as ADRD-highly likely by the novel algorithm but ADRD-negative by the CCW-27 algorithm were more frequently Medicare/Medicaid dual-eligible (52.9%) and non-White (39.5%) than concordant and alternative discordant groups.ConclusionsA tiered claims-based ADRD classification provides greater resolution than binary approaches and reveals clinically and sociodemographically distinct groups within the Medicare home health population. Such approaches may support more nuanced characterization of ADRD when clinical gold standards are unavailable.

PURPOSE:This is a qualitative analysis of speech-language pathology and occupational therapy documentation of bedside assessments of infants orally feeding on noninvasive respiratory support (NRS). METHOD:Data were extracted from speech-language pathology and occupational therapy electronic health record documentation of bedside feeding/swallowing assessment and treatment of infants on NRS. These data included the rate of documentation of objective metrics, as well as themes in feeding safety, quality, and therapeutic interventions. RESULTS:Notes from 37 speech-language pathologist and occupational therapist bedside visits were included. Data on the amount of NRS during oral feeding were inconsistently documented, but reported flow rate ranged from 0.2 to 5.0 l per minute. Approximately 57% of notes indicated some type of overt feeding problem. Objective data were inconsistently documented, but common metrics included signs of possible aspiration (cough in 16.2% and congestion in 13.5% of notes), liquid viscosity (43.2% of notes), feeding modality (94.6% of notes), volume offered (56.8% of notes) and consumed (81.1% of notes), and feeding time (56.8% of notes). Documentation themes include assessment of both safety and quality, implied stability and success rather than explicit documentation of such, infrequent instrumental assessment referral, differences between assessment versus follow-up treatment notes, differences in structured/templated notes versus unstructured narratives, and missing data. CONCLUSIONS:Missing data limited our ability to draw conclusions regarding safety and quality of oral feeding during NRS use. We make recommendations for documentation, including prioritizing objective data, clarifying clinical interpretations, patient responses to interventions trialed, and use of structured narratives and flowcharting.

Introduction Plantar fasciitis (PF) is a common diagnosis in the United States and worldwide. Core musculature helps to stabilize the spine in order to prevent buckling and provide optimal production of motion. Core deficits may contribute to lower extremity injury through kinematic changes in lower extremity movement. There may be an association between a theoretical core muscle deficit and the subsequent development of symptomatic PF. Methods A retrospective case-control study was designed using the Truven Health MarketScan® database. The incidence of new, concurrent PF diagnoses was determined within one year of the date of specific surgeries (cesarean section and posterior lumbar fusion) and for matched controls. The control group was selected using age, sex, employment, region, insurance, Charlson scores, and/or Elixhauser conditions as variables. The adjusted odds of a new PF diagnosis were determined using logistic regression. Results Women who underwent cesarean section had 24.1% greater odds of PF within 12 months of delivery compared to vaginal births (odds ratio (OR) 1.241, 95% confidence interval (CI): 1.152-1.336). Patients who underwent posterior lumbar fusion surgery had 11.7% greater odds of developing PF (OR 1.117, 95% CI: 1.084-1.150) than the control group who did not have an existing core or spinal condition diagnosis. Conclusion The risk of developing PF is increased after procedures that might create transient core weakness. Given the results of this model, attention to core strengthening and rehabilitation may be of value in the treatment and prevention of PF.

Objective Intravenous immunoglobulin (IVIG) is a known effective treatment to reduce the incidence of coronary artery aneurysms in Kawasaki disease (KD) patients. However, there has been an increase in IVIG-resistant patients and a lack of clinical trial data to determine the best second treatment. The Kawasaki Disease Comparative Effectiveness (KIDCARE) trial was a randomized trial comparing infliximab to a second IVIG infusion. Data from the trial were used for a cost-effectiveness analysis. Methods We developed a decision tree to estimate total costs and outcomes and calculated cost-effectiveness ratios for both treatment pathways. Cost and resource use was estimated from IBM MarketScan Commercial Database, US Bureau Labor of Statistics, IBM Micromedex Redbook and relevant peer-reviewed sources. Outcomes were measured using fever free days based on the KIDCARE study results. We addressed uncertainty using a one-way sensitivity analysis. Results Infliximab was the less costly treatment pathway in children with IVIG-resistant KD compared to a second dose of IVIG. The second IVIG treatment pathway cost $1,809 per additional fever free day while the infliximab treatment pathway cost $1,289 per additional fever free day. The incremental cost-effective ratio (ICER) was -$11,812 and was most sensitive to patient weight due to weight-based dosing but infliximab remained cost-effective. Conclusions Infliximab was the dominant economic treatment choice compared to a second dose of IVIG under a range of assumptions for both treatment patterns. This study suggests that clinicians could consider this when choosing treatment for IVIG-resistant KD patients.

