Timothy S Carey's research while affiliated with University of North Carolina at Chapel Hill and other places

Publications (203)

Article
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In 2019, the National Health Interview survey found that nearly 59% of adults reported pain some, most, or every day in the past 3 months, with 39% reporting back pain, making back pain the most prevalent source of pain, and a significant issue among adults. Often, identifying a direct, treatable cause for back pain is challenging, especially as it...
Article
Background: In the US, over 200 lives are lost from opioid overdoses each day. Accurate and prompt diagnosis of opioid use disorders (OUD) may help prevent overdose deaths. However, International Classification of Disease (ICD) codes for OUD are known to underestimate prevalence, and their specificity and sensitivity are unknown. We developed and...
Article
Background Natural disasters are associated with increased mental health disorders and suicidal ideation; however, associations with suicide deaths are not well understood. We explored how Hurricane Florence, which made landfall in September 2018, may have impacted suicide deaths in North Carolina (NC). Methods We used publicly available NC death...
Article
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Introduction: Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Bac...
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Background: Suicide deaths have been increasing for the past 20 years in the USA resulting in 45 979 deaths in 2020, a 29% increase since 1999. Lack of data linkage between entities with potential to implement large suicide prevention initiatives (health insurers, health institutions and corrections) is a barrier to developing an integrated framew...
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Background: The preferences of autism stakeholders regarding the top priorities for future autism research are largely unknown. Objective: This study had two objectives: First, to examine what autism stakeholders think new research investments should be and the attributes of investment that they consider important, and second, to explore the fea...
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Objectives. To assess linkages of patient data from a health care system in the southeastern United States to microdata from the American Community Survey (ACS) with the goal of better understanding health disparities and social determinants of health in the population. Methods. Once a data use agreement was in place, a stratified random sample of...
Conference Paper
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Statement of Purpose Natural disasters like hurricanes and flooding can lead to severe financial and mental health burdens, however, their impact on suicidal behaviors is unclear. We examined the impact of Hurricane Florence (September, 2018), which resulted in massive property damage, flooding, and 59 deaths across the Carolinas and Virginia, on s...
Article
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Institutions must decide how to manage the use of clinical data to support research while ensuring appropriate protections are in place. Questions about data use and sharing often go beyond what the Health Insurance Portability and Accountability Act of 1996 (HIPAA) considers. In this article, we describe our institution’s governance model and appr...
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Background Recent increases in state laws to reduce opioid prescribing have demonstrated a need to understand how they are interpreted and implemented in healthcare systems. The purpose of this study was to explore the systems, strategies, and resources that hospital administrators and prescribers used to implement the 2017 North Carolina Strengthe...
Preprint
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Background: In the US, over 200 lives are lost from opioid overdoses each day. Accurate and prompt diagnosis of opioid use disorders (OUD) may contribute substantially to prevention of overdose deaths. However, OUD research is limited, the specificity and sensitivity of OUD ICD codes are unknown, and the ICD codes are known to underestimate OUD pre...
Article
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Readmissions and emergency department (ED) visits after colorectal surgery (CRS) are common, burdensome, and costly. Effective strategies to reduce these unplanned postdischarge health care visits require a nuanced understanding of how and why patients make the decision to seek care. We used a purposefully stratified sample of 18 interview particip...
Conference Paper
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Statement of purpose In the US, over 130 lives are lost from opioid-related drug overdoses each day. Accurate and prompt diagnosis of opioid use disorders (OUD) may contribute substantially to prevention of overdose deaths. However, OUD research is limited because ICD codes used to identify OUD are specific but not sensitive, resulting in underesti...
Article
Background The HERO registry was established to support research on the impact of the COVID-19 pandemic on US healthcare workers.Objective Describe the COVID-19 pandemic experiences of and effects on individuals participating in the HERO registry.DesignCross-sectional, self-administered registry enrollment survey conducted from April 10 to July 31,...
