Kerri L Cavanaugh

Vanderbilt University, Nashville, Michigan, United States

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Publications (56)237.14 Total impact

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    ABSTRACT: Some patients referred for kidney transplant evaluation fail to attend the visit. Our goal was to compare demographic, socioeconomic, and psychologic factors between evaluation visit attendees and absentees. A convenience sample of patients referred and scheduled for kidney transplant evaluation at a single center from November 2012 to December 2013 participated in a phone survey reporting socioeconomic, demographic, and clinical characteristics; health literacy; and perceived knowledge and concerns about transplantation. Absentees were matched by race with attendees. Analyses of differences between groups were performed with chi-square test, Fisher exact test, and t tests. Multivariable logistic regression was adjusted for relevant demographic characteristics. One hundred four adults participated (61% men, 46% white, 52±12 years). Financial concerns were the most prevalent (67.3% affording medication, 64.1% affording operation). Previous evaluation at a different transplant center (P=0.029) and being on dialysis (P=0.008) were significantly associated with absence. Attendance was associated with concerns about finding a living donor (P=0.038) and higher perceived general knowledge about transplantation (P ≤0.001). No differences were appreciated in demographic, socioeconomic, or health literacy factors between groups. Both attendee and absentee patients were most concerned with the financial burden of kidney transplantation. Although concerns and perceived knowledge are important correlates of behavior, other considerations such as psychologic factors and prior medical experiences may influence patients' ability to complete the kidney transplant evaluation process. Although this pilot study was conducted in a small sample and has limited generalizability, our findings can guide future research.
    Transplantation 01/2015; DOI:10.1097/TP.0000000000000543 · 3.78 Impact Factor
  • Kerri L Cavanaugh
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    ABSTRACT: Patient-centered care is upheld as one of the fundamental components of high quality health care. Although a deceptively easy concept, patient-centered care is an elusive goal in clinical practice. A core objective for patient-centered care is a collaboration between health care providers and patients that aligns therapy with patients' values and preferences through shared decision making. Advances in communication training that are tailored to the specific requirements of nephrology care are promising methods for enhancing the skill-set of our providers. However, patient-centered care extends beyond shared decision-making and also involves attention to patients' physical and emotional symptoms, care coordination, and the inclusion of family members. Research about patient-centered care processes, interventions and outcomes among patients with kidney disease is sparse. Recent discussions among nephrology experts name patient-centered care as a priority for research and quality improvement in care. Given recent advances in methods for quantifying patient-centered care as well as patient reported outcomes, now is the time to prioritize our resources to evolve our health system and meet the needs of all patients with kidney disease. © 2014 Wiley Periodicals, Inc.
    Seminars in Dialysis 12/2014; DOI:10.1111/sdi.12326 · 2.07 Impact Factor
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    ABSTRACT: Health numeracy is linked to important clinical outcomes. Kidney disease management relies heavily on patient numeracy skills across the continuum of kidney disease care. Little data are available eliciting stakeholder perspectives from patients receiving dialysis about the construct of health numeracy. Using focus groups, we asked patients receiving hemodialysis open-ended questions to identify facilitators and barriers to their understanding, interpretation, and application of numeric information in kidney care. Transcripts were analyzed using content analysis. Twelve patients participated with a mean (standard deviation) age of 56 (12) years. All were African American, 50% were women, and 83% had an annual income <$20,000/year. Although patients felt numbers were critical to every aspect in life, they noted several barriers to understanding, interpreting and applying quantitative information specifically to manage their health. Low patient self-efficacy related to health numeracy and limited patient–provider communication about quantitatively based feedback, were emphasized as key barriers. Through focus groups of key patient stakeholders we identified important modifiable barriers to effective kidney care. Additional research is needed to develop tools that support numeracy-sensitive education and communication interventions in dialysis.
    Hemodialysis International 11/2014; DOI:10.1111/hdi.12239 · 1.44 Impact Factor
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    ABSTRACT: Disclaimer: The authors are responsible for the content of this article, which does not necessarily represent the views of the Institute of Medicine. Disclosures: The authors report no significant conflicts or financial disclosures related to this work.
