14 results on '"Hofer, Timothy P."'
Search Results
2. Evaluating alternative methods of comparing antihypertensive treatment intensity
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Aubert, Carole E, Chan, Chiao-Li, Terman, Samuel W, Hofer, Timothy P, Ha, Jin-Kyung, Cushman, William C, Sussman, Jeremy, and Min, Lillian
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sense organs ,skin and connective tissue diseases ,610 Medicine & health ,360 Social problems & social services - Abstract
OBJECTIVES To change blood pressure treatment, clinicians can modify medication count or dose. However, existing studies have measured count modification, which may miss clinically important dose change in the absence of count change. This research demonstrates how dose modification captures more information about management than medication count alone. STUDY DESIGN Retrospective cohort study. METHODS We included patients 65 years and older with established primary care at the Veterans Health Administration (July 2011-June 2013). We captured medication count and standardized dose change over 90 to 120 days using a validated pharmacy fill algorithm. We determined frequency of dose change without count change (and vice versa), no change in either, change in same direction ("concordant"), and change in opposite direction ("discordant"). We compared change according to systolic blood pressure (SBP) and compared concordance using a minimum threshold definition of dose change of at least 50% (instead of any change) of baseline dose modification. RESULTS Among 440,801 patients, 64.2% had dose change; 22.0%, count change; 35.6%, no change in either; 42.4%, dose change without count modification; and 0.2%, count change without dose modification. Discordance occurred in 2.1% of observations. Using the minimum threshold definition of change, 68.7% had no change in either dose or count. Treatment was more frequently changed at SBP greater than 140 mm Hg. CONCLUSIONS Measuring change in antihypertensive treatment using medication count frequently missed an isolated dose change in treatment modification and less often misclassified regimen modifications where there was no modification in total dose. In future research, measuring dose modification using our new algorithm would capture change in hypertension treatment intensity more precisely than current methods.
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- 2022
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3. Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults
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Aubert, Carole E, Sussman, Jeremy B, Hofer, Timothy P, Cushman, William C, Ha, Jin-Kyung, and Min, Lillian
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Hypertension ,Internal Medicine ,Humans ,General Medicine ,360 Social problems & social services ,Antihypertensive Agents ,Aged ,Monitoring, Physiologic - Published
- 2022
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4. sj-pdf-1-smm-10.1177_09622802211002866 - Supplemental material for Using multiple imputation to classify potential outcomes subgroups
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Li, Yun, Bondarenko, Irina, Elliott, Michael R, Hofer, Timothy P, and Taylor, Jeremy MG
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111099 Nursing not elsewhere classified ,111708 Health and Community Services ,160807 Sociological Methodology and Research Methods ,FOS: Health sciences ,FOS: Sociology - Abstract
Supplemental material, sj-pdf-1-smm-10.1177_09622802211002866 for Using multiple imputation to classify potential outcomes subgroups by Yun Li, Irina Bondarenko, Michael R Elliott, Timothy P Hofer and Jeremy MG Taylor in Statistical Methods in Medical Research
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- 2021
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5. sj-pdf-1-smm-10.1177_09622802211002866 - Supplemental material for Using multiple imputation to classify potential outcomes subgroups
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Li, Yun, Bondarenko, Irina, Elliott, Michael R, Hofer, Timothy P, and Taylor, Jeremy MG
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111099 Nursing not elsewhere classified ,111708 Health and Community Services ,160807 Sociological Methodology and Research Methods ,FOS: Health sciences ,FOS: Sociology - Abstract
Supplemental material, sj-pdf-1-smm-10.1177_09622802211002866 for Using multiple imputation to classify potential outcomes subgroups by Yun Li, Irina Bondarenko, Michael R Elliott, Timothy P Hofer and Jeremy MG Taylor in Statistical Methods in Medical Research
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- 2021
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6. Additional file 2 of Head to head randomized trial of two decision aids for prostate cancer
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Fagerlin, Angela, Holmes-Rovner, Margaret, Hofer, Timothy P., Rovner, David, Alexander, Stewart C., Knight, Sara J., Ling, Bruce S., A.Tulsky, James, Wei, John T., Hafez, Khaled, Kahn, Valerie C., Connochie, Daniel, Gingrich, Jeffery, and Ubel, Peter A.
