Megan Mahoney

All Publications

• COVID-19 Preoperative Assessment and Testing: From Surge to Recovery. Annals of surgery Lu, A. C., Schmiesing, C. A., Mahoney, M., Cianfichi, L., Semple, A. K., Watt, D., Fischer, S., Wald, S. H. 2020

  View details for DOI 10.1097/SLA.0000000000004124

  View details for PubMedID 32541233

• Implementation outcomes of humanwide: A pilot project of integrated precision health in team-based primary care Brown-Johnson, C., Safaeinili, N., Baratta, J., Morris, S., Palaniappan, L., Mahoney, M., Rosas, L., Winget, M. BMC. 2020

  View details for Web of Science ID 000533323500064

• CFIR simplified: Pragmatic application of and adaptations to the Consolidated Framework for Implementation Research (CFIR) for evaluation of a patient-centered care transformation within a learning health system. Learning health systems Safaeinili, N., Brown-Johnson, C., Shaw, J. G., Mahoney, M., Winget, M. 2020; 4 (1): e10201

  Abstract

  The Consolidated Framework for Implementation Research (CFIR) is a commonly used implementation science framework to facilitate design, evaluation, and implementation of evidence-based interventions. Its comprehensiveness is an asset for considering facilitators and barriers to implementation and also makes the framework cumbersome to use. We describe adaptations we made to CFIR to simplify its pragmatic application, for use in a learning health system context, in the evaluation of a complex patient-centered care transformation.We conducted a qualitative study and structured our evaluation questions, data collection methods, analysis, and reporting around CFIR. We collected qualitative data via semi-structured interviews and observations with key stakeholders throughout. We identified and documented adaptations to CFIR throughout the evaluation process.We analyzed semi-structured interviews with key stakeholders (n = 23) from clinical observations (n = 5). We made three key adaptations to CFIR: (a) promoted "patient needs and resources," a subconstruct of the outer setting, to its own domain within CFIR during data analysis; (b) divided the "inner setting" domain into three layers that account for the hierarchy of health care systems (i. pilot clinic, ii. peer clinics, and iii. overarching health care system); and (c) tailored several construct definitions to fit a patient-centered, primary care setting. Analysis yielded qualitative findings concentrated in the CFIR domains "intervention characteristics" and "outer setting," with a robust number of findings in the new domain "patient needs and resources."To make CFIR more accessible and relevant for wider use in the context of patient-centered care transformations within a learning health system, a few adaptations are key. Specifically, we found success by teasing apart interactions across the inner layers of a health system, tailoring construct definitions, and placing additional focus on patient needs.

  View details for DOI 10.1002/lrh2.10201

  View details for PubMedID 31989028

  View details for PubMedCentralID PMC6971122

• The Stanford Lightning Report Method: A comparison of rapid qualitative synthesis results across four implementation evaluations. Learning health systems Brown-Johnson, C., Safaeinili, N., Zionts, D., Holdsworth, L. M., Shaw, J. G., Asch, S. M., Mahoney, M., Winget, M. 2020; 4 (2): e10210

  Abstract

  Current evaluation methods are mismatched with the speed of health care innovation and needs of health care delivery partners. We introduce a qualitative approach called the lightning report method and its specific product-the "Lightning Report." We compare implementation evaluation results across four projects to explore report sensitivity and the potential depth and breadth of lightning report method findings.The lightning report method was refined over 2.5 years across four projects: team-based primary care, cancer center transformation, precision health in primary care, and a national life-sustaining decisions initiative. The novelty of the lightning report method is the application of Plus/Delta/Insight debriefing to dynamic implementation evaluation. This analytic structure captures Plus ("what works"), Delta ("what needs to be changed"), and Insights (participant or evaluator insights, ideas, and recommendations). We used structured coding based on implementation science barriers and facilitators outlined in the Consolidated Framework for Implementation Research (CFIR) applied to 17 Lightning Reports from four projects.Health care partners reported that Lighting Reports were valuable, easy to understand, and they implied reports supported "corrective action" for implementations. Comparative analysis revealed cross-project emphasis on the domains of Inner Setting and Intervention Characteristics, with themes of communication, resources/staffing, feedback/reflection, alignment with simultaneous interventions and traditional care, and team cohesion. In three of the four assessed projects, the largest proportion of coding was to the clinic-level domain of Inner Setting-ranging from 39% for the cancer center project to a high of 56% for the life-sustaining decisions project.The lightning report method can fill a gap in rapid qualitative approaches and is generalizable with consistent but flexible core methods. Comparative analysis suggests it is a sensitive tool, capable of uncovering differences and insights in implementation across projects. The Lightning Report facilitates partnered evaluation and communication with stakeholders by providing real-time, actionable insights in dynamic health care implementations.

