Browsing by Author "Wang, Hao"
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Item A Multi-Level Analysis of Individual and Neighborhood Factors Associated with Patient Portal Use among Adult Emergency Department Patients with Multimorbidity(MDPI, 2023-01-22) Wang, Hao; Shen, Chan; Barbaro, Michael; Ho, Amy F.; Pathak, Mona; Dunn, Cita; Sambamoorthi, UshaBACKGROUND: Patient portals tethered to electronic health records (EHR) have become vital to patient engagement and better disease management, specifically among adults with multimorbidity. We determined individual and neighborhood factors associated with patient portal use (MyChart) among adult patients with multimorbidity seen in an Emergency Department (ED). METHODS: This study adopted a cross-sectional study design and used a linked database of EHR from a single ED site to patients' neighborhood characteristics (i.e., zip code level) from the American Community Survey. The study population included all adults (age > 18 years), with at least one visit to an ED and multimorbidity between 1 January 2019 to 31 December 2020 (N = 40,544). Patient and neighborhood characteristics were compared among patients with and without MyChart use. Random-intercept multi-level logistic regressions were used to analyze the associations of patient and neighborhood factors with MyChart use. RESULTS: Only 19% (N = 7757) of adults with multimorbidity used the patient portal. In the fully adjusted multi-level model, at the patient level, having a primary care physician (AOR = 5.55, 95% CI 5.07-6.07, p < 0.001) and health insurance coverage (AOR = 2.41, 95% CI 2.23-2.61, p < 0.001) were associated with MyChart use. At the neighborhood level, 4.73% of the variation in MyChart use was due to differences in neighborhood factors. However, significant heterogeneity existed in patient portal use when neighborhood characteristics were included in the model. CONCLUSIONS: Among ED patients with multimorbidity, one in five adults used patient portals. Patient-level factors, such as having primary care physicians and insurance, may promote patient portal use.Item Association of multimorbidity with the use of health information technology(Sage Publications, 2023-05-01) Manning, Sydney E.; Wang, Hao; Dwibedi, Nilanjana; Shen, Chan; Wiener, R. Constance; Findley, Patricia A.; Mitra, Sophie; Sambamoorthi, UshaOBJECTIVE: To examine the association of multimorbidity with health information technology use among adults in the USA. METHODS: We used cross-sectional study design and data from the Health Information National Trends Survey 5 Cycle 4. Health information technology use was measured with ten variables comprising access, recent use, and healthcare management. Unadjusted and adjusted logistic and multinomial logistic regressions were used to model the associations of multimorbidity with health information technology use. RESULTS: Among adults with multimorbidity, health information technology use for specific purposes ranged from 37.8% for helping make medical decisions to 51.7% for communicating with healthcare providers. In multivariable regressions, individuals with multimorbidity were more likely to report general use of health information technology (adjusted odds ratios = 1.48, 95% confidence intervals = 1.01-2.15) and more likely to use health information technology to check test results (adjusted odds ratios = 1.85, 95% confidence intervals = 1.33-2.58) compared to adults with only one chronic condition, however, there were no significant differences in other forms of health information technology use. We also observed interactive associations of multimorbidity and age on various components of health information technology use. Compared to younger adults with multimorbidity, older adults (>/= 65 years of age) with multimorbidity were less likely to use almost all aspects of health information technology. CONCLUSION: Health information technology use disparities by age and multimorbidity were observed. Education and interventions are needed to promote health information technology use among older adults in general and specifically among older adults with multimorbidity.Item Can we use Decision Tools to predict Emergent Cardiac Testing and Outcomes among Chest Pain Patients placed in Emergency Department Observation Unit?