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2. A Bayesian Framework for Causal Analysis of Recurrent Events with Timing Misalignment

Author

Oganisian, Arman, Girard, Anthony, Steingrimsson, Jon A., and Moyo, Patience

Subjects
Statistics - Methodology, Computer Science - Machine Learning, Statistics - Applications, Statistics - Machine Learning
Abstract

Observational studies of recurrent event rates are common in biomedical statistics. Broadly, the goal is to estimate differences in event rates under two treatments within a defined target population over a specified followup window. Estimation with observational data is challenging because, while membership in the target population is defined in terms of eligibility criteria, treatment is rarely observed exactly at the time of eligibility. Ad-hoc solutions to this timing misalignment can induce bias by incorrectly attributing prior event counts and person-time to treatment. Even if eligibility and treatment are aligned, a terminal event process (e.g. death) often stops the recurrent event process of interest. In practice, both processes can be censored so that events are not observed over the entire followup window. Our approach addresses misalignment by casting it as a time-varying treatment problem: some patients are on treatment at eligibility while others are off treatment but may switch to treatment at a specified time - if they survive long enough. We define and identify an average causal effect estimand under right-censoring. Estimation is done using a g-computation procedure with a joint semiparametric Bayesian model for the death and recurrent event processes. We apply the method to contrast hospitalization rates among patients with different opioid treatments using Medicare insurance claims data.

Published
2023
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12. Exploring the Experiences and Perceptions of the Utilisation of Structured Clinical Handover Frameworks by Nurses Working in Acute Care Settings: A Scoping Review.

Author

Moyo, Patience, Anderson, Judith, Francis, Karen, and Biles, Jessica

Subjects
*WORK, *INTENSIVE care nursing, *INTERPROFESSIONAL relations, *MEDICAL quality control, *PATIENT safety, *SENSORY perception, *CINAHL database, *HOSPITAL admission & discharge, *NURSING, *EVALUATION of medical care, *SYSTEMATIC reviews, *MEDLINE, *CONCEPTUAL structures, *NURSES' attitudes, *EXPERIENTIAL learning, *ACUTE care nurse practitioners, *CRITICAL care medicine
Abstract

Background: There is increased interest in implementing structured clinical handover frameworks to improve clinical handover processes. Research postulates that structured clinical handover frameworks increase the quality of handovers; yet inconsistencies enacting these frameworks exist which has a potential to jeopardise the quality of communication during handovers thereby defeating the purpose of these frameworks. Aim: This scoping review aims to analyse and synthesise what is currently known of the nurses' experiences and perceptions in implementing structured clinical handover frameworks and identify knowledge gaps in relation to this topic area. Design: A scoping review guided by the PRISMA‐ScR checklist. Methods: A systematic search of five electronic databases was undertaken to identify peer‐reviewed primary research studies which met the predetermined eligibility criteria. In total, 301 studies were imported into COVIDENCE, screened and assessed for eligibility resulting in 23 studies remaining. From the eligible studies, data was extracted, collated, appraised, summarised and interpreted. Data Sources: MEDLINE, CINHAL, ProQuest, EMCARE, Web of Science and Informit. Results: Twenty three studies were included in this review which yielded the following major themes: (1) quality and completeness of information transfer; (2) interprofessional collaboration; (3) challenges impacting the experience of implementing the structured clinical handover frameworks and (4) perceived impacts on quality, patient safety and health outcomes. Conclusion: There are key benefits and issues experienced and perceived by nurses implementing structured clinical handover frameworks and this review identifies opportunities for further improvements. Future research should explore the perceived associations with patient outcomes. Relevance to Clinical Practice: This review highlights the importance of structured clinical handover frameworks, the nurses' experiences in implementing these frameworks and strategies to improve the effectiveness of these frameworks. Patient or Public Contributions: No Patient or Public Contributions as this study is a review of published primary evidence. [ABSTRACT FROM AUTHOR]

Published
2024
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23. Treatment Patterns and Population Characteristics of Nonpharmacologic Management of Chronic Pain in the United States’ Medicare Population: A Scoping Review

