The researchers examined medical records of 6,350 patients with NSCLC who had surgery and follow-up imaging, looking at whether the timing of the tests made a difference in health outcomes. As published in Annals of Surgery, patients who had imaging tests every three or six months lived no longer than those who had the tests every 12 months. More frequent testing also didn’t improve how early doctors detected returning or new cancers. As more and more people survive lung cancer, these results could help patients and their doctors weigh the benefits and risks of more-frequent imaging, and make better-informed care decisions.
How Best to Test for Brain Injuries in Children after Head Trauma
When a child has head trauma, such as from a sports injury, parents in the emergency room need to decide how best to check for signs of a traumatic brain injury. For children at low risk, doctors recommend home monitoring. For those at high risk, the answer is usually a CT scan. But for a child at medium risk, choosing between those two options can be difficult.
A project led by Erik Hess, MD, MS, sought to address that dilemma. Using input from parents of children who had had head injuries and other stakeholders, the team developed a simple paper decision aid to explain the pros and cons of CT scans. The team piloted the decision aid in seven emergency rooms across the country with two groups of parents; half used the aid when discussing care options with their child’s doctor and the other half did not.
Hess and his team reported in JAMA Network Open that parents who used the decision aid made better-informed decisions about whether their children would receive CT scans than those who did not. They also better understood the symptoms of concussion, their child’s relative risk of brain injury, and the pros and cons of head CT scans. A related commentary detailed how shared decision making is a vital part of enhancing parents’ knowledge and trust when making care decisions for children in the ER.
This is a great example of a study that goes to PCORI’s core mission to help patients and those who care for them make better-informed healthcare choices.
How Can Community Health Workers Best Help Patients Who Are Chronically Ill?
Community health workers serve as liaisons between healthcare providers and patients. They often come from the same community or have similar experiences to the patients they’re helping, and often work with populations who have historically lacked access to care.
There is evidence that community health workers are effective, but questions remain about how best to standardize their use. A project led by Judith Long sought to test a standardized community health worker-delivered intervention called IMPaCT—Individualized Management for Patient-Centered Targets—against usual care among patients in underserved populations.
The study monitored about 600 patients in Philadelphia who lived in a high-poverty zip code, were uninsured or publicly insured, and had at least two chronic diseases. Patients were randomly assigned to one of two groups. In both, they set a chronic disease management goal with their doctors, but patients in the IMPaCT group also received six months of tailored support from a community health worker.
This was the first multi-center randomized controlled trial to demonstrate these kinds of improvements resulting from a health system-based social intervention.
The team reported in JAMA Internal Medicine that, compared to the usual-care group, patients in the IMPaCT group were nearly twice as likely to report high-quality primary care, and spent fewer total days in the hospital at six and nine months. Patients receiving community health worker support also had lower rates of repeat hospitalizations.
The results suggest that community health worker-based interventions can improve patients’ perceived quality of care while reducing repeat hospitalization—a goal of all healthcare stakeholders.
Facilitating Goal Planning among Patients with Complex Medical Conditions
Finally, a randomized trial led by Rebecca Sudore, MD, of the University of California San Francisco offered important insights about how to improve conversations about the goals of care for people with complex medical situations, especially when language or cultural barriers get in the way.
Sudore’s team developed a website, PREPARE, that gives patients step-by-step tips for deciding what goals are important to them and how to talk to their providers about those goals. The tool produces a printable summary of the patient’s wishes. The researchers worked with two groups of patients with chronic health conditions; one used PREPARE and filled out an easy-to-read advance directive form, while the other completed the form alone.
The results were encouraging. Fifteen months after the intervention, more patients in the PREPARE group had documented advance-care planning than those that didn’t use PREPARE. And 98 percent of patients in the PREPARE group reported increased engagement—meaning behavior change or action—compared with 88 percent in the other group.
As the research team reported in JAMA Internal Medicine, these tools may ease literacy and language barriers to advance care planning, allow patients to begin planning independent of healthcare staff, and substantially improve the process for diverse English- and Spanish-speaking populations.
These latest results are in addition to those from a study we told you about last month. In the PCORnet Bariatric Study, researchers used data gathered through PCORnet to answer questions about the risks and benefits of the three most common surgical procedures that can help patients with severe obesity—a body mass index of 35 or higher—achieve weight loss not possible with diet and exercise alone.
These publications are among more than 100 that have appeared in leading medical journals summarizing the primary comparative effectiveness research results of the studies we’ve funded. Summaries from almost 200 completed projects, meanwhile, are now available on our website in versions for professionals and the general public, the latter in both English and Spanish.
We’re excited about this wealth of information coming from our funded projects, and we’re eager to share even more important results as they become available in the coming months.