  View details for DOI 10.1002/lrh2.10210

  View details for PubMedID 32313836

  View details for PubMedCentralID PMC7156867

• The Stanford Lightning Report Method: A comparison of rapid qualitative synthesis results across four implementation evaluations LEARNING HEALTH SYSTEMS Brown-Johnson, C., Safaeinili, N., Zionts, D., Holdsworth, L. M., Shaw, J. G., Asch, S. M., Mahoney, M., Winget, M. 2019

  View details for DOI 10.1002/lrh2.10210

  View details for Web of Science ID 000503760600001

• Ten Ways Artificial Intelligence Will Transform Primary Care JOURNAL OF GENERAL INTERNAL MEDICINE Lin, S. Y., Mahoney, M. R., Sinsky, C. A. 2019; 34 (8): 1626–30

  View details for DOI 10.1007/s11606-019-05035-1

  View details for Web of Science ID 000477976700044

• Role definition is key-Rapid qualitative ethnography findings from a team-based primary care transformation. Learning health systems Brown-Johnson, C., Shaw, J. G., Safaeinili, N., Chan, G. K., Mahoney, M., Asch, S., Winget, M. 2019; 3 (3): e10188

  Abstract

  Purpose: Implementing team-based care into existing primary care is challenging; understanding facilitators and barriers to implementation is critical. We assessed adoption and acceptability of new roles in the first 6months of launching a team-based care model focused on preventive care, population health, and psychosocial support.Methods: We conducted qualitative rapid ethnography at a community-based test clinic, including 74hours of observations and 28 semi-structured interviews. We identified implementation themes related to team-based care and specifically the integration of three roles purposively designed to enhance coordination for better patient outcomes, including preventive screening and mental health: (1) medical assistants as care coordinators; (2) extended care team specialists, including clinical pharmacist and behavioral health professional; and (3) advanced practice providers (APPs)-ie, nurse practitioners and physician assistants.Results: All stakeholders (ie, patients, providers, and staff) reported positive perceptions of care coordinators and extended care specialists; these roles were well defined and quickly implemented. Care coordinators effectively managed care between visits and established strong patient relationships. Specialist colocation facilitated patient access and well-supported diabetes services and mental health care. We also observed unanticipated value: Care coordinators relayed encounter-relevant chart information to providers while scribing; extended care specialists supported informal continuing medical education. In contrast, we observed uncertain definition and expectations of the APP role across stakeholders; accordingly, adoption and acceptability of the role varied.Conclusions: Practice redesign can redistribute responsibility and patient connection throughout a team but should emphasize well-defined roles. Ethnography, conducted early in implementation with multistakeholder perspectives, can provide rapid and actionable insights about where roles may need refinement or redefinition to support ultimate physical and mental health outcomes for patients.

  View details for DOI 10.1002/lrh2.10188

  View details for PubMedID 31317071

• Primary Care 2.0: Design of a Transformational Team-Based Practice Model to Meet the Quadruple Aim AMERICAN JOURNAL OF MEDICAL QUALITY Brown-Johnson, C. G., Chan, G. K., Winget, M., Shaw, J. G., Patton, K., Hussain, R., Olayiwola, J., Chang, S., Mahoney, M. 2019; 34 (4): 339–47

  View details for DOI 10.1177/1062860618802365

  View details for Web of Science ID 000476540300004

• Humanwide: A Comprehensive Data Base for Precision Health in Primary Care. Annals of family medicine Mahoney, M. R., Asch, S. M. 2019; 17 (3): 273

