Annual Spending per Patient and Quality in Hospital-Owned Versus Physician-Owned Organizations: an Observational Study.

BACKGROUND: Recent studies that compared patient spending in hospital-owned physician practices versus physician-owned groups did not compare quality of care. Past studies had incomplete measures of physician-hospital integration, or lacked patient-level data. OBJECTIVE: To measure the association between physician-hospital integration and both spending and quality using patient-level data and explicit physician-hospital contracting information. DESIGN: Retrospective review of claims data from 2014 through 2016. Adjustments were made for patient, physician, and regional characteristics. PATIENTS: Patients aged 19 to 64 enrolled in a Blue Cross Blue Shield Texas Preferred Provider Organization in the four largest metropolitan areas in Texas who could be attributed to a physician practice based on claims. MAIN OUTCOMES AND MEASURES: Annual spending per patient was compared for patients treated by a physician practice that is billing through a hospital, versus billing through an independent physician practice; spending was also subdivided by BETOS category, by site and type of care, and percent of patients with positive spending by subcategory. Quality measures included readmission within 30 days of discharge for hospitalized patients, appropriate care for diabetic patients, and screening mammography for women ages 50-64. RESULTS: Estimates suggest that patients in a preferred provider organization incur spending which is 5.8 percentage points higher when treated by doctors in hospital-owned versus physician-owned practices (95% CI 1.7 to 9.9; p = 0.006). Spending is significantly higher for durable medical equipment, imaging, unclassified services, and outpatient care. The spending difference appears attributable to greater service utilization rather than higher prices. There was no consistent difference in care quality for hospital-owned versus physician-owned practices. CONCLUSIONS AND RELEVANCE: We find that financial integration between physicians and hospitals raises patient spending, but not care quality. Given that higher spending raises the price of health insurance, policy makers should carefully consider policies that limit consolidation of hospitals and physicians.

Comparison of basiliximab vs antithymocyte globulin for induction in pediatric heart transplant recipients: An analysis of the International Society for Heart and Lung Transplantation database.

This study aims to compare 2 common induction strategies, basiliximab and ATG. Analysis of the ISHLT transplant registry was performed. The database was queried for pediatric heart transplants from January 1, 2000, to June 30, 2015, who had received induction with basiliximab or ATG. Primary end-point was graft survival. Secondary end-points included 1-year survival and 1-year conditional survival. There were 3158 heart transplants who received induction with basiliximab or ATG. The ATG cohort was younger, more likely to have congenital heart disease or be a retransplant, have a higher PRA, longer ischemic time, and been transplanted earlier in the study period (all P<.01). There was no difference in graft loss in the basiliximab cohort compared to the ATG cohort (HR 1.18 P=.06). On conditional 1-year survival analysis, basiliximab induction was associated with graft loss (HR=1.35 95% CI 1.1-1.7, P<.01), and in the propensity-matched cohort, the basiliximab cohort was more likely to experience rejection prior to discharge (P=.04). Infection prior to discharge was more common in the antithymocyte cohort. Induction with ATG is associated with improved late graft survival compared to basiliximab.

Alemtuzumab (Campath-1H) therapy for refractory rejections in pediatric heart transplant recipients.

Despite substantial improvements in survival after pediatric heart transplantation, refractory rejection remains a major cause of morbidity and mortality. We have utilized ALE (Campath-1H) in six consecutive patients with refractory rejection. These rejection episodes persisted despite conventional treatment, which included intravenous methylprednisolone, rituximab, immunoglobulin G, and antithymocyte globulin. In our series, after ALE therapy, LV SF increased from 22%±5% to 33%±5% (P=.01). However, in our series, ALE therapy neither led to persistent LV function recovery nor could it prevent subsequent antibody-mediated rejection.

Interaction of light quality and fertility on biomass, shoot pigmentation and xanthophyll cycle flux in Chinese kale.

