Mia Papas, PhD, MS

Scientific Leader

Publications

Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program
Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program
Williams KD, Jurkovitz CT, Papas MA, Muther AK, Anderson SL, Anderson TL

JMIR Form Res 2022 Aug;6(8):e39772

PMID: 35973033

Abstract

BACKGROUND: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD.

OBJECTIVE: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment.

METHODS: Eligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant's physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program.

RESULTS: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67%) and White (n=15, 83%). The majority of participants were Medicaid recipients (n=14, 78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program, with 2 (11%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment.

CONCLUSIONS: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality.

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Mapping the Burden of Chronic Diseases in Delaware for Public Health Decision Making
Mapping the Burden of Chronic Diseases in Delaware for Public Health Decision Making
McIntire RK, Brooks M, Siegel SD, , Papas M

Dela J Public Health 2019 Feb;5(1):26-28

PMID: 34467011

Abstract

Public health decision-makers need to consider geographic differences in rates of chronic disease risk factors and outcomes in order to focus intervention efforts on populations exhibiting the greatest burden of disease. Increasingly, public health agencies are using geographic information systems (GIS) to analyze area-based variations and identify geographic priority areas for health promoting interventions. The articles in this issue are descriptive studies presenting the geographic distribution of select chronic disease risk factors and outcomes among Delaware communities. These studies emerged from a collaboration between the Christiana Care Value Institute and the Jefferson College of Population Health. These studies show that the burden of chronic diseases is not distributed evenly among communities in Delaware. The results of these studies add to the evidence base about public health in Delaware, and should inform public health practitioners working to improve the health of Delaware communities.
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Malnourished adults' receipt of hospital discharge nutrition care instructions: a pilot study
Malnourished adults' receipt of hospital discharge nutrition care instructions: a pilot study
Brooks M, Vest MT, Shapero M, Papas M

J Hum Nutr Diet 2019 10;32(5):659-666

PMID: 31037779

Abstract

BACKGROUND">Malnutrition remains an important yet under-recognised problem among hospitalised adults. Although interventions exist aiming to improve nutritional status beyond hospitalisation, few studies examine how often and what type of nutrition care instructions are given at discharge. The present study sought to review nutrition-focused discharge care provided to malnourished adults.</Abstr: Malnutrition remains an important yet under-recognised problem among hospitalised adults. Although interventions exist aiming to improve nutritional status beyond hospitalisation, few studies examine how often and what type of nutrition care instructions are given at discharge. The present study sought to review nutrition-focused discharge care provided to malnourished adults.

METHODS">We reviewed the electronic medical record for discharge nutrition care instructions provided to adult patients identified by dietitians as malnourished over a 4-month period.</Abstr: We reviewed the electronic medical record for discharge nutrition care instructions provided to adult patients identified by dietitians as malnourished over a 4-month period.

RESULTS">Seventy-six eligible patients were identified during the study period. More than half of malnutrition cases (64.5%) were attributed to chronic illness. According to electronic medical record documentation, 6.6% received discharge instructions to consume oral nutrition supplements and 30.3% received new or changed prescriptions for vitamins/noncaloric supplements. Almost half of patients (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake.</Abstr: Seventy-six eligible patients were identified during the study period. More than half of malnutrition cases (64.5%) were attributed to chronic illness. According to electronic medical record documentation, 6.6% received discharge instructions to consume oral nutrition supplements and 30.3% received new or changed prescriptions for vitamins/noncaloric supplements. Almost half of patients (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake.

CONCLUSIONS">A majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. Clinician education and redesign of nutrition care options in the electronic medical record may improve the provision of post-discharge nutrition care instructions.© 2019 The British Dietetic Association Ltd.</CopyrightInfo: A majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. Clinician education and redesign of nutrition care options in the electronic medical record may improve the provision of post-discharge nutrition care instructions.