  View details for PubMedID 31085532

• Breast Cancer knowledge, perceptions and practices in a rural Community in Coastal Kenya. BMC public health Sayed, S., Ngugi, A. K., Mahoney, M. R., Kurji, J., Talib, Z. M., Macfarlane, S. B., Wynn, T. A., Saleh, M., Lakhani, A., Nderitu, E., Agoi, F., Premji, Z., Zujewski, J. A., Moloo, Z. 2019; 19 (1): 180

  Abstract

  BACKGROUND: Data on breast healthcare knowledge, perceptions and practice among women in rural Kenya is limited. Furthermore, the role of the male head of household in influencing a woman's breast health seeking behavior is also not known. The aim of this study was to assess the knowledge, perceptions and practice of breast cancer among women, male heads of households, opinion leaders and healthcare providers within a rural community in Kenya. Our secondary objective was to explore the role of male heads of households in influencing a woman's breast health seeking behavior.METHODS: This was a mixed method cross-sectional study, conducted between Sept 1st 2015 Sept 30th 2016. We administered surveys to women and male heads of households. Outcomes of interest were analysed in Stata ver 13 and tabulated against gender. We conducted six focus group discussions (FGDs) and 22 key informant interviews (KIIs) with opinion leaders and health care providers, respectively. Elements of the Rapid Assessment Process (RAP) were used to guide analysis of the FGDs and the KIIs.RESULTS: A total of 442 women and 237 male heads of households participated in the survey. Although more than 80% of respondents had heard of breast cancer, fewer than 10% of women and male heads of households had knowledge of 2 or more of its risk factors. More than 85% of both men and women perceived breast cancer as a very serious illness. Over 90% of respondents would visit a health facility for a breast lump. Variable recognition of signs of breast cancer, limited decision- autonomy for women, a preference for traditional healers, lack of trust in the health care system, inadequate access to services, limited early-detection services were the six themes that emerged from the FGDs and the KIIs. There were discrepancies between the qualitative and quantitative data for the perceived role of the male head of household as a barrier to seeking breast health care.CONCLUSIONS: Determining level of breast cancer knowledge, the characteristics of breast health seeking behavior and the perceived barriers to accessing breast health are the first steps in establishing locally relevant intervention programs.

  View details for DOI 10.1186/s12889-019-6464-3

  View details for PubMedID 30755192

• Effect of Electronic Clinical Decision Support on Imaging for the Evaluation of Acute Low Back Pain in the Ambulatory Care Setting. World neurosurgery Chen, D., Bhambhvani, H. P., Hom, J., Mahoney, M., Wintermark, M., Sharp, C., Ratliff, J., Chen, Y. R. 2019

  Abstract

  To assess the effectiveness of a clinical decision support tool consisting of an electronic medical record Best Practice Alert (BPA) on the frequency of lumbar imaging in patients with acute low back pain (LBP) in the ambulatory care setting. To understand why providers order imaging outside of clinical guidelines.We implemented a BPA pop-up alert on 3/23/16 that informed the ordering physician of the Choosing Wisely recommendation to not order imaging within the first 6 weeks of low back pain in the absence of red flags. We measured imaging rates 1 year before and after implementation of the BPA. To override the BPA, providers could ignore the alert or explain their rationale for ordering imaging using either pre-set options or free-text submission. We tracked pre-set options and manually reviewed 125 free-text submissions.Significant decreases in both total imaging rate (9.6% decrease, p = 0.02) and MRI rate (14.9% decrease, p < 0.01) were observed after implementation of the BPA. No change was found in the rates of x-ray or CT ordering. 64% of providers used pre-set options in overriding the BPA, while 36% of providers entered a free-text submission. Among those providers using a free-text submission, 56% entered a non-guideline supported rationale.The present study demonstrates the effectiveness of a simple, low-cost clinical decision support tool in reducing imaging rates for patients with acute low back pain. We additionally identify reasons providers order imaging outside of clinical guidelines.

