Santanu Datta | Duke University School of Medicine (original) (raw)

Papers by Santanu Datta

Cancer Epidemiology Biomarkers Prevention a Publication of the American Association For Cancer Research Cosponsored By the American Society of Preventive Oncology, Jun 1, 2002

Purpose: Markers of genetic susceptibility to tobaccorelated cancers could personalize harms of s... more Purpose: Markers of genetic susceptibility to tobaccorelated cancers could personalize harms of smoking and motivate cessation. Our objective was to assess whether a multicomponent intervention that included feedback about genetic susceptibility to lung cancer increased risk perceptions and rates of smoking cessation compared with a standard cessation intervention.

Physical therapy, Jan 19, 2015

Efficient approaches are needed for delivering non-pharmacological interventions for knee osteoar... more Efficient approaches are needed for delivering non-pharmacological interventions for knee osteoarthritis (OA). This trial compared group-based vs. individual physical therapy (PT) interventions for knee OA. 320 patients with knee OA at the VA Medical Center in Durham, NC (mean age = 60 years, 88% male; 58% non-white) were randomized to either the group intervention (GPT; six one-hour sessions, typically eight participants / group) or the individual intervention (IPT; two one-hour sessions). Both programs included instruction in home exercise, joint protection techniques and individual physical therapist evaluation. The primary outcome was the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC; range 0-96, higher scores indicate worse symptoms), measured at baseline, 12 weeks and 24 weeks. The secondary outcome was the Short Performance Physical Battery (SPPB; range 0-12, higher scores indicate better performance), measured at baseline and 12 weeks. Linear mixed m...

Evidence report/technology assessment (Summary)

Evidence report/technology assessment (Summary)

Evidence report/technology assessment (Summary)

Journal of genetic counseling, Jan 3, 2015

Telegenetics-genetic counseling via live videoconferencing-can improve access to cancer genetic c... more Telegenetics-genetic counseling via live videoconferencing-can improve access to cancer genetic counseling (CGC) in underserved areas, but studies on cancer telegenetics have not applied randomized methodology or assessed cost. We report cost, patient satisfaction and CGC attendance from a randomized trial comparing telegenetics with in-person CGC among individuals referred to CGC in four rural oncology clinics. Participants (n = 162) were randomized to receive CGC at their local oncology clinic in-person or via telegenetics. Cost analyses included telegenetics system; mileage; and personnel costs for genetic counselor, IT specialist, and clinic personnel. CGC attendance was tracked via study database. Patient satisfaction was assessed 1 week post-CGC via telephone survey using validated scales. Total costs were 106pertelegeneticspatientand106 per telegenetics patient and 106pertelegeneticspatientand244 per in-person patient. Patient satisfaction did not differ by group on either satisfaction scale. In-person patients were significantl...

Obesity, 2010

Although obese individuals utilize health care at higher rates than their normal weight counterpa... more Although obese individuals utilize health care at higher rates than their normal weight counterparts, they may be less likely to receive certain preventive services. We conducted a retrospective cohort study of veterans with visits to 136 national Veterans Affairs (VA) outpatient clinics in the United States in the year 2000. The cohort included 1,699,219 patients: 94% men, 48% white, and 76% overweight or obese. Overweight and obese patients had higher adjusted odds of receiving each of the targeted clinical preventive services as recommended over 5 years compared with normal weight patients. The odds for receiving vaccinations increased linearly with BMI category: influenza (men: odds ratio (OR) = 1.13 for overweight to OR = 1.42 for obese class 3; women: OR = 1.15 for overweight to OR = 1.61 for obese class 3) and pneumococcus (men: OR = 1.02 for overweight to OR = 1.15 for obese class 3; women: OR = 1.08 for overweight to OR = 1.28 for obese class 3). The odds for receiving the cancer screening services typically peaked in the mild-moderately obese categories. The highest OR for prostate cancer screening was in obese class 2 (OR = 1.29); for colorectal cancer, obese class 1 (men: OR = 1.15; women OR = 1.10); for breast cancer screening, obese class 2 (OR = 1.19); and for cervical cancer screening, obese class 2 (OR = 1.06). In a large national sample, obese patients received preventive services at higher, not lower, rates than their normal weight peers. This may be due to the VA health service coverage and performance directives, a more homogeneous patient demographic profile, and/or unmeasured factors related to service receipt.

