Gregory F Petroski

University of Missouri | Mizzou · School of Medicine

Background and objectives: Prospective studies comparing EUS-guided liver biopsy (EUS-LB) to percutaneous LB (PC-LB) are scarce. We compared the efficacy and safety of EUS-LB with those of PC-LB in a prospective randomized clinical trial. Methods: Between 2020 and 2021, patients were enrolled and randomized (1:1 ratio). The primary outcome was d...

Background Data on COVID-19 related nursing home infections and mortality accumulated at a rapid pace; yet little is known about the impact of nursing homes’ response to COVID-19 on resident clinical, functional, and psychosocial outcomes. Methods We examined aggregated Minimum Data Set (MDS) assessments to describe resident outcomes using an inte...

Patients with morbid obesity are at high risk for nonalcoholic fatty liver disease (NAFLD) complicated by liver fibrosis. The clinical utility of transient elastography (TE) by Fibroscan in patients with morbid obesity (body mass index (BMI) ≥ 40 kg/m2) is not well-defined. We examined the diagnostic accuracy of Fibroscan in predicting significant...

Objectives To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending. Design A four group comparative ana...

We assessed the relationship between serum alkaline phosphatase (ALP) and liver fibrosis by histology, in addition to other noninvasive parameters, in obese patients undergoing metabolic surgery. Patients scheduled for elective bariatric surgery were prospectively recruited from a bariatric clinic. An intraoperative liver biopsy was performed, and...

Objectives: The purpose of this article is to present six-year findings of the Missouri Quality Initiative (MOQI) to reduce unnecessary hospitalizations for long-stay nursing home residents. Design: A CMS funded demonstration project analyzed over 6-years using a single group design. Setting and participants: The setting was 16 Midwestern US n...

Background and objective: The purpose of this study was to evaluate the impact of using electrostatic precipitation to manage the surgical plume during low pressure laparoscopic gynecologic procedures. Methods: This was a prospective, blinded, randomized controlled study of women with a clinical indication for laparoscopic hysterectomy (n = 30)...

Neighborhood context impacts health. Using an index of geospatial disadvantage measures to predict neighborhood socioeconomic disparities would support area-based allocation of preventative resources, as well as the use of location as a clinical risk factor in care of individual patients. This study tested the association of the Area Deprivation In...

Objective: To evaluate the ability to perform activities of daily living (ADLs) in patients who required nursing home (NH) care after radical cystectomy (RC), as this surgery can impair patients' ability to perform ADLs in the post-operative period. Methods: Patients undergoing RC were identified in a novel database of patients with at least 2 N...

Introduction Antipsychotic use in nursing homes varies widely across the United States; inadequate staffing, skill mix, and geropsychiatric training impede sustained improvement. Aim This study identified risk factors of antipsychotic use in long‐stay residents lacking qualifying or potentially qualifying diagnoses. Method This secondary analysis...

Patient socioeconomic data is not usually included in medical records nor easily accessible to clinicians, yet socioeconomic disadvantage can be an important guide to disease management. This study evaluated the neighborhood-level Area Deprivation Index (ADI), a measure of neighborhood socioeconomic disadvantage, as a factor in diabetes mellitus pr...

Purpose: The purpose of this article is to review the impact of advanced practice registered nurses (APRNs) on the quality measure (QM) scores of the 16 participating nursing homes of the Missouri Quality Initiative (MOQI) intervention. The MOQI was one of 7 program sites in the US, with specific interventions unique to each site tested for the Ce...

Introduction: Cluttered documentation may contribute adversely to physician readers' cognitive load, inadvertently obscuring high-value information with less valuable information. We test the hypothesis that a novel, collapsible assessment, plan, subjective, objective (APSO) note design would be faster, more accurate, and more satisfying to use th...

Purpose: The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without r...

Background: Because 5% of patients incur 50% of healthcare expenses, population health managers need to be able to focus preventive and longitudinal care on those patients who are at highest risk of increased utilization. Predictive analytics can be used to identify these patients and to better manage their care. Data mining permits the developmen...