Author

Choudry, Erum, primary, Rofé, Kara L, additional, Konnyu, Kristin, additional, Marshall, Brandon D L, additional, Shireman, Theresa I, additional, Merlin, Jessica S, additional, Trivedi, Amal N, additional, Schmidt, Catherine, additional, Bhondoekhan, Fiona, additional, and Moyo, Patience, additional

Published
2023
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26. Prescription drug monitoring programs: Assessing the association between 'best practices' and opioid use in Medicare

Author

Moyo, Patience, Simoni-Wastila, Linda, Griffin, Beth Ann, Harrington, Donna, Alexander, G. Caleb, Palumbo, Francis, and Onukwugha, Eberechukwu

Subjects
Medicare -- Evaluation, Health policy, State laws, Drug abuse, Best practices, Prescriptions (Drugs) -- Evaluation, Beneficiaries, Prescription drug abuse, Opioids, Substance abuse, Business, Health care industry
Abstract

Objective: To estimate the impact of implementing prescription drug monitoring program (PDMP) best practices on prescription opioid use. Data Sources: 2007-2012 Medicare claims for noncancer pain patients, and PDMP attributes from the Prescription Drug Abuse Policy System. Study Design: We derived PDMP composite scores using the number of best practices adopted by states (range: 0-14), classifying states as either no PDMP, low strength (0 < score < median), or high strength (score [greater than or equal to] median). Using generalized linear models, we quantified the association between the PDMP score category and opioid use measures--overall and stratified by disability/age. Sensitivity analyses assessed the general Medicare sample regardless of pain diagnoses, individual PDMP characteristics, and compared GEE model findings to models with state fixed effects. Principal Findings: Compared to non-PDMP states, strong PDMP states had lower opioid cumulative doses (-296 mg; 95% CI: -512, -132), days supplied (-7.84; 95% CI: -10.6, -5.04), prescription fill rates (0.97; 95% CI: 0.95, 0.98), and mean daily doses (-2.31 mg; 95% CI: -3.14, -1.48) but greater prevalence of high opioid doses in disabled adults, whereas there was little or no change in older adults. Findings in states with weak PDMPs were substantively similar to those of strong PDMPs. Results from sensitivity analyses were mostly consistent with main findings except there was a null relationship with mean daily doses and high doses in models with state fixed effects. Conclusions: Comprehensive or minimal adoption of PDMP best practices was associated with mostly comparable effects on Medicare beneficiaries' opioid use; however, these effects were concentrated among nonelderly disabled adults. KEYWORDS drug utilization, medicare, opioids, prescription drug monitoring programs, state health policy, 1 | INTRODUCTION State prescription drug monitoring programs (PDMPs) are a primary tool used to confront overprescribing, diversion, and misuse of opioids and other controlled prescription drugs. (1,2) PDMPs collect, [...]

Published
2019
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28. A Bayesian Framework for Causal Analysis of Recurrent Events in Presence of Immortal Risk

Author

Oganisian, Arman, Girard, Anthony, Steingrimsson, Jon A., Moyo, Patience, Oganisian, Arman, Girard, Anthony, Steingrimsson, Jon A., and Moyo, Patience

Abstract

Observational studies of recurrent event rates are common in biomedical statistics. Broadly, the goal is to estimate differences in event rates under two treatments within a defined target population over a specified followup window. Estimation with observational claims data is challenging because while membership in the target population is defined in terms of eligibility criteria, treatment is rarely assigned exactly at the time of eligibility. Ad-hoc solutions to this timing misalignment, such as assigning treatment at eligibility based on subsequent assignment, incorrectly attribute prior event rates to treatment - resulting in immortal risk bias. Even if eligibility and treatment are aligned, a terminal event process (e.g. death) often stops the recurrent event process of interest. Both processes are also censored so that events are not observed over the entire followup window. Our approach addresses misalignment by casting it as a treatment switching problem: some patients are on treatment at eligibility while others are off treatment but may switch to treatment at a specified time - if they survive long enough. We define and identify an average causal effect of switching under specified causal assumptions. Estimation is done using a g-computation framework with a joint semiparametric Bayesian model for the death and recurrent event processes. Computing the estimand for various switching times allows us to assess the impact of treatment timing. We apply the method to contrast hospitalization rates under different opioid treatment strategies among patients with chronic back pain using Medicare claims data.