Introduction: Rural hospitals continue to close nationally. High fixed costs, low patient volume, and outmigration remain problematic for surviving rural hospitals. This article presents an innovative telemedicine partnership between a small, not-for-profit rural hospital and a tertiary care medical center in the southeast. The vision was to create a sustainable care delivery model where patients receive care at a rural hospital in their home community with the added benefit of clinical expertise from a tertiary care center. Methods: A single-center descriptive case study involving a 32-bed not-for-profit rural community hospital and South Carolina's only comprehensive medical center. This article details the development and implementation of this innovative care delivery model. The strategy and logic model utilized to analyze the program is described. Results: From fiscal year 2019 to 2022, Hampton Regional Medical Center saw an increased number of yearly admissions from 442 to 965. Associated, there was a 20% reduction in inpatient transfers to another facility and a 35% reduction in 30-day readmission, while seeing a more complex patient population as demonstrated by an increase in case-mix index. There was no increase in outmigration. Conclusions: While rural hospitals continue to close nationally, we describe an innovative telemedicine partnership between a small, not-for-profit rural hospital and a tertiary care medical center to build a sustainable care delivery model that can support rural hospital survivability.

BACKGROUND:With the increasing reliance on big data analytics in poststroke dysphagia research (which drives related health care decisions), accurate classification of large, complex data sets is crucial. Although medical coding is commonly used to define patient cohorts, there is no administrative-level instrument for classifying poststroke dysphagia severity. Thus, we aimed to develop a novel classification framework for poststroke dysphagia severity. METHOD:We used data from 445 patients diagnosed with acute ischemic stroke and dysphagia from the 2017 Medicare 5% Limited Data Set to develop our poststroke dysphagia severity classification framework. For our exploratory analysis, we used unsupervised k-means clustering to categorize patients based on dysphagia indicators constructed from International Classification of Diseases, Tenth Revision, codes. The resultant clustering solution was applied to three random 60% samples of the data set to verify the stability of the dysphagia severity clusters. RESULTS:Cluster analysis resulted in a three-cluster algorithm characterizing mild, moderate, and severe dysphagia severity. Inspection of the clusters revealed that dysphagia severity categories were not analogous to stroke severity categories. CONCLUSIONS:We developed a novel framework to classify poststroke dysphagia severity using administrative data. We also found discordance between stroke severity and dysphagia severity, which has implications for classification methodologies in administrative poststroke dysphagia research. Future studies are needed to validate this classification framework.

As rural hospitals experiencing low patient volume and workforce shortages continue to close nationally, we present an innovative telemedicine care delivery model utilized to support the opening of a new 25-bed rural hospital in South Carolina in 2023. Since opening, the tele-hospitalist service has been responsible for 84% of discharged patients with high patient experience scores. From quarter 1 to quarter 6, patients were admitted from a growing market area with a financially more favorable payer mix while demonstrating comparable clinical outcomes. We believe this model has the potential to be replicated in other rural hospitals throughout the United States.