  View details for DOI 10.1016/j.wneu.2019.11.031

  View details for PubMedID 31733384

• Ten Ways Artificial Intelligence Will Transform Primary Care. Journal of general internal medicine Lin, S. Y., Mahoney, M. R., Sinsky, C. A. 2019

  Abstract

  Artificial intelligence (AI) is poised as a transformational force in healthcare. This paper presents a current environmental scan, through the eyes of primary care physicians, of the top ten ways AI will impact primary care and its key stakeholders. We discuss ten distinct problem spaces and the most promising AI innovations in each, estimating potential market sizes and the Quadruple Aims that are most likely to be affected. Primary care is where the power, opportunity, and future of AI are most likely to be realized in the broadest and most ambitious scale. We propose how these AI-powered innovations must augment, not subvert, the patient-physician relationship for physicians and patients to accept them. AI implemented poorly risks pushing humanity to the margins; done wisely, AI can free up physicians' cognitive and emotional space for patients, and shift the focus away from transactional tasks to personalized care. The challenge will be for humans to have the wisdom and willingness to discern AI's optimal role in twenty-first century healthcare, and to determine when it strengthens and when it undermines human healing. Ongoing research will determine the impact of AI technologies in achieving better care, better health, lower costs, and improved well-being of the workforce.

  View details for PubMedID 31090027

• Perceptions regarding the scope of practice o family doctors amongst patients in primary care settings in Nairobi AFRICAN JOURNAL OF PRIMARY HEALTH CARE & FAMILY MEDICINE Mohamoud, G., Mash, B., Merali, M., Orwa, J., Mahoney, M. 2018; 10 (1): e1–e7

  Abstract

   Primary care (PC) is the foundation of the Kenyan health care system, providing comprehensive care, health promotion and managing all illnesses across the lifecycle. In the private sector in Nairobi, PC is principally offered by the general practitioners, also known as family doctors (FDs). The majority have no postgraduate training. Little is known about how patients perceive their capability. To assess patients' perceptions of the scope of practice of FDs working in private sector PC clinics in Nairobi and their awareness of the new category of family physicians (FPs) and the discipline of family medicine. Private sector PC clinics in Nairobi. A descriptive survey using a structured, self-administered questionnaire. Simple random sampling was used to recruit 162 patient participants. Of the participants, 30% knew the difference between FPs and FDs. There was a high to moderate confidence that FDs could treat common illnesses; provide lifestyle advice; family planning (66%) and childhood immunisations (64%). In adolescents and adults, low confidence was expressed in their ability to manage tuberculosis (58%), human immunodeficiency virus (55%) and cancer (33%). In the elderly, there was low confidence in their ability to manage depression (55%), anxiety (57%), urinary incontinence (57%) and diabetes (59%). There was low confidence in their ability to provide antenatal care (55%) and Pap smears (42%). Patients did not perceive that FDs could offer fully comprehensive PC services. These perceptions may be addressed by defining the expected package of care, designing a system that encourages the utilisation of PC and employing FPs.

  View details for DOI 10.4102/phcfm.v10i1.1818

  View details for Web of Science ID 000448326700001

  View details for PubMedID 30326721

  View details for PubMedCentralID PMC6191765

• A comparative study of artificial intelligence and human doctors for the purpose of triage and diagnosis arXiv Razzaki, S. 2018
• Transforming Medical Assistant to Care Coordinator to Achieve the Quadruple Aim. Society of General Internal Medicine Forum Levine, M. L. 2018 ; V4 (4)
• Community-Oriented Primary Care Curricula in Kenyan Family Medicine Residencies. African Journal of Primary Health Care and Family Medicine Nelligan, I., Shabani, J., Tache, S., Mohamoud, G., Mahoney, M. 2017
• Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial. Annals of family medicine Gidwani, R., Nguyen, C., Kofoed, A., Carragee, C., Rydel, T., Nelligan, I., Sattler, A., Mahoney, M., Lin, S. 2017; 15 (5): 427–33

  Abstract

  Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency.We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians' perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close.Scribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values <.001). Scribes had no effect on patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P =.028).To our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout.