Contemporary Clinical Trials, 2013

Despite recognition of the benefits associated with well-controlled diabetes and hypertension, co... more Despite recognition of the benefits associated with well-controlled diabetes and hypertension, control remains suboptimal. Effective interventions for these conditions have been studied within academic settings, but interventions targeting both conditions have rarely been tested in community settings. We describe the design and baseline results of a trial evaluating a behavioral intervention among community patients with poorly-controlled diabetes and comorbid hypertension. Tailored Case Management for Diabetes and Hypertension (TEACH-DM) is a 24-month randomized, controlled trial evaluating a telephone-delivered behavioral intervention for diabetes and hypertension versus attention control. The study recruited from nine community practices. The nurse-administered intervention targets 3 areas: 1) cultivation of healthful behaviors for diabetes and hypertension control; 2) provision of fundamentals to support attainment of healthful behaviors; and 3) identification and correction of patient-specific barriers to adopting healthful behaviors. Hemoglobin A1c and blood pressure measured at 6, 12, and 24 months are co-primary outcomes. Secondary outcomes include self-efficacy, self-reported medication adherence, exercise, and cost-effectiveness. Of 377 randomized patients, 193 were allocated to the intervention and 184 to attention control. The cohort is balanced in terms of gender, race, education level, and income. The cohort's mean baseline hemoglobin A1c and blood pressure are above goal, and mean baseline body mass index falls in the obese range. Baseline self-reported non-adherence is high for diabetes and hypertension medications. Trial results are pending. If effective, the TEACH-DM intervention's telephone-based delivery strategy and nurse administration make it well-suited for rapid implementation and broad dissemination in community settings.

Contemporary Clinical Trials, 2008

Osteoarthritis (OA) is a leading cause of disability among adults. Although self-management behav... more Osteoarthritis (OA) is a leading cause of disability among adults. Although self-management behaviors such as exercise and weight management can improve pain and function, these behaviors are vastly underutilized. There is a need to implement effective self-management programs among the growing number of adults with OA. The Self-Management of OsteoArthritis (SeMOA) in Veterans Study examines a 12-month telephone-based OA self-management program in the primary care setting. This manuscript details the design, methodology, and advances of the SeMOA trial. Participants (N=519) with hip or knee OA are randomly assigned to one of three groups: OA self-management, health education (attention control), or usual care. The OA self-management group receives written and audio materials regarding OA care (including health behaviors, medical care, and interacting with health care providers). A health educator calls participants monthly to review these materials and provide support for developing individualized goals and action plans related to OA management. The health education group receives written and audio materials and monthly calls from a health educator discussing health issues unrelated to OA. Usual care involves no additional materials or phone calls. The primary outcome is change in the Arthritis Impact Measurement Scales-2 pain subscale from baseline to 12 months. Analysis of covariance models will compare changes in pain across study groups. The cost-effectiveness of the OA self-management program will also be assessed. SeMOA is one of the first to examine telephone-based delivery of OA self-management and one of few trials to target the primary care setting. This program has the potential for broad dissemination because it reduces both the costs and barriers that accompany in-person programs. This study will provide important information about its feasibility and effectiveness in a real-world clinical setting.

Contemporary Clinical Trials, 2013

Physical therapy (PT) is a key component of treatment for knee osteoarthritis (OA) and can decrea... more Physical therapy (PT) is a key component of treatment for knee osteoarthritis (OA) and can decrease pain and improve function. Given the expected rise in prevalence of knee OA and the associated demand for treatment, there is a need for models of care that cost-effectively extend PT services for patients with this condition. This manuscript describes a randomized clinical trial of a group-based physical therapy program that can potentially extend services to more patients with knee OA, providing a greater number of sessions per patient, at lower staffing costs compared to traditional individual PT. Participants with symptomatic knee OA (n = 376) are randomized to either a 12-week group-based PT program (six 1 h sessions, eight patients per group, led by a physical therapist and physical therapist assistant) or usual PT care (two individual visits with a physical therapist). Participants in both PT arms receive instruction in an exercise program, information on joint care and protection, and individual consultations with a physical therapist to address specific functional and therapeutic needs. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and the secondary outcome is the Short Physical Performance Test Protocol (objective physical function). Outcomes are assessed at baseline and 12-week follow-up, and the primary outcome is also assessed via telephone at 24-week follow-up to examine sustainability of effects. Linear mixed models will be used to compare outcomes for the two study arms. An economic cost analysis of the PT interventions will also be conducted.

