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• Baylor Scott & White Health

Vulnerability is frequently conceptualized as a group attribute, with all members of that group automatically receiving additional safeguards, including denial of access. There has, however, been a move to recognize more nuanced, context-driven concepts of vulnerability. In the research setting, this has taken the form of a taxonomy that identifies...

Objective: To examine two waves of longitudinal survey data, at 1- and 2-years into the COVID-19 pandemic, to determine sociodemographic and economic risk factors for prolonged mental health distress. Methods: A longitudinal study of adults (N=1,412) began in April of 2020 in a large health system in Texas. Follow-up surveys were sent at 1, 3, 6, 1...

Donation after circulatory death (DCD) donors now represent over 30% of the deceased donor pool in the United States. Compared to donation after brain death (DBD), DCD donation is less likely to result in transplantation. For each potential donor whose organs cannot be utilized for transplantation (i.e., dry run), fees are associated with the attem...

Background: As uterus transplantation transitions to a clinical procedure for women with absolute uterine-factor infertility, transplant centers performing uterus transplantation need information about the experience of living donors. This study examined the psychosocial impact on 17 nondirected uterus donors in the Dallas UtErus Transplant Study...

Introduction: Early in the COVID-19 pandemic, primary care adopted telehealth rapidly to preserve access. Although policy flexibilities persist, but with in-person access restored, insight regarding long-term policy reform is needed for equitable access, especially for underserved, low income, and rural populations. Methods: We used electronic h...

COVID-19 vaccine uptake in the United States has proved challenging. A deeper characterization extending beyond demographics and political ideologies of those hesitating or resisting is needed to guide ongoing conversations. This study examined associations between US adults' vaccination intentions and mental health history, experience of the COVID...

Background: Ethical frameworks for organ donation following circulatory death (DCD) were established >20 years ago. However, considerable variation exists among these, indicating consensus has not been reached on all issues. Additionally, advances such as cardiac DCD transplants and normothermic regional perfusion (NRP) may have reignited old debat...

This study describes the characteristics of women who contacted an active program performing uterus transplantation (UTx) in the US, expressing interest in becoming a uterus transplant recipient or a living donor. Basic demographic and self-reported clinical information was collected from women who contacted any of the three US UTx programs from 20...

Background: Uterus transplantation (UTx) has come of age in the 21st Century, building on the 20th Century developments in vascular anastomosis and effective immunosuppressive protocols enabling solid organ transplantation to become the life extending and life improving treatment option we know today. However, UTx has the goal of enabling reproduc...

As the COVID-19 pandemic continues, interest in mental health impacts is shifting from short-term to long-term outcomes. As part of a longitudinal online survey study examining mental health impacts of the pandemic, we assessed the risk of attrition bias related to a history of depression—a condition research shows can increase challenges of recrui...

Background Little research is available regarding vaccination attitudes among those recently diagnosed with COVID-19. This is important to investigate, particularly among those experiencing mild-to-moderate illness, given the ongoing need to improve uptake of both initial vaccine series and booster doses, and the divergent ways such an experience c...

Background The prevalence of depression symptoms among U.S. adults increased dramatically during the early months of the COVID-19 pandemic. We sought to understand the impact of the pandemic on people with a history of depression. Methods In June 2020, a national sample of 5023 U.S. adults, including 760 reporting past/current diagnoses of depress...

Background Mental health impacts of the COVID-19 pandemic are well recognized, but little is known about the pandemic experience among people experiencing mental health symptoms. Methods In June 2020, a national sample of 5023 U.S. adults, including 785 scoring ⩾10 on the PHQ-8 for symptoms of depression, completed survey measures related to their...

Objectives: Information regarding vaccination and the association with individuals’ characteristics, experiences, and information sources is important for crafting public health campaigns to maximize uptake. Our objective was to investigate factors associated with intentions for COVID-19 vaccination among a sample of U.S. adults using a population-...