This study examined the relationships between individual and environmental factors and physical activity, and between physical activity and functional limitations and disability in residential care/assisted living (RC/AL) residents. Participants completed questionnaires and physical performance tests, and wore the Fitbit Motion Tracker® to capture...

As part of an intervention to improve health care in nursing homes with the goal of reducing potentially avoidable hospital admissions, 1,877 resident records were reviewed for advance directive (AD) documentation. At the initial phases of the intervention, 50 percent of the records contained an AD. Of the ADs in the resident records, 55 percent de...

Background and objective: Untrained family caregivers struggle with complicated medical management regimens for hospice patients. An intervention was tested to improve caregiver's perception of pain management and patient's pain. Design, setting, and participants: The intervention was tested with a 2-group (usual care vs intervention) randomized...

What is the impact of intentional weight loss and regain on serum androgens in women? We conducted an ancillary analysis of prospectively collected samples from a randomized controlled trial. The trial involved supervised 10% weight loss (8.5 kg on average) with diet and exercise over 4-6 months followed by supervised intentional regain of 50% of t...

Aim: Children with quadriplegic cerebral palsy (CP) have been found to have growth rates that differ from those of children with typical development. Little research has been performed to distinguish whether growth patterns in hemiplegic, diplegic, and quadriplegic CP differ from one another. The purpose of this study was to compare growth of chil...

Although many trials have evaluated abdominal aortic aneurysm (AAA) repair, the impact of these procedures on the functional status of frail elderly patients is not well-described. The effects of elective open AAA repair (OAR) and endovascular AAA repair (EVAR) and comorbidities were evaluated for their impact on functional trajectories after disch...

Clinical trials have reported a low time in therapeutic range (TTR) in patients with atrial fibrillation treated with both warfarin andamiodarone. These trials included centers and countries with both high and low TTRs. What is the impact of amiodarone on the TTR in a single, high-quality anticoagulation clinic? TTR was assessed in amiodarone and n...

Older adults' gait disorders present challenges for accurate activity monitoring. The current study compared the accuracy of accelerometer-detected to hand-tallied steps in 50 residential care/assisted living residents. Participants completed two walking trials wearing a Fitbit(®) Tracker and waist-, wrist-, and ankle-mounted Actigraph GT1M. Agreem...

Children with autism spectrum disorder (ASD) are at high risk for sleep problems. Previous research suggests that sensory problems and anxiety may be related to the development and maintenance of sleep problems in children with ASD. However, the relationships among these co-occurring conditions have not been previously studied. The current study ex...

Incidental reading provides a powerful opportunity for partial word knowledge growth in the school-age years. The extent to which children of differing language abilities can use reading experiences to glean partial knowledge of words is not well understood. The purpose of this study was to compare semantic-syntactic partial word knowledge growth o...

Technology-based aids for lifestyle change are becoming more prevalent for chronic conditions. Important "digital divides" remain, as well as concerns about privacy, data security, and lack of motivation. Researchers need a way to characterize participants' readiness to use health technologies. To address this need, we created an instrument to meas...

The ability of nursing home residents to function independently is associated with their quality of life. The impact of amputations on functional status in this population remains unclear. This analysis evaluated the effect of amputations-transmetatarsal (TM), below-knee (BK), and above-knee (AK)-on the ability of residents to perform self-care act...

To explore patterns of change in nursing home (NH) residents' activities of daily living (ADLs), particularly surrounding acute hospital stays. Longitudinal study using Medicare and Minimum Data Set (MDS) assessments. National sample of long-stay NH residents. NH residents who were hospitalized for the seven most-common inpatient diagnoses (N = 40,...

The impact of interventions for critical limb ischemia (CLI) on functional status in the elderly remains unclear. Open and endovascular procedures were evaluated. Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for lower extremity procedures for CLI. A functional impairment score (0-28; higher...

The Robert Wood Johnson Foundation (RWJF) provided Columbia MO with an Active Living by Design (ALbD) grant in 2003 to promote active living in the community. A separate project was funded in 2006 through RWJF's Active Living Research program. To evaluate whether participation in a Walking School Bus (WSB) program increased or decreased active livi...