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Additional file 2. Complex DA. This is the medical DA used in the study.
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- 2021
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7. Additional file 1 of Head to head randomized trial of two decision aids for prostate cancer
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Fagerlin, Angela, Holmes-Rovner, Margaret, Hofer, Timothy P., Rovner, David, Alexander, Stewart C., Knight, Sara J., Ling, Bruce S., A.Tulsky, James, Wei, John T., Hafez, Khaled, Kahn, Valerie C., Connochie, Daniel, Gingrich, Jeffery, and Ubel, Peter A.
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Additional file 1. Simple D. This is the full patient DA used in the study. This aid was developed by the authors and was not taken from another source.
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- 2021
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8. Additional file 1 of Development of a video-observation method for examining doctors’ clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria
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Aujla, Navneet, Temitope Ilori, Achiaka Irabor, Abimbola Obimakinde, Eme Owoaje, Olufunke Fayehun, Motunrayo M. Ajisola, Sinmisola O. Bolaji, Watson, Samuel I., Hofer, Timothy P., Akinyinka Omigbodun, and Lilford, Richard J.
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Data_FILES - Abstract
Additional file 1.
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- 2021
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9. Adding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults : A Prospective Observational Study
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Aubert, Carole E, Sussman, Jeremy B, Hofer, Timothy P, Cushman, William C, Ha, Jin-Kyung, and Min, Lillian
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610 Medicine & health ,360 Social problems & social services - Abstract
BACKGROUND There are 2 approaches to intensifying antihypertensive treatment when target blood pressure is not reached, adding a new medication and maximizing dose. Which strategy is better is unknown. OBJECTIVE To assess the frequency of intensification by adding a new medication versus maximizing dose, as well as the association of each method with intensification sustainability and follow-up systolic blood pressure (SBP). DESIGN Large-scale, population-based, retrospective cohort study. Observational data were used to emulate a target trial with 2 groups, new medication and maximizing dose, who underwent intensification of their drug regimen. SETTING Veterans Health Administration (2011 to 2013). PATIENTS Veterans aged 65 years or older with hypertension, an SBP of 130 mm Hg or higher, and at least 1 antihypertensive medication at less than the maximum dose. MEASUREMENTS The following 2 intensification approaches were emulated: adding a new medication, defined as a total dose increase with new medication, and maximizing dose, defined as a total dose increase without new medication. Inverse probability weighting was used to assess the observational effectiveness of the intensification approach on sustainability of intensified treatment and follow-up SBP at 3 and 12 months. RESULTS Among 178 562 patients, 45 575 (25.5%) had intensification by adding a new medication and 132 987 (74.5%) by maximizing dose. Compared with maximizing dose, adding a new medication was associated with less intensification sustainability (average treatment effect, -15.2% [95% CI, -15.7% to -14.6%] at 3 months and -15.1% [CI, -15.6% to -14.5%] at 12 months) but a slightly larger reduction in mean SBP (-0.8 mm Hg [CI, -1.2 to -0.4 mm Hg] at 3 months and -1.1 mm Hg [CI, -1.6 to -0.6 mm Hg] at 12 months). LIMITATION Observational data; largely male population. CONCLUSION Adding a new antihypertensive medication was less frequent and was associated with less intensification sustainability but slightly larger reductions in SBP. Trials would provide the most definitive support for our findings. PRIMARY FUNDING SOURCE National Institute on Aging and Veterans Health Administration.
