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Objectives. To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources, on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources. Methods. A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 to 74 years to an intervention (n = 209) or control (n = 202) group by alternating calendar week, December 2015 to August 2016. Intervention group participants received usual care and an electronic medical record–generated, personalized list of community resources. Surveys (baseline, 1-week, 1- and 3-months) measured HRQOL and confidence in finding community resources to manage health. Results. At 3 months, there was no difference between groups in mental (–1.03; 95% confidence interval [CI] = −3.02, 0.96) or physical HRQOL (0.59; 95% CI = −0.98, 2.16). Confidence in finding resources was higher in the intervention group (odds ratio = 2.08; 95% CI = 1.18, 3.63); the effect increased at each successive time point. Among intervention group participants, 65% recalled receiving the intervention; 48% shared community resource information with others. Conclusions. CommunityRx did not increase HRQOL, but its positive effect on confidence in finding resources for self-care suggests that this low-intensity intervention may have a role in population health promotion. Trial Registration. ClinicalTrials.gov Identifier: NCT02435511.

BackgroundConnecting patients to community-based resources is now a cornerstone of modern healthcare that supports self-management of health. The mechanisms that link resource information to behavior change, however, remain poorly understood.ObjectiveTo evaluate the impact of CommunityRx, an automated, low-intensity resource referral intervention, on patients’ knowledge, beliefs, and use of community resources.DesignReal-world controlled clinical trial at an urban academic medical center in 2015–2016; participants were assigned by alternating week to receive the CommunityRx intervention or usual care. Surveys were administered at baseline, 1 week, 1 month, and 3 months.ParticipantsPublicly insured adults, ages 45–74 years.InterventionCommunityRx generated an automated, personalized list of resources, known as HealtheRx, near each participant’s home using condition-specific, evidence-based algorithms. Algorithms used patient demographic and health characteristics documented in the electronic health record to identify relevant resources from a comprehensive, regularly updated database of health-related resources in the study area.Main MeasuresUsing intent-to-treat analysis, we examined the impact of HealtheRx referrals on (1) knowledge of the most commonly referred resource types, including healthy eating classes, individual counseling, mortgage assistance, smoking cessation, stress management, and weight loss classes or groups, and (2) beliefs about having resources in the community to manage health.Key ResultsIn a real-world controlled trial of 374 adults, intervention recipients improved knowledge (AOR = 2.15; 95% CI, 1.29–3.58) and beliefs (AOR = 1.68; 95% CI, 1.07–2.64) about common resources in the community to manage health, specifically gaining knowledge about smoking cessation (AOR = 2.76; 95% CI, 1.07–7.12) and weight loss resources (AOR = 2.26; 95% CI 1.05–4.84). Positive changes in both knowledge and beliefs about community resources were associated with higher resource use (P = 0.02).ConclusionsIn a middle-age and older population with high morbidity, a low-intensity health IT intervention to deliver resource referrals promoted behavior change by increasing knowledge and positive beliefs about community resources for self-management of health.NIH Trial RegistryNCT02435511

Background African American caregivers of community-residing persons with dementia are mostly unpaid and have high rates of unmet basic and health needs. The National Alzheimer’s Project Act (NAPA) mandates improved coordination of care for persons with dementia and calls for special attention to racial populations at higher risk for Alzheimer’s Disease or related dementias (ADRD) to decrease health disparities. The purpose of this study is to describe the perceptions of African American caregivers of people with dementia about community resources needed to support caregiving as well as their own self-care. Methods Using a qualitative study design, in-depth, semi-structured qualitative interviews were conducted with caregivers ( N  = 13) at an urban geriatric clinic to elicit community resource needs, barriers to and facilitators of resource use and how to optimize clinical referrals to community resources. Caregivers were shown a community resource referral list (“HealtheRx”) developed for people with dementia and were queried to elicit relevance, gaps and insights to inform delivery of this information in the healthcare setting. Data were iteratively coded and analyzed using directed content analysis. Results represent key themes. Results Most caregivers were women ( n  = 10, 77%) and offspring ( n  = 8, 62%) of the person with dementia. Community resource needs of these caregivers included social, entertainment, personal self-care and hospice services. Main barriers to resource use were the inability to leave the person with dementia unsupervised and the care recipient’s disinterest in participating in their own self-care. Facilitators of resource use included shared caregiving responsibility and learning about resources from trusted sources. To optimize clinical referrals to resources, caregivers wanted specific eligibility criteria and an indicator of dementia care capability. Conclusions African American caregivers in this study identified ways in which community resource referrals by clinicians can be improved to meet their caregiving and self-care needs.