Background In 2003, Columbia MO was the recipient of a Robert Wood Johnson Foundation (RWJF) Active Living by Design (ALbD) grant to foster active living in the community through behavioral (social marketing, education) and environmental change (improved street design standards, sidewalks around schools, activity-friendly infrastructure) strategies...

A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Intervention facilities (N = 29) received a 2-year multilevel intervention with monthly on-site consultation from expert nurses w...

Depression affects approximately 30% to 40% of nursing home residents but frequently goes unrecognized. Using the Missouri Minimum Data Set, we aimed to determine whether changes in clinical status, other than mood changes, were associated with new depression diagnosis in residents 65 and older without a recorded depression diagnosis. Of 127,587 po...

Determining prognosis for nursing home residents is important for care planning, but reliable prediction is difficult. We compared performance of four long-term mortality risk indices for nursing home residents-the Minimum Data Set Mortality Risk Index (MMRI), a recent revision to this index (MMRI-R), and the original and revised Flacker-Kiely mode...

There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and...

the MMRI-R. The file contains the MMRI-R scoring sheet.

Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS Mortality Rating Index (MMRI) for use in clinical practice to predict the probability of death in six months for care ho...

Visit nonadherence, that is, "no shows," in psychiatry costs the US healthcare $100 billion every year. Nonadherent visits undermine healthcare quality improvement efforts and erode patients' health. Previous research has focused on patient demographics or on redundant scheduling, rather than on the actual structure of visit nonadherence. Drawing o...

The Quality Improvement Program for Missouri (QIPMO), a state school of nursing project to improve quality of care and resident outcomes in nursing homes, has a special focus to help nursing homes identified as "at risk" for quality concerns. In fiscal year 2006, 92 of 492 Medicaid-certified facilities were identified as "at risk" using quality ind...

The current emphasis in cancer survivorship research, which includes health-related quality of life (HRQoL), drives the need to monitor the nation's cancer burden. Routine, ongoing public health surveillance tools, such as the Behavioral Risk Factor Surveillance System (BRFSS), may be relevant for this purpose. A subsample of the 2005 Missouri BRFS...

Ambulatory oxygen is an important component of long-term oxygen therapy. Pulse-dose technology conserves oxygen and thus increases the operation time of a portable oxygen system. We tested 4 ambulatory oxygen systems (Helios, HomeFill, FreeStyle, and the compressed-oxygen cylinder system we regularly provide for long-term oxygen therapy at our Vete...

Although laparoscopic appendectomy is widely used for treatment of appendicitis, it is still unclear if it is superior to the open approach. From the Nationwide Inpatient Sample 2000 to 2005, hospitalizations with the primary ICD-9 procedure code of laparoscopic (LA) and open appendectomy (OA) were included in this study. Outcomes of length of stay...

Treatment of adhesion-related complications is cost intensive and presents a considerable burden to the health care system. The objective of this study was to compare open (OLA) and laparoscopic lysis of adhesions (LLA) in the treatment of intestinal obstruction, based on a nationwide representative sample. Patients with intestinal obstruction unde...

To evaluate motor function in men with spinal cord injury (SCI) given testosterone replacement therapy (TRT). American Spinal Injury Association (ASIA) rehabilitation discharge motor index scores were compared between men with SCI given TRT (testosterone cypionate, 200 mg, monthly; n = 50) and a comparison group (n = 480) in a retrospective study....

Field test results are reported for the Observable Indicators of Nursing Home Care Quality Instrument-Assisted Living Version, an instrument designed to measure the quality of care in assisted living facilities after a brief 30-minute walk-through. The OIQ-AL was tested in 207 assisted-living facilities in two states using classical test theory, ge...

Medical research continues to focus overwhelmingly on biomedical interventions, such as drugs, devices, and procedures. The dysfunctional health care cultures and systems need more attention for quality of care to improve further. The existing health services management research has not used a systematic theoretical framework to predict the effects...

