Hayden Bosworth

Overview:

Dr. Bosworth is a health services research and Associate Director of the Center for Health Services Research in Primary Care at the Durham VA Medical Center. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 20 trials resulting in over 350 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy

Positions:

Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Professor in Psychiatry and Behavioral Sciences

Psychiatry & Behavioral Sciences
School of Medicine

Professor in Medicine

Medicine, General Internal Medicine
School of Medicine

Associate of the Duke Initiative for Science & Society

Duke Science & Society
Institutes and Provost's Academic Units

Core Faculty in Innovation & Entrepreneurship

Duke Innovation & Entrepreneurship
Institutes and Provost's Academic Units

Senior Fellow in the Center for Study of Aging

Center for the Study of Aging and Human Development
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1996

Pennsylvania State University

Grants:

Mid Southern Primary Care Networks Node

Administered By
Psychiatry & Behavioral Sciences, Social and Community Psychiatry
Awarded By
National Institutes of Health
Role
Investigator
Start Date
End Date

New Media Obesity Treatment in Community Health Centers

Administered By
Duke Global Health Institute
Awarded By
National Institutes of Health
Role
Investigator
Start Date
End Date

Improving SCD Care using Web-based Guidelines, Nurse Care Managers and Peer Mentors in Parimary Care Emergency Departments in Central North Carolina

Administered By
School of Nursing
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

Improving SCD Care using Web-based Guidelines, Nurse Care Managers and Peer Mentors in Parimary Care Emergency Departments in Central North Carolina

Administered By
School of Nursing
Awarded By
National Institutes of Health
Role
Co Investigator
Start Date
End Date

A nurse-led intervention to extend the HIV treatment cascade for cardiovascular disease prevention (EXTRA-CVD)

Administered By
Basic Science Departments
Awarded By
Case Western Reserve University
Role
Principal Investigator
Start Date
End Date

Publications:

Self-monitoring of blood pressure in patients with hypertension related multi-morbidity: Systematic review and individual patient data meta-analysis.

BACKGROUND: Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS: A systematic review was conducted of articles published in Medline, Embase and the Cochrane Library up to January 2018. Randomised controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorised by whether they examined a low/high intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12-months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS: A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (-3.12 mmHg, [95%CI -4.78, -1.46 mmHg]; p value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (p<0.001 for all outcomes), and possibly stroke (p<0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes or chronic kidney disease. CONCLUSIONS: Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high intensity co-interventions.
Authors
Sheppard, JP; Tucker, KL; Davison, WJ; Stevens, R; Aekplakorn, W; Bosworth, HB; Bove, A; Earle, K; Godwin, M; Green, BB; Hebert, P; Heneghan, C; Hill, N; Hobbs, FDR; Kantola, I; Kerry, SM; Leiva, A; Magid, DJ; Mant, J; Margolis, KL; McKinstry, B; McLaughlin, MA; McNamara, K; Omboni, S; Ogedegbe, O; Parati, G; Varis, J; Verberk, WJ; Wakefield, BJ; McManus, RJ
MLA Citation
URI
https://scholars.duke.edu/individual/pub1422003
PMID
31730171
Source
pubmed
Published In
Am J Hypertens
Published Date
DOI
10.1093/ajh/hpz182

Primary Care Providers' Acceptance of Pharmacists' Recommendations to Support Optimal Medication Management for Patients with Diabetic Kidney Disease.