Objectives People with Alzheimer's disease and related dementias (ADRD) experience significant barriers to accessing postacute care services. In 2020, Medicare implemented a new home health payment model, known as the Patient Driven Grouping Model (PDGM). The PDGM is concerning for people with ADRD because of it is heavy reliance on admission source and timing of episodes. Patient advocacy groups believe the PDGM disincentivizes agencies from admitting individuals who come from the community (vs an institutional setting) and require >1 episode of care. Home health has been recommended as a strategy to prevent hospitalizations for people with ADRD and has been shown to be effective with more frequent and longer durations of care. Reimbursement under the PDGM appears be in conflict with this need. To determine if the PDGM has altered access and utilization patterns of people living with ADRD, we aimed to describe baseline data by applying components of the PDGM to 2019 home health data. Design Retrospective analysis of 100% of Medicare beneficiaries receiving home health care in 2019. Setting Home health care. Participants Two propensity score-matched groups of 153,957 individuals with and without dementia were created based on patient demographics, caregiver support, cognitive status, prior functional status, prior health care utilization, and Charlson comorbidity scores. Interventions None. Main Outcome Measures A binary logistic regression was used to examine the relationship between ADRD and admission source. A negative binomial regression was used to examine the relationship between ADRD and the number of late episodes. Univariate regression with logit was used to examine the relationship between ADRD and the number of services provided. A gamma-distributed log link model was used to estimate the mean total charges. Results Individuals with ADRD had 1.095 greater odds (95% confidence interval, 1.083-1.109) of community admission. For the number of late episodes, individuals with ADRD had an estimated mean of 1.62 compared with 1.53 (P<.0001). Individuals with ADRD had 1.081 greater odds of receiving more services than their matched peers without ADRD. The difference in the estimated means for total charges between individuals with ADRD and those without ADRD was $24.00 (P<.0001). Conclusions Prior to the implementation of the PDGM, individuals with ADRD were more likely to be admitted to home health from the community, have more late episodes, and receive more services than their matched peers without ADRD. There was not a clinically meaningful difference in total charges between the 2 groups.Supported by NIA KO1AG073538. Disclosures none.

Purpose: Infants requiring noninvasive respiratory support (NRS) are often orally fed, although data supporting the safety and efficacy of this practice are limited. This study aimed to identify the rate of this practice, the amount of support received during oral feeding, and characteristics of infants orally fed during NRS use; describe feeding expert involvement; and assess change from before and after the onset of the COVID-19 pandemic. Method: Retrospective electronic health record data from one children's hospital were extracted and manually reviewed. Results: Results for 201 infants who required NRS during hospitalization in 2019 (n = 100) and 2022 (n = 101) were included, of which 91 (45.3%) were orally fed during NRS use. Of these, 33 were fed on high-flow nasal cannula (HFNC) with a mean flow rate of 2.75 L per minute (SD = 2.2, Mdn = 2 [min-max: 2-14]) and mean fraction of inspired oxygen (FiO2) of 0.47 (SD = 0.31, Mdn = 0.30 [min-max: 0.21-1.0]). Thirty-seven feeding specialist consults were placed for infants fed during NRS use. Factors increasing odds of oral feeding during NRS use included not having a dysphagia or feeding difficulty diagnosis. Infants admitted during 2022 were more likely to have a respiratory diagnosis than in 2019 and were more likely to be orally fed during HFNC (50.0% [n = 25/ 50] in 2022 vs. 20.5% [n = 8/39] in 2019). Conclusion: These results suggest that feeding infants on NRS is common, that some infants are more likely to be orally fed than others, and that feeding experts are rarely consulted in this population despite limited safety and efficacy data related to this practice.

Background During the COVID-19 pandemic, many US youth with HIV (YHIV) used telehealth services; others experienced disruptions in clinic and antiretroviral therapy (ART) access.Methods Using the Cost-effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent HIV microsimulation model, we evaluated 3 scenarios: 1) Clinic: in-person care; 2) Telehealth: virtual visits, without CD4 or viral load monitoring for 12 months, followed by return to usual care; and 3) Interruption: complete care interruption with no ART access or laboratory monitoring for 6 months (maximum clinic closure time), followed by return to usual care for 80%. We assigned higher 1-year retention (87% vs 80%) and lower cost/visit ($49 vs $56) for Telehealth vs Clinic. We modeled 2 YHIV cohorts with non-perinatal (YNPHIV) and perinatal (YPHIV) HIV, which differed by mean age (22 vs 16 years), sex at birth (85% vs 47% male), starting CD4 count (527/mu L vs 635/mu L), ART, mortality, and HIV-related costs. We projected life months (LMs) and costs/100 YHIV over 10 years.Results Over 10 years, LMs in Clinic and Telehealth would be similar (YNPHIV: 11 350 vs 11 360 LMs; YPHIV: 11 680 LMs for both strategies); costs would be $0.3M (YNPHIV) and $0.4M (YPHIV) more for Telehealth than Clinic. Interruption would be less effective (YNPHIV: 11 230 LMs; YPHIV: 11 620 LMs) and less costly (YNPHIV: $1.3M less; YPHIV: $0.2M less) than Clinic. Higher retention in Telehealth led to increased ART use and thus higher costs.Conclusions Telehealth could be as effective as in-person care for some YHIV, at slightly increased cost. Short interruptions to ART and laboratory monitoring may have negative long-term clinical implications.