This is a methodological article intended to demonstrate the integration of multiple goals, multiple projects with diverse foci, and multiple funding sources to develop an entrepreneurial program of research and service to directly affect and improve the quality of care of older adults, particularly nursing home residents. Examples that illustrate...

A leftward shift in a muscle's length-tension relationship is thought to impair myofilament overlap. We hypothesized that left-shifted muscles would incur greater eccentric contraction-induced damage compared to controls. We evaluated contractile properties and force deficits in regenerating murine extensor digitorum longus (EDL) muscles 7, 14, and...

To examine changes in postacute care (PAC) use during the initial Medicare payment reforms enacted by the Balanced Budget Act of 1997. We used claims data from the 5 percent Medicare beneficiary sample in 1996, 1998, and 2000. Linked data from the Denominator file, Provider of Service file, and Area Resource File provided additional patient, hospit...

The primary aim of this NINR-NIH-funded field test in 407 nursing homes in 3 states was to complete the development of and conduct psychometric testing for the Observable Indicators of Nursing Home Care Quality Instrument (Observable Indicators, OIQ). The development of the OIQ was based on extensive qualitative and iterative quantitative work that...

To compare long-term care (LTC) residents with and without multiple sclerosis (MS); to compare admission status of pain, physical disability, pressure ulcers, depression, and cognitive performance in LTC residents with and without MS; and to examine the impact of MS and pain on outcomes 90 and 180 days after LTC admission. Retrospective analysis of...

Rising nursing home (NH) costs and the poor quality of NH care make it important to recognize elders for whom NH care may be inappropriate. As a first step in developing a method to identify these elders, we examined the characteristics of NH residents requiring light-care and changes in their care level from NH admission to 12-months. Using data f...

Two major issues facing most skilled nursing facilities include concerns over quality of care and declining Medicaid reimbursement. The authors examined the relationship between variable costs and four specific quality measures: decline in ADLs, development of pressure ulcers, weight loss, and psychotropic drug use. The results revealed that variab...

To measure pressure ulcer quality indicator (QI) scores and to describe the self-reported skin integrity assessment, pressure ulcer risk assessment, and pressure ulcer prevention and treatment practices in long-term care facilities (LTCFs). Retrospective analysis of a large data set and comparative survey. LTCFs in Missouri. Three hundred sixty-two...

The purpose of this study was to describe the processes of care, organizational attributes, cost of care, staffing level, and staff mix in a sample of Missouri homes with good, average, and poor resident outcomes. A three-group exploratory study design was used, with 92 nursing homes randomly selected from all nursing homes in Missouri and classifi...

To compare hospice residents in nursing homes with residents who are noted as end-stage, but not in hospice programs. Descriptive comparison of the outcomes reported on Minimum Data Set (MDS) for all residents admitted to Missouri nursing homes in 1999. Nursing homes. Residents of nursing homes designated as either hospice or end-stage on admission...

Permanent placement in a Long-Term-Care (LTC) facility following hospitalization or when staying at home is no longer a viable option is the reality for a growing number of Americans. When death is imminent, the specialized knowledge and skill of the hospice team is required and accepted as an important component of end-of-life (EOL) care. The prov...

To test the hypothesis that eccentric contractions induce greater injury in dystrophic compared with normal canine muscle. Blinded cohort study. Animal laboratory. Ten dogs with a homologue to Duchenne muscular dystrophy (Golden retriever muscular dystrophy [GRMD]) and 10 normal littermates. Contractions induced in tibiotarsal flexors and extensors...

The purpose of the study was to determine if simply providing nursing facilities with comparative quality performance information and education about quality improvement would improve clinical practices and subsequently improve resident outcomes, or if a stronger intervention, expert clinical consultation with nursing facility staff, is needed. Nur...

To determine whether percutaneous (intramuscular) neuromuscular electric stimulation (perc-NMES) is less painful than transcutaneous neuromuscular electric stimulation (trans-NMES) for treating shoulder subluxation in hemiplegia. Double-blind, crossover trial. University-affiliated tertiary care hospital. A convenience sample of 10 hemiplegic subje...