BACKGROUND: Nutritionally important carotenoids in 21-day-old brassica microgreens increase following short and long-term exposure to narrow-band wavelengths from light-emitting diodes (LED). The present study aimed to measure the impact of: (1) fluorescent/incandescent light and different percentages of blue/red LED light and (2) different levels of nutrient fertility on biomass and pigment concentrations in 30-day-old 'Green Lance' Chinese kale (Brassica oleracea var. alboglabra). Kale plants were exposed to four light treatments and two fertility levels and were harvested 30 days after seeding and analyzed for nutritionally important shoot pigments. RESULTS: Kale under the fluorescent/incandescent light treatment had a significantly higher shoot fresh and dry mass. The shoot tissue concentrations of most pigment were significantly higher under blue/red LED light treatments. The higher fertility level resulted in higher concentrations for most pigments. Interestingly, the pool of xanthophyll cycle pigments and de-epoxidized xanthophylls was higher under all LED treatments. CONCLUSION: The results obtained in the present study support previous data demonstrating the stimulation of nutritionally important shoot tissue pigment concentrations following exposure to sole source blue/red LEDs compared to traditional lighting. Xanthophyll cycle flux was impacted by LEDs and this may support the role of zeaxanthin in blue light perception in leafy specialty crops. © 2016 Society of Chemical Industry.

Leaf yield and mineral content of mizuna in response to cut-and-come-again harvest, substrate particle size, and fertilizer formulation in a simulated spaceflight environment.

The Veggie plant-growth unit deployed onboard the International Space Station (ISS) grows leafy vegetables to supplement crew diets. "Cut-and-come-again" harvests are tested to maximize vegetative yield while minimizing crew time. Water, oxygen, and fertilizer delivery to roots of leafy greens growing in microgravity have become the center of attention for Veggie. Current Veggie technology wicks water into particulate root substrates incorporating controlled-release fertilizer (CRF). Mizuna mustard (Brassica rapa) was grown under ISS-like environments in ground-based Veggie-analogue units comparing crop response to combinations of two different substrate particle sizes, two different fertilizer formulations, and three leaf-harvest times from each plant. Fine-particle porous ceramic substrate (Profile©) was compared with a 40:60 mix of fine-particle porous ceramic Profile© + coarse porous ceramic Turface© substrate. Identical 18-6-8 (NPK) CRF formulations consisting of [50% fast-release (T70) + 50% intermediate-release (T100) prills] vs. [50% fast-release (T70) + 50% slow-release (T180) prills] were incorporated into each substrate, and leaf tissues were harvested from each treatment combination at 28, 48, and 56 days after sowing. The combination of T100 CRF in 100% Profile© substrate gave the highest fresh mass (FM) and leaf area (LA) across harvests, whereas T180 CRF in 40% Profile© gave the lowest. Dry-mass (DM) yields varied with effects on leaf area. Tissue nitrogen (N) and potassium (K) specific contents declined across harvests for all treatment combinations but tended to be highest for T100 CRF/100% Profile©, and lowest for T180 CRF/40% Profile©. These major macronutrients were taken up faster by roots growing in small particle-size substrate incorporating intermediate-rate CRF, but also were depleted faster from the same treatment combination, suggesting it may not continue to be the best combination for additional harvests. Micronutrients did not decline in tissue specific content across treatment combinations, but manganese (Mn) accumulated in leaf tissue across treatments and apparently comes mainly from the ceramic substrate, regardless of particle size. Substrate leachate analysis following final harvest indicated that pH remained in the range for nominal availability of mineral nutrients for root uptake, but electro-conductivity measurements suggested depletion of fertilizer salts from root zones, especially from the treatment combination supporting the highest yields and major macronutrient contents. Although 100% Profile© was the better growth substrate for mizuna in combination with intermediate-rate CRF and three cut-and-come-again harvests in ground-based studies, mixed-particle-size substrates may be a better choice for plant growth under microgravity conditions, where capillary forces predominant and tend to cause saturation of a fine medium with water. Since there were no statistically significant interactions between substrate and fertilizer in this study, our ground-based findings for CRF choice should translate to the best substrate choice for microgravity, but if NASA wants to consider additional cut-and-come-again harvests from the same mizuna plants, more complex CRF formulations likely will have to be investigated.

Close-canopy lighting, an effective energy-saving strategy for overhead sole-source LED lighting in indoor farming.