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- 2021
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10. Focus and features of prescribing indications spanning multiple chronic conditions in older adults: A narrative review
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Aubert, Carole E, Kerr, Eve A, Klamerus, Mandi L, Hofer, Timothy P, and Wei, Melissa Y
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multimorbidity ,360 Social problems & social services ,prescribing ,Medicine ,610 Medicine & health ,measure ,Patient Safety ,Criteria ,older adults - Abstract
Background: Inappropriate prescribing is frequent in older adults and associated with adverse outcomes. Prescribing indications aim to optimize prescribing, but little is known about the focus and features of prescribing indications for the most common chronic conditions in older adults. Understanding the conditions, medications, and issues addressed (e.g., patient perspective, drug-disease interaction, adverse drug event) in current prescribing indications may help to identify missing indications and develop standardized measures to improve prescribing quality. Methods: We searched Ovid/MEDLINE and EMBASE for articles published between 2015 and 2020 reporting prescribing indications for older adults. Prescribing indication included 1) prescribing “criteria,” or statements that guide prescribing action, and 2) prescribing “measures,” or prescribing actions observed in a population. We categorized their focus by conditions, medications and issues addressed, as well as level of evidence provided. Results: Among 16 sets of prescribing indications, we identified 748 criteria and 47 measures. The most common addressed medications were antihypertensives, analgesics/antirheumatics, and antiplatelets/anticoagulants. The most frequently addressed issues were drug-disease interaction, adverse drug event, administration, better therapeutic alternative, and (co-)prescription omission (20.8–36.1%). Age/functioning, drug-drug interaction, monitoring, and efficacy/ safety ratio were found in only 9.9–16.5% of indications. Indications rarely focused on the patient perspective or issues with multiple providers. Conclusion: Most prescribing indications for chronic conditions in older patients are criteria rather than measures. Indications accounting for patient perspective and multiple providers are limited. The gaps identified in this review may help improve the development of prescribing measures for older adults and ultimately improve quality of care.
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- 2021
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11. Additional file 3 of Head to head randomized trial of two decision aids for prostate cancer
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Fagerlin, Angela, Holmes-Rovner, Margaret, Hofer, Timothy P., Rovner, David, Alexander, Stewart C., Knight, Sara J., Ling, Bruce S., A.Tulsky, James, Wei, John T., Hafez, Khaled, Kahn, Valerie C., Connochie, Daniel, Gingrich, Jeffery, and Ubel, Peter A.
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Additional file 3. CONSORT checklist. This is the completed CONSORT checklist for the study.
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- 2021
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12. Using Multiple Imputation to Classify Potential Outcomes Subgroups
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Li, Yun, Bondarenko, Irina, Elliott, Michael R., Hofer, Timothy P., and Taylor, Jeremy M. G.
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Methodology (stat.ME) ,FOS: Computer and information sciences ,Applications (stat.AP) ,Statistics - Applications ,Statistics - Methodology - Abstract
With medical tests becoming increasingly available, concerns about over-testing and over-treatment dramatically increase. Hence, it is important to understand the influence of testing on treatment selection in general practice. Most statistical methods focus on average effects of testing on treatment decisions. However, this may be ill-advised, particularly for patient subgroups that tend not to benefit from such tests. Furthermore, missing data are common, representing large and often unaddressed threats to the validity of statistical methods. Finally, it is desirable to conduct analyses that can be interpreted causally. We propose to classify patients into four potential outcomes subgroups, defined by whether or not a patient's treatment selection is changed by the test result and by the direction of how the test result changes treatment selection. This subgroup classification naturally captures the differential influence of medical testing on treatment selections for different patients, which can suggest targets to improve the utilization of medical tests. We can then examine patient characteristics associated with patient potential outcomes subgroup memberships. We used multiple imputation methods to simultaneously impute the missing potential outcomes as well as regular missing values. This approach can also provide estimates of many traditional causal quantities. We find that explicitly incorporating causal inference assumptions into the multiple imputation process can improve the precision for some causal estimates of interest. We also find that bias can occur when the potential outcomes conditional independence assumption is violated; sensitivity analyses are proposed to assess the impact of this violation. We applied the proposed methods to examine the influence of 21-gene assay, the most commonly used genomic test, on chemotherapy selection among breast cancer patients.