The Annals of Thoracic Surgery, 2004

Background. The full kallikrein-inhibiting dose of aprotinin has been shown to reduce blood loss,... more Background. The full kallikrein-inhibiting dose of aprotinin has been shown to reduce blood loss, transfusion requirements, and the systemic inflammatory response associated with cardiopulmonary bypass graft surgery (CABG). A half-dose regimen, although having a reduced delivery cost, inhibits plasmin and fibrinolysis without substantially effecting kallikrein-mediated inflammation associated with bypass surgery. The differing pharmacologic effects of the two regimens impact the decision-making process. The current study assessed the medical cost offset of full-dose and half-dose aprotinin from short-and long-term perspectives to provide a rational decision-making framework for clinicians.

Annals of Internal Medicine, 2010

Osteoarthritis is a leading cause of pain and disability, and self-management behaviors for osteo... more Osteoarthritis is a leading cause of pain and disability, and self-management behaviors for osteoarthritis are underutilized. To examine the effectiveness of a telephone-based self-management intervention for hip or knee osteoarthritis in a primary care setting. Randomized clinical trial with equal assignment to osteoarthritis self-management, health education (attention control), and usual care control groups. (ClinicalTrials.gov registration number: NCT00288912) Primary care clinics in a Veterans Affairs Medical Center. 515 patients with symptomatic hip or knee osteoarthritis. The osteoarthritis self-management intervention involved educational materials and 12 monthly telephone calls to support individualized goals and action plans. The health education intervention involved nonosteoarthritis educational materials and 12 monthly telephone calls related to general health screening topics. The primary outcome was score on the Arthritis Impact Measurement Scales-2 pain subscale (range, 0 to 10). Pain was also assessed with a 10-cm visual analog scale. Measurements were collected at baseline and 12 months. 461 participants (90%) completed the 12-month assessment. The mean Arthritis Impact Measurement Scales-2 pain score in the osteoarthritis self-management group was 0.4 point lower (95% CI, -0.8 to 0.1 point; P = 0.105) than in the usual care group and 0.6 point lower (CI, -1.0 to -0.2 point; P = 0.007) than in the health education group at 12 months. The mean visual analog scale pain score in the osteoarthritis self-management group was 1.1 points lower (CI, -1.6 to -0.6 point; P < 0.001) than in the usual care group and 1.0 point lower (CI, -1.5 to -0.5 point; P < 0.001) than in the health education group. Health care use did not differ across the groups. The study was conducted at 1 Veterans Affairs Medical Center, and the sample consisted primarily of men. A telephone-based osteoarthritis self-management program produced moderate improvements in pain, particularly compared with a health education control group. U.S. Department of Veterans Affairs Health Services Research and Development Service.

Data Revues 00029378 V195i4 S0002937806002262, Aug 19, 2011

Objective: The purpose of this study was to quantify the total direct cost to the US health care ... more Objective: The purpose of this study was to quantify the total direct cost to the US health care system for the management of uterine leiomyomas. Study design: We used Center for Disease Control heath care databases for estimates of inpatient care, ambulatory care, and outpatient care of leiomyomas. With International Classification of Diseases-9 codes for fibroid tumors and fibroid-related conditions, all fibroid-related care was identified in each database. Inpatient and ambulatory surgical cases were stratified by surgical procedure, and outpatient clinical cases were categorized by type of visit and health care provider. With the use of Medicare's RBRVU reimbursement rates for 2000 as a proxy for the cost of physician services and Medicare diagnostic-related group reimbursement as a proxy for facility costs, the total direct cost to the US health care system for the care of fibroid tumors was estimated. Results: Total direct cost to treat uterine fibroid tumors was estimated at $2,151,484,847. Most of the cost was due to inpatient care, in particular, hysterectomy. Conclusion: Uterine fibroid tumors consume a significant amount of health care resources in the United States. Ó 2006 Mosby, Inc. All rights reserved.

Journal of Substance Abuse Treatment, 2016

Quality Enhancement Research Initiative's (QUERI's) Evidence-based Synthesis Program (ESP) was es... more Quality Enhancement Research Initiative's (QUERI's) Evidence-based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to Veterans Affairs (VA) managers and policymakers, as they work to improve the health and healthcare of Veterans. The ESP disseminates these reports throughout VA.