Significant advancement has been achieved improving electrical efficiency and photon efficacy of light-emitting diodes (LEDs) as the sole source of crop lighting for indoor farming. However, a significant portion of highly efficient photon emissions from improved LEDs is wasted by natural beam spread beyond cropping areas. Additional attention is needed to enhance crop-canopy photon capture efficiency (CCPCE), the fraction of photons emitted from LEDs actually incident upon foliar canopies. We postulate that by taking advantage of unique physical properties of LEDs, such as low radiant heat at photon-emitting surfaces and dimmable photon emissions, reduced vertical separation distance between light-emitting surfaces and light-receiving surfaces will enhance CCPCE by capturing more obliquely emitted photons that otherwise are lost. This "close-canopy-lighting" (CCL) strategy was tested in two ways: For an energy-efficiency strategy, LEDs were dimmed to the same photosynthetic photon flux density (PPFD) of 160 µmol m-2 s-1 at 45-, 35-, 25-, and 15-cm separation distances between lamps and cropping surfaces. For a yield-enhancement strategy, dimming was not applied, so higher PPFDs occurred at each separation distance closer than 45 cm for the same input energy. In the first strategy, the same biomass of lettuce (Lactuca sativa L. cv. Rouxai) was produced at each separation distance, while significantly lower energy was expended for lighting at each closer separation. Significantly higher biomass was produced at reduced separation distances with the same energy expenditure by LEDs using the yield-enhancement strategy. For both strategies, energy-utilization efficiency (g/kWh) doubled at the closest separation distance of 15 cm compared to the standard 45-cm separation distance. Even higher energy-utilization efficiency was achieved at a 25-cm separation distance when growth compartments were enclosed with a reflective curtain in the yield-enhancement strategy. Our findings suggest that CCL is a highly effective energy-saving strategy for overhead LED lighting, suggesting the need for innovative next-generation re-design of height-adjustable LED mounts and controlled air movement between tiers of indoor farms utilizing CCL.

Enhancing learning through an interprofessional project competition.

This article describes the process of using an interprofessional team project to address one of the most commonly occurring challenges in health care delivery--medication reconciliation. We describe the planning and execution of the process and the lessons learned from the experience. The intent of this article is to document the significance of each process and the importance of each member involved in the process, and to act as a guideline for institutions planning similar interprofessional team project experiences for students.

Comparison of two controlled-release fertilizer formulations for cut-and-come-again harvest yield and mineral content of Lactuca sativa L. cv. Outredgeous grown under International Space Station environmental conditions.

Red Romaine leaf lettuce (Lactuca sativa L. cv. Outredgeous) was grown in ground-based analogues of the Veggie plant-growth units used to grow salad vegetables for astronauts on the International Space Station (ISS). Plants were grown for 56 days with three "cut-and-come again" leaf harvests from the same plants. Six Biomass-Production-Systems-for-Education (BPSe) units were used to grow 'Outredgeous' ('OR') lettuce in a walk-in growth chamber under temperature, humidity, and LED-lighting conditions similar to those occurring in Veggie on ISS. Because of the ISS micro-gravity environment, both Veggie and ground-based BPSe units utilize one-way capillary wicking of water into an arcillite clay root substrate. In the present study, two different controlled-release fertilizer (CRF) formulations incorporated into the arcillite were compared for effects on 'OR' growth rate, overall yield, and mineral content of leaves harvested from the same plants 28, 48, and 56 days after planting. Both CRF treatments had a rapid-releasing T70 component that kept growth rate equivalent over the first two harvests. Growth rate for both CRF treatments increased from the first to the second harvest, but then declined from the second to the third harvest, more so for the slower-releasing T180 CRF than for the moderately-releasing T100 CRF. Tissue content of the macro-nutrients N, P, and K declined at each harvest for both CRFs, while content of the micro-nutrients B, Zn, and Mn increased. Although pH did not go out of the nominal range for availability of mineral nutrients to roots over the cropping cycle, and electrical-conductivity of rootzone salts was neither excessive nor depleted, tissue macronutrient depletion and micro-nutrient accumulation may have contributed to yield declines. Although either CRF formulation can support adequate yield of 'OR' lettuce over a 56-day period, the moderately-releasing T100 formulation tends to give slightly higher yield, especially during the last growth increment, and with non-deficient mineral content.

