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Author: C Madeline Mitchell (36)


Dec
1969

Engaging stakeholders in research carries the promise of enhancing the research relevance, transparency, and speed of getting findings into practice. By describing the context and functional aspects of stakeholder groups, like those working as community advisory boards (CABs), others can learn from these experiences and operationalize their own CABs. Our objective is to describe our experiences with diverse CABs affiliated with our community engagement group within our institution's Clinical Translational Sciences Award (CTSA).

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Jul
2017

The value of self-monitoring of blood glucose (SMBG) levels in patients with non-insulin-treated type 2 diabetes has been debated.
To compare 3 approaches of SMBG for effects on hemoglobin A1c levels and health-related quality of life (HRQOL) among people with non-insulin-treated type 2 diabetes in primary care practice.
The Monitor Trial study was a pragmatic, open-label randomized trial conducted in 15 primary care practices in central North Carolina.

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Dec
1969

For the nearly 75% of patients living with type 2 diabetes (T2DM) that do not use insulin, decisions regarding self-monitoring of blood glucose (SMBG) can be especially problematic. While in theory SMBG holds great promise for sparking favorable behavior change, it is a resource intensive activity without firmly established patient benefits. This study describes our study protocol to assess the impact of three different SMBG testing approaches on patient-centered outcomes in patients with non-insulin treated T2DM within a community-based, clinic setting.

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Dec
1969

The National Committee for Quality Assurance patient-centered medical home recognition program provides practices an opportunity to implement medical home activities. Understanding the costs to apply for recognition may enable practices to plan their work.
Practice coaches identified 5 exemplar practices (3 pediatric and 2 family medicine practices) that received level 3 recognition.

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Oct
2014

To describe the prevalence, characteristics, and appropriateness of systemic antibiotic use in assisted living (AL) and to conduct a preliminary quality improvement intervention trial to reduce inappropriate prescribing.
Pre-post study, with a 13-month intervention period.
Four AL communities.

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Jan
2014

To provide empirically based recommendations for incorporating body temperature into clinical decision-making regarding diagnosing infection in nursing home (NH) residents.
Retrospective.
Twelve North Carolina NHs.

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Jan
2014

Primary care organizations must transform care delivery to realize the Institute for Healthcare Improvement's Triple Aim of better healthcare, better health, and lower healthcare costs. However, few studies have considered the financial implications for primary care practices engaged in transformation. In this qualitative, comparative case study, we examine the practice-level personnel and nonpersonnel costs and the benefits involved in transformational change among 12 primary care practices participating in North Carolina's Improving Performance in Practice (IPIP) program.

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May
2014

To create data-driven typologies of licensed nurse staffing and health services in residential care and assisted living (RC/AL).
Cluster analysis was used to describe the patterns of licensed nurse staffing and 47 services and the extent to which these clusters were related.
RC/AL communities in the United States.

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May
2014

To determine whether antibiotic prescribing can be reduced in nursing homes using a quality improvement (QI) program that involves providers, staff, residents, and families.
A 9-month quasi-experimental trial of a QI program in 12 nursing homes (6 comparison, 6 intervention) conducted from March to November 2011.
Nursing homes in two regions of North Carolina, roughly half of whose residents received care from a single practice of long-term care providers.

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May
2014

Chronic disease collaboratives help practices redesign care delivery. The North Carolina Improving Performance in Practice program provides coaches to guide implementation of 4 key practice changes: registries, planned care templates, protocols, and self-management support. Coaches rate progress using the Key Drivers Implementation Scales (KDIS).

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Apr
2013

To better understand the antibiotic prescribing process in assisted living (AL) communities given the growing rate of antibiotic resistance.
Cross-sectional survey.
Four AL communities in North Carolina.

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Apr
2013

The Loeb minimum criteria (LMC), developed by a 2001 consensus conference, are minimum standards for initiation of antibiotics in long term care settings, intended to reduce inappropriate prescribing. This study examined the relationship between nursing home prescriber adherence to the LMC and antibiotic prescribing rates, overall and for each of three specific conditions (urinary tract infections, respiratory infections, and skin and soft tissue infections).
We performed a cross-sectional analysis at the resident-day level.

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Dec
2011

To describe the provision of medical care in assisted living (AL) as provided by physicians who are especially active in providing care to older adults and AL residents; to identify characteristics associated with physician confidence in AL staff; and to ask physicians a variety of questions about their experience providing care to AL residents and how it compares with providing care in the nursing home and home care settings.
Cross-sectional descriptive study.
AL communities in 27 states.