CommunityRx (CRx), an information technology intervention, provides patients with a personalized list of healthful community resources (HealtheRx). In repeated clinical studies, nearly half of those who received clinical “doses” of the HealtheRx shared their information with others (“social doses”). Clinical trial design cannot fully capture the impact of information diffusion, which can act as a force multiplier for the intervention. Furthermore, experimentation is needed to understand how intervention delivery can optimize social spread under varying circumstances. To study information diffusion from CRx under varying conditions, we built an agent-based model (ABM). This study describes the model building process and illustrates how an ABM provides insight about information diffusion through in silico experimentation. To build the ABM, we constructed a synthetic population (“agents”) using publicly-available data sources. Using clinical trial data, we developed empirically-informed processes simulating agent activities, resource knowledge evolution and information sharing. Using RepastHPC and chiSIM software, we replicated the intervention in silico , simulated information diffusion processes, and generated emergent information diffusion networks. The CRx ABM was calibrated using empirical data to replicate the CRx intervention in silico . We used the ABM to quantify information spread via social versus clinical dosing then conducted information diffusion experiments, comparing the social dosing effect of the intervention when delivered by physicians, nurses or clinical clerks. The synthetic population (N = 802,191) exhibited diverse behavioral characteristics, including activity and knowledge evolution patterns. In silico delivery of the intervention was replicated with high fidelity. Large-scale information diffusion networks emerged among agents exchanging resource information. Varying the propensity for information exchange resulted in networks with different topological characteristics. Community resource information spread via social dosing was nearly 4 fold that from clinical dosing alone and did not vary by delivery mode. This study, using CRx as an example, demonstrates the process of building and experimenting with an ABM to study information diffusion from, and the population-level impact of, a clinical information-based intervention. While the focus of the CRx ABM is to recreate the CRx intervention in silico , the general process of model building, and computational experimentation presented is generalizable to other large-scale ABMs of information diffusion.

Background CommunityRx is an evidence-based social care intervention delivered to family and friend caregivers (“caregivers”) at the point of healthcare to address health-related social risks (HRSRs). Two CommunityRx randomized controlled trials (RCTs) are being fielded concurrently on Chicago’s South Side, a predominantly African American/Black community. CommunityRx-Hunger is a double-blind RCT enrolling caregivers of hospitalized children. CommunityRx-Dementia is a single-blind RCT enrolling caregivers of community-residing people with dementia. RCTs with caregivers face recruitment barriers, including caregiver burden and lack of systematic strategies to identify caregivers in clinical settings. COVID-19 pandemic-related visitor restrictions exacerbated these barriers and prompted the need for iteration of the protocols from in-person to remote operations. This study describes these protocols and methods used for successful iteration to overcome barriers. Methods and findings CommunityRx uses individual-level data to generate personalized, local community resource referrals for basic, health and caregiving needs. In early 2020, two in-person RCT protocols were pre-tested. In March 2020, when pandemic conditions prohibited face-to-face clinical enrollment, both protocols were iterated to efficient, caregiver-centered remote operations. Iterations were enabled in part by the Automated Randomized Controlled Trial Information-Communication System (ARCTICS), a trial management system innovation engineered to integrate the data collection database (REDCap) with community resource referral (NowPow) and SMS texting (Mosio) platforms. Enabled by engaged Community Advisory Boards and ARCTICS, both RCTs quickly adapted to remote operations. To accommodate these adaptations, launch was delayed until November (CommunityRx-Hunger) and December (CommunityRx-Dementia) 2020. Despite the delay, 65% of all planned participants (CommunityRx-Hunger n  = 417/640; CommunityRx-Dementia n  = 222/344) were enrolled by December 2021, halfway through our projected enrollment timeline. Both trials enrolled 13% more participants in the first 12 months than originally projected for in-person enrollment. Discussion Our asset-based, community-engaged approach combined with widely accessible institutional and commercial information technologies facilitated rapid migration of in-person trials to remote operations. Remote or hybrid RCT designs for social care interventions may be a viable, scalable alternative to in-person recruitment and intervention delivery protocols, particularly for caregivers and other groups that are under-represented in traditional health services research. Trial registration ClinicalTrials.gov: CommunityRx-Hunger (NCT04171999, 11/21/2019); CommunityRx for Caregivers (NCT04146545, 10/31/2019).

