5 results on '"Danis, Marion"'
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2. How will we respond to chronic critical illness?
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Danis, Marion
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CHRONIC disease treatment , *ARTIFICIAL respiration , *CHRONIC diseases , *CRITICAL care medicine , *DIAGNOSIS related groups , *INTENSIVE care units , *PROGNOSIS - Published
- 2004
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3. How Would Low-Income Communities Prioritize Medicaid Spending?
- Author
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Myers, C. Daniel, Kieffer, Edith C., Fendrick, A. Mark, Hyungjin Myra Kim, Calhoun, Karen, Szymecko, Lisa, LaHahnn, Lynnette, Ledón, Charo, Danis, Marion, Rowe, Zachary, and Dorr Goold, Susan
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DENTAL economics , *CHRONIC diseases , *COMMUNITIES , *HEALTH care rationing , *INSURANCE , *MATHEMATICAL models , *MEDICAID , *MEDICAL care use , *MEDICAL emergencies , *HEALTH policy , *MEDICAL specialties & specialists , *POLICY sciences , *POVERTY , *PRIMARY health care , *SURVEYS , *INFORMATION resources , *PATIENT participation , *HEALTH insurance reimbursement , *THEORY , *GROUP process , *DATA analysis software , *DESCRIPTIVE statistics - Abstract
Context: Medicaid plays a critical role in low-income, minority, and medically underserved communities, particularly in states that have expanded Medicaid under the Affordable Care Act. Yet, the voices of underresourced communities are often unheard in decisions about how to allocate Medicaid's scarce resources, and traditional methods of public engagement are poorly suited to gathering such input. We argue that deliberative public engagement can be a useful tool for involving communities in setting Medicaid priorities. Method: We engaged 209 residents of low-income, medically underserved Michigan communities in discussions about Medicaid spending priorities using an exercise in informed deliberation: CHAT (CHoosing All Together). Participants learned about Medicaid, deliberated in small groups, and set priorities both individually and collectively. Findings: Participants prioritized broad eligibility consistent with the ACA expansion, accepted some cost sharing, and prioritized spending in areas--including mental health--that are historically underfunded. Participants allocated less funding beyond benefit coverage, such as spending on healthy communities. Participants perceived the deliberative process as fair and informative, and they supported using it in the policy-making process. Conclusion: The choices of participants from low-income, medically underserved communities reflect a unique set of priorities and suggest that engaging low-income communities more deeply in Medicaid policy making might result in different prioritization decisions. [ABSTRACT FROM AUTHOR]
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- 2020
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4. Modifiable elements of ICU supportive care and communication are associated with surrogates' PTSD symptoms.
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Wendlandt, Blair, Ceppe, Agathe, Choudhury, Summer, Cox, Christopher E., Hanson, Laura C., Danis, Marion, Tulsky, James A., Nelson, Judith E., and Carson, Shannon S.
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BETA (Finance) , *POST-traumatic stress disorder , *CRITICALLY ill , *RANDOMIZED controlled trials , *CHRONIC diseases , *INTENSIVE care units , *INTERVIEWING , *MEDICAL personnel , *PALLIATIVE treatment , *RESEARCH funding , *FAMILY relations , *PATIENTS' families - Abstract
Purpose: To identify specific components of ICU clinician supportive care and communication that are associated with increased post-traumatic stress disorder (PTSD) symptoms for surrogate decision makers of patients with chronic critical illness (CCI).Methods: We conducted a secondary analysis of data from a randomized controlled trial of palliative care-led meetings to provide information and support for CCI surrogates. The primary outcome for this secondary analysis was PTSD symptoms at 90 days, measured by the Impact of Event Scale-Revised (IES-R). Caregiver perceptions of clinician support and communication were assessed using a version of the After-Death Bereaved Family Member Interview (ADBFMI) instrument modified for use in non-bereaved in addition to bereaved caregivers. The association between ADBFMI items and IES-R score was analyzed using multiple linear regression.Results: Ninety-day follow up was complete for 306 surrogates corresponding to 224 patients. Seventy-one percent of surrogates were female, and the mean age was 51 years. Of the domains, negative perception of the patient's physical comfort and emotional support was associated with the greatest increase in surrogate PTSD symptoms (beta coefficient 1.74, 95% CI 0.82-2.65). The three specific preselected items associated with increased surrogate PTSD symptoms were surrogate perception that clinicians did not listen to concerns (beta coefficient 10.7, 95% CI 3.6-17.9), failure of the physician to explain how the patient's pain would be treated (beta coefficient 12.1, 95% CI 4.9-19.3), and lack of sufficient religious contact (beta coefficient 11.7, 95% CI 2-21.3).Conclusion: Modifiable deficits in ICU clinician support and communication were associated with increased PTSD symptoms among CCI surrogates. [ABSTRACT FROM AUTHOR]- Published
- 2019
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5. Effect of Palliative Care-Led Meetings for Families of Patients With Chronic Critical Illness: A Randomized Clinical Trial.