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    ABSTRACT: Health literacy (HL) may be a mediator for known socioeconomic and racial disparities in living kidney donation. We evaluated the associations of patient and demographic characteristics with HL in living kidney donors (LD), living donor kidney transplant recipients (LDR), and deceased donor recipients (DDR) in a single-center retrospective review of patients undergoing kidney donation or transplantation from September 2010 to July 2012. HL and demographic data were collected. HL was assessed via the Short Literacy Survey (SLS) comprising three self-reported screening questions scored using the five-point Likert scale (low [3-8], moderate [9-14], high [15]). Chi-square and logistic regression were used to test factors associated with lower HL. The sample included 360 adults (105 LD, 103 LDR, and 152 DDR; 46±14 years; 70% white; 56% male; 14±3 years of education). HL scores were skewed (49% high, 41% moderate, and 10% low). The distribution of HL categories differed significantly among groups (P=0.019). After controlling for age, race, sex, education, and a race-education interaction term, DDR was more likely to have moderate or low HL than LDR (OR, 1.911; 95%CI, 1.096-3.332; P=0.022). Overall, living donors had high HL. The distribution of low, moderate, and high HL differed significantly between LD, DDR, and LDR. DDR had a higher likelihood of having low HL than LDR. Screening kidney transplant candidates and donors for lower HL may identify barriers to living donation. Future interventions addressing HL may be important to increase living donation and reduce disparities.
    Transplantation 02/2014; DOI:10.1097/TP.0000000000000027 · 3.78 Impact Factor
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    ABSTRACT: The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) developed guidelines to care for patients with chronic kidney disease (CKD). While these are disseminated through the NKF's website and publications, the guidelines' usage remains suboptimal. The KDOQI Educational Committee was formed to identify barriers to guideline implementation, determine provider and patient educational needs and develop tools to improve care of patients with CKD. An online survey was conducted from May to September 2010 to evaluate renal providers' familiarity, current use of and attitudes toward the guidelines and tools to implement the guidelines. Most responders reported using the guidelines often and felt that they could be easily implemented into clinical practice; however, approximately one-half identified at least one barrier. Physicians and physician extenders most commonly cited the lack of evidence supporting KDOQI guidelines while allied health professionals most commonly listed patient non-adherence, unrealistic guideline goals and provider time-constraints. Providers thought that the guidelines included too much detail and identified the lack of a quick resource as a barrier to clinical implementation. Most were unaware of the Clinical Action Plans. Perceived barriers differed between renal clinicians and allied health professionals; educational and implementation tools tailored for different providers are needed.
    BMC Nephrology 10/2013; 14(1):230. DOI:10.1186/1471-2369-14-230 · 1.52 Impact Factor
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    ABSTRACT: Preparation for end-stage renal disease (ESRD) is widely acknowledged to be suboptimal in the United States. We sought to determine whether participation in a kidney disease screening and education program resulted in improved ESRD preparation and survival in 595 adults who developed ESRD after participating in the National Kidney Foundation Kidney Early Evaluation Program (KEEP), a community-based screening and education program. Non-KEEP patients were selected from a national ESRD registry and matched to KEEP participants based on demographic and clinical characteristics. The main outcomes were pre-ESRD nephrologist care, placement of permanent vascular access, use of peritoneal dialysis, pre-emptive transplant wait listing, transplantation, and mortality after ESRD. Participation in KEEP was associated with significantly higher rates of pre-ESRD nephrologist care (76.0% vs. 69.3%), peritoneal dialysis (10.3% vs. 6.4%), pre-emptive transplant wait listing (24.2% vs. 17.1%), and transplantation (9.7% vs. 6.4%) but not with higher rates of permanent vascular access (23.4% vs. 20.1%). Participation in KEEP was associated with a lower risk for mortality (hazard ratio 0.80), but this was not statistically significant after adjusting for ESRD preparation. Thus, participation in a voluntary community kidney disease screening and education program was associated with higher rates of ESRD preparation and survival.Kidney International advance online publication, 25 September 2013; doi:10.1038/ki.2013.369.
