Publications

Sexual Orientation- and Gender Identity-Affirming Activities Provided in Primary Care.

Akre EL, Yang CW, Bauer GR, Mackwood MB, O'Malley AJ, Fisher ES, Schifferdecker KE

2025 Mar 3;8(3):e250392doi: 10.1001/jamanetworkopen.2025.0392

Addressing health disparities in lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities has been a significant policy focus for more than a decade. Ensuring access to safe, respectful primary health care from knowledgeable clinicians is crucial for reducing health inequalities.

JAMA Netw Open|2025 Mar 3

Perceptions and Use of Germline Genetic Testing Among Patients With Prostate Cancer.

Beidler LB, Zayhowski K, Nahorniak M, Loo S, Gignac GA, Wang C, Gunn CM

2025 Mar 3;:OP2400624doi: 10.1200/OP-24-00624

Many patients with prostate cancer are eligible for germline genetic testing, but it is underutilized in clinical practice. We aimed to explore perceptions of and decision making about undergoing genetic testing among patients with prostate cancer.

JCO Oncol Pract|2025 Mar 3

Provider and Staff Perspectives on Screening and Referral for Social Determinants of Health During Perinatal Care: Implications Using the Consolidated Framework for Implementation Research.

Allen SE, Goodman DJ, Bielaski T, Sisson S, Canavan CR, Cass I, Ngugi B, Saunders CH, Dev A

2025 Feb 27;pii: S1049-3867(25)00007-6. doi: 10.1016/j.whi.2025.01.007

New federal mandates require universal screening and referral for social determinants of health (SDOHs), and evidence exists supporting its integration into primary care practice. However, implementation in maternity care remains understudied and underfunded. To inform maternal health practice, we studied clinical stakeholders' perspectives on SDOH screening and referral knowledge, priority, challenges, and opportunities across four hospital-affiliated obstetrics and gynecology clinics in New Hampshire.

Womens Health Issues|2025 Feb 27

An electronic pre-visit agenda-setting questionnaire in ambulatory palliative care is feasible and acceptable to patients, care partners, and clinicians: A mixed methods evaluation.

Wilson MM, Broglio K, Vergo MT, Barnato AE, Cullinan AM, Doherty JR, King JR, Devito AM, Holmes AB, Hinson JJ, Holt KR, Holthoff MM, Kobin EG, Legere AR, Nelson EC, O'Donnell EA, Saunders CH, Tomlin SC, Kirkland KB, Van Citters AD

2025 Feb 25;:2692163251321327doi: 10.1177/02692163251321327

To provide patient-centered healthcare for people with serious illness, healthcare teams must elicit needs, goals, preferences, and values from patients and care partners.

Palliat Med|2025 Feb 25

Neonatal Intensive Care Outcomes in the Military Health System: Comparison of Military and Civilian Hospital Births.

Mu TS, Romano CJ, Hall C, Gumbs GR, Conlin AMS, Vereen RJ, Leyenaar JK, Goodman DC

2025 Feb 24;pii: usaf043. doi: 10.1093/milmed/usaf043

Military Health System (MHS)-insured newborns receive care in military and civilian hospitals. Differences in delivery location and corresponding payment schemas raise questions regarding possible health system effects on utilization and outcomes. We hypothesize that newborn utilization and clinical outcomes differ between military and civilian hospitals and that the differences may be more pronounced among lower risk newborns (i.e., late preterm and non-preterm infants).

Mil Med|2025 Feb 24

Cross-State Travel for Cancer Care and Implications for Telehealth Reciprocity.

Moen EL, Wang Q, Liu L, Wang F, Tosteson ANA, Smith RE, Cowan L, Onega T

2025 Feb 3;8(2):e2461021doi: 10.1001/jamanetworkopen.2024.61021

Patients often travel for cancer care, yet the extent to which patients cross state lines for cancer care is not well understood. This knowledge can have implications for policies that regulate telehealth access to out-of-state clinicians.

JAMA Netw Open|2025 Feb 3

Adherence to a digital therapeutic mediates the relationship between momentary self-regulation and health risk behaviors.

Plaitano EG, McNeish D, Bartels SM, Bell K, Dallery J, Grabinski M, Kiernan M, Lavoie HA, Lemley SM, Lowe MR, MacKinnon DP, Metcalf SA, Onken L, Prochaska JJ, Sand CL, Scherer EA, Stoeckel LE, Xie H, Marsch LA

2025;7:1467772doi: 10.3389/fdgth.2025.1467772

Smoking, obesity, and insufficient physical activity are modifiable health risk behaviors. Self-regulation is one fundamental behavior change mechanism often incorporated within digital therapeutics as it varies momentarily across time and contexts and may play a causal role in improving these health behaviors. However, the role of momentary self-regulation in achieving behavior change has been infrequently examined. Using a novel momentary self-regulation scale, this study examined how targeting self-regulation through a digital therapeutic impacts adherence to the therapeutic and two different health risk behavioral outcomes.

