Molly Conroy

Introduction: The Advancing Chronic Care with Effective Scalable Solutions (ACCESS) model is a new outcome-aligned payment model intended to support technology-enabled chronic disease management among Traditional Medicare (TM) beneficiaries. However, the national population potentially eligible for ACCESS remains poorly characterized, particularly those with multiple chronic conditions. Methods: Using nationally representative survey data from the 2023 Medical Expenditure Panel Survey, we described the health characteristics and health care utilization patterns of TM beneficiaries potentially eligible for the ACCESS model. Results: A total of 56.3% of beneficiaries (estimated 9.1 million) were potentially eligible to participate in the model, 24% of beneficiaries (estimated 2.2 million) had multiple chronic conditions, and beneficiary telehealth use for cardio-kidney-metabolic and musculoskeletal conditions was limited. Conclusion: The sizable proportion of TM beneficiaries potentially eligible for more than one ACCESS track suggests a deliberate approach to care coordination to support technology-enabled chronic disease management in older adults.

Introduction: The expansion of telehealth following the COVID-19 pandemic has enhanced access to care, but questions remain about how well telehealth supports the delivery of comprehensive, guideline-concordant care for type 2 diabetes. Methods: We conducted an observational cross-sectional study using nationally representative survey data from the 2021-2023 Medical Expenditures Panel Survey to make unadjusted descriptive comparisons between adults with any diabetes-related telehealth use and those receiving only in-person diabetes care. Results: Of 4348 respondents who had at least one visit for type 2 diabetes from 2021 to 2023, 90.7% had only in-person visits, whereas 9.3% had ≥1 telehealth visits. Insulin prescriptions were more common among telehealth users compared to nonusers (47.5% [95% CI, 41.0%-54.1%] vs 34.4% [95%CI, 32.1%-36.7%]). Conclusion: Overall, this study provides current national data on patterns of telehealth use among US adults with type 2 diabetes. Differences in insulin prescription fill patterns may reflect greater clinical complexity and care needs among patients who use telehealth. These findings offer important context for policy-makers and health systems as they evaluate the role of telehealth in managing chronic disease and consider how virtual care models can be implemented while maintaining high-quality diabetes care.

People with chronic liver disease (CLD) and health-related social needs (HRSN) experience poor health outcomes. Therefore, screening for and reducing HRSN in liver clinics may lead to improved CLD-related outcomes. The objective of this study is to assess patient perspective and acceptability of HRSN screening conducted in liver clinic among those with CLD. This is a qualitative study conducted using semi-structured interviews from November 2023 to June 2024. Patients with CLD were recruited from liver clinic. Purposive sampling ensured diversity by self-reported HRSN. A previously published interview guide, adapted for this study, was used to assess participants’ perception of HRSN screening. Interviews were conducted virtually in English and audio recorded. Participants were given $50, and interviews were collected, recorded, and transcribed verbatim. Data were analyzed using Crabtree & Miller’s approach creating codes and identifying themes through “open coding”, a process of developing codes for salient concepts as they emerge iteratively during the analysis process. Fifteen interviews were conducted. Among them, 87% of interviewees were women, the mean age was 57 years old, 67% were Non-Hispanic White, 20% were Hispanic, and 13% were American Indian/Alaska Native; 53% had cirrhosis. HRSN were prevalent: 20% with food insecurity, 53% with financial strain, 13% with financial needs, and 20% with housing instability. Interviews ranged from 9 to 63 min (average time of 25 min). HRSN screening was reported to be acceptable; interviewees felt comfortable or neutral answering questions. Most participants indicated close associations with health and HRSN like stress, transportation needs, financial strain, and social isolation. One patient reported losing their social circle to maintain sobriety as advised. Some expressed a desire for providers to offer referrals to resources. Specifically, participants requested assistance with transportation, finding more affordable medications, and strategies to cope with alcohol use triggers (e.g., isolation or stress). HRSN screening in liver clinic is pertinent for the CLD patient population. The patient perspective demonstrates that liver clinics provide an invaluable opportunity to help address HRSN. The online version contains supplementary material available at 10.1186/s12876-026-04797-3.