  View details for PubMedID 28893812

• Preparing Family Physicians to Care for Underserved Populations: A Historical Perspective Family Medicine Rodgers, D., Wendling, A., Saba, G., Mahoney, M., Brown Speights, J. 2017
• An academic achievement calculator for clinician-educators in primary care Family Medicine Lin, S., Mahoney, M., Singh, B., Schillinger, E. 2017
• An Academic Achievement Calculator for Clinician-Educators in Primary Care. Family medicine Lin, S., Mahoney, M., Singh, B., Schillinger, E. 2017; 49 (8): 640–43

  Abstract

  Academic medical centers need better ways to quantify the diverse academic contributions of primary care clinician-educators. We examined the feasibility and acceptability of an "academic achievement calculator" that quantifies academic activities using a point system.A cohort of 16 clinician-educators at a single academic medical center volunteered to assess the calculator using a questionnaire. Key measures included time needed to complete the calculator, how well it reflected participants' academic activities, whether it increased their awareness of academic opportunities, whether they intend to pursue more academic work, and their overall satisfaction with the calculator.Most participants (69%) completed the calculator in less than 20 minutes. Three-quarters (75%) reported that the calculator reflected the breadth of their academic work either "very well" or "extremely well". The majority (81%) stated that it increased their awareness of opportunities for academic engagement, and that they intend to pursue more academic activities. Overall, three-quarters (75%) were "very satisfied" or "extremely satisfied" with the calculator.To our knowledge, this is the first report of a tool designed to quantify the diverse academic activities of primary care clinician-educators. In this pilot study, we found that the use of an academic achievement calculator may be feasible and acceptable. This tool, if paired with an annual bonus plan, could help incentivize and reward academic contributions among primary care clinician-educators, and assist department leaders with the promotion process.

  View details for PubMedID 28953298

• Utilization of health services in a resource-limited rural area in Kenya: Prevalence and associated household-level factors. PloS one Ngugi, A. K., Agoi, F., Mahoney, M. R., Lakhani, A., Mang'ong'o, D., Nderitu, E., Armstrong, R., MacFarlane, S. 2017; 12 (2)

  Abstract

  Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services.1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05-0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.

  View details for DOI 10.1371/journal.pone.0172728

  View details for PubMedID 28241032

  View details for PubMedCentralID PMC5328402

• An assessment of implementation of CommunityOriented Primary Care in Kenyan family medicine postgraduate medical education programmes. African journal of primary health care & family medicine Nelligan, I. J., Shabani, J., Taché, S., Mohamoud, G., Mahoney, M. 2016; 8 (1): e1-e4

  Abstract

  Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC) curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya.Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed.Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1) making a community diagnosis, (2) understanding social determinants of health and (3) training in participatory research. Three community-based enablers for sustainability of COPC were (1) partnerships with community health workers, (2) community empowerment and engagement and (3) institutional financial support.Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.

  View details for DOI 10.4102/phcfm.v8i1.1064

  View details for PubMedID 28155322

  View details for PubMedCentralID PMC5153406

• "I have it just like you do": voices of HIV-negative partners in serodifferent relationships receiving primary care at a public clinic in San Francisco. AIDS care Mahoney, M., Weber, S., Bien, M., Saba, G. 2015; 27 (3): 401-408

  Abstract

  HIV transmission among serodifferent couples has a significant impact on incidence of HIV worldwide. Antiretroviral interventions (i.e., preexposure prophylaxis, post-exposure prophylaxis, and treatment as prevention) are important aspects of comprehensive prevention and care for serodifferent couples. In this study, HIV-negative members of serodifferent couples were interviewed using open-ended questions to explore their health-care needs, perceptions of clinic-based prevention services, and experience of having an HIV-infected partner. Analysis of interviews with 10 HIV-negative partners revealed the following themes: (1) health needs during joint medical visits; (2) sexual risk reduction strategies; (3) relationship dynamics; and (4) strategies for coping. This study elucidated relationship, health and health care factors that might affect development and implementation of clinic-based prevention interventions for HIV serodifferent couples. The findings point to possible relationship-centered recommendations for health-care providers who serve HIV-affected couples in clinical settings.