The researchers examined the relationships between statewide implementation of comprehensive guidance and counseling programs and indicators of safety and success for seventh graders. Hierarchical linear modeling was used to analyze data from 22,601 seventh graders attending 184 Missouri schools and 4,868 middle school teachers. After researchers c...

To examine the effects of stress management training on pain behavior exhibited by persons with rheumatoid arthritis (RA) and the relationship of change in pain behavior with certain patient characteristics as well as change in self-reported levels of pain. Patients with RA (n = 131) were randomly assigned to 1 of 3 groups: a stress management grou...

The Category Test, notable for its length, has been the subject of many proposed short-form versions. In our present managed care era, the pressure to utilize short forms of various tests with clinical populations has increased, yet the appropriateness of using short forms with various populations must be demonstrated not assumed. The present study...

To test whether change in cognitive-behavioral variables (such as self-efficacy, coping strategies, and helplessness) is a mediator in the relation between cognitive behavior therapy and reduced pain and depression in persons with rheumatoid arthritis (RA). A sample of patients with RA who completed a stress management training program (n = 47) was...

Objective To test whether change in cognitive–behavioral variables (such as self-efficacy, coping strategies, and helplessness) is a mediator in the relation between cognitive behavior therapy and reduced pain and depression in persons with rheumatoid arthritis (RA). Methods A sample of patients with RA who completed a stress management training p...

Emotional and behavioural difficulties are one of the most common difficulties following traumatic brain injury (TBI), although it is not clear which individuals with TBI become most distressed. Numerous factors contribute to adjustment following TBI, and the current study examined degree of cognitive decline as one potential contributor to distres...

The "Observable Indicators of Nursing Home Care Quality" instrument was developed as a new measure of nursing home care quality. The instrument is based on a theoretical model of quality nursing home care grounded in data from provider and consumer focus groups. The instrument was piloted in 10 Missouri nursing homes. Subsequent versions were teste...

Background: Determining meaningful thresholds to reinforce excellent performance and flag potential problem areas in nursing home care is critical for preparing reports for nursing homes to use in their quality improvement programs. This article builds on the work of an earlier panel of experts that set thresholds for quality indicators (QIs) deri...

To examine the factor structure of the Center for Epidemiologic Studies Depression Scale (CES-D) in a sample of patients with rheumatoid arthritis (RA), testing all of the alternative models suggested by the previous evidence. The CES-D was administered to a group of RA patients (n = 685) during a structured telephone interview. The telephone inter...

To describe the prevalence, incidence, management, and predictors of venous ulcers in residents of certified long-term-care facilities using the Minimum Data Set. Retrospective cohort study. 32,221 residents admitted to long-term-care facilities in Missouri between January 1, 1996, and October 30, 1998. Version 2.0 of the Minimum Data Set was utili...

The purpose of this study was to assess carbon monoxide (CO) exposure during equine anesthesia with either halothane (H) or isoflurane (I) delivered in a circle rebreathing system. Prospective clinical investigation. Fifty client-owned horses. Horses were randomly assigned for anesthetic maintenance with H (n = 26) or I (n = 24). Two large animal a...

Force generated due to torque caused by tarsal joint flexion and extension was measured noninvasively at 3, 4.5, 6, and 12 months of age in dogs with the Duchenne homologue, golden retriever muscular dystrophy (GRMD). Absolute and body-weight-corrected GRMD twitch and tetanic force values were lower than normal at all ages (P<0.01 for most). Tarsal...

To test the hypothesis that application of an inhibitory cast to the spastic upper limb will decrease a vibratory inhibition index (VII) of the H-reflex in the spastic upper limb. Prospective, nonrandomized, open-label trial. University tertiary care center. Eight adults with upper limb spasticity. Fiberglass cast application spanning the wrist to...

Changes in the health care delivery system are forcing clinicians to use less timely and more cost efficient measures. In rehabilitation, more efficient measures of emotional-behavioural functioning are being administered to patients with traumatic brain injury (TBI), including the Brief Symptom Inventory (BSI), a 53 item short version of the Sympt...