Background: Hispanic/Latino (H/L) adults show lower engagement and smaller weight-loss outcomes than non-Hispanic White (NHW) participants in the National Diabetes Prevention Program (NDPP), a gap driven by delivery rather than biological differences. Purpose: To evaluate the feasibility, engagement, and preliminary clinical outcomes of Paso a Paso, a community co-designed, culturally relevant diabetes prevention program for Spanish-speaking H/L adults, across two cohorts: instructor-trainees (Cohort 1) and community participants (Cohort 2). Methods: Single-arm feasibility pilot guided by RE-AIM, EPIS, and ERIC frameworks. Cohort 1 (n = 18 H/L community leaders) completed 16 weekly in-person sessions; Cohort 2 (n = 30 at two sites) completed 13–15 weekly sessions, both led by a registered dietitian. Participants were classified into three engagement tiers: high-dose (≥50% sessions), low-dose community-connected (<50% but retained at the final session), and discontinued. Body mass index (BMI), waist circumference, and HbA1c were assessed at baseline and 4 months. Results: Cohort 1 achieved 100% retention and a median attendance rate of 93.8% (range 31.2%–100.0%). Cohort 2 achieved 73% 4-month retention and a median attendance rate of 61.5% (range 0.0%–93.3%). Among 21 paired participants, mean % body weight change was −1.5% (SD, 2.3) and 81% achieved any weight reduction; participants with overweight and obesity, the primary target population, lost −1.7% (SD, 1.5) and −1.9% (SD, 2.6) respectively. Conclusions: Paso a Paso suggests feasibility, with engagement and retention exceeding NDPP benchmarks for H/L participants and preliminary, clinically meaningful weight reductions observed across the winter holiday season. These hypothesis-generating findings support advancement to a powered hybrid effectiveness-implementation trial.

Background: Social drivers of health (SDoH) contribute to health disparities among patients with chronic liver disease (CLD). Little is known about the feasibility and acceptability of SDoH screening in hepatology clinics. This study aimed to define SDoH prevalence among CLD patients, identify a feasible and acceptable screening approach, and assess the convergent validity of a locally developed screener. Methods: Among adult patients with CLD receiving care in hepatology clinics, 2 SDoH screeners were administered to eligible participants: (1) default electronic medical record (EMR) questions and (2) Screener for Intensifying Community Referrals for Health (SINCERE). The primary outcomes were (1) prevalence of SDoH, (2) SDoH screening feasibility and acceptability, and (3) factors associated with screening acceptability. As a secondary outcome, the convergent validity of SINCERE to EMR was assessed. Results: Among 250 participants, the mean age was 56 years, 56% were women, 22% were Hispanic, 7% were American Indian/Alaska Native, 58% had cirrhosis, 29% completed high school or less, 22% were unemployed/disabled, and 29% had an annual income <$35,000. Based on SINCERE, 26% had food insecurity, 8% transportation needs, 43% financial strain, 5% lack of social support, and 24% housing instability. Most respondents (69%) were comfortable or very comfortable completing SDoH screening. Using the McNemar test, there were statistically significant differences between screeners for financial strain and housing instability. Conclusions: Among CLD patients at our center, SDoH were prevalent, and screening within the hepatology clinic was feasible and acceptable. To detect social needs, SINCERE, a locally developed screener, had overall acceptable convergent validity. These data support SDoH screening in hepatology clinics. Future multicenter studies evaluating the effective implementation of SDoH screening for CLD patients, including contextualized care plans and connection to available resources, should be conducted. Export