  View details for DOI 10.1080/09540121.2014.964659

  View details for PubMedID 25311152

• Global-Local Framework on Medical Vulnerabilities Medical Management of Underserved and Vulnerable Populations Stephanie, T., Sarah, M., Megan, M., Kevin, G. 2015
• AIDS Family Medicine Saberi, P., Mahoney, M., Goldschmidt, R. McGraw-Hill. 2014; 6
• Reversely Innovative Journal for the San Francisco Medical Association Mahoney, M. 2014
• Formal hepatitis C education enhances HCV care coordination, expedites HCV treatment and improves antiviral response LIVER INTERNATIONAL Lubega, S., Agbim, U., Surjadi, M., Mahoney, M., Khalili, M. 2013; 33 (7): 999-1007

  Abstract

  Formal Hepatitis C virus (HCV) education improves HCV knowledge but the impact on treatment uptake and outcome is not well described. We aimed to evaluate the impact of formal HCV patient education on primary provider-specialist HCV comanagement and treatment.Primary care providers within the San Francisco safety-net health care system were surveyed and the records of HCV-infected patients before and after institution of a formal HCV education class by liver specialty (2006-2011) were reviewed retrospectively.Characteristics of 118 patients who received anti-HCV therapy were: mean age 51, 73% males and ~50% White and uninsured. The time to initiation of HCV treatment was shorter among those who received formal education (median 136 vs 284 days, P < 0.0001). When controlling for age, gender, race and HCV viral load, non-1 genotype (OR 6.17, 95% CI 2.3-12.7, P = 0.0003) and receipt of HCV education (OR 3.0, 95% CI 1.1-7.9, P = 0.03) were associated with sustained virologic treatment response. Among 94 provider respondents (response rate = 38%), mean age was 42, 62% were White, and 63% female. Most providers agreed that the HCV education class increased patients' HCV knowledge (70%), interest in HCV treatment (52%), and provider-patient communication (56%). A positive provider attitude (Coef 1.5, 95% CI 0.1-2.9 percent, P = 0.039) was independently associated with referral rate to education class.Formal HCV education expedites HCV therapy and improves virologic response rates. As primary care provider attitude plays a significant role in referral to HCV education class, improving provider knowledge will likely enhance access to HCV specialty services in the vulnerable population.

  View details for DOI 10.1111/liv.12150

  View details for Web of Science ID 000321344000005

  View details for PubMedID 23509897

• ADAPTATION OF AN EVIDENCE-BASED HIV PREVENTION INTERVENTION FOR WOMEN WITH INCARCERATED PARTNERS: EXPANDING TO COMMUNITY SETTINGS AIDS EDUCATION AND PREVENTION Mahoney, M., Bien, M., Comfort, M. 2013; 25 (1): 1-13

  Abstract

  High rates of incarceration in urban, low income communities may exacerbate women's risk of HIV infection by decreasing the number of available male sexual partners and disrupting long-term partnerships. The Health Access Program for Prevention, Empowerment, and Networking for Women (HAPPEN) was established to address the HIV prevention needs of women partnered with incarcerated or recently released men in community settings. HAPPEN is an adaptation of the evidence-based HIV prevention intervention Health Options Mean Empowerment (HOME) project. HOME was designed specifically for women visiting their incarcerated male partners and was delivered at a prison visiting center. Recruitment and program implementation for HAPPEN occurred at community-based organizations serving women with histories of substance abuse, intimate partner violence and incarceration, and provided health education, HIV testing, and linkage to health care and social services. This paper describes the process of adapting HOME using input from target organization stakeholders and target population members.

  View details for Web of Science ID 000315129800001

  View details for PubMedID 23387947

• Applying HIV Testing Guidelines in Clinical Practice AMERICAN FAMILY PHYSICIAN Mahoney, M. R., Fogler, J., Weber, S., Goldschmidt, R. H. 2009; 80 (12): 1441-1444

  Abstract

  An estimated one fourth of persons with human immunodeficiency virus (HIV) are not aware they are infected. Early diagnosis of HIV has the potential to ensure optimal outcomes for infected persons and to limit the spread of the virus. Important barriers to testing among physicians include insufficient time, reimbursement issues, and lack of patient acceptance. Current HIV testing guidelines address many of these barriers by making the testing process more streamlined and less stigmatizing. The opt-out consent process has been shown to improve test acceptance. Formal pretest counseling and written consent are no longer recommended by the Centers for Disease Control and Prevention. Nevertheless, pretest discussions provide an opportunity to give information about HIV, address fears of discrimination, and identify ongoing high-risk activities. With increased HIV screening in the primary care setting, more persons with HIV could be identified earlier, receive timely and appropriate care, and get treatment to prevent clinical progression and transmission.