Article
Background: Thirty-day readmissions, emergency department visits, and observation stays are common after colorectal surgery (9%-25%, 8%-12%, and 3%-5%), yet it is unknown to what extent planned postdischarge care can decrease the frequency of emergency department visits. Objective: This study's aim was to determine whether early follow-up with t...
Article
Background Adult colorectal surgery patients continue to have high rates of readmissions, despite known risk factors for non-routine postdischarge care (emergency department (ED) visit or rehospitalization) and countless interventions to address these. It is unclear how the difficult-to-quantify patient perspective frames and modifies the impact of...
Article
Expert groups, including the U.S. Preventive Services Task Force (USPSTF), recommend a range of clinical preventive services for persons at average risk for disease. Use of these services often is substantially lower among racial and ethnic minority groups, rural residents, and persons of lower socioeconomic status. On 19 and 20 June 2019, the Nati...
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Importance Increases in prescription opioid use in the United States have been attributed to changing prescribing guidelines and attitudes toward pain relief; however, the spread of opioid use within households through drug diversion may also be a contributing factor. Objective To investigate whether individuals living in a household with a prescr...
Article
Context: Investigators need novel methods for timely identification of patients with serious illness to test or implement new palliative care models. Objective: The study aim was to develop an electronic health record (EHR) phenotype to identify patients with late-stage dementia for a clinical trial of palliative care consultation. Methods: We...
Article
In the U.S., two-thirds of people with dementia die in nursing homes, meaning family members are positioned to inform care from admission through the end of life. Unfortunately, communication between family, staff, and medical providers about issues such as life-sustaining treatments is limited, often resulting in unwanted, aggressive treatments. T...
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Importance: In advanced dementia, goals of care decisions are challenging and medical care is often more intensive than desired. Objective: To test a goals of care (GOC) decision aid intervention to improve quality of communication and palliative care for nursing home residents with advanced dementia. Design, setting, and participants: A singl...
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Objective: To develop an efficient surveillance approach for childhood diabetes by type across 2 large US health care systems, using phenotyping algorithms derived from electronic health record (EHR) data. Materials and methods: Presumptive diabetes cases <20 years of age from 2 large independent health care systems were identified as those havi...
Article
We aimed to develop an efficient surveillance approach for childhood diabetes. We analyzed EHR data from two independent US academic health care systems. Presumptive diabetes cases were identified as those having >1 of the five diabetes indicators in the past 3.5 years. EHRs of the presumptive cases were manually reviewed. We developed a stepwise s...
Article
After recovery, patients often query their health care professional on how to avoid future episodes of LBP. The well-conducted systematic review by Steffens and colleagues² provides us with concrete evidence on the value of exercise. They summarize several low- to moderate-quality trials that examine the benefits of exercise and education on primar...
Article
Study design: Analysis of the State Inpatient Database of North Carolina, 2005-2012, and the Nationwide Inpatient Sample, including all inpatient lumbar fusion admissions from non-federal hospitals. Objective: To examine the influence of a major commercial policy change that restricted lumbar fusion for certain indications, and to forecast the p...
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Physical therapy researchers are interested in how beneficial an intervention is or the “treatment effect.” There are many measures of treatment effect that are applicable for understanding the efficacy and effectiveness of health interventions. Given that each treatment effect has its own set of advantages and disadvantages, understanding these ch...
Article
Practice-based research networks (PBRNs) have been in existence for several decades, and they provide one mechanism to conduct research outside of academic research centers. Two transformative changes to the practice environment pose significant challenges to the manner in which PBRNs have functioned in the past and require changes to their current...
Article
Patients with end-stage renal disease (ESRD) receiving dialysis have poor health-related quality of life. Physical symptoms are highly prevalent among dialysis-dependent patients and play important roles in health-related quality of life. A range of symptom assessment tools have been used in dialysis-dependent patients, but there has been no previo...
Article
This is a secondary analysis of a cross-sectional population-based survey. Shorten the modified 23-item Roland (mRoland) scale using item response theory (IRT) methods and describe where in the functional disability range each scale is the most precise. The Roland-Morris Disability Questionnaire is recommended for a functional disability outcome me...