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Food Insecurity in Delaware: A Triangulation of Spatial Data Sources
Food Insecurity in Delaware: A Triangulation of Spatial Data Sources
Harrison C, Brooks M, Goldstein JN, Papas M

Prev Chronic Dis 2021 08;18():E81

PMID: 34410907

Abstract

No abstract available.
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Prediction model for COVID-19 patient visits in the ambulatory setting
Prediction model for COVID-19 patient visits in the ambulatory setting
Li RC, Harrison CK, Jurkovitz CT, Papas MA, Ndura K, Kerzner R, Teal C, Chiam T

Res Sq 2021 Mar;():

PMID: 33688638

Abstract

Array
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Diabetes and acculturation in African immigrants to the United States: analysis of the 2010-2017 National Health Interview Survey (NHIS)
Diabetes and acculturation in African immigrants to the United States: analysis of the 2010-2017 National Health Interview Survey (NHIS)
Mukaz DK, Melby MK, Papas MA, Setiloane K, Nmezi NA, Commodore-Mensah Y

Ethn Health 2020 Sep;():1-11

PMID: 32977725

Abstract

Array
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Hospital length of stay among COVID-19-positive patients
Hospital length of stay among COVID-19-positive patients
Chiam T, Subedi K, Chen D, Best E, Bianco FB, Dobler G, Papas M

J Clin Transl Res 2021 Jun;7(3):377-385

PMID: 34239994

Abstract

Background and Aim: This study aims to determine COVID-19 patient demographics and comorbidities associated with their hospital length of stay (LOS).

Methods: Design: Single-site, retrospective study. Setting: A suburban 700-bed community hospital in Newark, Delaware, USA. Patients: Patients admitted to the hospital from March 11, 2020, to August 11, 2020, with a positive COVID-19 status. We followed a time-to-event analysis approach and used Kaplan-Meir curves and log-rank tests for bivariate analyses, and an accelerated failure time model for a multivariable model of hospital LOS.

Results: Six hundred and eighty-seven patients discharged alive (mean [SD] age, 60.94 [18.10] years; 339 men [49.34%]; 307 Black/African-American [44.69%]; and 267 White [38.86%]) were included in the investigation. Bivariate analysis using Kaplan-Meir curves showed that patients' age, sex, ethnicity, insurance type, comorbidity of fluid and electrolyte disorder, hypertension, renal failure, diabetes, coagulopathy, congestive heart failure, peripheral vascular disease, neurological disorder, coronary artery disease, and cardiac arrhythmias to be significantly associated with LOS (<0.05). In the multivariable analysis, patients' age, sex, ethnicity, number of Elixhauser comorbidities, and number of weeks since onset of the pandemic was significantly associated with LOS (<0.05). Fluid and electrolyte disorder is the only comorbidity independently associated with LOS after adjusting for patients' age, sex, race, ethnicity, number of Elixhauser comorbidities, and weeks since onset of pandemic.

Conclusion: COVID-19 patients LOS vary based on multiple factors. Understanding these factors are crucial to improving the prediction accuracy of COVID-19 patient census in hospitals for resource planning and care delivery.

Relevance for patients: Understanding of the factors associated with LOS of the COVID-19 patients may help the care providers and the patients to better anticipate the LOS, optimize the resources and processes, and prevent protracted stays.

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Validation of a 2-Item Food Insecurity Screen Among Adult General Medicine Outpatients
Validation of a 2-Item Food Insecurity Screen Among Adult General Medicine Outpatients
Harrison C, Goldstein JN, Gbadebo A, Papas M

Popul Health Manag 2021 08;24(4):509-514

PMID: 33021444

Abstract

Food insecurity is defined as limited access to food and is associated with adverse physical, social, and emotional health outcomes. As social needs are addressed in heath care, efficient methods to identify patients living in food insecure households are necessary. A 2-item screen (HFSS-2) derived from the US Department of Agriculture Household Food Security Scale (HFSS-18) has been validated among parents of pediatric patients with a sensitivity of 97% and specificity of 83%. The objective was to validate the HFSS-2 in adult general medicine outpatients. HFSS-18 was administered to a sample of adult general medicine outpatients in Delaware from 2018 to 2019. The authors evaluated the sensitivity and specificity of the HFSS-2. Multivariable logistic regression was used to calculate convergent validity between the HFSS-18 and the HFSS-2. Three hundred ninety patients were approached with 295 (75%) enrolling in this study; 17.6% (52/295) were food insecure. A confirmatory response to either of the 2 items from the HFSS-2 had a sensitivity of 98% (95% CI: 94%, 100%) and specificity of 91% (95% CI: 87%, 94%). Food insecurity was associated with increased odds of coronary heart disease (adjusted odds ratio [AOR] 4.63; 95% CI: 1.55, 13.79; AOR 4.19; 95% CI: 1.51, 11.59) and diabetes (AOR 4.19; 95% CI: 1.94, 9.08; AOR 3.73; 95% CI: 1.83, 7.92) using both the HFSS-18 and the HFSS-2. HFSS-2 was found to be highly sensitive and specific. This is the first study to validate this tool in this population that the authors are aware of.
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Impact of early rapid weight gain on odds for overweight at one year differs between breastfed and formula-fed infants
Impact of early rapid weight gain on odds for overweight at one year differs between breastfed and formula-fed infants
Trabulsi JC, Smethers AD, Eosso JR, Papas MA, Stallings VA, Mennella JA

