Devon Check

Overview:

Devon Check, PhD is a health services researcher focused on understanding and overcoming barriers to the delivery of equitable, high-quality care for patients with cancer and other potentially life-limiting conditions.

Dr. Check received her PhD in Health Policy and Management from the Gillings School of Global Public Health at UNC-Chapel Hill. Prior to joining the Department of Population Health Sciences at Duke, she completed a postdoctoral fellowship in Delivery Science at Kaiser Permanente Northern California.

Areas of Expertise: Implementation Science and Health Services Research

Positions:

Assistant Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Member of the

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2016

University of North Carolina - Chapel Hill

Grants:

Collaboratory Resource Coordinating Center for Pragmatic and Implementation Studies for the Management of Pain (PRISM) (U24)

Administered By
Duke Clinical Research Institute
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Promotion of Prostate Cancer Screening Equity: A Quality Improvement Education Initiative

Administered By
Population Health Sciences
Awarded By
National Minority Quality Forum
Role
Principal Investigator
Start Date
End Date

Publications:

Predictors of Chronic Opioid Use: A Population-Level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims.

BACKGROUND: No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. METHODS: We conducted a retrospective cohort study using North Carolina cancer registry data linked with claims from public and private insurance (2006-2016). We included adults with nonmetastatic cancer who had no prior chronic opioid use (n = 38 366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13-24 months following diagnosis) associated with patient characteristics. RESULTS: Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR] 50-59 vs 60-69 = 1.23, 95% confidence interval [CI] = 1.05 to 1.43), baseline depression (aRR = 1.22, 95% CI = 1.06 to 1.41) or substance use (aRR = 1.43, 95% CI = 1.15 to 1.78) and Medicaid (aRR vs private = 1.93, 95% CI = 1.56 to 2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in survivorship (aRR = 2.62, 95% CI = 2.28 to 3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95% CI = 14.30 to 19.40). CONCLUSIONS: Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities to improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.
Authors
Check, DK; Baggett, CD; Kim, K; Roberts, AW; Roberts, MC; Robinson, T; Oeffinger, KC; Dinan, MA
MLA Citation
Check, Devon K., et al. “Predictors of Chronic Opioid Use: A Population-Level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims.J Natl Cancer Inst, vol. 113, no. 11, Nov. 2021, pp. 1581–89. Pubmed, doi:10.1093/jnci/djab082.
URI
https://scholars.duke.edu/individual/pub1480897
PMID
33881543
Source
pubmed
Published In
J Natl Cancer Inst
Volume
113
Published Date
Start Page
1581
End Page
1589
DOI
10.1093/jnci/djab082

Financial Burden of Drugs Prescribed for Cancer-Associated Symptoms.

<h4>Purpose</h4>The financial toxicity of anticancer drugs is well-documented, but little is known about the costs of drugs used to manage cancer-associated symptoms.<h4>Methods</h4>We reviewed relevant guidelines and compiled drugs used to manage seven cancer-associated symptoms (anorexia and cachexia, chemotherapy-induced peripheral neuropathy, constipation, diarrhea, exocrine pancreatic insufficiency, cancer-associated fatigue, and chemotherapy-induced nausea and vomiting). Using GoodRx website, we identified the retail price (cash price at retail pharmacies) and lowest price (discounted, best-case scenario of out-of-pocket costs) for patients without insurance for each drug or formulation for a typical fill. We describe lowest prices here.<h4>Results</h4>For anorexia and cachexia, costs ranged from $5 US dollars (USD; generic olanzapine or mirtazapine tablets) to $1,156 USD (brand-name dronabinol solution) and varied widely by formulation of the same drug or dosage: for olanzapine 5 mg, $5 USD (generic tablet) to $239 USD (brand-name orally disintegrating tablet). For chemotherapy-induced peripheral neuropathy, costs of duloxetine varied from $12 USD (generic) to $529 USD (brand-name). For constipation, the cost of sennosides or polyethylene glycol was <$15 USD, whereas newer agents such as methylnaltrexone were expensive ($1,001 USD). For diarrhea, the cost of generic loperamide or diphenoxylate-atropine tablets was <$15 USD. For exocrine pancreatic insufficiency, only brand-name formulations were available, range of cost, $1,072 USD-$1,514 USD. For cancer-associated fatigue, the cost of generic dexamethasone or dexmethylphenidate was <$15 USD, whereas brand-name modafinil was more costly ($1,284 USD). For a 4-drug nausea and vomiting prophylaxis regimen, costs ranged from $181 USD to $1,430 USD.<h4>Conclusion</h4>We highlight the high costs of many symptom control drugs and the wide variation in the costs of these drugs. These findings can guide patient-clinician discussions about cost-effectively managing symptoms, while promoting the use of less expensive formulations when possible.
Authors
Gupta, A; Nshuti, L; Grewal, US; Sedhom, R; Check, DK; Parsons, HM; Blaes, AH; Virnig, BA; Lustberg, MB; Subbiah, IM; Nipp, RD; Dy, SM; Dusetzina, SB
MLA Citation
Gupta, Arjun, et al. “Financial Burden of Drugs Prescribed for Cancer-Associated Symptoms.Jco Oncology Practice, Sept. 2021, p. OP2100466. Epmc, doi:10.1200/op.21.00466.
URI
https://scholars.duke.edu/individual/pub1497124
PMID
34558297
Source
epmc
Published In
Jco Oncology Practice
Published Date
Start Page
OP2100466
DOI
10.1200/op.21.00466