    Kidney International 09/2013; 85(3). DOI:10.1038/ki.2013.369 · 8.52 Impact Factor
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    ABSTRACT: The National Kidney Foundation and the US Food and Drug Administration (FDA) convened a symposium in September 2010, bringing together more than 70 experts, including representatives from the FDA, the National Institutes of Health, the Critical Path Institute, nephrologists, patients, and the pharmaceutical industry to discuss the feasibility and process of developing patient-reported outcome (PRO) measures to access how patients feel or function to be used in clinical trials for regulatory review of treatment benefit. Three disease areas were evaluated for development of end point models in which PRO measures may be useful: anemia secondary to chronic kidney disease, autosomal dominant polycystic kidney disease (ADPKD), and nephrotic syndrome. The participants thought it valuable to use observational data to generate hypotheses regarding patient baseline characteristics that are likely to predict clinically important changes in PROs in response to anemia treatment and to design adequately powered blinded randomized controlled trials of anemia treatment using PROs as primary rather than secondary end points. Validated PRO instruments that reflect the patient experience in ADPKD and nephrotic syndrome are essential to incorporate into clinical trials of new therapeutic interventions because glomerular filtration rate decline may occur late in the disease course, at which point therapeutic benefit is less likely. Conference attendees addressed how PRO measures could be used to evaluate, monitor, provide care, and facilitate the introduction of treatments for patients with these challenging conditions.
    American Journal of Kidney Diseases 08/2013; 62(6). DOI:10.1053/j.ajkd.2013.07.004 · 5.76 Impact Factor
  • Leigh Anne Dageforde, Kerri L Cavanaugh
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    ABSTRACT: Health literacy represents the communication among patients, their social networks, providers, and health systems to promote patients' understanding and engagement in their care. This is particularly relevant in kidney disease, in which the complexity of the medical condition and the extent of the health-care team require strategies to overcome health-literacy-related barriers. Limited literacy is common in patients with all stages of kidney disease and is associated with important outcomes, including reduced knowledge, less adherence, hospitalization, and death. A growing understanding and characterization of the health system, or organizational health literacy, may further our understanding of this dynamic relationship. Although various valid methods exist, assessment of health literacy within individuals or systematically within care settings has not been routinely performed. This may be in part due to the limited research in kidney-specific strategies to address limited health literacy. Future research to understand the mechanisms of health literacy will permit targeted, efficient interventions to bridge gaps and improve outcomes even in patients with complex kidney disease.
    Advances in chronic kidney disease 07/2013; 20(4):311-9. DOI:10.1053/j.ackd.2013.04.005 · 2.42 Impact Factor
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    ABSTRACT: There is currently a lack of valid instruments to measure adolescent diabetes numeracy. The Diabetes Numeracy Test (DNT) was adapted for type 1 diabetes and was administered to 2 samples of adolescents. Sample 1 was administered the 39-item version of the DNT (DNT-39) with measures of self-management, responsibility, reading, and glycemic control (A1C). Sample 2 was administered the 14-item version of the DNT (DNT-14) with measures of self-management, responsibility, problem solving, and A1C. Both versions of the DNT showed adequate internal reliability. In Sample 1, the DNT-39 and DNT-14 were related (r = .87, p = .001), and both DNT versions were related to parent education (for DNT-14, r = .31, p = .02; for DNT-39, r = .29, p = .03) and reading (for DNT-14, r = .36, p = .005; for DNT-39, r = .40, p = .001). In Sample 2, the DNT-14 was related to A1C (r =-.29, p = .001), reading skills (r = .36, p = .005), diabetes problem solving (r = .27, p = .02), adolescent age (r = .19, p = .03), and parent education (r = .31, p = .02). In combined analyses, 75% of items were answered correctly on the DNT-14 (range = 7-100), and performance was associated with age (r = .19, p = .03), pump use (r = .33 p = .001), and A1C (r =-.29, p = .001). The DNT-14 is a feasible, reliable, and valid numeracy assessment that indicated adolescents with type 1 diabetes have numeracy deficits that may affect their glycemic control.