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Dec
2011

the clinical utility of the prehypertension label is questionable. We sought to estimate how often patients with prehypertension are being told about it by their primary care clinicians.
we conducted a cross-sectional study of adult patients visiting practices within the North Carolina Family Medicine Research Network in summer 2008.

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Sep
2010

Little information exists about current patient perceptions of medical mistakes in ambulatory care within a diverse population. We aimed to learn about the perceptions of medical mistakes, what factors were associated with perceived mistakes, and whether the participants changed physicians because of these perceived mistakes.
We conducted a cross-sectional survey at 7 primary care practices in North Carolina of English- or Spanish-speaking adults, aged 18 years and older, who saw a health care professional during 2008.

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Jun
2010

Our objective was to describe primary care patients' perceptions of informed and shared decision making about cancer screening tests in a diverse sample.
We administered a 33-item survey to 467 women and 257 men aged 50 years and older from seven practices in a family medicine practice-based research network. We used ordered logistic regression to assess the relationship between gender, race, education, marital status, and self-rated health with measures of patient-centered care relating to cancer screening tests, controlling for practice site.

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Oct
2010

To evaluate the effect of ambient bright light therapy (BLT) on agitation among institutionalized persons with dementia.
High intensity, low glare ambient lighting was installed in activity and dining areas of a state psychiatric hospital unit in North Carolina and a dementia-specific residential care facility in Oregon. The study employed a cluster-unit crossover design involving four ambient lighting conditions: AM bright light, PM bright light, All Day bright light, and Standard light.

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Oct
2008

Blood pressure (BP) monitors are commonly stationed in public places such as pharmacies, but it is uncertain how many people with hypertension currently use them. We sought to estimate the proportion of hypertensive patients who use these types of monitors and examine whether use varies by demographic or health characteristics.
We conducted a cross-sectional mail survey of hypertensive adults enrolled in a practice based research network of 24 primary care practices throughout the state of North Carolina.

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Oct
2008

We sought to assess primary care patients' current knowledge about various aspects of high blood pressure (BP).
We mailed a questionnaire to 700 hypertensive patients enrolled in a practice-based research network cohort from 24 practices in North Carolina. We determined percentages of respondents (total and by subgroups) incorrectly answering each of 6 questions pertaining to various aspects of high BP.

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Apr
2008

Using a survey of a cohort of primary care patients, the authors determined the proportion currently using home blood pressure monitoring (HBPM) and calculated odds ratios (ORs) of factors associated with such use. Overall, 530 questionnaires were received (80% response rate); 35.2% of respondents reported that their doctor had recommended HBPM (95% confidence interval [CI], 31.

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Apr
2008

Significant contact between nursing staff and nursing home residents with dementia occurs during assistance with activities of daily living during morning care; however, the content and process of morning care have received little attention in the scientific literature. To better understand the morning care process and its role in generation of pain symptoms, 51 videotaped episodes of morning care involving 17 nursing home residents from 3 long-term care facilities were coded and analyzed; each resident had a diagnosis of dementia and concern about possible pain during assistance with activities of daily living. The typical morning care episode involved performance of multiple activities of daily living during a short period of time, during which pain stimulation and expression occurred frequently.

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Nov
2007

To assess the effect of ambient bright light therapy on depressive symptoms in persons with dementia.
A cluster-unit crossover intervention trial involving four lighting conditions: morning bright light, evening bright light, all-day bright light, and standard light.
The common areas of two geriatric units in a state-operated psychiatric hospital in North Carolina and in a dementia-specific residential care facility in Oregon.

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Dec
1969

Assisted living facilities have become increasingly popular for older adults needing assistance. They are intended to enable privacy and provide support, but the extent to which they do so, and the degree to which these relate to residents' needs, are unknown. This observational study of 1830 residents in 182 facilities indicates that, during the mid-afternoon, the majority of residents are awake (79%), and one-half (49%) are awake and in public spaces.

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Oct
2007

To determine whether high-intensity ambient light in public areas of long-term care facilities will improve sleeping patterns and circadian rhythms of persons with dementia.
A cluster-unit crossover intervention trial involving four conditions: morning bright light, evening bright light, all-day bright light, and minimum standard light.
The common areas of two geriatric units in a psychiatric hospital and a dementia-specific residential care facility.

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Oct
2007

The prevalence and nature of sleep disorders in primary care has not been widely studied. As part of a survey conducted in 5 family practice offices in North Carolina, we screened adult patients for sleep syndromes and sought to ascertain which demographic status and health status were associated with these disorders.
We approached 2963 consecutive adults who presented for office visits to the 5 study practices.