Front Digit Health|2025

Disparities in Standard-of-Care, Advanced, and Same-Day Diagnostic Services among Patients with Abnormal Screening Mammography.

Lawson MB, Zhu W, Miglioretti DL, Onega T, Henderson LM, Rauscher GH, Kerlikowske K, Sprague BL, Bowles EJA, O'Meara ES, Tosteson ANA, diFlorio-Alexander RM, Hubbard RA, Lee JM, Lee CI

2025 Feb;314(2):e241673doi: 10.1148/radiol.241673

Background Diagnostic imaging and biopsy are used to evaluate abnormal screening mammography. Differences in on-site availability and receipt of these diagnostic services may contribute to disparities in breast cancer outcomes across sociodemographic groups. Purpose To identify multilevel factors associated with on-site availability and receipt of diagnostic imaging and biopsy after screening mammography. Materials and Methods This retrospective study included female patients (age range, 40-89 years) who underwent screening mammography at 136 facilities in the United States from January 2010 to December 2020. The primary exposure variables were race and ethnicity and neighborhood-level educational attainment, household income, and rurality. The adjustment variables were age, breast density, breast biopsy history, personal and family history of breast cancer, time from prior mammographic examination to screening mammography, screening modality, facility academic affiliation, and screening examination year. The relative risk (RR) of factors for on-site availability at screening facilities and undergoing standard-of-care imaging (ie, mammography and/or US) and advanced diagnostic imaging (ie, digital breast tomosynthesis, MRI) and biopsy, and undergoing any same-day diagnostic service and biopsy were estimated using modified Poisson regression. Results In total, 1 123 177 female patients (median age, 59 years; IQR, 51-67 years) underwent 3 519 502 screening mammographic examinations: 10.3% Asian patients (362 440 of 3 519 502), 12.7% Black patients (447 777 of 3 519 502), 6.5% Hispanic patients (227 177 of 3 519 502), 68.3% White patients (2 403 159 of 3 519 502), and 2.2% all other races and ethnicities (78 949 of 3 519 502). In most fully adjusted models, race or ethnicity and neighborhood-level socioeconomic status were not associated with on-site diagnostic service availability. However, compared with White patients, patients belonging to racial and ethnic minority groups were less likely to undergo same-day diagnostic services after abnormal screening mammography (Asian patients: RR, 0.74 [95% CI: 0.64, 0.85]; Black patients: RR, 0.56 [95% CI: 0.49, 0.63]; Hispanic patients: RR, 0.61 [95% CI: 0.52, 0.71]). Black patients were less likely to undergo same-day biopsies after an abnormal diagnostic workup (RR, 0.46; 95% CI: 0.33, 0.65). Conclusion Although no evidence existed that on-site diagnostic service availability varied by race and ethnicity in most models, patients in racial and ethnic minority groups were less likely to be provided same-day diagnostic services and Black patients were less likely to undergo same-day biopsy. © RSNA, 2025 See also the editorial by Mullen in this issue.

Radiology|2025 Feb

Organizational characteristics associated with sustained participation in internal quality improvement: Findings from two waves of a national sample of physician practices in the United States.

Hurley VB, Brewster AL, DePuccio MJ, Hung DY, O'Malley AJ, Schifferdecker KE

2025 Mar;369:117826doi: 10.1016/j.socscimed.2025.117826

Engagement in internal quality improvement (QI) within physician practices is a key avenue by which to deliver evidence-based and patient-centered care, but it can be difficult to sustain such engagement. Consequently, research is needed that identifies organizational factors associated with sustained internal QI. We utilized two waves of a national survey of physician practices to explore whether organizational innovation characteristics including organizational culture, health information technology (HIT) capacity, and Accountable Care Organization (ACO) affiliation distinguish physician practices that sustain their engagement in internal QI from those that do not.

Soc Sci Med|2025 Mar

A behavioural science framework for tackling upstream challenges in health systems.

Smith J, Zimmerman E, Gachiengo Nyabero W, Nanda P, Fasawe O, Roder-DeWan S

2025 Feb 16;10(2)doi: 10.1136/bmjgh-2024-016897

Insights from behavioural science can inform a wide range of solutions including policy reforms, infrastructure changes, process reengineering, communications, devices and others. Its application in global health has, however, often focused on narrowly defined issues with linear theories of change that are relatively straightforward to study. Using behavioural science to examine 'upstream' actors in complex health systems holds promise as a complementary and underused approach to improving health systems. Behavioural scientists have missed opportunities to tackle systemic issues and the field of health systems strengthening rarely accounts for human behaviour at the macrolevel of health systems. We present a framework, developed by experts from a range of disciplinary backgrounds in global health and behavioural science that guides (1) the distillation of a health system challenge into concrete, addressable behaviours (specific actors and accompanying actions) and (2) the investigation of contextual factors that influence each behaviour.

BMJ Glob Health|2025 Feb 16