    Journal of Health Communication 04/2013; DOI:10.1080/10810730.2012.757394 · 1.61 Impact Factor
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    ABSTRACT: BACKGROUND: Limited research exists on physician-delivered education interventions. We examined the feasibility and impact of an educational tool on facilitating physician-patient kidney disease communication. STUDY DESIGN: Pilot feasibility clinical trial with a historical control to examine effect size on patient knowledge and structured questions to elicit physician and patient feedback. SETTING & PARTICIPANTS: Adults with chronic kidney disease (CKD) stages 1-5, seen in nephrology clinic. INTERVENTION: 1-page educational worksheet, reviewed by physicians with patients. OUTCOMES: Kidney knowledge between patient groups and provider/patient feedback. MEASUREMENTS: Patient kidney knowledge was measured using a previously validated questionnaire compared between patients receiving the intervention (April to October 2010) and a historical cohort (April to October 2009). Provider input was obtained using structured interviews. Patient input was obtained through survey questions. Patient characteristics were abstracted from the medical record. RESULTS: 556 patients were included, with 401 patients in the historical cohort and 155 receiving the intervention. Mean age was 57 ± 16 (SD) years, with 53% men, 81% whites, and 78% with CKD stages 3-5. Compared with the historical cohort, patients receiving the intervention had higher adjusted odds of knowing they had CKD (adjusted OR, 2.20; 95% CI, 1.16-4.17; P = 0.02), knowing their kidney function (adjusted OR, 2.25; 95% CI, 1.27-3.97; P = 0.005), and knowing their stage of CKD (adjusted OR, 3.22; 95% CI, 1.49-6.92; P = 0.003). Physicians found the intervention tool easy and feasible to integrate into practice and 98% of patients who received the intervention recommended it for future use. LIMITATIONS: Study design did not randomly assign patients for comparison and enrollment was performed in clinics at one center. CONCLUSIONS: In this pilot study, a physician-delivered education intervention was feasible to use in practice and was associated with higher patient kidney disease knowledge. Further examination of physician-delivered education interventions for increasing patient disease understanding should be tested through randomized trials.
    American Journal of Kidney Diseases 03/2013; 62(1). DOI:10.1053/j.ajkd.2013.01.023 · 5.76 Impact Factor
  • Saugar Maripuri, T Alp Ikizler, Kerri L Cavanaugh
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    ABSTRACT: Background/Aims: Pre-end-stage renal disease (ESRD) care is associated with improved outcomes among patients receiving dialysis. It is unknown what proportion of US micropolitan and rural dialysis patients receive pre-ESRD care and benefit from such care when compared to urban. Methods: A retrospective cohort study was performed using data from the US Renal Data System. Patients ≥18 years old who initiated dialysis in 2006 and 2007 were classified as rural, micropolitan or urban and the prevalence of pre-ESRD care (early nephrology care >6 months, permanent vascular access, -dietary education) was determined using the medical evidence report. The association of pre-ESRD care with dialysis mortality and transplantation was assessed using Cox regression with stratification for geographic residence. Results: Of 204,463 dialysis patients, 80% were urban, 10.2% were micropolitan and 9.8% were rural. Overall attainment of pre-ESRD care was poor. After adjustment, there were no significant geographic differences in attainment of early nephrology care or permanent dialysis access. Receiving care reduced all-cause mortality and increased the likelihood of transplantation to a similar degree regardless of geographic residence. Both micropolitan and rural patients received less dietary education (relative risk = 0.80, 95% CI = 0.76-0.84 and relative risk = 0.85, 95% CI = 0.80-0.89, respectively). Conclusion: Among patients who receive dialysis, the prevalence of early nephrology care and permanent dialysis access is poor and does not vary by geographic residence. Micropolitan and rural patients receive less dietary education despite an observed mortality benefit, suggesting that barriers may exist to quality dietary care in more remote locations.