BACKGROUND: Patients with diabetic kidney disease (DKD) often struggle with blood pressure control. In team-based models of care, pharmacists and primary care providers (PCPs) play important roles in supporting patients' blood pressure management. OBJECTIVE: To describe whether PCPs' acceptance of pharmacists' recommendations impacts systolic blood pressure (SBP) at 36 months. DESIGN: An observational analysis of a subset of participants randomized to the intervention arm of the Simultaneous risk factor control using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study. PARTICIPANTS: STOP-DKD participants for whom (1) the pharmacist made at least one recommendation to the PCP; (2) there were available data regarding the PCP's corresponding action; and (3) there were SBP measurements at baseline and 36 months. INTERVENTION: Participants received monthly telephone calls with a pharmacist addressing health behaviors and medication management. Pharmacists made medication-related recommendations to PCPs. MAIN MEASURES: We fit an unadjusted generalized linear mixed model to assess the association between the number of pharmacists' recommendations for DKD and blood pressure management and PCPs' acceptance of such recommendations. We used a linear regression model to evaluate the association between PCP acceptance and SBP at 36 months, adjusted for baseline SBP. KEY RESULTS: Pharmacists made 176 treatment recommendations (among 59 participants), of which 107 (61%) were accepted by PCPs. SBP significantly declined by an average of 10.5 mmHg (p < 0.01) among 47 of 59 participants who had valid measurements at baseline and 36 months. There was a significant association between the number of pharmacist recommendations and the odds of PCP acceptance (OR 1.19; 95%CI 1.00, 1.42; p < 0.05), but no association between the number of accepted recommendations and SBP. CONCLUSIONS: Pharmacists provided actionable medication-related recommendations. We identified a significant decline in SBP at 36 months, but this reduction was not associated with recommendation acceptance. TRIAL REGISTRATION: NCT01829256.
Authors
Zullig, LL; Jazowski, SA; Davenport, CA; Diamantidis, CJ; Oakes, MM; Patel, S; Moaddeb, J; Bosworth, HB
MLA Citation
Zullig, Leah L., et al. “Primary Care Providers' Acceptance of Pharmacists' Recommendations to Support Optimal Medication Management for Patients with Diabetic Kidney Disease..” J Gen Intern Med, Oct. 2019. Pubmed, doi:10.1007/s11606-019-05403-x.
URI
https://scholars.duke.edu/individual/pub1417898
PMID
31659655
Source
pubmed
Published In
J Gen Intern Med
Published Date
DOI
10.1007/s11606-019-05403-x

Warrior Wellness: A randomized controlled pilot trial of the effects of exercise on physical function and clinical health risk factors in older military veterans with PTSD.

BACKGROUND: Military veterans living with posttraumatic stress disorder (PTSD) face significant physical and functional health disparities, which are often aggravated over time and in the context aging. Evidence has shown that physical activity can positively impact age-related health conditions, yet exercise trials in older adults with mental disorders are rare. Our study was a tailored and targeted pilot exercise intervention for older veterans with PTSD. METHODS: Fifty-four older veterans with PTSD (mean age = 67.4 years, 90.7% male, 85.2% non-white) were randomized to supervised exercise (n=38) or wait-list usual care (WL; n=18) for 12 weeks. Physical activity (MET-min/wk) and aerobic endurance (assessed with the 6-minute walk test), were primary outcomes. Secondary outcomes were physical performance (strength, mobility, balance), cardiometabolic risk factors (e.g., waist circumference), and health-related quality of life. RESULTS: At 12 weeks, a large effect of the intervention on physical activity levels (Cohen's d=1.37) was observed compared to WL. Aerobic endurance improved by 69 meters in the exercise group compared to 10 meters in WL, reflecting a moderate between-group effect (Cohen's d=.50). Between-group differences on 12-week changes in physical performance, cardiometabolic risk factors, and health-related quality of life ranged from small to large effects (Cohen's d=.28-1.48), favoring the exercise arm. CONCLUSION: Participation in supervised exercise improved aerobic endurance, physical performance, and health-related clinical factors in older veterans with PTSD; a medically complex population with multiple morbidity. Group exercise is a low-cost, low-stigma intervention and implementation efforts among older veterans with PTSD warrants further consideration.
Authors
Hall, KS; Morey, MC; Beckham, JC; Bosworth, HB; Sloane, R; Pieper, CF; Pebole, MM
MLA Citation
URI
https://scholars.duke.edu/individual/pub1417142
PMID
31646339
Source
pubmed
Published In
J Gerontol a Biol Sci Med Sci
Published Date
DOI
10.1093/gerona/glz255

Novel application of approaches to predicting medication adherence using medical claims data.