The American Heart Journal, Jan 3, 2009

Background Less than one third of the 65 million Americans with hypertension have adequate blood ... more Background Less than one third of the 65 million Americans with hypertension have adequate blood pressure (BP) control. This study examined the effectiveness of 2 interventions for improving patient BP control.

Physical therapy, Jan 19, 2015

Efficient approaches are needed for delivering non-pharmacological interventions for knee osteoar... more Efficient approaches are needed for delivering non-pharmacological interventions for knee osteoarthritis (OA). This trial compared group-based vs. individual physical therapy (PT) interventions for knee OA. 320 patients with knee OA at the VA Medical Center in Durham, NC (mean age = 60 years, 88% male; 58% non-white) were randomized to either the group intervention (GPT; six one-hour sessions, typically eight participants / group) or the individual intervention (IPT; two one-hour sessions). Both programs included instruction in home exercise, joint protection techniques and individual physical therapist evaluation. The primary outcome was the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC; range 0-96, higher scores indicate worse symptoms), measured at baseline, 12 weeks and 24 weeks. The secondary outcome was the Short Performance Physical Battery (SPPB; range 0-12, higher scores indicate better performance), measured at baseline and 12 weeks. Linear mixed m...

JAMA dermatology, Jan 16, 2015

The costs and utility of teledermatology are important features of implementation. Such an analys... more The costs and utility of teledermatology are important features of implementation. Such an analysis requires a description of the perspective of the entity that will bear the cost. To assess the costs and utility of a store-and-forward teledermatology referral process compared with a conventional referral process from the perspectives of the Department of Veterans Affairs (VA) and society. Three hundred ninety-one randomized participants were referred from remote sites of primary care to the dermatology services of 2 VA medical facilities for ambulatory skin conditions from December 2008 through June 2010, and follow-up was completed in March 2011. The time trade-off utility measures and costs were collected during a 9-month period among participants in a 2-site parallel group randomized clinical trial. The perspectives of the VA and society were evaluated. The multiple imputation procedure or weighted means were used for missing data elements. Data were analyzed from January to Jul...

Cancer Epidemiology Biomarkers Prevention a Publication of the American Association For Cancer Research Cosponsored By the American Society of Preventive Oncology, Jun 1, 2002

Purpose: Markers of genetic susceptibility to tobaccorelated cancers could personalize harms of s... more Purpose: Markers of genetic susceptibility to tobaccorelated cancers could personalize harms of smoking and motivate cessation. Our objective was to assess whether a multicomponent intervention that included feedback about genetic susceptibility to lung cancer increased risk perceptions and rates of smoking cessation compared with a standard cessation intervention.

Physical therapy, Jan 19, 2015

Efficient approaches are needed for delivering non-pharmacological interventions for knee osteoar... more Efficient approaches are needed for delivering non-pharmacological interventions for knee osteoarthritis (OA). This trial compared group-based vs. individual physical therapy (PT) interventions for knee OA. 320 patients with knee OA at the VA Medical Center in Durham, NC (mean age = 60 years, 88% male; 58% non-white) were randomized to either the group intervention (GPT; six one-hour sessions, typically eight participants / group) or the individual intervention (IPT; two one-hour sessions). Both programs included instruction in home exercise, joint protection techniques and individual physical therapist evaluation. The primary outcome was the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC; range 0-96, higher scores indicate worse symptoms), measured at baseline, 12 weeks and 24 weeks. The secondary outcome was the Short Performance Physical Battery (SPPB; range 0-12, higher scores indicate better performance), measured at baseline and 12 weeks. Linear mixed m...

Evidence report/technology assessment (Summary)

Evidence report/technology assessment (Summary)

Evidence report/technology assessment (Summary)

Journal of genetic counseling, Jan 3, 2015

Telegenetics-genetic counseling via live videoconferencing-can improve access to cancer genetic c... more Telegenetics-genetic counseling via live videoconferencing-can improve access to cancer genetic counseling (CGC) in underserved areas, but studies on cancer telegenetics have not applied randomized methodology or assessed cost. We report cost, patient satisfaction and CGC attendance from a randomized trial comparing telegenetics with in-person CGC among individuals referred to CGC in four rural oncology clinics. Participants (n = 162) were randomized to receive CGC at their local oncology clinic in-person or via telegenetics. Cost analyses included telegenetics system; mileage; and personnel costs for genetic counselor, IT specialist, and clinic personnel. CGC attendance was tracked via study database. Patient satisfaction was assessed 1 week post-CGC via telephone survey using validated scales. Total costs were 106pertelegeneticspatientand106 per telegenetics patient and 106pertelegeneticspatientand244 per in-person patient. Patient satisfaction did not differ by group on either satisfaction scale. In-person patients were significantl...