    American Journal of Nephrology 03/2013; 37(3):274-280. DOI:10.1159/000348377 · 2.65 Impact Factor
  • Kerri L Cavanaugh
    American Journal of Kidney Diseases 03/2013; 61(3):368-70. DOI:10.1053/j.ajkd.2013.01.003 · 5.76 Impact Factor
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    ABSTRACT: OBJECTIVE: Because existing numeracy measures may not optimally assess 'health numeracy', we developed and validated the General Health Numeracy Test (GHNT). METHODS: An iterative pilot testing process produced 21 GHNT items that were administered to 205 patients along with validated measures of health literacy, objective numeracy, subjective numeracy, and medication understanding and medication adherence. We assessed the GHNT's internal consistency reliability, construct validity, and explored its predictive validity. RESULTS: On average, participants were 55.0±13.8 years old, 64.9% female, 29.8% non-White, and 51.7% had incomes ≤$39K with 14.4±2.9 years of education. Psychometric testing produced a 6-item version (GHNT-6). The GHNT-21 and GHNT-6 had acceptable-good internal consistency reliability (KR-20=0.87 vs. 0.77, respectively). Both versions were positively associated with income, education, health literacy, objective numeracy, and subjective numeracy (all p<.001). Furthermore, both versions were associated with participants' understanding of their medications and medication adherence in unadjusted analyses, but only the GHNT-21 was associated with medication understanding in adjusted analyses. CONCLUSIONS: The GHNT-21 and GHNT-6 are reliable and valid tools for assessing health numeracy. PRACTICE IMPLICATIONS: Brief, reliable, and valid assessments of health numeracy can assess a patient's numeracy status, and may ultimately help providers and educators tailor education to patients.
    Patient Education and Counseling 02/2013; DOI:10.1016/j.pec.2013.01.001 · 2.60 Impact Factor
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    ABSTRACT: PurposeThe purpose of this study is to describe the association between numeracy and self-reported dietary intake in patients with type 2 diabetes.Methods Numeracy and dietary intake were assessed with the validated Diabetes Numeracy Test and a validated food frequency questionnaire in a cross-sectional study of 150 primary care patients enrolled in a randomized clinical trial at an academic medical center between April 2008 and October 2009. Associations between numeracy and caloric and macronutrient intakes were examined with linear regression models.ResultsPatients with lower numeracy consumed a higher percentage of calories from carbohydrates and lower percentages from protein and fat. However, no differences in energy consumption or the percentage of energy intake owing to carbohydrates, fat, or protein were observed in adjusted analyses. Patients with lower numeracy were significantly more likely to report extremely high or low energy intake inconsistent with standard dietary intake.Conclusions Numeracy was not associated with dietary intake in adjusted analyses. Low numeracy was associated with inaccurate dietary reporting. Providers who take dietary histories in patients with diabetes may need to consider numeracy in their assessment of dietary intake.
    The Diabetes Educator 02/2013; 39(2). DOI:10.1177/0145721713475841 · 1.92 Impact Factor
  • Kerri L Cavanaugh, T Alp Ikizler
    American Journal of Kidney Diseases 01/2013; 61(4). DOI:10.1053/j.ajkd.2012.12.005 · 5.76 Impact Factor
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    12/2012; 10(5). DOI:10.1007/s12468-012-0045-0
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    ABSTRACT: We evaluated whether black race is associated with higher incidence of End Stage Renal Disease (ESRD) among a cohort of blacks and whites of similar, generally low socioeconomic status, and whether risk factor patterns differ among blacks and whites and explain the poorly understood racial disparity in ESRD. Incident diagnoses of ESRD among 79,943 black and white participants in the Southern Community Cohort Study (SCCS) were ascertained by linkage with the United States Renal Data System (USRDS) from 2002 through 2009. Person-years of follow up were calculated from date of entry into the SCCS until date of ESRD diagnosis, date of death, or September 1, 2009, whichever occurred first. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for incident ESRD among black and white participants in relation to baseline characteristics. After 329,003 person-years of follow-up, 687 incident cases of ESRD were identified in the cohort. The age-adjusted ESRD incidence rate was 273 (per 100,000) among blacks, 3.5-fold higher than the rate of 78 among whites. Risk factors for ESRD included male sex (HR = 1.6; 95% CI 1.4-1.9), low income (HR = 1.5; 95% CI 1.2-1.8 for income below vs. above $15,000), smoking (HR = 1.2; 95% CI 1.02-1.4) and histories of diabetes (HRs increasing to 9.4 (95% CI 7.4-11.9) among those with ≥20 years diabetes duration) and hypertension (HR = 2.9; 95% CI 2.3-3.7). Patterns and magnitudes of association were virtually identical among blacks and whites. After adjustment for these risk factors, blacks continued to have a higher risk for ESRD (HR = 2.4; 95% CI = 1.9-3.0) relative to whites. The black-white disparity in risk of ESRD was attenuated but not eliminated after control for known risk factors in a closely socioeconomically matched cohort. Further research characterizing biomedical factors, including CKD progression, in ESRD occurrence in these two racial groups is needed.
