People with cardiovascular disease who took aspirin to lower their chances of having a heart attack or stroke experienced similar health benefits, including reduced death and hospitalization, whether they took a high or low dose of the medication, according to findings from the PCORI-funded ADAPTABLE Study, the largest aspirin dosing trial conducted in routine care and clinical settings. The results were presented at ACC.21 – the American College of Cardiology’s 70th Annual Scientific Session – and simultaneously published in the New England Journal of Medicine in May 2021.
The study is also the first randomized controlled trial conducted using PCORnet®, the National Patient-Centered Clinical Research Network. Read more about the study in this PCOR Blog post and watch a video featuring the study's co-investigator. In addition, learn more about the findings in this news release, at TheAspirinStudy,org or through these English or Spanish results summaries.
People with serious mental illnesses often struggle to receive care to address common chronic physical health problems. Certain serious mental illnesses may make it hard for people to work or live on their own or to arrange for health care. These problems can be worse if language or cultural issues are barriers to receiving care.
This PCORI-funded study's research team compared two types of care to help these patients: integrated care—physical and mental health care at the same clinic—and integrated care with a peer navigator. Peer navigators have backgrounds similar to patients and help patients find and use healthcare services. Overall, people who worked with peer navigators improved more than people who didn’t, reporting better physical health and empowerment. They also scheduled more appointments with clinicians, which could help them avoid emergency room visits.
In this PCORI Story, read about how this project and three others are testing ways to help people with serious mental illness get the physical health care they need.
Parkinson’s disease is the second most common neurodegenerative condition in the United States, affecting 1 to 2 percent of people over age 60. This disease can cause poor balance; shaking in the hands, legs, or face; and pain, fatigue, dementia, and depression. Progress has been made in treating patients’ motor symptoms. But gaps remain in addressing other patient concerns.
This PCORI-funded project compared the effectiveness of team-based outpatient palliative care to current standards of care for people living with Parkinson’s disease. The palliative care intervention included quarterly visits with a team that included a neurologist, social worker, chaplain, and nurse who used checklists to assess and manage palliative care.
The project team reported in JAMA Neurology that, compared to usual care that used a neurologist and primary care practitioner, patients receiving palliative care at six months had improvements in their quality of life, symptom control, grief, and advance care planning. Caregivers had improved anxiety and spiritual well-being at six months and reduced caregiving burden at 12 months. A related editorial calls palliative care "the next frontier" in treating Parkinson's disease.
Through a Dissemination and Implementation award, the program is now being rolled out as part of standard care at 34 medical centers designated as Centers of Excellence by the Parkinson’s Foundation. The centers vary in size, type, staffing, and resources to support staff, and serve diverse patient populations.
According to the U.S. Department of Health and Human Services, American Indian/Alaska Native adults are almost three times more likely than non-Hispanic white adults to be diagnosed with diabetes.
In response, this PCORI-funded study trained laypeople known as community health representatives to coach and help coordinate care for people in their own Navajo communities. Because many of the communities are rural, there are geographical challenges with access to health clinics.
As reported in International Journal for Equity in Health, compared to those not in the program, people in it lowered blood sugar and cholesterol levels at a greater level, and they also were more likely to make and keep appointments with doctors and other health providers. This PCORI Blog post provides additional insight into the study and others like it that are focused on the health of people living in the Navajo Nation.
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Lung cancer is one of the most common and deadly cancers, causing more deaths than colon, breast, and prostate cancers combined, according to the American Cancer Society. Treatment requires an array of specialists. One promising approach is multidisciplinary care, in which all of the specialists involved in a patient’s care work together to develop a coordinated treatment plan. Leading cancer organizations recommend this approach, but questions remain about its effectiveness and how to best implement it.
Results from a PCORI-funded study suggest patients receiving multidisciplinary care—in which pulmonologists, oncologists, radiologists, and surgeons meet to design a care plan with patients and their families—get more-thorough procedures to pinpoint the stage of their cancer than those who see specialists through a sequence of referrals. As a result, the multidisciplinary treatment that patients receive is more appropriate for their stage of cancer. Finally, patients who received multidisciplinary care and their caregivers also were more satisfied with their overall care.
In this PCORI Story, read about how the research team found that with up-front treatment planning among the different specialists, patients get treatment that is more appropriate for their cancer’s severity
People with a serious mental illness (SMI) may have difficulty with daily activities. In this study, the research team compared two programs to help people with SMI manage their symptoms. In the FOCUS program, people used a smartphone app. In the Wellness Recovery Action Plan, or WRAP, program, people went to group sessions at a clinic. They wanted to see if one program was more effective at helping patients get the care they need.
As published in Psychiatric Services, participants assigned to the smartphone program were more likely than those assigned to the clinic-based program to start treatment—90 percent versus 58 percent—and remain fully engaged in eight weeks of care—56 percent versus 40 percent. Participants in both groups improved significantly and did not differ in clinical outcomes. The increased engagement by the telehealth group suggests that the smartphone-based treatment plan may help increase access to care for patients with SMI.
In this study, the research team found that video house calls were an effective way for people with Parkinson’s disease to get care from specialists. Most patients reported being satisfied or very satisfied with care they received during video house calls. After 12 months, there were no differences between patients who received video house calls and those who didn’t in quality of life, quality of care, or amount of caregiver burden.
Compared with patients who had in-person visits at clinics, patients who used video house calls spent less time traveling to doctor visits. Patients who used video house calls also spent more time talking with specialists during visits.
Now, through a Dissemination and Implementation project, the research team is expanding its telehealth services to include visits with doctors and nurses who specialize in conditions that often accompany Parkinson’s disease, such as dementia and depression.
More than 70 percent of adults with uncomplicated appendicitis were able to safely delay surgery for at least three months by taking a course of intravenous antibiotics, according to early results from The CODA Study published in the New England Journal of Medicine. Researchers issued the results early in response to its relevancy to patients and healthcare providers during the coronavirus pandemic.
The study found that health outcomes associated with antibiotics and appendectomy were similar. The majority of patients on antibiotics also missed less time away from work or school. However, nearly 30 percent who received antibiotics ultimately needed surgery and this group experienced more emergency department and hospital visits than the appendectomy group The study was conducted at 25 sites nationwide and involved a wider range of patients than previous studies, making its results more broadly applicable to typical patients with appendicitis.
An accompanying editorial—noting the timing of the release of the results and the American College of Surgeon’s recent guidance on triage of nonemergency surgical procedures during the pandemic—states that “it will be important to ensure that some people, in particular vulnerable populations, are not offered antibiotic therapy preferentially or without adequate education regarding the longer-term implications.”
View a summary of the early findings from the study. In addition, listen to an episode of “Behind the Knife: The Surgery Podcast,” during which members of the research team discussed the early results of the trial. Listen on Apple Podcasts or Spotify.