Jennifer L. Barton

Association Between Clinician Computer Use and Communication With Patients in Safety-Net Clinics

Title: Association Between Clinician Computer Use and Communication with Patients in Safety- Net Clinics Neda Ratanawongsa, MD, MPH 1,2 neda.ratanawongsa@ucsf.edu Jennifer L. Barton, MD 3 bartoje@ohsu.edu Courtney R. Lyles, PhD 1,2 courtney.lyles@ucsf.edu Michael Wu, BS 4 MichaelWu0322@gmail.com Edward H. Yelin, PhD, MCP 5,6 ed.yelin@ucsf.edu Diana Martinez, MD 1,2 diana.martinez@ucsf.edu Dean Schillinger, MD 1,2 dean.schillinger@ucsf.edu Division of General Internal Medicine, the University of California, San Francisco (UCSF) UCSF Center for Vulnerable Populations at San Francisco General Hospital Department of Medicine at Oregon Health & Science University and VA Portland Health Care System John Burns School of Medicine, University of Hawaii Division of Rheumatology, University of California, San Francisco Institute for Health Policy Studies, University of California, San Francisco Word count: 600 References: 7 Tables: 2 Corresponding Author: Neda Ratanawongsa, MD, MPH Associate Professor of Medicine, Division of General Internal Medicine UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center 1001 Potrero Avenue, Box 1364 San Francisco CA 94110 Phone: 415-206-3188 Fax: 415-206-5586 neda.ratanawongsa@ucsf.edu Presentations: Preliminary data from this manuscript was presented at the International Conference on Communication in Healthcare, Montreal, Quebec, Canada, September 30, 2013 Acknowledgements: Author Contributions: Dr. Ratanawongsa had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Ratanawongsa, Yelin, Schillinger. Acquisition, analysis, or interpretation of data: Ratanawongsa, Barton, Lyles, Wu, Martinez. Drafting of the manuscript: Ratanawongsa, Yelin. Critical revision of the manuscript for important intellectual content: Barton, Lyles,Wu, Yelin, Martinez, Schillinger. Statistical analysis: Ratanawongsa, Yelin. Obtained funding: Ratanawongsa, Schillinger. Administrative, technical, or material support: Barton, Lyles,Wu, Martinez,

Muscle strength and changes in physical function in women with systemic lupus erythematosus

Cross‐sectional studies have observed that muscle weakness is associated with worse physical function among women with systemic lupus erythematosus (SLE). The present study examines whether reduced upper and lower extremity muscle strength predict declines in function over time among adult women with SLE.

Use of Low-Literacy Decision Aid to Enhance Knowledge and Reduce Decisional Conflict Among a Diverse Population of Adults With Rheumatoid Arthritis: Results of a Pilot Study.

Despite innovations in treatment of rheumatoid arthritis (RA), adherence is poor and disparities persist. Shared decision making (SDM) promotes patient engagement and enhances adherence; however, few tools support SDM in RA. Our objective was to pilot a low‐literacy medication guide and decision aid to facilitate patient‐clinician conversations about RA medications.

Development of a Draft Core Set of Domains for Measuring Shared Decision Making in Osteoarthritis: An OMERACT Working Group on Shared Decision Making

Objective. Despite the importance of shared decision making for delivering patient-centered care in rheumatology, there is no consensus on how to measure its process and outcomes. The aim of this Outcome Measures in Rheumatology (OMERACT) working group is to determine the core set of domains for measuring shared decision making in intervention studies in adults with osteoarthritis (OA), from the perspectives of patients, health professionals, and researchers. Methods. We followed the OMERACT Filter 2.0 method to develop a draft core domain set by (1) forming an OMERACT working group; (2) conducting a review of domains of shared decision making; and (3) obtaining opinions of all those involved using a modified nominal group process held at a session activity at the OMERACT 12 meeting. Results. In all, 26 people from Europe, North America, and Australia, including 5 patient research partners, participated in the session activity. Participants identified the following domains for measuring shared decision making to be included as part of the draft core set: (1) identifying the decision, (2) exchanging information, (3) clarifying views, (4) deliberating, (5) making the decision, (6) putting the decision into practice, and (7) assessing the effect of the decision. Contextual factors were also suggested. Conclusion. We proposed a draft core set of shared decision-making domains for OA intervention research studies. Next steps include a workshop at OMERACT 13 to reach consensus on these proposed domains in the wider OMERACT group, as well as to detail subdomains and assess instruments to develop a core outcome measurement set.