The volume of abdominal organ offers received by the Baylor Simmons Transplant Institute has increased over time, resulting in a higher workload for our donor call team. To quantify the increase in organ offers, determine the characteristics of these offers, and estimate the impact on our transplant center workload, we collected center-specific org...

Objectives Studies investigating the association between vitamin D and severity of COVID-19 have mixed results perhaps due to immunoassay assessment of total 25-hydroxyvitamin D (tD) (the sum of 25-hydroxyvitamin-D2 [25-OH-D2] and 25-hydroxyvitamin-D3 [25-OH-D3]). Liquid chromatography tandem mass spectrometry (LC-MS/MS) has high analytical specifi...

Objective: Our objectives were two-fold: 1) To evaluate the benefits of population health strategies focused on social determinants of health and integrated into the primary care medical home (PCMH) and 2) to determine how these strategies impact diabetes and cardiovascular disease outcomes among a low-income, primarily minority community. We also...

Uterus transplantation (UTx) offers women with absolute uterine factor infertility a path to motherhood that enables them to carry their own pregnancy. Debates about the ethics of UTx have evolved in tandem with its clinical evolution: clinical trials have provided evidence regarding risks and benefits to donors and recipients that were initially u...

The COVID-19 pandemic disrupted many usual processes for recruiting and enrolling research participants. We present our experience with electronic recruitment in a survey study investigating the impact of the COVID-19 pandemic on mental health. Adults (≥18 years) in communities served by Baylor Scott and White Health (BSWH) were recruited via patie...

Background Substantial evidence is emerging regarding the broad societal and psychological impacts of the COVID-19 pandemic, but little is known about whether infected individuals are differently affected. Aim We evaluated psychological differences between individuals who do vs. do not report testing positive for COVID-19. Methods An online surve...

Minimally invasive procurement of uterine grafts for transplantation can decrease living donor recovery time. We examined recipient outcomes for grafts procured by robotic-assisted donor hysterectomies with transvaginal extraction in the Dallas UtErus Transplant Study (DUETS). All 5 grafts were successfully transplanted. Recipients had a median 4.5...

Objectives Opioid-induced respiratory depression (OIRD) and oversedation are rare but potentially devastating adverse events in hospitalised patients. We investigated which features predict an individual patient’s risk of OIRD or oversedation; and developed a risk stratification tool that can be used to aid point-of-care clinical decision-making....

Acute kidney injury (AKI) and chronic kidney disease (CKD) are important drivers of morbidity and mortality in patients with cirrhosis before and after liver transplantation (LT). In this review, we examine the role of novel kidney biomarkers for early recognition of kidney injury. Studies are limited by lack of reference standards, heterogeneous d...

The COVID-19 pandemic has caused disproportionate suffering among vulnerable and socioeconomically disadvantaged portions of the population. Low-income and minority populations are likely to experience disparate disease and mental health burdens. Currently, there is little evidence regarding how the experience of the early months of the US COVID-19...

Purpose of review: Uterus transplantation (Utx) offers women with absolute uterine factor infertility the opportunity to carry their own pregnancies. As Utx transitions from an experimental to standard clinical procedure, we review the status of the ethical issues applicable to the stakeholders involved. Recent findings: With more than 65 Utx pr...

Importance Acuity circles (AC) liver allocation policy was implemented to eliminate donor service area geographic boundaries from liver allocation and to decrease variability in median Model of End-stage Liver Disease (MELD) score at transplant and wait list mortality. However, the broader sharing of organs was also associated with more flights for...

Introduction: Restrictive sternal precautions intended to prevent cardiac surgery patients from damaging healing sternotomies lack supporting evidence and may decrease independence and increase post-acute care utilization. Data regarding the impact of alternative approaches on safety and outcomes are needed to guide evidence-based best practices....

Objective To investigate the impact of limiting the definition of post-coronary artery bypass graft (CABG) atrial fibrillation (AF) to AF/flutter requiring treatment—as in the Society of Thoracic Surgeons' (STS) database— on the association with survival. Patients and Methods We assessed in-hospital incidence of post-CABG AF in 7110 consecutive is...