Published
2023

34. Digital design and technology and market outreach in rural Zimbabwe

Author

Moyo, Patience and Tengeh, Robertson

Subjects
Digital marketing, business.industry, digital and design entrepreneurship, 05 social sciences, Social Sciences, Qualitative property, Focus group, Digital media, Outreach, market outreach, rural entrepreneurship, 0502 economics and business, rural zimbabwe, digital marketing, 050211 marketing, Design and Technology, Thematic analysis, Marketing, business, Digital Revolution, digital media, 050203 business & management
Abstract

Despite producing top of the range products and services, entrepreneurs in Zimbabwe's rural Gokwe face limited access to markets. Access to local and regional trading markets is further aggravated by inadequate technological infrastructure and financial resources to carry out business activities. Aim: This article investigates the role of digital design and technology in expanding market outreach in Zimbabwe. Methods: A mixed methods research design was adopted. The qualitative data, obtained from semi-structured interviews and a focus group discussion, was analysed through thematic analysis. The quantitative data was obtained from the administration of a questionnaire and used to corroborate the findings of the qualitative tool. Results: The findings revealed that while digital design and technology had little effect on identifying entrepreneurial opportunities and communicating with potential customers in Gokwe, there were clear signs that plans were being made to integrate digital technology and internet connectivity in at least one sector of the rural economy of the district. Implications: The findings may provide vital information for rural entrepreneurs and policymakers looking to benefit from the digital revolution. Recommendation: The paper encourages the use of digital marketing and advertising to take advantage of entrepreneurial opportunities.

Published
2021
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36. Receipt of Physical Therapy and Chiropractic Care by Adults Diagnosed with Chronic Pain: Analysis of the 2016–2018 Rhode Island All Payer Claims Database

Author

MOYO, PATIENCE, SCHMIDT, CATHERINE, LEE, YOOJIN, JOSHI, RICHA, MUKHDOMI, TAIF, TRIVEDI, AMAL, and SHIREMAN, THERESA I.

Subjects
Adult, Humans, Rhode Island, Chronic Pain, Medicare, Article, Chiropractic, Physical Therapy Modalities, United States, Aged
Abstract

OBJECTIVE: To examine trends and factors associated with physical therapy (PT) and chiropractic care use among Rhode Islanders with private or publicly-funded health insurance who were diagnosed with chronic pain from 2016–2018. METHODS: We measured monthly PT and chiropractic care use from the RI All Payer Claims Database, and conducted logistic regression to identify factors associated with utilization. RESULTS: There were 284,942 unique adults with chronic pain representing over one-quarter of insured persons in the state. Chiropractic care use remained unchanged but was more prevalent (7.2%) than PT whose use increased minimally from 4.0% (2016) to 4.5% (2018). Traditional Medicare or Medicaid enrollment was associated with lower odds of receiving PT and chiropractic care than in private plans. CONCLUSIONS: PT and chiropractic care use varied across payers; however, there were little to no changes in their use over time despite clinical guidelines that encourage non-pharmacologic options to manage chronic pain.

Published
2022

41. Additional file 1 of Discharge locations after hospitalizations involving opioid use disorder among medicare beneficiaries

Author

Moyo, Patience, Eliot, Melissa, Shah, Asghar, Goodyear, Kimberly, Jutkowitz, Eric, Thomas, Kali, and Zullo, Andrew R.

Abstract

Additional file 1: Appendix S1. Sample selection flow diagram indicating hospital discharge location following OUD-related hospitalizations. Appendix S2. Percentages of select primary diagnoses identified during OUD-related hospitalizations in Medicare during 2016-2018. Appendix S3. Demographic, comorbidity and health care utilization characteristics of opioid use disorder-related hospitalizations among older adult (age ≥65 years) fee-for-service Medicare beneficiaries, 2016-18. Appendix S4. Demographic, comorbidity and health care utilization characteristics of opioid use disorder-related hospitalizations among younger (age

Published
2022
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44. Dr. Richard Saitz

Author

Vocci, Frank, primary, Dunn, Kelly, additional, Petrakis, Ismene, additional, Wunsch, Martha, additional, Moyo, Patience, additional, Han, Ben, additional, and Smid, Marcela, additional

Published
2022
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