Article
The use of antipsychotics, particularly second generation antipsychotics, among children and adolescents has increased markedly during the past 20 years. Existing evidence gaps make this practice controversial and hinder treatment decision-making. This article describes and prioritizes future research needs regarding antipsychotic treatment in yout...
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Although similar to cancer patients regarding symptom burden and prognosis, patients with heart failure (HF) tend to receive palliative care far less frequently. We sought to explore factors perceived by cardiology, primary care, and palliative care providers to impede palliative care referral for HF patients. We conducted semistructured interviews...
Article
Objectives Groups such as the Institute of Medicine emphasize the importance of attention to financial conflicts of interest. Little guidance exists, however, on managing the risk of bias for systematic reviews from nonfinancial conflicts of interest. We sought to create practical guidance on ensuring adequate clinical or content expertise while ma...
Article
Background The performance of automated algorithms for childhood diabetes case ascertainment and type classification may differ by demographic characteristics. Objective This study evaluated the potential of administrative and electronic health record (EHR) data from a large academic care delivery system to conduct diabetes case ascertainment in yo...
Article
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Background: As the role of palliative care (PC) has yet to be clearly defined in patients with heart failure (HF), such patients may face barriers regarding PC referral. In order to maximally meet the needs of HF patients, it is necessary to understand how they compare to the classic PC population: patients with cancer. Objective: To characteriz...
Article
With onset often occurring before 6 years of age, attention-deficit/hyperactivity disorder (ADHD) involves attention problems, impulsivity, overactivity, and sometimes disruptive behavior. Impairment usually persists into adulthood, with an estimated worldwide prevalence in adults of 2.5%. Existing gaps in evidence concerning ADHD hinder decision-m...
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An important challenge in comparative effectiveness research is the lack of infrastructure to support pragmatic clinical trials, which compare interventions in usual practice settings and subjects. These trials present challenges that differ from those of classical efficacy trials, which are conducted under ideal circumstances, in patients selected...
Article
Nationwide estimates examining Bone Morphogenetic Protein (BMP) use with cervical spine fusions have been limited to perioperative outcomes. Determined the one-year risk of complications, cervical revision fusions, hospital re-admissions and healthcare services utilization. A retrospective cohort study from 2002 to 2009 utilizing a nationwide claim...
Article
To describe quality of care for feeding problems in advanced dementia and probability and predictors of weight loss and mortality. Prospective cohort. Twenty-four nursing homes (NHs). Nursing home residents with advanced dementia and feeding problems and family surrogates (N = 256). Family reported on quality of feeding care at enrollment and 3 mon...
Article
Research needs are many in the current health care environment. In this article, we describe a novel method developed by the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center Program for pri- oritizing areas for future research. Using a recent- ly published systematic review as a foundation, investigators worked with...
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In 2011, The Institute of Medicine (IOM) identified a set of methodological standards to improve the validity, trustworthiness, and usefulness of systematic reviews. These standards, based on a mix of theoretical principles, empiric evidence, and commonly considered best practices, set a high bar for authors of systematic reviews. Based on over 15...
Article
Purpose: (1) To describe demographic and health-related characteristics among rural/urban residents with chronic low back pain (LBP); (2) To determine if the utilization of diagnostics and treatments differs between rural and urban residents with chronic LBP; and (3) To determine the association between rural/urban residence and health care provide...
Article
Lumbar spine osteoarthritis (OA) is very common, with estimates of prevalence ranging from 40-85 %. The process of degeneration of the spine has commonly been classified as OA (disc space narrowing together with vertebral osteophyte formation); however, anatomically, the facet joint is the only synovial joint in the spine that has a similar patholo...
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Objective: To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use. Data sources: Medicare inpatient and outpatient claims from 2002 to 2008 for patients receiving multivessel revascularization for symptomatic coronary disease in 2003-2004. Study design: This...
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Data management is essential for health services research. Data sources such as inpatient records, insurance claims, and large national surveys form the basis for majority of research studies addressing questions related to health care access, delivery and outcomes. The purpose of these secondary data sources is generally not specific to the my...