Building and Advancing Coalition Capacity to Promote Health Equity: Insights from the Health Equity Collective's Approach to Addressing Social Determinants of Health.

This article presents the structure and function of the Health Equity Collective in developing a systemic approach to promoting health equity across the Greater Houston area. Grounded in Kania and Kramer's five phases of collective impact for coalition building, The Collective operationalizes its mission through its backbone team, steering committees, and eight workgroups; each has goals that mutually reinforce and advance its vision. To date, Phase I (generating ideas), Phase II (initiating action), and Phase III (organizing for impact) have been completed. Phases IV (implementation) and Phase V (sustainability) are currently underway.

Growth and photosynthetic responses of Chinese cabbage (Brassica rapa L. cv. Tokyo Bekana) to continuously elevated carbon dioxide in a simulated Space Station "Veggie" crop-production environment.

Among candidate leafy vegetable species initially considered for astronauts to pick and eat from the Veggie plant-growth unit on the International Space Station (ISS), Chinese cabbage (Brassica rapa L. cv. Tokyo Bekana) ranked high in ground-based screening studies. However, subsequent attempts to optimize growth within rigorous ISS-like growth environments on the ground were frustrated by development of leaf chlorosis, necrosis, and uneven growth. 'Tokyo Bekana' ('TB') grown on ISS during the VEG-03B and C flights developed similar stress symptoms. After lengthy troubleshooting efforts to identify causes of sub-par growth in highly controlled environments, the super-elevated CO2 concentrations that plants on ISS are exposed to continuously (average of 2,800 µmol/mol) emerged as a candidate environmental condition responsible for the observed plant-stress symptoms. Subsequent ground-based studies found continuous exposure to ISS levels of CO2 under Veggie environmental and cultural conditions to significantly inhibit growth of 'TB' compared to near-Earth-normal CO2 controls. The present study investigated growth and gas-exchange responses of 'TB' to sub-ISS but still elevated CO2 levels (900 or 1,350 µmol/mol) in combination with other potential stressors related to ISS/Veggie compared to 450 µmol/mol CO2 controls. Shoot dry mass of plants grown at 450 µmol•mol-1 CO2 for 28 days was 96% and 80% higher than that of plants grown at 900 µmol•mol-1 CO2 and 1,350 µmol•mol-1 CO2, respectively. Leaf number and leaf area of controls were significantly higher than those of plants grown at 1,350 µmol•mol-1 CO2. Photosynthetic rate measured using a leaf cuvette was significantly lower for plants grown at 900 µmol•mol-1 CO2 than for controls. The ratio of leaf internal CO2 concentration (Ci) to cuvette ambient CO2 concentration (Ca) was significantly lower for plants grown at 450 µmol•mol-1 CO2 than for plants grown at elevated CO2. Thus, continuously elevated CO2 in combination with a Veggie cultivation system decreased growth, leaf area, and photosynthetic efficiency of Chinese cabbage 'Tokyo Bekana'. The results of this study suggest that 'Tokyo Bekana' is very sensitive to continuously elevated CO2 in such a growth environment, and indicate the need for improved environmental control of CO2 and possibly root-zone factors for successful crop production in the ISS spaceflight environment. Differential sensitivity of other salad crops to an ISS/Veggie growth environment also is possible, so it is important to mimic controllable ISS-like environmental conditions as precisely as possible during ground-based screening.

Ammonia Measurement in the IVC Microenvironment.

In this review, we describe the methods and technology used to measure intracage ammonia levels; the data were derived from 38 articles published since 1970. Ammonia concentration is commonly used as a surrogate for assessing environmental quality inside rodent cages. Data generated from this group of publications have been used to support new husbandry practices, determine the effect of ammonia on health, and establish the effectiveness of caging systems. Consequently, the data generated from these studies have a direct effect on animal welfare and therefore should demonstrate a high level of reproducibility. Obtaining reproducible results requires a critical understanding of the methodology and the technology used to collect ammonia concentration data. This review highlights the need for consistent methodology for measuring ammonia that considers the technology used to capture the data as well as the environmental parameters that affect ammonia concentrations, to facilitate the design of future studies.