    PLoS ONE 10/2012; 7(10):e48407. DOI:10.1371/journal.pone.0048407 · 3.53 Impact Factor
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    ABSTRACT: Micropolitan and rural patients face challenges when initiating dialysis, including healthcare access. Previous studies have shown little association of nonurban residence with dialysis outcomes but have not examined the association of dialysis modality with residence location. This retrospective cohort study used data from the U.S. Renal Data System. Adults who initiated maintenance dialysis between January 1, 2006, and December 31, 2007, were classified as rural, micropolitan, or urban. Early and long-term mortality and kidney transplantation were examined with Cox regression stratified by dialysis modality. Of 204,463 patients, 80% were urban; 10.2%, micropolitan; and 9.8%, rural. Micropolitan and rural patients were older, were less racially diverse, had more comorbid conditions, and were more likely to start peritoneal dialysis (PD). Median follow-up was 2.0 years. Early mortality or long-term hemodialysis (HD) mortality did not significantly differ by geographic residence. After adjustment, micropolitan and rural PD patients had higher risk for long-term mortality (hazard ratio [HR], 1.21 [95% confidence interval (CI), 1.09-1.35] and 1.12 [95% CI, 1.01-1.24], respectively) than urban PD patients. After adjustment, kidney transplantation was more likely in micropolitan and rural HD patients (HR, 1.19 [95% CI, 1.11-1.28] and 1.30 [CI, 1.21-1.40]) than urban HD patients, and micropolitan PD patients (HR, 1.31 [95%, CI 1.13-1.51]) than urban PD patients. Micropolitan and rural residence is associated with higher mortality in PD patients and similar or higher likelihood of kidney transplantation among HD and PD patients. Studies examining the underlying mechanisms of these associations are warranted.
    Clinical Journal of the American Society of Nephrology 04/2012; 7(7):1121-9. DOI:10.2215/CJN.10831011 · 5.07 Impact Factor
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    ABSTRACT: To describe patient hypertension knowledge and associations with blood pressure measurements. Patients with chronic kidney disease (CKD) were asked about the impact of high blood pressure on kidneys and their target blood pressure goal. Systolic blood pressure was measured using automated sphygmomanometers. In 338 adults with hypertension and pre-dialysis CKD, the median [IQR] age was 59 [47,68] years, 45% [n = 152] were women, and 18% [n = 62] were non-white. Lower systolic blood pressure (SBP) was associated with female sex (SBP mmHg median [IQR] 132 [117,149] women vs. 137 [124,152] men; p = 0.04), less advanced CKD (SBP 134 [122,147] stages 1-2 vs. 132 [118,148] stage 3 vs. 140 [125,156] stages 4-5; p = 0.01), and patient ability to correctly identify SBP goal (SBP 134 [119,150] correct vs. 141 [125,154] incorrect; p = 0.05). In adjusted analysis, knowledge of blood pressure goal remained independently associated with lower SBP (-9.96 mmHg [-19.97, -1.95] in correct respondents vs. incorrect; p<0.001). Patient knowledge of goal blood pressure is independently associated with improved blood pressure control. Interventions to improve patient knowledge of specific blood pressure targets may have an important role in optimizing blood pressure management.
    Patient Education and Counseling 03/2012; 88(2):184-8. DOI:10.1016/j.pec.2012.02.015 · 2.60 Impact Factor

Publication Stats

744 Citations
237.14 Total Impact Points


  • 2007–2014
    • Vanderbilt University
      • • Department of Medicine
      • • Center for Health Services Research
      Nashville, Michigan, United States
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, Maryland, United States
  • 2013
    • University of Texas Southwestern Medical Center
      Dallas, Texas, United States
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2012
    • University of Michigan
      • Department of Internal Medicine
      Ann Arbor, MI, United States
  • 2009
    • Johns Hopkins University
      • Department of Medicine
      Baltimore, MD, United States
    • Fresenius Medical Care North America
      Волтам, Massachusetts, United States