To determine if topical morphine can enter the synovial cavity and the effect of ultrasound on this process. A randomized control trial to investigate which body fluids morphine enters after topical application. A university animal laboratory. Ten mongrel dogs raised by the Comparative Medicine Department. All animals were certified to be free of d...

We used the Genetics Office Automation System (GOAS), a database management system designed to facilitate collection and analysis of medical genetic data, to evaluate the Missouri Genetics Disease Program (MGDP). From 1985 through 1995, patient data were collected at four tertiary care genetic centers. The number of genetic visits per 100,000 peopl...

Tarsal joint forces were measured in dogs over 70 days following botulinum toxin type A (BTX-A) injections. Three dogs were injected at motor end-plates located by electromyography (EMG), while 3 dogs were similarly injected, but without EMG guidance. Extension forces were significantly (P < 0.05) smaller in limbs injected at motor end-plates than...

To determine how well hospitals complied with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) tobacco control standards, which required banning smoking in hospital buildings; to explore issues involved in developing and implementing smoking bans; and to ascertain the perceived success of the policies. Postal survey conduct...

Background: Determining meaningful thresholds to reinforce excellent performance and flag potential problem areas is critical for quality improvement reports. Without thresholds, an organization may interpret its performance as superior to others because it is "better than average" and falsely assume it does not have care problems in certain areas...

In recent years, electrodiagnostic studies have become an expected component in the work up and evaluation of carpal tunnel syndrome. We conducted a retrospective review of 460 carpal tunnel decompressions to determine whether the accuracy of diagnosis and the prediction of therapeutic outcome could be related to the positivity and severity of find...

In 1994 12.7% of the population was 65 and over, while 10.6% were 85 and over. Expenditures for nursing homes reached $72.3 billion in 1994 (much of which is tax-supported) accounting for 8.7% of all personal health money spent. Data from the 1993 Missouri Medicaid cost reports for 403 nursing homes were reviewed to determine differences in costs p...

To test and cross-validate a model using disease activity, pain, and helplessness to predict future psychological and physical disability in persons with rheumatoid arthritis (RA) across time. Measures of disease activity, pain, helplessness, psychological function, and physical function were collected from 63 males with RA at baseline, 3 months, a...

Efforts to improve the quality of care and outcomes for nursing home residents are constantly of concern to state and federal regulators, nursing home providers, nursing home advocacy groups, and health policy researchers. The article describes a study that analyzed the quality indicators identified by the Health Care Financing Administration-spons...

Fine wire (FW) intramuscular electrodes and spectral analysis have not previously been used to quantify metabolic muscle fatigue in deep muscles not accessible with surface electrodes. This study compares initial median frequency (IMF) and decline in median frequency with fatigue (SLOPE) using surface and FW electrodes. Eighteen men performed isome...

Objective. To test and cross-validate a model using disease activity, pain, and helplessness to predict future psychological and physical disability in persons with rheumatoid arthritis (RA) across time. Methods. Measures of disease activity, pain, helplessness, psychological function, and physical function were collected from 63 males with RA at b...

The optimal heparin dosing schedule to achieve rapid and therapeutic anticoagulation has not been established. The objective of this study is to determine whether an intravenous heparin dosing nomogram based on body weight achieves adequate anticoagulation more rapidly than a standard-care nomogram. Sixty-four patients requiring intravenous heparin...

Lipid abnormalities are seen frequently in renal transplant patients. Cardiovascular disease is an important cause of morbidity and mortality in these patients. We assessed the efficacy and safety of the lipid-lowering drugs, nicotinic acid (short acting) and lovastatin, the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor. Twelve renal tr...

Much effort has been directed toward the development of an ideal multipurpose controlled medical vocabulary for use in human and veterinary medicine. SNOMED International is one effort that has resulted in a larger and more complex nomenclature system. Although it was able to code more concepts, SNOMED International failed to statistically improve...

Tables of critical values are given, which can be used to execute interim analyses in clinical trials involving two groups when the joint distribution of the test statistics can be approximated by a multivariate normal distribution. Critical values are given for both the one and two interim analyses cases for a variety of partitions of α and correl...