Inpatient palliative care utilization for patients with brain metastases.

Introduction: Given the high symptom burden and complex clinical decision making associated with a diagnosis of brain metastases (BM), specialty palliative care (PC) can meaningfully improve patient quality of life. However, no prior study has formally evaluated patient-specific factors associated with PC consultation among BM patients. Methods: We examined the rates of PC consults in a cohort of 1303 patients with BM admitted to three tertiary medical centers from October 2015 to December 2018. Patient demographics, surgical status, 30-day readmission, and death data were collected via retrospective chart review. PC utilization was assessed by identifying encounters for which an inpatient consult to PC was placed. Statistical analyses were performed to compare characteristics and outcomes between patients who did and did not receive PC consults. Results: We analyzed 1303 patients admitted to the hospital with BM. The average overall rate of inpatient PC consultation was 19.6%. Rates of PC utilization differed significantly by patient race (17.5% in White/Caucasian vs 26.0% in Black/African American patients, P = .0014). Patients who received surgery during their admission had significantly lower rates of PC consultation (3.9% vs 22.4%, P < .0001). Patients who either died during their admission or were discharged to hospice had significantly higher rates of PC than those who were discharged home or to rehabilitation (P < .0001). Conclusions: In our dataset, PC consultation rates varied by patient demographic, surgical status, discharging service, and practice setting. Further work is needed to identify the specific barriers to optimally utilizing specialty PC in this population.
Authors
Price, M; Howell, EP; Dalton, T; Ramirez, L; Howell, C; Williamson, T; Fecci, PE; Anders, CK; Check, DK; Kamal, AH; Goodwin, CR
MLA Citation
Price, Meghan, et al. “Inpatient palliative care utilization for patients with brain metastases.Neurooncol Pract, vol. 8, no. 4, Aug. 2021, pp. 441–50. Pubmed, doi:10.1093/nop/npab016.
URI
https://scholars.duke.edu/individual/pub1488917
PMID
34277022
Source
pubmed
Published In
Neuro Oncology Practice
Volume
8
Published Date
Start Page
441
End Page
450
DOI
10.1093/nop/npab016

Integration of Improvement and Implementation Science in Practice-Based Research Networks: a Longitudinal, Comparative Case Study.