Ventricular Assist Device Support as a Bridge to Transplantation in Pediatric Patients.

BACKGROUND: Pediatric ventricular assist device (VAD) use has evolved dramatically over the last 2 decades. OBJECTIVES: This study sought to describe the evolution of VAD support to heart transplantation (HTx) in children in a large international multicenter cohort. METHODS: Using data from the Pediatric Heart Transplant Study, comparisons were made between children (<18 years) supported to HTx (January 1, 1993 to December 31, 2015) with VAD or extracorporeal membrane oxygenation (ECMO) to VAD support. RESULTS: Of 7,135 listed patients, 5,145 underwent HTx; 995 (19.3%) were supported by a VAD (113 with congenital heart disease [CHD]). Patients with a VAD as their first device (n = 821) were older, larger, and more likely to have cardiomyopathy (80%) than patients transitioned from ECMO to VAD (n = 164). In the VAD-only cohort, 79% underwent HTx and 14% died, compared with 69% and 24% in the ECMO-to-VAD cohort, respectively. Patients with cardiomyopathy achieved HTx 84% of the time, with a 9% waitlist mortality rate compared with 55% and 36%, respectively, for CHD. Among VAD-treated patients, 79% were age >10 years in the earliest era, a percentage decreasing to 34% more recently, though neonates still represent <1%. Overall, survival at 2 and 20 years showed no difference between VAD and no support (2 years: 75% vs. 80%; 20 years: 55% vs. 54%). Post-HTx outcomes were better for durable versus temporary VADs (p < 0.01) and for continuous versus pulsatile VADs (p < 0.01) from 2005 onward; timing of VAD had no impact on post-HTx survival (p = 0.65). CONCLUSIONS: For one-quarter of a century, major advances have occurred in mechanical support technology for children, thereby expanding the capability to bridge to HTx without compromising post-HTx outcomes. Significant challenges remain, especially for neonates and patients with CHD, but ongoing innovation portends improved methods of support during the next decade.

The asthma dialogues: a model of interactive education for skills.

INTRODUCTION: A gap exists between asthma guidelines and actual care delivered. We developed an educational intervention using simulated physician-patient encounters as part of a project to improve asthma management by community-based primary care providers. We hypothesized that this type of skills-based interactive training would improve learners' care choices for simulated patients after training compared with their choices before training. METHODS: After a pilot project was done on a small group of providers, a larger group of primary care providers (PCPs) was recruited to be trained with our interactive materials. The pilot session, with 39 providers, showed that the cases were felt to be appropriate, that the time allocated for discussion was adequate, that the models were useful, that the experience was educational, and that the experience captured their interest. Two subsequent training sessions were held with 240 PCPs. Participants completed a questionnaire to elicit perceived barriers and self-efficacy and then viewed a short simulated physician-patient dialogue. They then completed a set of scaled questions about treatment choices. This served as a pretest assessment. A similar simulation was then shown, and the group discussed their thoughts on diagnosis and treatment. Finally, they viewed another physician-patient interaction and responded to the same questions as posed for the pretest assessment; the responses before and after assessment were compared. RESULTS: Following completion of the intervention, providers were significantly (p < 0.05) more likely to make use of controller medications, asthma equipment, and patient training. Significant (p < 0.05) increases were also seen in action plan development and the availability of office visits. Providers were significantly (p < 0.05) less likely to refer asthma patients to an emergency department or for hospitalization. Significant (p < 0.05) improvements were also seen in perceptions of self-efficacy and barriers to treatment. There were significant (p < 0.05) increases in learners' confidence about their own and patients' abilities to improve asthma care, and fewer barriers to asthma management were reported after the training. DISCUSSION: This method of training resulted in learners showing a measurable improvement in their intent to follow guidelines as applied to simulated patients. An evaluation addressing actual patient outcomes will need to be done.

The Care of Children With Congenital Heart Disease in Their Primary Medical Home.