Obesity, 2010

Although obese individuals utilize health care at higher rates than their normal weight counterpa... more Although obese individuals utilize health care at higher rates than their normal weight counterparts, they may be less likely to receive certain preventive services. We conducted a retrospective cohort study of veterans with visits to 136 national Veterans Affairs (VA) outpatient clinics in the United States in the year 2000. The cohort included 1,699,219 patients: 94% men, 48% white, and 76% overweight or obese. Overweight and obese patients had higher adjusted odds of receiving each of the targeted clinical preventive services as recommended over 5 years compared with normal weight patients. The odds for receiving vaccinations increased linearly with BMI category: influenza (men: odds ratio (OR) = 1.13 for overweight to OR = 1.42 for obese class 3; women: OR = 1.15 for overweight to OR = 1.61 for obese class 3) and pneumococcus (men: OR = 1.02 for overweight to OR = 1.15 for obese class 3; women: OR = 1.08 for overweight to OR = 1.28 for obese class 3). The odds for receiving the cancer screening services typically peaked in the mild-moderately obese categories. The highest OR for prostate cancer screening was in obese class 2 (OR = 1.29); for colorectal cancer, obese class 1 (men: OR = 1.15; women OR = 1.10); for breast cancer screening, obese class 2 (OR = 1.19); and for cervical cancer screening, obese class 2 (OR = 1.06). In a large national sample, obese patients received preventive services at higher, not lower, rates than their normal weight peers. This may be due to the VA health service coverage and performance directives, a more homogeneous patient demographic profile, and/or unmeasured factors related to service receipt.

Contemporary Clinical Trials, 2013

Despite recognition of the benefits associated with well-controlled diabetes and hypertension, co... more Despite recognition of the benefits associated with well-controlled diabetes and hypertension, control remains suboptimal. Effective interventions for these conditions have been studied within academic settings, but interventions targeting both conditions have rarely been tested in community settings. We describe the design and baseline results of a trial evaluating a behavioral intervention among community patients with poorly-controlled diabetes and comorbid hypertension. Tailored Case Management for Diabetes and Hypertension (TEACH-DM) is a 24-month randomized, controlled trial evaluating a telephone-delivered behavioral intervention for diabetes and hypertension versus attention control. The study recruited from nine community practices. The nurse-administered intervention targets 3 areas: 1) cultivation of healthful behaviors for diabetes and hypertension control; 2) provision of fundamentals to support attainment of healthful behaviors; and 3) identification and correction of patient-specific barriers to adopting healthful behaviors. Hemoglobin A1c and blood pressure measured at 6, 12, and 24 months are co-primary outcomes. Secondary outcomes include self-efficacy, self-reported medication adherence, exercise, and cost-effectiveness. Of 377 randomized patients, 193 were allocated to the intervention and 184 to attention control. The cohort is balanced in terms of gender, race, education level, and income. The cohort's mean baseline hemoglobin A1c and blood pressure are above goal, and mean baseline body mass index falls in the obese range. Baseline self-reported non-adherence is high for diabetes and hypertension medications. Trial results are pending. If effective, the TEACH-DM intervention's telephone-based delivery strategy and nurse administration make it well-suited for rapid implementation and broad dissemination in community settings.