BACKGROUND: Implementation science (IS) and quality improvement (QI) inhabit distinct areas of scholarly literature, but are often blended in practice. Because practice-based research networks (PBRNs) draw from both traditions, their experience could inform opportunities for strategic IS-QI alignment. OBJECTIVE: To systematically examine IS, QI, and IS/QI projects conducted within a PBRN over time to identify similarities, differences, and synergies. DESIGN: Longitudinal, comparative case study of projects conducted in the Oregon Rural Practice-based Research Network (ORPRN) from January 2007 to January 2019. APPROACH: We reviewed documents and conducted staff interviews. We classified projects as IS, QI, IS/QI, or other using established criteria. We abstracted project details (e.g., objective, setting, theoretical framework) and used qualitative synthesis to compare projects by classification and to identify the contributions of IS and QI within the same project. KEY RESULTS: Almost 30% (26/99) of ORPRN's projects included IS or QI elements; 54% (14/26) were classified as IS/QI. All 26 projects used an evidence-based intervention and shared many similarities in relation to objective and setting. Over half of the IS and IS/QI projects used randomized designs and theoretical frameworks, while no QI projects did. Projects displayed an upward trend in complexity over time. Project used a similar number of practice change strategies; however, projects classified as IS predominantly employed education/training while all IS/QI and most QI projects used practice facilitation. Projects including IS/QI elements demonstrated the following contributions: QI provides the mechanism by which the principles of IS are operationalized in order to support local practice change and IS in turn provides theories to inform implementation and evaluation to produce generalizable knowledge. CONCLUSIONS: Our review of projects conducted over a 12-year period in one PBRN demonstrates key synergies for IS and QI. Strategic alignment of IS/QI within projects may help improve care quality and bridge the research-practice gap.
Authors
Davis, MM; Gunn, R; Kenzie, E; Dickinson, C; Conway, C; Chau, A; Michaels, L; Brantley, S; Check, DK; Elder, N
MLA Citation
Davis, Melinda M., et al. “Integration of Improvement and Implementation Science in Practice-Based Research Networks: a Longitudinal, Comparative Case Study.J Gen Intern Med, vol. 36, no. 6, June 2021, pp. 1503–13. Pubmed, doi:10.1007/s11606-021-06610-1.
URI
https://scholars.duke.edu/individual/pub1478721
PMID
33852140
Source
pubmed
Published In
J Gen Intern Med
Volume
36
Published Date
Start Page
1503
End Page
1513
DOI
10.1007/s11606-021-06610-1

Opioid Use Disorder and Overdose in Older Adults With Breast, Colorectal, or Prostate Cancer.

BACKGROUND: Despite high rates of opioid therapy, evidence about the risk of preventable opioid harms among cancer survivors is underdeveloped. Our objective was to estimate the odds of opioid use disorder (OUD) and overdose following breast, colorectal, or prostate cancer diagnosis among Medicare beneficiaries. METHODS: We conducted a retrospective cohort study using 2007-2014 Surveillance, Epidemiology, and End Results-Medicare data for cancer survivors with a first cancer diagnosis of stage 0-III breast, colorectal, or prostate cancer at age 66-89 years between 2008 and 2013. Cancer survivors were matched to up to 2 noncancer controls on age, sex, and Surveillance, Epidemiology, and End Results region. Using Firth logistic regression, we estimated adjusted 1-year odds of OUD or nonfatal opioid overdose associated with a cancer diagnosis. We also estimated adjusted odds of OUD and overdose separately and by cancer stage, prior opioid use, and follow-up time. RESULTS: Among 69 889 cancer survivors and 125 007 controls, the unadjusted rates of OUD or nonfatal overdose were 25.2, 27.1, 38.9, and 12.4 events per 10 000 patients in the noncancer, breast, colorectal, and prostate samples, respectively. There was no association between cancer and OUD. Colorectal survivors had 2.3 times higher odds of opioid overdose compared with matched controls (adjusted odds ratio = 2.33, 95% confidence interval  = 1.49 to 3.67). Additionally, overdose risk was greater in those with more advanced disease, no prior opioid use, and preexisting mental health conditions. CONCLUSIONS: Opioid overdose was a rare, but statistically significant, outcome following stage II-III colorectal cancer diagnosis, particularly among previously opioid-naïve patients. These patients may require heightened screening and intervention to prevent inadvertent adverse opioid harms.
Authors
Roberts, AW; Eiffert, S; Wulff-Burchfield, EM; Dusetzina, SB; Check, DK
MLA Citation
Roberts, Andrew W., et al. “Opioid Use Disorder and Overdose in Older Adults With Breast, Colorectal, or Prostate Cancer.J Natl Cancer Inst, vol. 113, no. 4, Apr. 2021, pp. 425–33. Pubmed, doi:10.1093/jnci/djaa122.
URI
https://scholars.duke.edu/individual/pub1456578
PMID
32805032
Source
pubmed
Published In
J Natl Cancer Inst
Volume
113
Published Date
Start Page
425
End Page
433
DOI
10.1093/jnci/djaa122

Research Areas:

Cancer
Communication
Decision Making
Delivery of Health Care
Diffusion of Innovation
Guideline Adherence
Health Services Research
Healthcare Disparities
Implementation Science
Palliative Care
Quality of Health Care
Survivorship