Bio

Bio


Maria Yefimova PhD RN is a nurse researcher working to address disability, social and palliative needs of older patients and support their caregivers in the home and community-based settings. Her research focuses on emergent technological solutions, such as remote health monitoring and predictive analytics.
She is a health services researcher with the HSR&D Center for Innovation to Implementation (Ci2i) at VA Palo Alto Healthcare System. She also has a position with the Office of Research, Patient Care Services at Stanford Healthcare. Dr. Yefimova earned her Bachelor?s, Master?s and PhD degrees in Nursing from the University of California, Los Angeles (UCLA). She completed her post-doctoral fellowship in the National Clinician Scholars Program at UCLA, among the first nurses to receive health services research training alongside physicians in the legacy of Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program.

Academic Appointments


Publications

All Publications


  • Palliative Care and End of Life Outcomes Following High Risk Surgery Yefimova, M., Aslakson, R., Yang, J., Garcia, A., Boothroyd, D., Giannitrapani, K., Morris, A., Johanning, J., Shreve, S., Wachterman, M., Lorenz, K. ELSEVIER SCIENCE INC. 2020: 535
  • Palliative Care and End-of-Life Outcomes Following High-Risk Surgery. JAMA surgery Yefimova, M., Aslakson, R. A., Yang, L., Garcia, A., Boothroyd, D., Gale, R. C., Giannitrapani, K., Morris, A. M., Johanning, J. M., Shreve, S., Wachterman, M. W., Lorenz, K. A. 2020

    Abstract

    Importance: Palliative care has the potential to improve care for patients and families undergoing high-risk surgery.Objective: To characterize the use of perioperative palliative care and its association with family-reported end-of-life experiences of patients who died within 90 days of a high-risk surgical operation.Design, Setting, and Participants: This secondary analysis of administrative data from a retrospective cross-sectional patient cohort was conducted in the Department of Veterans Affairs (VA) Healthcare System. Patients who underwent any of 227 high-risk operations between January 1, 2012, and December 31, 2015, were included.Exposures: Palliative-care consultation within 30 days before or 90 days after surgery.Main Outcomes and Measures: The outcomes were family-reported ratings of overall care, communication, and support in the patient's last month of life. The VA surveyed all families of inpatient decedents using the Bereaved Family Survey, a valid and reliable tool that measures patient and family-centered end-of-life outcomes.Results: A total of 95?204 patients underwent high-risk operations in 129 inpatient VA Medical Centers. Most patients were 65 years or older (69?278 [72.8%]), and the most common procedures were cardiothoracic (31?157 [32.7%]) or vascular (23?517 [24.7%]). The 90-day mortality rate was 6.0% (5740 patients) and varied by surgical subspecialty (ranging from 278 of 7226 [3.8%] in urologic surgery to 875 of 6223 patients [14.1%] in neurosurgery). A multivariate mixed model revealed that families of decedents who received palliative care were 47% more likely to rate overall care in the last month of life as excellent than those who did not (odds ratio [OR], 1.47 [95% CI, 1.14-1.88]; P=.007), after adjusting for patient's characteristics, surgical subspecialty of the high-risk operation, and survey nonresponse. Similarly, families of decedents who received palliative care were more likely to rate end-of-life communication (OR, 1.43 [95% CI, 1.09-1.87]; P=.004) and support (OR, 1.31 [95% CI, 1.01-1.71]; P=.05) components of medical care as excellent. Of the entire cohort, 3374 patients (3.75%) had a palliative care consultation, and 770 patients (0.8%) received it before surgery. Of all decedents, 1632 (29.9%) had a palliative care consultation, with 319 (5.6%) receiving it before surgery.Conclusions and Relevance: Receipt of a palliative consultation was associated with better ratings of overall end-of-life care, communication, and support, as reported by families of patients who died within 90 days of high-risk surgery. Yet only one-third of decedents was exposed to palliative care. Expanding integration of perioperative palliative care may benefit patients undergoing high-risk operations and their families.

    View details for DOI 10.1001/jamasurg.2019.5083

    View details for PubMedID 31895424

  • Daily Context for Abusive and Neglectful Behavior in Family Caregiving for Dementia. The Gerontologist Pickering, C. E., Yefimova, M., Maxwell, C., Puga, F., Sullivan, T. 2019

    Abstract

    BACKGROUND AND OBJECTIVES: The purpose of this study was to identify risk and protective factors for abusive and neglectful behavior in the context of daily caregiving.RESEARCH DESIGN AND METHODS: Family caregivers who co-reside with a care recipient with Alzheimer's disease and related dementia, recruited from social media, completed 21-days of diaries. Multilevel modeling with days (n = 831) nested within caregivers (N = 50) was used to evaluate relationships between hypothesized risk and protective factors and the odds of an abusive or neglectful behavior on a given day.RESULTS: Disruptions in the daily routine and stress of the caregiver related to behavioral symptoms of the care recipient are significant risk factors for abusive and neglectful behavior. Participating in a meaningful activity with the care recipient when it occurs twice in a day is a significant protective factor against use of a neglect behavior (OR = 0.19; CI 0.06-0.64; p = .01), but not for abusive behavior. Hypotheses that spending the full day together would increase risk, and that receipt of instrumental support and caregiver participation in self-care would decrease risk, were not supported.DISCUSSION AND IMPLICATIONS: Findings demonstrate that risk of an abusive or neglectful behavior varies from day-to-day in the presence and absence of contextual factors, and that the majority of the variance in the odds an abusive or neglectful behavior occurring is related to day-level factors. Findings demonstrate that diary surveys are critical to identifying ecologically valid modifiable risk and protective factors for abusive and neglectful behaviors that can be targeted in future interventions.

    View details for DOI 10.1093/geront/gnz110

    View details for PubMedID 31425586

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