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Oct
2007

To examine associations between personal nutritional patterns and various indicators of health, disease risk, and chronic illness in a diverse, representative sample of adult patients from primary care settings.
As part of a survey of adult patients conducted in the waiting rooms of 4 primary care practices in North Carolina (recruitment rate 74.8%), a 7-item nutrition screen was administered to 1788 study participants.

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Aug
2006

When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing, nursing home caregivers are in a unique position to improve residents' experience. This report addresses whether certified nursing assistants (CNAs) who received training in a person-centered approach with showering and with the towel bath showed improved caregiving behaviors (gentleness and verbal support) and experienced greater preparedness (confidence and ease) and less distress (hassles) when assisting residents with bathing.
We used a crossover design and randomized 15 nursing homes into two treatment groups and a control group of 5 facilities each.

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Aug
2006

We wanted to evaluate the feasibility of conducting syndromic surveillance in a primary care office using billing data.
A 1-year study was conducted in a primary care practice; comparison data were obtained from emergency department records of visits by county residents. Within the practice, a computer program converted billing data into de-identified daily summaries of International Classification of Diseases, Ninth Revision (ICD-9) codes by sex and age-group; and a staff member generated daily summaries and e-mailed them to the analysis team.

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Mar
2006

To examine whether hospice enrollment for nursing home (NH) and residential care/assisted living (RC/AL) residents near the end of life is associated with symptoms and symptom management, personal care, spiritual support, and family satisfaction.
Structured, retrospective telephone interviews with family and staff who attended to NH and RC/AL residents in the last month of life.
A stratified sample of 26 NH and 55 RC/AL facilities in four states.

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Jan
2006

Efforts to develop "laboratories" for primary care research have largely focused on the development of networks that recruit subjects on a project-specific basis. We sought to develop an alternative model--a representative cohort of adult primary care patients maintained for use in multiple projects.
In 2001, research assistants in waiting areas of a representative sample of 16 family medicine practices in North Carolina approached all adult patients during a 4-week period.

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Nov
2004

To evaluate the efficacy of two nonpharmacological techniques in reducing agitation, aggression, and discomfort in nursing home residents with dementia. The techniques evaluated were person-centered showering and the towel bath (a person-centered, in-bed bag-bath with no-rinse soap).
A randomized, controlled trial, with a usual-care control group and two experimental groups, with crossover.

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Sep
2004

To identify immediate antecedents of bathing-related physical assaults against caregivers by nursing home residents with Alzheimer's disease and related disorders, videotapes of nursing home residents who physically assaulted nursing assistants during baths were analyzed. Caregiver behaviors that occurred significantly (p < .01) more often during the 5 seconds preceding an assault included: calling the resident by name, confrontational communication, invalidation of the resident's feelings, failure to prepare the resident for a task, disrespectful speech, any touch, absence of physical restraint, and hurried pace of bath.

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Feb
2004

To understand which specific student behaviors predict performance ratings from standardized patients and behavioral scientist preceptors.
In 1996-98, objective, real-time ratings of student verbal and nonverbal behaviors were conducted on 75 videotaped interviews between second-year medical students and standardized patients at University of North Carolina at Chapel Hill School of Medicine. The coding system used in these analyses was developed based on evidence-based literature reviews and used software that provides for real-time recording; 30 nonverbal and 33 behaviors were coded.

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Nov
2003

To define the current state of end-of-life care in residential care/assisted living (RC/AL) facilities and nursing homes (NHs) and to compare these two types of care settings.
Interviews of staff and family informants about deaths that occurred during a longitudinal study.
Fifty-five RC/AL facilities and 26 NHs in Florida, Maryland, New Jersey, and North Carolina.

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Nov
2003

Although residential care/assisted living facilities and nursing homes have increasingly become a significant site of death for older Americans, little is known about staff perceptions of end-of-life care, perceived need for improvement in care, and differences by type of setting.
Ninety-nine staff provided their perceptions of end-of-life care for 99 decedents from 74 residential care/assisted living facilities and nursing homes in four states as part of a larger cohort study. Staff were interviewed retrospectively regarding care provided during residents' last month of life.

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Mar
2002

To develop an observational instrument that describes the ability of physical environments of institutional settings to address therapeutic goals for persons with dementia.
A National Institute on Aging workgroup identified and subsequently revised items that evaluated exit control, maintenance, cleanliness, safety, orientation/cueing, privacy, unit autonomy, outdoor access, lighting, noise, visual/tactile stimulation, space/seating, and familiarity/homelikeness. The final instrument contains 84 discrete items and one global rating.

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