Pediatr Obes 2020 10;15(10):e12688

PMID: 32705816

Abstract

BACKGROUND">Early rapid weight gain (RWG) increases, whereas longer durations of breastfeeding decreases, odds for later obesity.</Abstr: Early rapid weight gain (RWG) increases, whereas longer durations of breastfeeding decreases, odds for later obesity.

OBJECTIVES">To determine the independent and interactive effects of early weight gain and diet on infant weight status trajectories and odds for overweight at 1 year.</Abstr: To determine the independent and interactive effects of early weight gain and diet on infant weight status trajectories and odds for overweight at 1 year.

METHODS">We conducted secondary analysis on data from two longitudinal trials with repeated anthropometric measures. One trial consisted of predominantly or exclusively breastfed (BF, n = 97) infants, whereas the other consisted of exclusively formula-fed (FF, n = 113) infants. Weight-for-length z-score (WLZ) change from 0.5 to 4.5 months was used to categorize early weight gain as slow (<-0.67; SWG), normal (-0.67 to 0.67; NWG) or rapid (>0.67; RWG). Linear-mixed effects models were fit to examine the independent effects and interaction of early diet (BF, FF) and weight gain (SWG, NWG, RWG) groups on WLZ trajectories; logistic regression was used to assess odds for overweight at 1 year.</Abstr: We conducted secondary analysis on data from two longitudinal trials with repeated anthropometric measures. One trial consisted of predominantly or exclusively breastfed (BF, n = 97) infants, whereas the other consisted of exclusively formula-fed (FF, n = 113) infants. Weight-for-length z-score (WLZ) change from 0.5 to 4.5 months was used to categorize early weight gain as slow (0.67; RWG). Linear-mixed effects models were fit to examine the independent effects and interaction of early diet (BF, FF) and weight gain (SWG, NWG, RWG) groups on WLZ trajectories; logistic regression was used to assess odds for overweight at 1 year.

RESULTS">While similar percentages (41%) of BF and FF infants experienced RWG, we found a significant diet × early weight gain group interaction (P < .001) on weight status. At 1 year, the WLZ of FF infants with RWG (1.57 ± 0.99) was twice that of BF infants with RWG (0.83 ± 0.92). Using BF infants with NWG as the reference group, FF infants with RWG had increased odds [OR: 25.3 (95% CI: 3.21, 199.7)] for overweight at 1 year, whereas BF infants with RWG did not.</Abstr: While similar percentages (41%) of BF and FF infants experienced RWG, we found a significant diet × early weight gain group interaction (P < .001) on weight status. At 1 year, the WLZ of FF infants with RWG (1.57 ± 0.99) was twice that of BF infants with RWG (0.83 ± 0.92). Using BF infants with NWG as the reference group, FF infants with RWG had increased odds [OR: 25.3 (95% CI: 3.21, 199.7)] for overweight at 1 year, whereas BF infants with RWG did not.

CONCLUSIONS">Early diet interacts with early weight gain and influences weight status trajectories and overweight risk at 1 year.© 2020 World Obesity Federation.</CopyrightInfo: Early diet interacts with early weight gain and influences weight status trajectories and overweight risk at 1 year.

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Identifying community spread of COVID-19 via a free drive-through screening event
Identifying community spread of COVID-19 via a free drive-through screening event
Drees ML, Papas MA, Corbo TE, Williams KD, Kurfuerst ST

Infect Control Hosp Epidemiol 2021 06;42(6):778-780

PMID: 32684180

Abstract

No abstract available.
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