Objective Extracorporeal membrane oxygenation (ECMO) use in adult patient populations has grown rapidly with wide variation in practices and outcomes. We evaluated the impact on patient outcomes, resource use, and costs of an initiative to coordinate and standardize best practices across ECMO programs within a large integrated health care system....

Efficiency is a measure of the quantity and/or quality of output (health outcome or service) for a given level of input (cost) – i.e., its value. Managing value requires measuring patient-level costs and outcomes, encompassing entire care cycles. Such data are seldom obtainable, leaving efficiency measures reliant on charges billed (or reimbursemen...

Background: New-onset post-coronary artery bypass graft surgery (CABG) atrial fibrillation (AF) is associated with poor outcomes, but data on the effects of its characteristics are lacking and conflicting. We examined the effect number of post-CABG AF events has on long-term mortality risk, and whether this is sex dependent. Methods: Routinely-c...

Background Two quality measures used in public reporting and value-based payment programs require β-blockers be administered less than 24 hours before isolated coronary artery bypass graft surgery to prevent atrial fibrillation and mortality. Questions have arisen about continued use of these measures. Methods We conducted a systematic search for...

Objective: To compare diagnostic accuracy between primary care E-Visit and face-to-face (F2F) encounters for low-acuity illnesses. Patients and methods: This cross-sectional retrospective analysis of electronic health records in a large not-for-profit integrated delivery system included patients covered by the health care system's employee healt...

Background: We sought to fill important gaps in the existing evidence regarding new-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) by comparing the incidence, characteristics, and effect on long-term survival between men and women. Methods: Nine thousand two hundred three consecutive patients without preoperativ...

Objective: Studies with authors trained in research methods are of higher quality than those without. We examined inclusion of authors with master’s or doctoral degrees incorporating advanced research methods training on original research articles in high-impact journals, investigating differences between journals and by first-author sex. Methods:...

Objectives Postoperative atrial fibrillation (AF) following coronary artery bypass graft surgery (CABG) is significantly associated with reduced survival, but poor characterisation and inconsistent definitions present barriers to developing effective prophylaxis and management. We sought to address this knowledge gap. Methods From 2002 to 2010, 11...

Background: New-onset atrial fibrillation (AF) after coronary artery bypass graft (CABG) operation is associated with poorer survival. Blanket prophylaxis efforts have not appreciably decreased incidence, making targeted prevention for high-risk patients desirable. We compared predictive abilities of existing scores developed/used to predict adver...

Background: Despite many studies comparing on- versus off-pump coronary artery bypass graft (CABG), there is no consensus as to whether one of these techniques offers patients better outcomes. Methods: We searched PubMed from inception to June 30, 2015, and identified additional studies from bibliographies of meta-analyses and reviews. We identi...

Background: The patient-centered medical home (PCMH) shows promise for improving care and reducing costs. We sought to reduce the uncertainty regarding the time and cost of PCMH transformation by quantifying the direct costs of transforming 57 practices in a medical group to National Committee for Quality Assurance (NCQA)-recognized Level III PCMH...

Objective Inconsistent definitions of atrial fibrillation (AF) following coronary artery bypass graft surgery (CABG) have caused uncertainty about its incidence and risk. We examined the extent to which limiting the definition to post-CABG AF events requiring treatment underestimates its incidence and impact on 30-day mortality. Methods We assesse...

Primary care practices become patient-centered medical homes (PCMHs) to improve care. However, investment costs and opportunities to offset those costs are critical to the decision. We examined potential offsets through commercial payer per-member-per-month (PMPM) payments and the Medicare Merit-based Incentive Payment System (MIPS) for a network t...

Background: New-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) is associated with increased morbidity and poorer long-term survival. Although many studies show differences in outcome in women versus men after CABG, little is known about the sex-specific incidence and characteristics of post-CABG AF. Methods and r...

Objective: To examine changes in representation of women among first authors of original research published in high impact general medical journals from 1994 to 2014 and investigate differences between journals. Design: Observational study. Study sample: All original research articles published in Annals of Internal Medicine, Archives of Internal M...