(2016-03-23) Watson, Katherine; Umeijiego, Johnbosco; Hamblin, Layton; Hoang, Steven; Domanski, Kristina; Overstreet, Sterling; Akin, Amanda; Robinson, Richard; Krech, Ryan; Schrader, Chet; Stroder, Ryan; Leuck, JoAnna; Zenarosa, Nestor R.; Wang, HaoChest pain decision tools (HEART, GRACE, and TIMI) have been used to predict the risk of acute coronary syndrome and their major cardiac event outcomes (MACE) in many studies. However, their use to predict emergent cardiac testing is limited in Emergency Medicine Observation Unit (EDOU) patients. This study aims to 1) identify the role of chest pain decision tools in determining emergent cardiac testing; and 2) further validate their use in the prediction of MACE among EDOU chest pain patients. This is a prospective observational study and included patients placed to EDOU due to chest pain. Cardiac testing included any exercise/dobutamine stress echo, exercise/regadenoson nuclear stress test, treadmill, or invasive coronary angiography. Objective stress testing were ordered by EDOU physician and invasive coronary angiography by cardiologists. All providers were blinded and ordered any cardiac testing at their own discretions. HEART, GRACE, and TIMI scores were calculated and categorized as low or above-low risks. Patients followed up at 6 months upon the index discharge. Results of cardiac testing, EDOU length of stay (LOS), and MACE at 6 months were analyzed and compared with different decision tools. ANOVA was used to compare groups with continuous data and Chi square test was used for categorical data. From 01-2014 until 06-2015, 986 total patients were enrolled. Emergent cardiac testing was performed on 62% of patients. Majority of patients placed to EDOU were deemed low risk by any of the decision tools (85% by HEART, 81% by GRACE, and 80% by TIMI) which also had low abnormal cardiac testing results than patients with above-low risks, especially when HEART tool was used. Average LOS was 33h in patients with emergent cardiac testing versus 26h without. In all low risk patients, the occurrence of MACE in 6 month showed no significant difference regardless of whether cardiac testing was done emergently or not (MACE of 0.31% in low risk HEART patients without versus 0.97% with emergent cardiac testing during index admission, 0.27% versus 0.95% in TIMI, and 0% versus 0.81% in GRACE, p [greater than] 0.05). Using chest pain decision tools may minimize the emergent cardiac testing need among EDOU patients withItem Coronavirus disease 2019 pandemic associated with anxiety and depression among Non-Hispanic whites with chronic conditions in the US(Elsevier B.V., 2022-02-22) Wang, Hao; Paul, Jenny; Ye, Ivana; Blalock, Jake; Wiener, R. Constance; Ho, Amy F.; Alanis, Naomi; Sambamoorthi, UshaOBJECTIVES: During the coronavirus 2019 (COVID-19) pandemic, increased anxiety and depression were reported, with mixed findings among individuals of different races/ethnicities. This study examines whether anxiety and depression increased during the COVID-19 pandemic compared to the pre-COVD-19 period among different racial/ethnic groups in the US. METHODS: The Health Information National Trend Surveys 5 (HINTS 5) Cycle 4 data was analyzed. We used the time when the survey was administered as the pre-COVID-19 period (before March 11, 2020, weighted N = 77,501,549) and during the COVID-19 period (on and after March 11, 2020, weighted N = 37,222,019). The Patient Health Questionnaire (PHQ) was used to measure anxiety/depression and further compared before and during COVID-19. Separate multivariable logistic regression analyses were used to determine the association of the COVID-19 pandemic with anxiety/depression after adjusting for age, sex, insurance, income, and education. RESULT: A higher percentage of Non-Hispanic whites (NHW) with chronic conditions reported anxiety (24.3% vs. 11.5%, p = 0.0021) and depression (20.7% vs. 9.3%, p = 0.0034) during COVID-19 than pre-COVID-19. The adjusted odds ratio (AOR) of anxiety and depression for NHWs with chronic conditions during the COVID-19 pandemic was 2.02 (95% confidence interval of 1.10-3.73, p = 0.025) and 2.33 (1.17-4.65, p = 0.018) compared to NHWs who participated in the survey before the COVID-19. LIMITATIONS: Limited to the NHW US population. PHQ can only be used as the initial screening tool. CONCLUSION: The COVID-19 pandemic was associated with an increased prevalence of anxiety and depression among NHW adults with chronic conditions, but not among people of color.Item Coronavirus Disease 2019 Pandemic Associated with Depression among Non-Hispanic Whites with Chronic Conditions in the United States(2022) Paul, Jenny; Wang, Hao; Ye, IvanaPurpose: During the coronavirus 2019 (COVID-19) pandemic, increased depression was