Congenital heart disease (CHD) is the most common birth anomaly. With advances in repair and palliation of these complex lesions, more and more patients are surviving and are discharged from the hospital to return to their families. Patients with CHD have complex health care needs that often must be provided for or coordinated for by the primary care provider (PCP) and medical home. This policy statement aims to provide the PCP with general guidelines for the care of the child with congenital heart defects and outlines anticipated problems, serving as a repository of current knowledge in a practical, readily accessible format. A timeline approach is used, emphasizing the role of the PCP and medical home in the management of patients with CHD in their various life stages.

Tsunami overview.

Historically, floods and tsunamis have caused relatively few severe injuries; an exception to that tendency followed the great Andaman Island-Sumatra earthquake and tsunami of 2004. More than 280,000 people died, the coastal plains were massively scoured, and more than 1 million individuals were made homeless by the quake and resulting tsunami, which affected a 10-nation region around the Indian Ocean. This destruction overwhelmed local resources and called forth an unprecedented, prolonged, international response. The USNS Mercy deployed on a unique mission and rendered service to the people and government of Indonesia. This introduction provides background on the nature and extent of the damage, conditions upon arrival of the hospital ship 5 weeks after the initial destruction, and the configuration of professionals aboard (officers and sailors of the U.S. Navy, civilian volunteers from Project HOPE, officers of the U.S. Public Health Service, and officers and civilian mariners of the Military Sealift Command). Constraints on the mission provide context for the other articles of this issue that document and comment on the activities, challenges, methods, and accomplishments of this unique mission's "team of teams," performing humanitarian assistance and disaster relief in the Pacific theater.

Persistent Epstein-Barr viral load in Epstein-Barr viral naïve pediatric heart transplant recipients: Risk of late-onset post-transplant lymphoproliferative disease.

AIM: To examine the risk of late-onset post-transplant lymphoproliferative disorder (PTLD) in the presence of persisting high Epstein-Barr virus (EBV) in EBV naïve pediatric heart transplant (HT) recipients. METHODS: A retrospective review of the medical records of the 145 pediatric HT recipients who had serial EBV viral load monitoring at our center was performed. We defined EBV naive patients whose EBV serology either IgM or IgG in the blood were negative at the time of HT and excluded passive transmission from mother to child in subjects less than 6 mo of age. RESULTS: PTLD was diagnosed in 8 out of 145 patients (5.5%); 6/91 (6.5%) in those who were EBV seropositive and 2/54 (3.7%) in the EBV naïve group at the time of HT (P = 0.71). We found 32/145 (22%) patients with persistently high EBV load during continuing follow-up; 20/91 (22%) in EBV seropositive group vs 12/54 (22%) in EBV naïve group (P = 0.97). There was no significant association between pre-HT serostatus and EBV load after transplant (P > 0.05). In the EBV seropositive group, PTLD was diagnosed in 15% (3/20) of patients with high EBV vs 4.2% (3/71) of patients with low or undetectable EBV load (P = 0.14) whereas in EBV naïve patients 8.3% (1/12) of those with high EBV load and 2.3% (1/42) with low or undetectable EBV load (P = 0.41). There was a highly significant association between occurrence of PTLD in those with high EBV load and duration of follow up (4.3 ± 3.9 years) after HT by Cochran-Armitage test for the entire cohort (P = 0.005). At least one episode of acute rejection occurred in 72% (23/32) of patients with high EBV vs 36% (41/113) patients with low or undetectable EBV after HT (P < 0.05). CONCLUSION: There is an association between persistently high EBV load during post-HT follow up and the occurrence of late-onset PTLD in pediatric HT recipients irrespective of serostatus at the time of transplant. The occurrence of allograft rejection increased in patients with high EBV load presumably due to reduction in immunosuppression.

Academic Peer Detailing-The Preparation and Experience of Detailers Involved in a Project to Disseminate a Comparative Effectiveness Module.