Objective: Female sex is considered a risk factor for adverse outcomes following isolated coronary artery bypass graft (CABG) surgery. We assessed the association between sex and short-term mortality following isolated CABG, and estimated the ‘excess’ deaths occurring in women. Methods: Short-term mortality was investigated in 13 327 consecutive...

While many health care organizations need to improve health care quality and lower costs, most lack specific strategies and tactics for implementing these changes. Baylor Scott & White Health has established and continues to develop an accountable care organization (ACO) called the Baylor Scott & White Quality Alliance (BSWQA) to improve the qualit...

In this chapter we looked at the process and methods involved in conducting a quantitative systematic review of the published literature, using the example of comparing mortality following off-pump vs. on-pump CABG. Before starting a quantitative systematic review it is critical to develop a meta-analysis protocol, specifying the systematic search...

Randomized controlled trials have shown no significant difference in survival between immediate open repair and surveillance with selective repair for asymptomatic abdominal aortic aneurysms of 4.0 to 5.5 cm in diameter. This lack of difference has been shown to hold true for all diameters in this range, in men and women, but the question of whethe...

To report 5 years of adverse events (AEs) identified using an enhanced Global Trigger Tool (GTT) in a large health care system. Records from monthly random samples of adults admitted to eight acute care hospitals from 2007 to 2011 with lengths of stay ≥3 days were reviewed. We examined AE incidence overall and by presence on admission, severity, st...

Deep sternal wound infections (DSWIs) are serious complications of sternotomy, leading to increased mortality and costs of care. Topical applications of autologous platelet concentrate and vancomycin have both shown promise in preventing DSWIs. From January 1, 1998, to November 30, 2010, 1,866 patients without previous sternotomy underwent cardiac...

Health information technology shows promise for improving chronic disease care. This study assessed the impact of a diabetes management form (DMF), accessible within an electronic health record. From 2007 to 2009, 2108 diabetes patients were seen in 20 primary care practices; 1103 visits involved use of the DMF in 2008. The primary outcome was "opt...

To estimate a commercially available ambulatory electronic health record's (EHR's) impact on workflow and financial measures. Administrative, payroll, and billing data were collected for 26 primary care practices in a fee-for-service network that rolled out an EHR on a staggered schedule from June 2006 through December 2008. An interrupted time ser...

To assess whether survival differences exist between patients undergoing immediate open repair vs surveillance with selective repair for 4.0- to 5.4-cm abdominal aortic aneurysms (AAAs) and whether these differences vary by diameter, within sexes, or overall. The study cohort included 2226 patients randomized to immediate repair or surveillance for...

Objective: To adapt the Global Trigger Tool (GTT) as a sustainable monitoring tool able to characterize adverse events (AEs) for organizational learning, within the context of limited resources. Methods: Baylor Health Care System (BHCS) expanded the AE data collected to include judgments of preventability, presence on admission, relation to care...

In November 2011 the Social Security Administration removed ~5% of the death records in the publicly-available Death Master File (DMF) and started excluding ~40% of newly received death records based on its determination that data submitted electronically by the states cannot be publicly shared. Healthcare researchers and providers rely heavily on...

To assess the impact of electronic health record (EHR) implementation on primary care diabetes care. Charts were abstracted semi-annually for 14,051 diabetes patients seen in 34 primary care practices in a large, fee-for-service network from January 1, 2005 to December 31, 2010. The study sample was limited to patients aged 40 years or older. A nat...

Adoption of healthcare innovations frequently outpaces the evidence of effectiveness. Endovascular repair (EVAR) for abdominal aortic aneurysms in the USA demonstrates how comparative effectiveness research without evidence-based reimbursement changes may fail to influence clinical practice. Randomized controlled trials for small abdominal aortic a...

Bioprinting may offer a new solution to the age-old problem of the human body’s lack of “spare parts” when the failure of a small but critical piece threatens the survival of the whole. This report provides a general overview of the current state of bioprinting technology, examining its potential as a future source for tissue grafts and full organ...