reported, with mixed findings among individuals of different races and ethnicities. This study examines whether depression increased during the COVID-19 pandemic compared to the pre-COVD-19 period among different racial and ethnic groups in the United States. Methods: A cross-sectional analysis of secondary data from the National Cancer Institute's Health Information National Trend Surveys 5 (HINTS 5) Cycle 4 was conducted. Survey responses were separated into two groups based on date of response; a pre-COVID-19 cohort (before March 11, 2020, weighted N = 77,501,549) and a COVID-19 cohort (on and after March 11, 2020, weighted N = 37,222,019). The Patient Health Questionnaire (PHQ) was used to measure depression and results were further compared before and during COVID-19. Separate multivariable logistic regression analyses were used to determine the association of the COVID-19 pandemic depression after adjusting for age, sex, insurance, income, and education. Results: A higher percentage of Non-Hispanic Whites (NHW) with chronic conditions reported depression (20.7% vs. 9.3%, p=0.0034) during COVID-19 than pre-COVID-19. The adjusted odds ratio (AOR) of depression for NHWs with chronic conditions during the COVID-19 pandemic was 2.33 (1.17-4.65, p=0.018) compared to NHWs who participated in the survey before the COVID-19. Conclusions: The COVID-19 pandemic was associated with an increased prevalence of depression among NHW adults with chronic conditions, but not among people of color.Item Increase in body mass index during the COVID-19 pandemic among people who smoke: An analysis of multi-site electronic health records(PLOS, 2023-04-12) Wiener, R. Constance; Waters, Christopher; Morgan, Emily; Findley, Patricia A.; Shen, Chan; Wang, Hao; Sambamoorthi, UshaThe effects of the COVID-19 period among people who smoke (compared by sex) are largely unknown. The purpose of this study was to compare body mass index (BMI) increase among men and women who smoked during the pandemic. We used a retrospective longitudinal, observational study design of secondary data. We used electronic health records from TriNetX network (n = 486,072) from April 13, 2020-May 5, 2022 among adults aged 18-64 who smoked and had a normal BMI prior to the pandemic. The main measure was a change of BMI from < 25 to >/=25. Risk ratio was determined between men and women with propensity score matching. Overall, 15.8% increased BMI to >/=25; 44,540 (18.3%) were women and 32,341 (13.3%) were men (Risk Ratio = 1.38, 95% CI: 1.36, 1.40; p < .0001). Adults with diabetes, hypertension, asthma, COPD or emphysema or who were women, were more likely to develop BMI>/=25 during the pandemic. Women who smoked were more likely to have an increase in BMI than men who smoked during the COVID-19 period.Item Multi-Institutional Controlled Trial Comparing the Patient-Perceived Empathic Behavior of EM Residents(2020) D'Etienne, James; Alanis, Naomi; Kao, Jeremy; Singh, Jatinder; Fernandez, Chloe; Bell, Charles; Sunderji, Aman; Wombwell, Tamsyn; Pettit, Katie; Kline, Jeffrey; Wang, HaoPurpose: The ED poses multiple challenges to physician empathy including rapid pace, lack of privacy, frequent interruptions, the absence of pre-existing relationships between patients and providers, and the possibility of patients having a general distrust of providers. The goal of this project is to test the effectiveness of an educational intervention to improve patient perception of resident physician empathy and trust in the emergency department (ED) setting. Methods: Patient-participants were given The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and the Trust in Physicians Scale (TIPS). There were 6 participating institutions; 3 were the intervention institutions and 3 which were control institutions. JPS was one of the control institutions. Results: This study suggests that the intervention provided no effect in terms of patient perceptions of physician empathy assessed using the JSPPPE but had a modest effect on perception of trust based upon TIPS measured 4-6 months later. An educational intervention on clinician empathy showed modest improvement in one of our primary outcomes as assessed by patients (TIPS). Conclusions: Although we were able to find only modestly significant improvements in patients perception of trust, we believe further work in this area will continue to show the benefit of empathy training for our patients and providers.Item Multimorbidity and chronic pain management with opioids and other therapies among adults