- Author
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Carson, Shannon S., Cox, Christopher E., Wallenstein, Sylvan, Hanson, Laura C., Danis, Marion, Tulsky, James A., Chai, Emily, and Nelson, Judith E.
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CHRONICALLY ill , *PATIENTS' families , *MEDICAL decision making , *PALLIATIVE treatment , *ANXIETY diagnosis , *ANXIETY treatment , *DIAGNOSIS of mental depression , *MENTAL depression , *THERAPEUTICS , *PSYCHOLOGY of caregivers , *CATASTROPHIC illness , *CHRONIC diseases , *COMPARATIVE studies , *DECISION making , *FAMILIES , *GUARDIAN & ward , *LENGTH of stay in hospitals , *INTENSIVE care units , *RESEARCH methodology , *MEDICAL cooperation , *PAMPHLETS , *PATIENT satisfaction , *POST-traumatic stress disorder , *RESEARCH , *EVALUATION research , *RANDOMIZED controlled trials , *IMPACT of Event Scale - Abstract
Importance: Family caregivers of patients with chronic critical illness experience significant psychological distress.Objective: To determine whether family informational and emotional support meetings led by palliative care clinicians improve family anxiety and depression.Design, Setting, and Participants: A multicenter randomized clinical trial conducted from October 2010 through November 2014 in 4 medical intensive care units (ICUs). Adult patients (aged ≥21 years) requiring 7 days of mechanical ventilation were randomized and their family surrogate decision makers were enrolled in the study. Observers were blinded to group allocation for the measurement of the primary outcomes.Interventions: At least 2 structured family meetings led by palliative care specialists and provision of an informational brochure (intervention) compared with provision of an informational brochure and routine family meetings conducted by ICU teams (control). There were 130 patients with 184 family surrogate decision makers in the intervention group and 126 patients with 181 family surrogate decision makers in the control group.Main Outcomes and Measures: The primary outcome was Hospital Anxiety and Depression Scale symptom score (HADS; score range, 0 [best] to 42 [worst]; minimal clinically important difference, 1.5) obtained during 3-month follow-up interviews with the surrogate decision makers. Secondary outcomes included posttraumatic stress disorder experienced by the family and measured by the Impact of Events Scale-Revised (IES-R; total score range, 0 [best] to 88 [worst]), discussion of patient preferences, hospital length of stay, and 90-day survival.Results: Among 365 family surrogate decision makers (mean age, 51 years; 71% female), 312 completed the study. At 3 months, there was no significant difference in anxiety and depression symptoms between surrogate decision makers in the intervention group and the control group (adjusted mean HADS score, 12.2 vs 11.4, respectively; between-group difference, 0.8 [95% CI, -0.9 to 2.6]; P = .34). Posttraumatic stress disorder symptoms were higher in the intervention group (adjusted mean IES-R score, 25.9) compared with the control group (adjusted mean IES-R score, 21.3) (between-group difference, 4.60 [95% CI, 0.01 to 9.10]; P = .0495). There was no difference between groups regarding the discussion of patient preferences (intervention, 75%; control, 83%; odds ratio, 0.63 [95% CI, 0.34 to 1.16; P = .14]). The median number of hospital days for patients in the intervention vs the control group (19 days vs 23 days, respectively; between-group difference, -4 days [95% CI, -6 to 3 days]; P = .51) and 90-day survival (hazard ratio, 0.95 [95% CI, 0.65 to 1.38], P = .96) were not significantly different.Conclusions and Relevance: Among families of patients with chronic critical illness, the use of palliative care-led informational and emotional support meetings compared with usual care did not reduce anxiety or depression symptoms and may have increased posttraumatic stress disorder symptoms. These findings do not support routine or mandatory palliative care-led discussion of goals of care for all families of patients with chronic critical illness.Trial Registration: clinicaltrials.gov Identifier: NCT01230099. [ABSTRACT FROM AUTHOR]- Published
- 2016
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