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The Clinical and Translational Science Award (CTSA) Workgroup for Comparative Effectiveness Research (CER) Education, Training, and Workforce Development identified a need to delineate the competencies that practitioners and users of CER for patient-centered outcomes research, should acquire. With input from CTSA representatives and collaborators,...
Article
To determine the prevalence of lumbar spine individual radiographic features (IRFs) of disc space narrowing (DSN), osteophytes (OST), and facet joint osteoarthritis (FOA); to describe the frequencies of demographic, clinical, and radiographic knee, hip, and hand osteoarthritis (OA) across lumbar spine IRFs; and to determine factors associated with...
Article
(1) To determine associations between radiographic features of lumbosacral (LS) spine disc space narrowing (DSN) and osteophytes (OST) and joint metabolism biomarkers (serum cartilage oligomeric matrix protein (COMP), hyaluronic acid (HA), collagen neoepitope (C2C), C-propeptide of type II procollagen (CP-II), urine C-terminal cross-linking telopep...
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Instrumental variable (IV) methods can correct for unmeasured confounding when using administrative (claims) data for cardiovascular outcomes research, but difficulties identifying valid IVs have limited their use. We evaluated the safety and efficacy of drug-eluting coronary stents (DES) compared with bare-metal stents (BMS) for Medicare beneficia...
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Insights from systematic reviews can help new studies better meet the priorities and needs of patients and communities. However, systematic reviews unfortunately have not yet achieved this position to direct and guide new research studies. The Agency for Healthcare Research and Quality's Evidence-based Practice Center Program uses systematic review...
Article
The optimal use of stress testing after coronary revascularization remains unclear, and overuse of stress testing might increase the rates of repeat revascularization. We analyzed the association at both the patient and regional level between the use of stress testing and repeat revascularization for a cohort of Medicare beneficiaries receiving rev...
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Aims: To evaluate the impact of systematic reviews on research funded by the Agency for Healthcare Research and Quality (AHRQ) through Evidence-based Practice Centers (EPCs), and to identify barriers to and facilitators for the effects of these documents on future research. Methods & materials: Two AHRQ systematic reviews were selected as case s...
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The repetition of computed tomography (CT) imaging in caring for injured patients transferred between institutions is common, but it is not well studied. Our objective is to quantify and describe the characteristics associated with repeating chest and abdominal CT images for patients transferred to trauma centers and to determine whether repeat ima...
Article
Chronic back pain is common, disabling, and expensive. Essentially all people will have some back pain during their lives, but in a minority of individuals acute back pain will become chronic, with symptoms lasting longer than 3 months and severe enough that some daily activities are impaired. In several recent studies, the proportion of the adult...
Article
To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia. Cluster randomized controlled trial. Twenty-four nursing homes in North Carolina. Residents with advanced dementia and feeding problems and their surrogates. Intervention surrogates received an audio or print decision aid on feeding option...
Article
Since 2003, North Carolina nursing homes have been required by state law to report all medication errors, but the nursing homes have not had usable and timely access to their own error data. We created and pilot tested a new online graphic reporting feature to give homes practical and timely reports on their own reported errors for use in improving...
Article
Recently, use of advanced imaging modalities, such as MRI, has increased dramatically. One novel but still evolving use for MRI is in the diagnosis and clinical staging of newly diagnosed breast cancer patients. Compared with mammography, MRI is more sensitive, but less specific, and far more expensive. The purpose of this study is to examine the p...
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To review the benefits of oral feeding options in people with dementia. Systematic literature search with review of potentially eligible studies by two independent investigators. PubMed/MEDLINE, EMBASE, the Cochrane Library, CINAHL, and PsychINFO literature indices between January 1990 and October 2009. Clinical trials with random or nonrandom cont...
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To estimate the effect of two separate policy changes in the North Carolina Medicaid program: (1) reduced prescription lengths from 100 to 34 days' supply, and (2) increased copayments for brand name medications. Medicaid claims data were obtained from the Centers for Medicare and Medicaid Services for January 1, 2000-December 31, 2002. We used a p...