in the United States: A cross-sectional study(Sage Publications, 2024-03-08) Neba, Rolake A.; Wang, Hao; Kolala, Misozi; Sambamoorthi, UshaBACKGROUND: Multimorbidity, defined as the concurrent presence of >/= 2 chronic conditions, and chronic pain (i.e., pain lasting >/=3 months) often co-exist. Multimodal pain management that includes non-pharmacologic treatment and non-opioid therapy is recommended to prevent serious risks associated with opioids. PURPOSE: Estimate the prevalence of types of pain treatment and analyze their associations with multimorbidity using a nationally representative survey in the United States (US). METHODS: Data was collected from the 2020 National Health Interview Survey among adults with chronic pain and chronic conditions (N= 12,028). Chronic pain management was grouped into four categories: opioid therapy; non-opioid multimodal pain treatment; pain treatment with monotherapy; and no pain treatment. Chi-square tests and multivariable multinomial logistic regressions were used to analyze the association of multimorbidity with types of pain treatment after controlling for age, sex, social determinants of health (SDoH), and lifestyle characteristics. RESULTS: Among NHIS respondents, 68% had multimorbidity. In adjusted multinomial logistic regressions with "pain management with monotherapy" as the reference group, those with multimorbidity were more likely to utilize opioids (AOR=1.63, 95% CI=1.23, 2.17). Those with severe pain were also more likely to use opioid therapy (AOR=19.36, 95% CI=13.35, 28.06) than those with little pain. Those with low income and education were less likely to have multimodal pain management without opioids. CONCLUSION: Seven in 10 adults had multimorbidity. Those with multimorbidity reported severe pain and relied on opioids for pain control. Regardless of multimorbidity status, SDoH was associated with types of chronic pain management.Item NeuroD4 converts glioblastoma cells into neuron-like cells through the SLC7A11-GSH-GPX4 antioxidant axis(Springer Nature, 2023-08-16) Wang, Hao; Zhao, Peiqi; Zhang, Ying; Chen, Zhen; Bao, Han; Qian, Wenqi; Wu, Jian; Xing, Zhenqiu; Hu, Xiaowei; Jin, Kunlin; Zhuge, Qichuan; Yang, JianjingCell fate and proliferation ability can be transformed through reprogramming technology. Reprogramming glioblastoma cells into neuron-like cells holds great promise for glioblastoma treatment, as it induces their terminal differentiation. NeuroD4 (Neuronal Differentiation 4) is a crucial transcription factor in neuronal development and has the potential to convert astrocytes into functional neurons. In this study, we exclusively employed NeuroD4 to reprogram glioblastoma cells into neuron-like cells. In vivo, the reprogrammed glioblastoma cells demonstrated terminal differentiation, inhibited proliferation, and exited the cell cycle. Additionally, NeuroD4 virus-infected xenografts exhibited smaller sizes compared to the GFP group, and tumor-bearing mice in the GFP+NeuroD4 group experienced prolonged survival. Mechanistically, NeuroD4 overexpression significantly reduced the expression of SLC7A11 and Glutathione peroxidase 4 (GPX4). The ferroptosis inhibitor ferrostatin-1 effectively blocked the NeuroD4-mediated process of neuron reprogramming in glioblastoma. To summarize, our study demonstrates that NeuroD4 overexpression can reprogram glioblastoma cells into neuron-like cells through the SLC7A11-GSH-GPX4 signaling pathway, thus offering a potential novel therapeutic approach for glioblastoma.Item Roles of disease severity and post-discharge outpatient visits as predictors of hospital readmissions(BioMed Central Ltd., 2016-10-10) Wang, Hao; Johnson, Carol; Robinson, Richard D.; Nejtek, Vicki A.; Schrader, Chet D.; Leuck, JoAnna; Umejiego, Johnbosco; Trop, Allison; Delaney, Kathleen A.; Zenarosa, Nestor R.BACKGROUND: Risks prediction models of 30-day all-cause hospital readmissions are multi-factorial. Severity of illness (SOI) and risk of mortality (ROM) categorized by All Patient Refined Diagnosis Related Groups (APR-DRG) seem to predict hospital readmission but lack large sample validation. Effects of risk reduction interventions including providing post-discharge outpatient visits remain uncertain. We aim to determine the accuracy of using SOI and ROM to predict readmission and further investigate the role of outpatient visits in association with hospital readmission. METHODS: Hospital readmission data were reviewed retrospectively from September 2012 through June 2015. Patient demographics and clinical