OBJECTIVE: To compare predictive analytic approaches to characterize medication nonadherence and determine under which circumstances each method may be best applied. DATA SOURCES/STUDY SETTING: Medicare Parts A, B, and D claims from 2007 to 2013. STUDY DESIGN: We evaluated three statistical techniques to predict statin adherence (proportion of days covered [PDC ≥ 80 percent]) in the year following discharge: standard logistic regression with backward selection of covariates, least absolute shrinkage and selection operator (LASSO), and random forest. We used the C-index to assess model discrimination and decile plots comparing predicted values to observed event rates to evaluate model performance. DATA EXTRACTION: We identified 11 969 beneficiaries with an acute myocardial infarction (MI)-related admission from 2007 to 2012, who filled a statin prescription at, or shortly after, discharge. PRINCIPAL FINDINGS: In all models, prior statin use was the most important predictor of future adherence (OR = 3.65, 95% CI: 3.34-3.98; OR = 3.55). Although the LASSO regression model selected nearly 90 percent of all candidate predictors, all three analytic approaches had moderate discrimination (C-index ranging from 0.664 to 0.673). CONCLUSIONS: Although none of the models emerged as clearly superior, predictive analytics could proactively determine which patients are at risk of nonadherence, thus allowing for timely engagement in adherence-improving interventions.
Authors
Zullig, LL; Jazowski, SA; Wang, TY; Hellkamp, A; Wojdyla, D; Thomas, L; Egbuonu-Davis, L; Beal, A; Bosworth, HB
MLA Citation
Zullig, Leah L., et al. “Novel application of approaches to predicting medication adherence using medical claims data..” Health Serv Res, vol. 54, no. 6, Dec. 2019, pp. 1255–62. Pubmed, doi:10.1111/1475-6773.13200.
URI
https://scholars.duke.edu/individual/pub1404396
PMID
31429471
Source
pubmed
Published In
Health Services Research
Volume
54
Published Date
Start Page
1255
End Page
1262
DOI
10.1111/1475-6773.13200

Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case-control analysis.

Purpose: The growing number of colorectal cancer (CRC) survivors often have multiple chronic conditions. Comparing nonmetastatic CRC survivors and matched noncancer controls, our objectives were to determine the odds of CRC survivors being diagnosed with cardiovascular disease (CVD)-related chronic conditions and their likelihood of control during the year after CRC diagnosis. Patients and methods: We retrospectively identified patients diagnosed with nonmetastatic CRC in the Veterans Affairs health care system from fiscal years 2009 to 2012 and matched each with up to 3 noncancer control patients. We used logistic regression to assess differences in the likelihood of being diagnosed with CVD-related chronic conditions and control between nonmetastatic CRC survivors and noncancer controls. Results: We identified 9,758 nonmetastatic CRC patients and matched them to 29,066 noncancer controls. At baseline, 69.4% of CRC survivors and their matched controls were diagnosed with hypertension, 52.4% with hyperlipidemia, and 36.7% with diabetes. Compared to matched noncancer controls, CRC survivors had 57% higher odds of being diagnosed with hypertension (OR=1.57, 95% CI=1.49-1.64) and 7% higher odds of controlled blood pressure (OR=1.07, 95% CI 1.02, 1.13) in the subsequent year. Compared to matched noncancer control patients, CRC survivors had half the odds of being diagnosed with hyperlipidemia (OR=0.50, 95% CI=0.48-0.52) and lower odds of low-density lipoprotein (LDL) control (OR 0.88, 95% CI 0.81-0.94). There were no significant differences between groups for diabetes diagnoses or control. Conclusion: Compared to noncancer controls, nonmetastatic CRC survivors have 1) greater likelihood of being diagnosed with hypertension and worse blood pressure control in the year following diagnosis; 2) lower likelihood of being diagnosed with hyperlipidemia or LDL control; and 3) comparable diabetes diagnoses and control. There may be a need for hypertension control interventions targeting cancer survivors.
Authors
Zullig, LL; Smith, VA; Lindquist, JH; Williams, CD; Weinberger, M; Provenzale, D; Jackson, GL; Kelley, MJ; Danus, S; Bosworth, HB
MLA Citation
Zullig, Leah L., et al. “Cardiovascular disease-related chronic conditions among Veterans Affairs nonmetastatic colorectal cancer survivors: a matched case-control analysis..” Cancer Manag Res, vol. 11, 2019, pp. 6793–802. Pubmed, doi:10.2147/CMAR.S191040.
URI
https://scholars.duke.edu/individual/pub1404026
PMID
31413631
Source
pubmed
Published In
Cancer Management and Research
Volume
11
Published Date
Start Page
6793
End Page
6802
DOI
10.2147/CMAR.S191040