Jennifer Hemler - Academia.edu (original) (raw)

Papers by Jennifer Hemler

Academic Pediatrics, Jul 1, 2023

Context: The IOM, NCI and professional organizations have endorsed an active role for primary car... more Context: The IOM, NCI and professional organizations have endorsed an active role for primary care in the care of individuals with a history of cancer. While primary care has not adopted this role widely, innovations in survivorship care delivery have emerged in recent years. Objective: To describe emerging forms of primary care survivorship care delivery.

Journal of Clinical Oncology

e24040 Background: Although healthcare leaders in the US support an active role for primary care ... more e24040 Background: Although healthcare leaders in the US support an active role for primary care (PC) in the care of patients with a history of breast cancer, the nature of this role remains unclear. Methods: We invited 40 innovators in breast cancer survivorship care to participate in a 4-round online Delphi panel to identify strategies for defining and fostering PC’s role in breast cancer survivorship. Innovators included primary care physicians, oncologists, researchers and policy makers from government and professional organizations participating in survivorship care programs in the US. Round 1 elicited strategies for improving PC’s role in survivorship care. To reduce the number of strategies and participant burden in subsequent rounds, Round 2 asked panelists to prioritize the top 10 strategies they perceived to be most crucial for implementation. Round 3 asked panelists to assess the importance and feasibility of the previously ranked strategies on a 1 -9 scale. In the final ...

Patient Education and Counseling

Cancer research (not screening)

Journal of the American Board of Family Medicine, Sep 16, 2022

ERIC strategy names and definitions. (DOCX 52 kb)

Example from a single cooperativeâ s table of interventions. (DOCX 23 kb)

Context: Improving health care quality in small-to-medium-size primary care practices, where the ... more Context: Improving health care quality in small-to-medium-size primary care practices, where the majority of Americans receive care, is a national priority, but little is known about these practices\u27 ability to use quality improvement (QI) strategies to deliver high quality care. Objective: To examine variations in the use of QI strategies across small-to-medium primary care practices and to assess practice-level factors associated with variations. Design: Cross-sectional study. Multivariable linear regression was used to examine the independent relationship between practice characteristics and the use of QI strategies as measured by the strategies scale of the Change Process Capability Questionnaire (CPCQ), a validated instrument designed to measure practice use of QI strategies. Setting: Data from 1,091 small-to-medium-size practices (≤10 clinicians) in 12 US states engaged in a national initiative to improve quality of care for heart health. Participants: Survey of practice leaders to assess practices characteristics and use of improvement strategies. Results: Of the practices surveyed, 84% had 10 or fewer clinicians, 21% had experienced multiple disruptive changes in the prior year, and most had meaningful use-certified electronic health records. Mean CPCQ strategies score was 8.6 (range -28 to +28, SD=12.2). Mean CPCQ scores were higher for practices that were part of accountable care organizations (+2.06, p=0.006) or had participated in demonstration projects (+1.59, p=0.04). Also, practices that discussed clinical quality data during meetings, that had someone in practice to configure EHR quality reports, and that had produced quality reports at least once in the prior six months had higher CPCQ strategies scores. Practices experiencing major disruptive changes had lower mean CPCQ scores (-3.0, p=0.001). Conclusion: Use of QI strategies varied greatly among small-to-medium-size primary care practices. Findings suggest that strengthening organizational makeup, increasing practice EHR capabilities and reducing organizational disruption could enhance the quality of care delivered by small-to-medium-size practic

American journal of medical quality : the official journal of the American College of Medical Quality, 2017

Engaging primary care practices in initiatives designed to enhance quality, reduce costs, and pro... more Engaging primary care practices in initiatives designed to enhance quality, reduce costs, and promote safety is challenging as practices are already participating in numerous projects and mandated programs designed to improve care delivery and quality. Recruiters must expand their recruitment tools to engage today's practices in quality improvement. Using grant proposals, online diaries, observational site visits, and interviews with key stakeholders, the authors identify successful practice recruitment strategies in the EvidenceNOW initiative, which aimed to recruit approximately 1500 small- to medium-sized primary care practices. Recruiters learned they needed to articulate how participation in EvidenceNOW aligned with other initiatives and could help practices succeed with federal and state initiatives, recognition programs, and existing or future payment requirements. Recruiters, initiative leaders, and funders must now consider how their efforts align with ongoing initiativ...

Translational Behavioral Medicine, 2012

Survivor care plans have been described as useful tools for enhancing the quality of follow-up ca... more Survivor care plans have been described as useful tools for enhancing the quality of follow-up care that cancer survivors receive after their active treatment has been completed. The relative success of current survivor care plan models is strongly dependent on the actions of individual patients. In this qualitative study of 33 cancer survivors, we explored patients' understanding of follow-up care and their motivations and resources for seeking care. Three types of survivor experiences were identified from narratives of patients treated in community oncology and National Cancer Institutedesignated comprehensive cancer centers, ranging from nonactivated patients who need enhanced health care communication and decision support to navigate their care to highly activated patients adept at navigating complex health care settings. Using the patient-centered medical home as a conceptual framework, we propose a research, policy, and practice agenda that advocates for multifaceted decision support to enhance cancer survivorship and follow-up care.