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There are limited population-based studies of determinants of physical therapy use for chronic low back pain (LBP) and of the types of treatments received by individuals who see a physical therapist. The purposes of this study were: (1) to identify determinants of physical therapy use for chronic LBP, (2) to describe physical therapy treatments for...
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Background. The psychometric properties of the Modified Work APGAR (MWA) scale are not established, yet researchers use this scale as an overall measure of job satisfaction. Objective. Perform psychometric analyses on the MWA scale using data from two populations. Methods. A landmark occupational cohort and a clinical cohort are populations with...
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To determine the prevalence of chronic low back pain (LBP) in older North Carolinians, describe their health and health care utilization, and compare these findings with younger subgroups. A cross-sectional, telephone survey of 5,357 households was conducted to identify 732 adults with chronic, impairing LBP. Chronic LBP prevalence in older adults...
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To estimate the prevalence of chronic neck pain in North Carolina, to describe health care use (providers, treatments, and diagnostic testing) for chronic neck pain, and to correlate health care use with the current best evidence. We used data from a cross-sectional telephone survey of a representative sample of North Carolina households in 2006. A...
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Legislation enacted in the US State of North Carolina in 2003 requires all licenced nursing homes to report all medication errors. In 2007, nursing homes were encouraged to voluntarily convert from aggregate reporting to a new online system where they reported each individual error. A new optional web-based reporting tool was made available to all...
Article
Comparative effectiveness of interventional treatment strategies for the very elderly with acute coronary syndrome remains poorly defined due to study exclusions. Interventions include percutaneous coronary intervention (PCI), usually with stents, or coronary artery bypass grafting (CABG). The elderly are frequently directed to PCI because of provi...
Article
In February 2009, President Obama signed the American Recovery and Reinvestment Act of 2009, which, among other initiatives, appropriated $1.1 billion for comparative effectiveness research (CER). Of that $1.1 billion, $300 million was allocated to the Agency for Healthcare Research and Quality (AHRQ); $400 million to the National Institutes of Hea...
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Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate...
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Unlabelled: We analyzed a statewide survey of individuals with chronic back and neck pain to determine whether prevalence and care use varied by patient race or ethnicity. We conducted a telephone survey of a random sample of 5,357 North Carolina households in 2006. Adults with chronic (>3 months duration or >24 episodes of pain per year), impairi...
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Unlabelled: Our objective was to assess predictors of self-reported opioid use among patients with back pain due to lumbar disc herniation or spinal stenosis. Data were from the Spine Patient Outcomes Research Trial (SPORT), a multi-site observational study and randomized trial. We examined characteristics shown or hypothesized to be associated wi...
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The adoption of electronic health records (EHRs) offers the potential to improve the delivery, quality, and continuity of clinical care, but widespread use has not yet occurred. In this article, we describe our use of clinical (production) data that were derived from outpatient and inpatient visits at a university teaching hospital for clinical res...
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Chronic back pain is a condition characterized by high rates of disability, health-care service use, and costs. The purpose of this study was to identify factors associated with patients' satisfaction with their last health-care provider visit for chronic low back pain (LBP). A cross-sectional, state-level, telephone survey was administered to pati...
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A cross-sectional, telephone survey of a representative sample of North Carolina households in 2006. The primary objectives of these analyses were to describe health care use (providers, medications, treatments, diagnostic tests) for chronic low back pain (LBP) and relate current patterns of use to current best evidence for care of the condition. C...
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Cross-sectional survey. Our primary objective was to describe spine and pain clinics serving North Carolina residents with respect to organizational characteristics. Our secondary objective was to assess the multidisciplinary nature of the clinics surveyed. Pain clinics have become common in the United States, and patients with chronic back pain ha...
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National or state-level estimates on trends in the prevalence of chronic low back pain (LBP) are lacking. The objective of this study was to determine whether the prevalence of chronic LBP and the demographic, health-related, and health care-seeking characteristics of individuals with the condition have changed over the last 14 years. A cross-secti...