Show Low

Researchers are evaluating surgical and minimally invasive treatments for lumbar spinal stenosis (LSS) by comparing Medicare patients who received the MILD procedure against those who had interspinous process decompression (IPD). The study focuses on outcomes such as the rate of harms related to the initial procedure and the frequency of additional surgical or minimally invasive interventions within 24 months after treatment. Enrollment includes patients treated from January 1, 2017, onward, with continuation until the sponsor decides to stop. The MILD procedure involves percutaneous image-guided lumbar decompression, performed under fluoroscopy through a dorsal approach to partially remove tissue and bone at the affected spinal level. The control group receives the IPD procedure for LSS. Both groups are monitored for a 24-month period post-index procedure using Medicare claims data to track reoperations and any harms. Participants contribute data through Medicare claims without needing prior enrollment or consent, as the study is exempt from IRB oversight. Researchers collect and analyze information on procedure-related harms and subsequent interventions over two years. This approach allows evaluation of long-term safety and effectiveness outcomes for patients treated with either MILD or IPD.

Researchers are evaluating ways to improve advance care planning (ACP) among underserved communities, who often receive lower quality end-of-life care and unwanted, costly treatments. This study compares two conversation-based tools designed to encourage discussions about end-of-life wishes and motivate ACP behaviors. The goal is to increase high-quality end-of-life care, reduce health disparities, and lessen unnecessary suffering for patients and families. The study is a cluster randomized controlled trial involving 75 underserved communities across the US. It compares a serious conversation game called Hello, the widely used Conversation Project (CP) Starter Kit, and usual care where only an advance directive is distributed. The Hello game has 32 questions prompting sharing of values and beliefs about end-of-life issues, while the CP Starter Kit is a workbook with prompts and resources to facilitate conversations. The third group receives a general conversation game called Table Topics. Participants include adults from underserved populations who have not completed an advance directive in the past 5 years. Researchers will assess completion of a visually verified advance directive six months after the intervention. Other ACP behaviors will also be measured. The study involves community events, follow-up, and data collection to understand which tools best engage underserved groups in ACP and improve end-of-life care outcomes.