Krankheitskonstruktionen und Krankheitstreiberei, 2013

“Compulsive shopping” is not listed in the DSM, the Diagnostic and Statistical Manual of Mental D... more “Compulsive shopping” is not listed in the DSM, the Diagnostic and Statistical Manual of Mental Disorder, widely held by psychiatrists and mental health practitioners in the U.S. as “the bible” for diagnosing mental illness.

Obesity, 2012

Obese women are at increased risk of developing and dying from cancer, but are less likely than n... more Obese women are at increased risk of developing and dying from cancer, but are less likely than non-obese women to receive cancer screening examinations. Our qualitative study explores obese women's barriers to Pap smears and mammograms in greater depth than previous research. We also seek to understand why some obese women undergo screening while others do not. A purposive sample of moderately to severely obese women over age 40 was recruited from community-based organizations, health clinics, and retail establishments. Semi-structured in-depth interviews (N=33) informed by the Theory of Care-Seeking Behavior and three prior focus groups of obese women (N=18) were recorded and transcribed. Qualitative analysis was iterative, using a grounded theory approach involving a series of immersion/crystallization cycles. Participants verified many barriers to cervical and breast cancer screening previously identified in the general population, including fear, modesty, competing demands, and low perceived risk. Participants also highlighted several weight-related barriers, including insensitive comments about weight, and equipment and gowns that could not accommodate them. Comparison of participants who were up-to-date with both Pap smears and mammograms with those not up-to-date with either screening showed no discernable differences in these barriers, however. Instead, we found that the participants who followed through on their cancer screenings may share certain personality traits, such as conscientiousness or self-regulatory ability, that allow them to complete difficult or feared tasks. Our research therefore suggests that personality may act as an important mediator in health Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:

The Journal of the American Board of Family Medicine, 2012

Background: Physician recommendation is one of the strongest, most consistent predictors of color... more Background: Physician recommendation is one of the strongest, most consistent predictors of colorectal cancer (CRC) screening. Little is known regarding characteristics associated with patient adherence to physician recommendations in community and academic based primary care settings. Methods: Data were analyzed from 975 patients, aged >50 years, recruited from 25 primary care practices in New Jersey. Chi-square and generalized estimate equation analyses determined independent correlates of receipt of and adherence to physician recommendation for CRC. Results: Patients reported high screening rates for CRC (59%). More than three fourths of patients reported either screening or having received a screening recommendation (82%). Men (P ‫؍‬ .0425), nonsmokers (P ‫؍‬ .0029), and patients who were highly educated (P ‫؍‬ .0311) were more likely to receive a CRC screening recommendation. Patients more adhere to CRC screening recommendations were older adults (P < .0001), nonsmokers (P ‫؍‬ .0005), those who were more highly educated (P ‫؍‬ .0365), Hispanics (P ‫؍‬ .0325), and those who were married (P < .0001). Conclusions: Community and academic primary care clinicians appropriately recommended screening to high-risk patients with familial risk factors. However, they less frequently recommended screening to others (ie, women and smokers) also likely to benefit. To further increase CRC screening, clinicians must systematically recommend screening to all patients who may benefit. (J Am Board Fam Med 2012;25:782-791.

The Annals of Family Medicine, 2012

BACKGROUND Nearly one-third of offi ce visits for cancer are handled by primary care physicians. ... more BACKGROUND Nearly one-third of offi ce visits for cancer are handled by primary care physicians. Yet, few studies examine patient perspectives on these physicians' roles in their cancer follow-up care or their care preferences. METHODS We explored survivor preferences through qualitative, semistructured, in-depth interviews drawing on patients recruited from 2 National Cancer Institute-designated comprehensive cancer centers and 6 community hospitals. We recruited a purposive sample of early-stage breast and prostate cancer survivors aged 47 to 80 years, stratifi ed by age, race, and length of time from and location of cancer treatment. Survivors were at least 2 years beyond completion of their active cancer treatment RESULTS Forty-two survivors participated in the study. Most participants expressed strong preferences to receive follow-up care from their cancer specialists (52%). They described the following barriers to the primary care physician's engagement in follow-up care: (1) lack of cancer expertise, (2) limited or no involvement with original cancer care, and (3) lack of care continuity. Only onethird of participants (38%) believed there was a role for primary care in cancer follow-up care and suggested the following opportunities: (1) performing routine cancer-screening tests, (2) supplementing cancer and cancer-related specialist care, and (3) providing follow-up medical care when "enough time has passed" or the survivors felt that they could reintegrate into the noncancer population. CONCLUSION Survivors have concerns about seeing their primary care physician for cancer-related follow-up care. Research interventions to address these issues are necessary to enhance the quality of care received by cancer survivors.