Background Hypertension affects nearly half of adults in the U.S., with African American and Black (AA/B) adults experiencing some of the highest rates domestically and globally. Despite improvements in blood pressure control in the general population, rates of control among AA/B adults have stagnated, contributing to significant health disparities in the prevalence of hypertension and its long-term health impacts. Systemic barriers, including poverty and historically earned distrust in healthcare, hinder patient and clinician adherence to best practices for hypertension management. Community-based interventions, particularly those involving faith-based organizations, show promise in improving blood pressure control among AA/B adults. Methods The CIRCL-Chicago Implementation Research Center will test the effectiveness of a community-adapted hypertension control program, a “bundled” intervention developed by and tested in the Kaiser Permanente system, in South Side Chicago community health centers. A key partner for this trial, the Total Resource Community Development Organization, isa faith-based community outreach hub networked with faith-based organizations throughout Chicago’s South Side community. The study employs a type 3 hybrid effectiveness-implementation approach with a parallel cluster-randomized trial. Sixteen clinics will be randomized to implement a community-adapted Kaiser bundle with or without practice facilitation. We will recruit adults who live, work, or practice their faith in Chicago’s South Side community to populate a community-based hypertension registry (target n = 5,760 participants). The primary implementation outcome is the reach of the intervention, measured by the proportion of eligible patients in the registry who receive the adapted Kaiser bundle. Secondary outcomes include blood pressure control rates, assessed at 12 months post-enrollment. The study will use community-engaged adaptation, practice facilitation, and education and training strategies to support implementation. Discussion The CIRCL-Chicago study aims to address cardiovascular health disparities by integrating clinical and community-based approaches to hypertension management. By leveraging trusted community settings and engaging local partners, the study seeks to enhance the reach and effectiveness of evidence-based hypertension interventions. The findings could inform scalable models for hypertension control in diverse urban communities, potentially reducing health disparities for AA/B adults. Trial registration Clinicaltrials.gov NCT04755153 on 24 August 2023, https://www.centerwatch.com/clinical-trials/listings/NCT04755153/community-intervention-to-reduce-cardiovascular-disease-in-chicago

Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists' findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns.

Objectives. To test the diagnostic accuracy of the American Academy of Pediatrics (AAP) recommended food insecurity screener. Methods. We conducted prospective diagnostic accuracy studies between July and November 2016 in Chicago, Illinois. We recruited convenience samples of adults from adult and pediatric emergency departments (12-month recall study: n = 188; 30-day recall study: n = 154). A self-administered survey included the 6-item Household Food Security Screen (gold standard), the validated 2-item Hunger Vital Sign (HVS; often, sometimes, never response categories), and the 2-item AAP tool (yes-or-no response categories). Results. Food insecurity was prevalent (12-month recall group: 46%; 30-day group: 39%). Sensitivity of the AAP tool using 12-month and 30-day recall was, respectively, 76% (95% confidence interval [CI] = 65%, 85%) and 72% (95% CI = 57%, 84%). The HVS sensitivity was significantly higher than the AAP tool (12-month: 94% [95% CI = 86%, 98%; P = .002]; 30-day: 92% [95% CI = 79%, 98%; P = .02]). Conclusions. The AAP tool missed nearly a quarter of food-insecure adults screened in the hospital; the HVS screening tool was more sensitive. Public health implications. Health care systems adopting food insecurity screening should optimize ease of administration and sensitivity of the screening tool.