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- 2020
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13. The Effect of Health Information Technology on Health Care Provider Communication: A Mixed-Method Protocol
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Manojlovich, Milisa, Adler-Milstein, Julia, Harrod, Molly, Sales, Anne, Hofer, Timothy P, Saint, Sanjay, and Krein, Sarah L
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Protocol (science) ,medicine.medical_specialty ,business.product_category ,Knowledge management ,interdisciplinary communication ,Health information technology ,business.industry ,General Medicine ,Root cause ,Focus group ,health information technology ,3. Good health ,Telephone interview ,Information and Communications Technology ,Acute care ,Protocol ,medicine ,Sociology ,computer communication networks ,Pager ,business ,hospital communication systems - Abstract
Background: Communication failures between physicians and nurses are one of the most common causes of adverse events for hospitalized patients, as well as a major root cause of all sentinel events. Communication technology (ie, the electronic medical record, computerized provider order entry, email, and pagers), which is a component of health information technology (HIT), may help reduce some communication failures but increase others because of an inadequate understanding of how communication technology is used. Increasing use of health information and communication technologies is likely to affect communication between nurses and physicians. Objective: The purpose of this study is to describe, in detail, how health information and communication technologies facilitate or hinder communication between nurses and physicians with the ultimate goal of identifying how we can optimize the use of these technologies to support effective communication. Effective communication is the process of developing shared understanding between communicators by establishing, testing, and maintaining relationships. Our theoretical model, based in communication and sociology theories, describes how health information and communication technologies affect communication through communication practices (ie, use of rich media; the location and availability of computers) and work relationships (ie, hierarchies and team stability). Therefore we seek to (1) identify the range of health information and communication technologies used in a national sample of medical-surgical acute care units, (2) describe communication practices and work relationships that may be influenced by health information and communication technologies in these same settings, and (3) explore how differences in health information and communication technologies, communication practices, and work relationships between physicians and nurses influence communication. Methods: This 4-year study uses a sequential mixed-methods design, beginning with a quantitative survey followed by a two-part qualitative phase. Survey results from aim 1 will provide a detailed assessment of health information and communication technologies in use and help identify sites with variation in health information and communication technologies for the qualitative phase of the study. In aim 2, we will conduct telephone interviews with hospital personnel in up to 8 hospitals to gather in-depth information about communication practices and work relationships on medical-surgical units. In aim 3, we will collect data in 4 hospitals (selected from telephone interview results) via observation, shadowing, focus groups, and artifacts to learn how health information and communication technologies, communication practices, and work relationships affect communication. Results: Results from aim 1 will be published in 2016. Results from aims 2 and 3 will be published in subsequent years. Conclusions: As the majority of US hospitals do not yet have HIT fully implemented, results from our study will inform future development and implementation of health information and communication technologies to support effective communication between nurses and physicians. [JMIR Res Protoc 2015;4(2):e72]
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- 2015
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14. Cardiac Risk Is Not Associated With Hypertension Treatment Intensification
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Jeremy Sussman, Zulman, Donna M., Hayward, Rodney, Hofer, Timothy P., and Kerr, Eve A.
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Decision Making ,Middle Aged ,Risk Assessment ,Article ,Midwestern United States ,Cohort Studies ,Logistic Models ,Cardiovascular Diseases ,Hypertension ,Humans ,Prospective Studies ,Antihypertensive Agents ,Aged ,Veterans - Abstract
Considering cardiovascular (CV) risk could make clinical care more efficient and individualized, but most practice guidelines focus on single risk factors. We sought to determine if hypertension treatment intensification (TI) is more likely in patients with elevated CV risk.Prospective cohort study of 856 US veterans with diabetes and elevated blood pressure (BP).We used multilevel logistic regression to compare TI across 3 CV risk groups: those with history of heart disease, a high-risk primary prevention group (10-year event risk20% but no history of heart disease), and those with low/ medium CV risk (10-year event risk20%).There were no significant differences in TI rates across risk groups, with adjusted odds ratios (ORs) of 1.19 (95% confidence interval 0.77-1.84) and 1.18 (0.76-1.83) for high-risk patients and those with a history of CVD, respectively, compared with those of low/medium risk. Several individual risk factors were associated with higher rates of TI: systolic BP, mean BP in the prior year, and higher glycated hemoglobin. Self-reported home BP140/90 mm Hg was associated with lower rates of TI. Incorporating CV risk into TI decision algorithms could prevent an estimated 38% more cardiac events without increasing the number of treated patients.While an individual's BP alters clinical decisions about TI, overall CV risk does not appear to play a role in clinical decision making. Adoption of TI decision algorithms that incorporate CV risk could substantially enhance the efficiency and clinical utility of CV preventive care.
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