Association of Sweet's Syndrome and Systemic Lupus Erythematosus

Sweets syndrome is an acute febrile neutrophilic dermatosis which usually presents as an idiopathic disorder but can also be drug induced, associated with hematopoetic malignancies and myelodysplastic disorders, and more, infrequently, observed in autoimmune disorders. Sweets syndrome has been reported in three cases of neonatal lupus, three cases of hydralazine-induced lupus in adults, and in nine pediatric and adult systemic lupus erythematosus (SLE) patients. We describe three additional adult cases of Sweets associated with SLE and provide a focused review on nondrug-induced, nonneonatal SLE and Sweets. In two of three new cases, as in the majority of prior cases, the skin rash of Sweets paralleled underlying SLE disease activity. The pathogenesis of Sweets remains elusive, but evidence suggests that cytokine dysregulation may be central to the clinical and pathological changes in this condition, as well as in SLE. Further research is needed to define the exact relationship between the two conditions.

Multitasking and Silent Electronic Health Record Use in Ambulatory Visits

Author(s): Ratanawongsa, Neda; Matta, George Y; Lyles, Courtney R; Koenig, Christopher J; Barton, Jennifer L; Yu, Kaylin; Schillinger, Dean

Who receives contraception counseling when starting new lupus medications? The potential roles of race, ethnicity, disease activity, and quality of communication.

Objective Family planning discussions are an important aspect of medical care for women with systemic lupus erythematosus (SLE) as active disease is a risk factor for poor pregnancy outcomes, and the medications used for treatment can be harmful to the fetus when used during conception and pregnancy. Our objective was to examine the impact of patient perception of quality and type of communication on receiving contraception counseling. Methods Data were derived from patients enrolled in the University of California, San Francisco Lupus Outcomes Study. Individuals participate in a yearly structured telephone interview that includes assessment of contraception counseling when starting new medications, and measures of communication and decision making. Logistic regression was performed to identify predictors of not receiving contraception counseling. Results Of the 68 women included in this analysis, one-third did not receive contraception counseling when starting new medications. Older age, white race, depressive symptoms, and higher SLE disease activity were independently associated with not receiving contraception counseling. Participants who did not receive contraception counseling rated their physicians lower in shared decision-making (SDM) communication. Conclusions This study demonstrates a gap in family planning counseling among women with SLE starting new medications. Future studies to address these potential areas of intervention, including education about the need for contraception through menopause, and mechanisms to engage in SDM surrounding contraception are needed to improve quality of care for women with lupus.

Poverty, Depression, or Lost in Translation? Ethnic and Language Variation in Patient-Reported Outcomes in Rheumatoid Arthritis.

Despite advances in therapies, disparities in outcomes have been documented for rheumatoid arthritis (RA) patients for both ethnicity and English language proficiency. The goals of these analyses were to compare differences in RA patient‐reported outcomes, by both self‐identification of ethnicity and English language proficiency, and to identify factors that might explain differences among groups.

Toward Ensuring Health Equity: Readability and Cultural Equivalence of OMERACT Patient-reported Outcome Measures

Objective. The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. Methods. The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool, the Evaluative Linguistic Framework for Questionnaires, developed to assess text quality of questionnaires. We also considered a study assessing cross-cultural adaptation with/without back-translation and/or expert committee. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM. Results. Thirty-one OMERACT delegates attended the equity session. Twenty-six participants agreed that PROM should be assessed for comprehensibility and for use of suitable methods (4 abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement for improving translation and adaptation. Conclusion. Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures.

Toward the development of a core set of outcome domains to assess shared decision-making interventions in rheumatology : results from an OMERACT Delphi survey and consensus meeting

Objective. The aim of this Outcome Measures in Rheumatology (OMERACT) Working Group was to determine the core set of outcome domains and subdomains for measuring the effectiveness of shared decision-making (SDM) interventions in rheumatology clinical trials. Methods. Following the OMERACT Filter 2.0, and based on a previous literature review of SDM outcome domains and a nominal group process at OMERACT 2014, (1) an online Delphi survey was conducted to gather feedback on the draft core set and refine its domains and subdomains, and (2) a workshop was held at the OMERACT 2016 meeting to gain consensus on the draft core set. Results. A total of 170 participants completed Round 1 of the Delphi survey, and 116 completed Round 2. Respondents came from 29 countries, with 49% being patients/caregivers. Results showed that 14 out of the 17 subdomains within the 7 domains exceeded the 70% criterion (endorsement ranged from 83% to 100% of respondents). At OMERACT 2016, only 8% of the 96 attendees were patients/caregivers. Despite initial votes of support in breakout groups, there was insufficient comfort about the conceptualization of these 7 domains and 17 subdomains for these to be endorsed at OMERACT 2016 (endorsement ranged from 17% to 68% of participants). Conclusion. Differences between the Delphi survey and consensus meeting may be explained by the manner in which the outcomes were presented, variations in participant characteristics, and the context of voting. Further efforts are needed to address the limited understanding of SDM and its outcomes among OMERACT participants.