BACKGROUND: Sedentary behavior (SB) is observationally associated with cardiovascular disease risk. However, randomized clinical trials testing causation are limited. We hypothesized that reducing SB would decrease blood pressure (BP) and pulse wave velocity (PWV) in sedentary adults. METHODS: This parallel-arm, 3-month randomized clinical trial recruited desk workers, age 18 to 65 years, with systolic BP 120 to 159 or diastolic BP (DBP) 80 to 99 mm Hg, off antihypertensive medications, and reporting P P =0.808) and 0.13±0.61 mm Hg ( P =0.827), respectively. The findings were similarly null for ambulatory BP and PWV. Decreases in work-time SB were associated with favorable reductions in resting DBP (r=0.15, P =0.017). Contrary to our hypotheses, reductions in work-time SB (r=−0.19, P =0.006) and increases in work-time standing (r=0.17, P =0.011) were associated with unfavorable increases in carotid-femoral PWV. As expected, increases in nonwork-time standing were favorably associated with carotid-femoral PWV (r=−0.14, P =0.038). CONCLUSIONS: A 3-month intervention that decreased SB and increased standing by ≈1 hour during the work day was not effective for reducing BP. Future directions include examining effects of interventions reducing SB through activity other than work-time standing and clarifying association between standing and PWV in opposite directions for work and nonwork time. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03307343.

Maintaining a healthy weight postintentional weight loss is crucial for preventing chronic health conditions, yet many regain weight postintervention. Electronic health record (EHR) portals offer a promising avenue for weight management interventions, leveraging patient-primary care relationships. Our previous research demonstrated that coaching alongside self-monitoring improves weight maintenance compared to monitoring alone. Integrating weight management into routine clinical practice by training existing staff could enhance scalability and sustainability. However, challenges such as inconsistent staff qualifications and high coach turnover rates could affect intervention effectiveness. Standardizing services, training, and coaching continuity seem crucial for success. To report on developing, testing, and evaluating an EHR-based coaching training program for clinical staff, guided by an implementation tool for the MAINTAIN PRIME study. Conducted across 14 University of Utah primary care sites, we developed, tested, and evaluated a coaching training for clinical staff. Guided by a planning model and the Predisposing, Enabling, and Reinforcing (PER) tool, stakeholders actively participated in planning, ensuring alignment with clinic priorities. All clinical staff were invited to participate voluntarily. Evaluation measures included staff interest, training effectiveness, confidence, and readiness. Data collection utilized REDCap, with survey results analyzed using descriptive statistics. Despite increased clinical workload and reassignments posed by coronavirus disease 2019, we were able to train 39 clinical staff, with 34 successfully coaching patients. Feedback indicated high readiness and positive perceptions of coaching feasibility. Coaches reported satisfaction with training, support, and enjoyed establishing connections with patients. The PER strategies allowed us to implement a well-received training program found effective by primary care coaches.

The integration of health and activity data from various wearable devices into research studies presents technical and operational challenges. The Awesome Data Acquisition Method (ADAM) is a versatile, web-based system that was designed for integrating data from various sources and managing a large-scale multiphase research study. As a data collecting system, ADAM allows real-time data collection from wearable devices through the device’s application programmable interface and the mobile app’s adaptive real-time questionnaires. As a clinical trial management system, ADAM integrates clinical trial management processes and efficiently supports recruitment, screening, randomization, data tracking, data reporting, and data analysis during the entire research study process. We used a behavioral weight-loss intervention study (SMARTER trial) as a test case to evaluate the ADAM system. SMARTER was a randomized controlled trial that screened 1741 participants and enrolled 502 adults. As a result, the ADAM system was efficiently and successfully deployed to organize and manage the SMARTER trial. Moreover, with its versatile integration capability, the ADAM system made the necessary switch to fully remote assessments and tracking that are performed seamlessly and promptly when the COVID-19 pandemic ceased in-person contact. The remote-native features afforded by the ADAM system minimized the effects of the COVID-19 lockdown on the SMARTER trial. The success of SMARTER proved the comprehensiveness and efficiency of the ADAM system. Moreover, ADAM was designed to be generalizable and scalable to fit other studies with minimal editing, redevelopment, and customization. The ADAM system can benefit various behavioral interventions and different populations.