Contemporary Clinical Trials, 2008

Osteoarthritis (OA) is a leading cause of disability among adults. Although self-management behav... more Osteoarthritis (OA) is a leading cause of disability among adults. Although self-management behaviors such as exercise and weight management can improve pain and function, these behaviors are vastly underutilized. There is a need to implement effective self-management programs among the growing number of adults with OA. The Self-Management of OsteoArthritis (SeMOA) in Veterans Study examines a 12-month telephone-based OA self-management program in the primary care setting. This manuscript details the design, methodology, and advances of the SeMOA trial. Participants (N=519) with hip or knee OA are randomly assigned to one of three groups: OA self-management, health education (attention control), or usual care. The OA self-management group receives written and audio materials regarding OA care (including health behaviors, medical care, and interacting with health care providers). A health educator calls participants monthly to review these materials and provide support for developing individualized goals and action plans related to OA management. The health education group receives written and audio materials and monthly calls from a health educator discussing health issues unrelated to OA. Usual care involves no additional materials or phone calls. The primary outcome is change in the Arthritis Impact Measurement Scales-2 pain subscale from baseline to 12 months. Analysis of covariance models will compare changes in pain across study groups. The cost-effectiveness of the OA self-management program will also be assessed. SeMOA is one of the first to examine telephone-based delivery of OA self-management and one of few trials to target the primary care setting. This program has the potential for broad dissemination because it reduces both the costs and barriers that accompany in-person programs. This study will provide important information about its feasibility and effectiveness in a real-world clinical setting.

Contemporary Clinical Trials, 2013

Physical therapy (PT) is a key component of treatment for knee osteoarthritis (OA) and can decrea... more Physical therapy (PT) is a key component of treatment for knee osteoarthritis (OA) and can decrease pain and improve function. Given the expected rise in prevalence of knee OA and the associated demand for treatment, there is a need for models of care that cost-effectively extend PT services for patients with this condition. This manuscript describes a randomized clinical trial of a group-based physical therapy program that can potentially extend services to more patients with knee OA, providing a greater number of sessions per patient, at lower staffing costs compared to traditional individual PT. Participants with symptomatic knee OA (n = 376) are randomized to either a 12-week group-based PT program (six 1 h sessions, eight patients per group, led by a physical therapist and physical therapist assistant) or usual PT care (two individual visits with a physical therapist). Participants in both PT arms receive instruction in an exercise program, information on joint care and protection, and individual consultations with a physical therapist to address specific functional and therapeutic needs. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and the secondary outcome is the Short Physical Performance Test Protocol (objective physical function). Outcomes are assessed at baseline and 12-week follow-up, and the primary outcome is also assessed via telephone at 24-week follow-up to examine sustainability of effects. Linear mixed models will be used to compare outcomes for the two study arms. An economic cost analysis of the PT interventions will also be conducted.

The Annals of Thoracic Surgery, 2004

Background. The full kallikrein-inhibiting dose of aprotinin has been shown to reduce blood loss,... more Background. The full kallikrein-inhibiting dose of aprotinin has been shown to reduce blood loss, transfusion requirements, and the systemic inflammatory response associated with cardiopulmonary bypass graft surgery (CABG). A half-dose regimen, although having a reduced delivery cost, inhibits plasmin and fibrinolysis without substantially effecting kallikrein-mediated inflammation associated with bypass surgery. The differing pharmacologic effects of the two regimens impact the decision-making process. The current study assessed the medical cost offset of full-dose and half-dose aprotinin from short-and long-term perspectives to provide a rational decision-making framework for clinicians.

Annals of Internal Medicine, 2010

Osteoarthritis is a leading cause of pain and disability, and self-management behaviors for osteo... more Osteoarthritis is a leading cause of pain and disability, and self-management behaviors for osteoarthritis are underutilized. To examine the effectiveness of a telephone-based self-management intervention for hip or knee osteoarthritis in a primary care setting. Randomized clinical trial with equal assignment to osteoarthritis self-management, health education (attention control), and usual care control groups. (ClinicalTrials.gov registration number: NCT00288912) Primary care clinics in a Veterans Affairs Medical Center. 515 patients with symptomatic hip or knee osteoarthritis. The osteoarthritis self-management intervention involved educational materials and 12 monthly telephone calls to support individualized goals and action plans. The health education intervention involved nonosteoarthritis educational materials and 12 monthly telephone calls related to general health screening topics. The primary outcome was score on the Arthritis Impact Measurement Scales-2 pain subscale (range, 0 to 10). Pain was also assessed with a 10-cm visual analog scale. Measurements were collected at baseline and 12 months. 461 participants (90%) completed the 12-month assessment. The mean Arthritis Impact Measurement Scales-2 pain score in the osteoarthritis self-management group was 0.4 point lower (95% CI, -0.8 to 0.1 point; P = 0.105) than in the usual care group and 0.6 point lower (CI, -1.0 to -0.2 point; P = 0.007) than in the health education group at 12 months. The mean visual analog scale pain score in the osteoarthritis self-management group was 1.1 points lower (CI, -1.6 to -0.6 point; P < 0.001) than in the usual care group and 1.0 point lower (CI, -1.5 to -0.5 point; P < 0.001) than in the health education group. Health care use did not differ across the groups. The study was conducted at 1 Veterans Affairs Medical Center, and the sample consisted primarily of men. A telephone-based osteoarthritis self-management program produced moderate improvements in pain, particularly compared with a health education control group. U.S. Department of Veterans Affairs Health Services Research and Development Service.