  View details for Web of Science ID 000273015000012

  View details for PubMedID 20000306

• Clinicians' knowledge of 2007 Food and Drug Administration recommendation to discontinue nelfinavir use during pregnancy. Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002) Fogler, J., Weber, S., Mahoney, M. R., Goldschmidt, R. H. 2009; 8 (4): 249-252

  Abstract

  In 2007, the US Food and Drug Administration (FDA) and Pfizer Inc recommended immediate discontinuation of nelfinavir (NFV) during pregnancy due to contamination with a potential teratogen. A few weeks after the announcement, we surveyed antenatal HIV care providers to determine how widely the warning was disseminated. Overall, 69 of 121 (57.0%) providers knew to discontinue NFV. Callers with more than 50 HIV-infected patients were 2.54 times as likely to be aware as callers with 1-3 HIV-infected patients (P < .01). Only 12 (33.3%) obstetricians were aware, compared to 21 (80.8%) infectious diseases specialists (P < .001). The FDA/Pfizer Inc recommendation to avoid nelfinavir mesylate (NFV) in pregnancy appears to have successfully reached HIV experts. However, not all pregnant women have access to experts and may receive most of their care from providers without extensive HIV experience. More effective dissemination of critical HIV-related information to all antenatal care providers, including general obstetricians, family physicians, and midwives, may be needed.

  View details for DOI 10.1177/1545109709337034

  View details for PubMedID 19506052

• . In Reply to HIV Testing: Removing Barriers Can Lead to Earlier Detection and Reduced Transmission American Family Physician Goldschmidt, R., Mahoney, M., Neff, S., Weber, S. 2009
• Minority Faculty Voices on Diversity in Academic Medicine: Perspectives From One School ACADEMIC MEDICINE Mahoney, M. R., Wilson, E., Odom, K. L., Flowers, L., Adler, S. R. 2008; 83 (8): 781-786

  Abstract

  To examine the perceptions and experiences of ethnic minority faculty at University of California-San Francisco regarding racial and ethnic diversity in academic medicine, in light of a constitutional measure outlawing race- and gender-based affirmative action programs by public universities in California.In 2005, underrepresented minority faculty in the School of Medicine at University of California-San Francisco were individually interviewed to explore three topics: participants' experiences as minorities, perspectives on diversity and discrimination in academic medicine, and recommendations for improvement. Interviews were tape-recorded, transcribed verbatim, and subsequently coded using principles of qualitative, text-based analysis in a four-stage review process.Thirty-six minority faculty (15 assistant professors, 11 associate professors, and 10 full professors) participated, representing diversity across specialties, faculty rank, gender, and race/ethnicity. Seventeen were African American, 16 were Latino, and 3 were Asian. Twenty participants were women. Investigators identified four major themes: (1) choosing to participate in diversity-related activities, driven by personal commitment and institutional pressure, (2) the gap between intention and implementation of institutional efforts to increase diversity, (3) detecting and reacting to discrimination, and (4) a need for a multifaceted approach to mentorship, given few available minority mentors.Minority faculty are an excellent resource for identifying strategies to improve diversity in academic medicine. Participants emphasized the strong association between effective mentorship and career satisfaction, and many delineated unique mentoring needs of minority faculty that persist throughout academic ranks. Findings have direct application to future institutional policies in recruitment and retention of underrepresented minority faculty.

  View details for Web of Science ID 000267654300013

  View details for PubMedID 18667896

• African-American clinicians providing HIV care: The experience of the national HIV/AIDS clinicians' consultation center JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION Mahoney, M. R., Sterkenburg, C., Thom, D. H., Goldschmidt, R. H. 2008; 100 (7): 779-782

  Abstract

  This analysis compares patient and provider characteristics of African-American clinicians and non-African-American clinicians who called the National HIV Telephone Consultation Service (Warmline). In 2004, a total of 2,077 consultations were provided for 1,020 clinicians, 70 (6.9%) of whom were African American. Compared to the non-African-American group, a higher percentage of African-American clinicians were nurses (20.0% vs. 8.8%, p=0.002). A significantly lower percentage of African-American physicians were infectious disease specialists (3.5% vs. 25.6%, p=0.007). African-American clinicians were more likely to work in a community clinic (48.5% vs. 34.1%, p=0.015). Both African-American and non-African American clinicians reported caring for a similar number of HIV-infected patients. Patient-provider racial concordance was common among African-American clinicians (76.4%), whereas non-African-American clinicians called about patients of more diverse racial and ethnic backgrounds. African-American clinicians who called Warmline exhibited differences in patient and provider characteristics when compared to all other clinicians. These findings contribute to the growing body of research on HIV providers in the United States.