variables including insurance type, homeless status, substance abuse, psychiatric problems, length of stay, SOI, ROM, ICD-10 diagnoses and medications prescribed at discharge, and prescription ratio at discharge (number of medications prescribed divided by number of ICD-10 diagnoses) were analyzed using logistic regression. Relationships among SOI, type of hospital visits, time between hospital visits, and readmissions were also investigated. RESULTS: A total of 6011 readmissions occurred from 55,532 index admissions. The adjusted odds ratios of SOI and ROM predicting readmissions were 1.31 (SOI: 95 % CI 1.25-1.38) and 1.09 (ROM: 95 % CI 1.05-1.14) separately. Ninety percent (5381/6011) of patients were readmitted from the Emergency Department (ED) or Urgent Care Center (UCC). Average time interval from index discharge date to ED/UCC visit was 9 days in both the no readmission and readmission groups (p > 0.05). Similar hospital readmission rates were noted during the first 10 days from index discharge regardless of whether post-index discharge patient clinic visits occurred when time-to-event analysis was performed. CONCLUSIONS: SOI and ROM significantly predict hospital readmission risk in general. Most readmissions occurred among patients presenting for ED/UCC visits after index discharge. Simply providing early post-discharge follow-up clinic visits does not seem to prevent hospital readmissions.Item The association of COVID-19 vaccine availability with mental health among adults in the United States(Frontiers Media S.A., 2022-08-09) Shen, Chen; Rashiwala, Lucy; Wiener, R. Constance; Findley, Patricia A.; Wang, Hao; Sambamoorthi, UshaObjective: To assess whether COVID-19 vaccine approval and availability was associated with reduction in the prevalence of depression and anxiety among adults in the United States. Methods: We adopted cross sectional and quasi-experimental design with mental health measurements before vaccine availability (June 2020, N = 68,009) and after vaccine availability (March 2021, N = 63,932) using data from Census Pulse Survey. Depression and anxiety were derived from PHQ-2 and GAD-2 questionnaires. We compared rates of depression and anxiety between June 2020 and March 2021. Unadjusted and adjusted analysis with replicate weights were conducted. Results: Depression prevalence was 25.0% in June 2020 and 24.6% in March 2021; anxiety prevalence was 31.7% in June 2020 and 30.0% in March 2021 in the sample. In adjusted analysis, there were no significant differences in likelihood of depression and anxiety between June 2020 and March 2021. Conclusion: Depression and anxiety were not significantly different between June 2020 and March 2021, which suggests that the pandemic effect continues to persist even with widespread availability of vaccines.Item The Association of Mobile Health Applications with Self-Management Behaviors among Adults with Chronic Conditions in the United States(MDPI, 2021-09-30) Wang, Hao; Ho, Amy F.; Wiener, R. Constance; Sambamoorthi, UshaBACKGROUND: Mobile applications related to health and wellness (mHealth apps) are widely used to self-manage chronic conditions. However, research on whether mHealth apps facilitate self-management behaviors of individuals with chronic conditions is sparse. We aimed to evaluate the association of mHealth apps with different types of self-management behaviors among patients with chronic diseases in the United States. METHODS: This is a cross-sectional observational study. We used data from adult participants (unweighted n = 2340) of the Health Information National Trends Survey in 2018 and 2019. We identified three self-management behaviors: (1) resource utilization using electronic personal health records; (2) treatment discussions with healthcare providers; and (3) making healthcare decisions. We analyzed the association of mHealth apps to self-management behaviors with multivariable logistic and ordinal regressions. RESULTS: Overall, 59.8% of adults (unweighted number = 1327) used mHealth apps. Adults using mHealth apps were more likely to use personal health records (AOR = 3.11, 95% CI 2.26-4.28), contact healthcare providers using technology (AOR = 2.70, 95% CI 1.93-3.78), and make decisions on chronic disease management (AOR = 2.59, 95% CI 1.93-3.49). The mHealth apps were associated with higher levels of self-management involvement (AOR = 3.53, 95% CI 2.63-4.72). CONCLUSION: Among individuals with chronic conditions, having mHealth apps was associated with positive self-management behaviors.