Data Revues 00029378 V195i4 S0002937806002262, Aug 19, 2011

Objective: The purpose of this study was to quantify the total direct cost to the US health care ... more Objective: The purpose of this study was to quantify the total direct cost to the US health care system for the management of uterine leiomyomas. Study design: We used Center for Disease Control heath care databases for estimates of inpatient care, ambulatory care, and outpatient care of leiomyomas. With International Classification of Diseases-9 codes for fibroid tumors and fibroid-related conditions, all fibroid-related care was identified in each database. Inpatient and ambulatory surgical cases were stratified by surgical procedure, and outpatient clinical cases were categorized by type of visit and health care provider. With the use of Medicare's RBRVU reimbursement rates for 2000 as a proxy for the cost of physician services and Medicare diagnostic-related group reimbursement as a proxy for facility costs, the total direct cost to the US health care system for the care of fibroid tumors was estimated. Results: Total direct cost to treat uterine fibroid tumors was estimated at $2,151,484,847. Most of the cost was due to inpatient care, in particular, hysterectomy. Conclusion: Uterine fibroid tumors consume a significant amount of health care resources in the United States. Ó 2006 Mosby, Inc. All rights reserved.

Journal of Substance Abuse Treatment, 2016

Quality Enhancement Research Initiative's (QUERI's) Evidence-based Synthesis Program (ESP) was es... more Quality Enhancement Research Initiative's (QUERI's) Evidence-based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to Veterans Affairs (VA) managers and policymakers, as they work to improve the health and healthcare of Veterans. The ESP disseminates these reports throughout VA.

The American Heart Journal, Jan 3, 2009

Background Less than one third of the 65 million Americans with hypertension have adequate blood ... more Background Less than one third of the 65 million Americans with hypertension have adequate blood pressure (BP) control. This study examined the effectiveness of 2 interventions for improving patient BP control.

Physical therapy, Jan 19, 2015

Efficient approaches are needed for delivering non-pharmacological interventions for knee osteoar... more Efficient approaches are needed for delivering non-pharmacological interventions for knee osteoarthritis (OA). This trial compared group-based vs. individual physical therapy (PT) interventions for knee OA. 320 patients with knee OA at the VA Medical Center in Durham, NC (mean age = 60 years, 88% male; 58% non-white) were randomized to either the group intervention (GPT; six one-hour sessions, typically eight participants / group) or the individual intervention (IPT; two one-hour sessions). Both programs included instruction in home exercise, joint protection techniques and individual physical therapist evaluation. The primary outcome was the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC; range 0-96, higher scores indicate worse symptoms), measured at baseline, 12 weeks and 24 weeks. The secondary outcome was the Short Performance Physical Battery (SPPB; range 0-12, higher scores indicate better performance), measured at baseline and 12 weeks. Linear mixed m...

JAMA dermatology, Jan 16, 2015

The costs and utility of teledermatology are important features of implementation. Such an analys... more The costs and utility of teledermatology are important features of implementation. Such an analysis requires a description of the perspective of the entity that will bear the cost. To assess the costs and utility of a store-and-forward teledermatology referral process compared with a conventional referral process from the perspectives of the Department of Veterans Affairs (VA) and society. Three hundred ninety-one randomized participants were referred from remote sites of primary care to the dermatology services of 2 VA medical facilities for ambulatory skin conditions from December 2008 through June 2010, and follow-up was completed in March 2011. The time trade-off utility measures and costs were collected during a 9-month period among participants in a 2-site parallel group randomized clinical trial. The perspectives of the VA and society were evaluated. The multiple imputation procedure or weighted means were used for missing data elements. Data were analyzed from January to Jul...