  View details for Web of Science ID 000257844700001

  View details for PubMedID 18672554

• Care of HIV-infected Latinos in the United States: A description of calls to the National HIV/AIDS Clinicians' Consultation Center 20th Annual Conference of the Association-of-Nurses-in-AIDS-Care Mahoney, M. R., Khamarko, K., Goldschmidt, R. H. ELSEVIER SCIENCE INC. 2008: 302–10

  Abstract

  HIV disproportionately affects the Latino population in the United States. Little is known about clinicians who provide HIV care to the Latino community or the types of issues they face. This report presents descriptive analyses of calls made by clinicians who care for HIV-infected Latinos to two lines of the National HIV/AIDS Clinicians' Consultation Center, the National HIV Telephone Consultation Service (Warmline) and the National Perinatal HIV Consultation and Referral Service (Perinatal HIV Hotline). Separate analyses of data from Latino clinicians are also presented. The majority of Warmline calls about Latino patients (81.0%) concerned antiretroviral treatment strategies or HIV-related conditions. More than half (54.3%) of perinatal-specific calls concerned HIV management during pregnancy and the care of HIV-exposed infants. Latino clinicians most frequently called about minority patients. This descriptive study adds to the growing literature about the care of the Latino HIV-infected patient. The Warmline and Perinatal HIV Hotline are resources for HIV care providers in the nursing and medical care of Latinos.

  View details for DOI 10.1016/j.jana.2008.05.002

  View details for Web of Science ID 000257758100007

  View details for PubMedID 18598905

• Chronic Care Program: Hepatitis C California Department of Corrections and Rehabilitation. Inmate Medical Services Policies and Procedures edited by Mahoney, M. 2008
• Consultation needs in perinatal HIV care: experience of the National Perinatal HIV consultation service AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY Fogler, J. A., Weber, S., Goldschmidt, R. H., Mahoney, M. R., Cohan, D. 2007; 197 (3): S137-S141

  Abstract

  This study evaluates the consultation needs of clinicians who provide perinatal human immunodeficiency virus (HIV) care in the United States. The Perinatal Hotline (1-888-448-8765) is a telephone consultation service for providers who treat HIV-infected pregnant women and their infants. Hotline calls were analyzed for demographics about callers and their patients and information about consultation topics. There were 430 calls to the hotline from January 1, 2005, through June 30, 2006. Most calls (59.5%) were related to pregnant patients; 5.1% of the calls pertained to women currently in labor. The most common topic was HIV care in pregnancy (49.1%), particularly antiretroviral drug use (42.1%). HIV testing was discussed in 21.9%, and intrapartum treatment was discussed in 24.0%. Callers most often requested help choosing antiretroviral drug regimens; many of the discussions were about drug toxicities and viral resistance. Although the hotline received few calls about women in labor, the need for these consultations is expected to increase with the expanding use of rapid HIV testing. Access to 24-hour consultation can help ensure that state-of-the-art care is provided.

  View details for DOI 10.1016/j.ajog.2007.02.033

  View details for Web of Science ID 000249582700019

  View details for PubMedID 17825645

• Syphilis Taylor's 10-minute diagnosis manual: symptoms and signs in the time-limited encounter Mahoney, M. 2007
• AIDS Family Medicine 5th Edition Cocohoba, J., Mahoney, M., Goldschmidt, R. 2007
• The changing role of family physicians in HIV care AMERICAN FAMILY PHYSICIAN Mahoney, M. R., Goldschmidt, R. H. 2006; 74 (10): 1683-1684

  View details for Web of Science ID 000242144600002

  View details for PubMedID 17136997

• HIV Infection: Clues to Timely Diagnosis. Consultant Mahoney, M., Fogler, J. 2006; 46 (8): 853-860
• Beyond Antiretrovirals Synapse Mahoney, M. 2000