Purpose:The objective of this study is to describe patterns in barriers to breast cancer screening uptake with the end goal of improving screening adherence and decreasing the burden of mortality due to breast cancer. This study looks at social determinants of health and their association to screening and mortality. It also investigates the extent that models trained on county data are generalizable to individuals. Methods:County level screening uptake and age adjusted mortality due to breast cancer are combined with the Centers for Disease Controls Social Vulnerability Index (SVI) to train a model predicting screening uptake rates. Patterns learned are then applied to de-identified electronic medical records from individual patients to make predictions on mammogram screening follow through. Results:Accurate predictions can be made about a county's breast cancer screening uptake with the SVI. However, the association between increased screening, and decreased age adjusted mortality, doesn't hold in areas with a high proportion of minority residents. It is also shown that patterns learned from county SVI data have little discriminative power at the patient level. Conclusion:This study demonstrates that social determinants in the SVI can explain much of the variance in county breast cancer screening rates. However, these same patterns fail to discriminate which patients will have timely follow through of a mammogram screening test. This study also concludes that the core association between increased screening and decreased age adjusted mortality does not hold in high proportion minority areas.

OBJECTIVE:This large database study assessed whether extended pharmacologic prophylaxis for venous thromboembolism after colon cancer resection was associated with improved oncologic survival. BACKGROUND:Heparin derivatives may confer an antineoplastic effect via a variety of mechanisms (eg, inhibiting angiogenesis in the tumor microenvironment). Studies evaluating the oncologic benefit of heparin and its derivatives have been limited in postsurgical patients. Multiple society guidelines recommend consideration of 30-day treatment with low molecular weight heparin to reduce venous thromboembolism risk after abdominopelvic cancer surgery. However, utilization of extended prophylaxis remains low. METHODS:Surveillance, Epidemiology, and End Results-Medicare data were used to identify patients (age 65+) undergoing resection for nonmetastatic colon cancer from 2016 to 2017. The primary outcomes were overall and cancer-specific survival. Log-rank testing and multivariable Cox regression compared survival in patients who received extended prophylaxis versus those who did not in an inverse propensity treatment weighted cohort. RESULTS:A total of 20,102 patients were included in propensity-weighting and analyzed. Eight hundred (3.98%) received extended pharmacologic prophylaxis. Overall survival and cancer-specific survival were significantly higher in patients receiving prophylaxis on log-rank tests ( P =0.0017 overall, P =0.0200 cancer-specific). Multivariable Cox regression showed improved overall survival [adjusted hazard ratio 0.66 (0.56-0.78)] and cancer-specific survival [adjusted hazard ratio 0.56 (0.39-0.81)] with prophylaxis after controlling for patient, treatment, and hospital factors. CONCLUSIONS:Extended pharmacologic prophylaxis after colon cancer resection was independently associated with improved overall and cancer-specific survival. These results suggest a potential antineoplastic effect from heparin derivatives when used in the context of preventing postsurgical venous thromboembolism.

Importance Intimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated. Objective To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice. Design, Setting, and Participants This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study. Intervention A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template. Main Outcomes and Measures The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures. Results The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]). Conclusions and Relevance The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV.

ImportanceIntimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated.ObjectiveTo assess the effect of an electronic health record (EHR)–based multifactorial intervention screening on the detection of IPV risk in primary care practice.Design, Setting, and ParticipantsThis cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study.InterventionA noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template.Main Outcomes and MeasuresThe main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures.ResultsThe study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]).Conclusions and RelevanceThe intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV.Trial RegistrationClinicalTrials.gov Identifier: NCT06284148