INTRODUCTION: Academic detailing uses communication skills, relationship building, and feedback to facilitate behavior change. This report, part of a larger initiative to disseminate evidence summaries of systematic reviews, demonstrates the feasibility of disseminating a comparative effectiveness module to physicians using peer detailers and examines the development of faculty for this process. We describe planning and implementation of a train-the-detailer session, detailer reactions to the process, and results of the dissemination project. METHODS: We recruited 10 experienced primary care clinical faculties in Family and Social Medicine at the Albert Einstein College of Medicine. Detailers attended a 90-minute train-the-detailer session and detailed 150 practitioners at community practices. We evaluated the experiences of the learners and detailers with questionnaires, a focus group, and individual interviews of the detailers. RESULTS: The experiences of detailing in different contexts were uniformly positive. Learners felt the materials were valuable, and that they would implement them or already had implemented them. In the postsurvey completed by 65 of the 150 detailed learners, 97% percent stated that they changed their practice or had already incorporated the practice change before the detailing. All detailers reported a change in their own practice. Detailers found the teaching materials and detailers' guide helpful. Some initially expressed a concern about not knowing enough, which lessened with detailing experience. DISCUSSION: Peer detailing seems doable and well received, especially with the availability of high quality, previously prepared, and tested evidence-based content and materials. Detailers were easily recruited and trained to apply their teaching skills in this new format. The amount of time spent in training sessions on detailing training as opposed to content mastery can be adjusted depending on faculty needs.

Dissemination of Evidence From Systematic Reviews Through Academic CME Providers: A Feasibility Study.

INTRODUCTION: Although systematic reviews represent a source of best evidence to support clinical decision-making, reviews are underutilized by clinicians. Barriers include lack of awareness, familiarity, and access. Efforts to promote utilization have focused on reaching practicing clinicians, leaving unexplored the roles of continuing medical education (CME) directors and faculty in promoting systematic review use. This study explored the feasibility of working with CME directors and faculty for that purpose. METHODS: A convenience sample of five academic CME directors and faculty agreed to participate in a feasibility study exploring use in CME courses of systematic reviews from the Agency for Healthcare Research and Quality (AHRQ-SRs). AHRQ-SR topics addressed the comparative effectiveness of health care options. Participants received access to AHRQ-SR reports, associated summary products, and instructional resources. The feasibility study used mixed methods to assess 1) implementation of courses incorporating SR evidence, 2) identification of facilitators and barriers to integration, and 3) acceptability to CME directors, faculty, and learners. RESULTS: Faculty implemented 14 CME courses of varying formats serving 1700 learners in urban, suburban, and rural settings. Facilitators included credibility, conciseness of messages, and availability of supporting materials; potential barriers included faculty unfamiliarity with SRs, challenges in maintaining review currency, and review scope. SR evidence and summary products proved acceptable to CME directors, course faculty, and learners by multiple measures. DISCUSSION: This study demonstrates the feasibility of approaches to use AHRQ-SRs in CME courses/programming. Further research is needed to demonstrate generalizability to other types of CME providers and other systemic reviews.

Improving the Reach of the National Diabetes Prevention Program Within a Health Disparities Population: A Bronx New York Pilot Project Crossing Health- and Community-Based Sectors.

INTRODUCTION: Diabetes affects upward of 30% of South Bronx residents. The Centers for Disease Control and Prevention's National Diabetes Prevention Program (NDPP) reduces risk of progression to diabetes, yet implementation has been elusive within health disparities populations. METHODS: This community-based, collaborative project piloted the NDPP in the South Bronx and evaluated implementation challenges and enablers. The New York State training group prepared community peer lifestyle coaches recruited by a community organization. A professional society trained academic detailers from local faculty. An interview process evaluated community needs and public health officials' beliefs. A portal managed by the New York State training group collected demographic and biometric data from the community participants and facilitated online registration. Data from interviews and observations were coded systematically using a thematic analysis framework. RESULTS: We were successful at recruiting and training 14 lifestyle coaches and 7 academic detailers, as well as recruiting members of the health disparities population in the South Bronx into the program. Fifty-two individuals completed the first 6 months of the yearlong program, attending an average of 12.7 of 16 sessions. By week 16, weight loss averaged 7.4 lbs and many had doubled their minutes of physical activity. Local electronic referral and feedback systems were developed. DISCUSSION: Health professionals, their teams, public health centers, and communities can work together to prevent diabetes by enhancing the reach of the NDPP to health disparities populations. Peer education using lifestyle coaches can provide a trustworthy process for crossing the boundaries between health teams and community support groups.