Interventions for dementia caregivers should be scalable and available at the point of care. CommunityRx‐Dementia (CRxD) is an IT‐based intervention to improve caregiver outcomes by providing information about local community resources and connection to a resource navigator and online resource finder. We compared self‐reported unmet needs and resource knowledge among 343 caregivers enrolled in a randomized trial of CRxD vs usual care (UC). At baseline,1 and 3 months, caregivers’ reported their knowledge of and need for any of 14 resource types (e.g., respite care, end‐of‐life planning, food) and, at 12 months, they reported their use of acute care. For the outcomes of knowledge and needs, mixed‐effects regression models were fit with treatment arm, time, treatment arm by time interaction and baseline knowledge or needs as predictors. For acute care utilization outcomes, negative binomial regression models were fit with treatment group and baseline utilization as predictors. Incidence rate ratios (IRR) and corresponding 95% CIs were calculated. Participants (78% women, 81% non‐Hispanic Black, 49% aged 50‐64, 64% income ≥$50k/year) included both newer (22% 6 months‐2 years) and more experienced caregivers (44% > 5 years). At baseline, caregivers in both study arms reported an average of 4 unmet needs (87% ≥1, 65% ≥3, most often [61%] for caregiver education), and knew of an average of 6 resources. At 3 months, the number of known resources was greater in the CRxD than UC group (6.5 vs 5.2; β: 1.0, 95% CI 0.3, 1.7) and the number of unmet needs was lower (2.8 vs 3.6; β: ‐0.5, 95% CI ‐1.1, 0.0). Over 12 months, caregivers in CRxD had lower ED visits rates than UC participants (0.3 vs 0.5; IRR: 0.6, 95% CI 0.3, 0.9) but similar hospitalization rates (0.1 vs 0.2; IRR: 0.7, 95% CI 0.3, 1.2). This low‐intensity social care intervention for dementia caregivers may improve knowledge of available resources, decrease unmet needs, and reduce caregivers’ use of emergency care.

Interventions for dementia caregivers should be scalable and available at the point of care. CommunityRx-Dementia (CRxD) is an IT-based intervention to improve caregiver outcomes by providing information about local community resources and connection to a resource navigator and online resource finder. We compared self-reported unmet needs and resource knowledge among 343 caregivers enrolled in a randomized trial of CRxD vs usual care (UC). At baseline,1 and 3 months, caregivers' reported their knowledge of and need for any of 14 resource types (e.g., respite care, end-of-life planning, food) and, at 12 months, they reported their use of acute care. For the outcomes of knowledge and needs, mixed-effects regression models were fit with treatment arm, time, treatment arm by time interaction and baseline knowledge or needs as predictors. For acute care utilization outcomes, negative binomial regression models were fit with treatment group and baseline utilization as predictors. Incidence rate ratios (IRR) and corresponding 95% CIs were calculated. Participants (78% women, 81% non-Hispanic Black, 49% aged 50-64, 64% income ≥$50k/year) included both newer (22% 6 months-2 years) and more experienced caregivers (44% > 5 years). At baseline, caregivers in both study arms reported an average of 4 unmet needs (87% ≥1, 65% ≥3, most often [61%] for caregiver education), and knew of an average of 6 resources. At 3 months, the number of known resources was greater in the CRxD than UC group (6.5 vs 5.2; β: 1.0, 95% CI 0.3, 1.7) and the number of unmet needs was lower (2.8 vs 3.6; β: -0.5, 95% CI -1.1, 0.0). Over 12 months, caregivers in CRxD had lower ED visits rates than UC participants (0.3 vs 0.5; IRR: 0.6, 95% CI 0.3, 0.9) but similar hospitalization rates (0.1 vs 0.2; IRR: 0.7, 95% CI 0.3, 1.2). This low-intensity social care intervention for dementia caregivers may improve knowledge of available resources, decrease unmet needs, and reduce caregivers' use of emergency care.