Estimated Survival and Major Comorbidities of Very Preterm Infants Discharged Against Medical Advice vs Treated With Intensive Care in China
A significant proportion of very preterm infants (
Gespeichert in:
| Veröffentlicht in: | JAMA network open 2021-06, Vol.4 (6), p.e2113197-e2113197 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e2113197 |
|---|---|
| container_issue | 6 |
| container_start_page | e2113197 |
| container_title | JAMA network open |
| container_volume | 4 |
| creator | Jiang, Siyuan Huang, Xiangyuan Zhang, Lan Han, Junyan Yang, Yi Wang, Weiping Lee, Shoo K Yan, Weili Cao, Yun |
| description | A significant proportion of very preterm infants ( |
| doi_str_mv | 10.1001/jamanetworkopen.2021.13197 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2542363975</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2667823075</sourcerecordid><originalsourceid>FETCH-LOGICAL-a418t-28ee2b938b5fa65aa885e0fef42ce4bb15177e4746d1d601ea80a1734e09dcc73</originalsourceid><addsrcrecordid>eNpdkc1u1DAUhSMEolXbV0AWbNjM4N_YYTcKBSq1olILLC0nvul4mNhT2wnqO_DQuNMWoa6uF-ece32-qnpL8JJgTD5szGg85N8h_go78EuKKVkSRhr5ojqkQvIFU1i8_O99UJ2ktMEYU0xYU4vX1QHjhElF1WH15zRlN5oMFl1NcXaz2SLjLbowmxBRG8YQO2dddpBQGNAPiHfoMkKGOKIzPxifE_rkUr828aZkrG6M8ymjC7CuL1ErO7se0JzQdYT9lp8ur4szg09uBtSaCMh51K6dN8fVq8FsE5w8zqPq--fT6_br4vzbl7N2db4wnKi8oAqAdg1TnRhMLYxRSgAeYOC0B951RBApgUteW2JrTMAobIhkHHBj-16yo-r9Q-4uhtsJUtZj-QJst6XZMCVNBaesZo0URfrumXQTpujLdZrWdemQ4b3q44OqjyGlCIPexdJqvNME63ts-hk2fY9N77EV85vHFVM3gv1nfYLE_gJaTpm0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2667823075</pqid></control><display><type>article</type><title>Estimated Survival and Major Comorbidities of Very Preterm Infants Discharged Against Medical Advice vs Treated With Intensive Care in China</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Jiang, Siyuan ; Huang, Xiangyuan ; Zhang, Lan ; Han, Junyan ; Yang, Yi ; Wang, Weiping ; Lee, Shoo K ; Yan, Weili ; Cao, Yun</creator><creatorcontrib>Jiang, Siyuan ; Huang, Xiangyuan ; Zhang, Lan ; Han, Junyan ; Yang, Yi ; Wang, Weiping ; Lee, Shoo K ; Yan, Weili ; Cao, Yun ; Reduction of Infection in Neonatal Intensive Care Units Using the Evidence-Based Practice for Improving Quality (REIN-EPIQ) Study Group</creatorcontrib><description>A significant proportion of very preterm infants (<32 weeks' gestation) are discharged against medical advice (DAMA) from neonatal intensive care units in China. There is minimal information available on the potential outcomes of providing complete care before discharge in these infants.
To describe potential neonatal outcomes of DAMA in very preterm infants if they receive complete care based on estimates derived from a group of propensity score-matched infants who are not DAMA.
This cohort study enrolled all infants born at between 24 and 31 weeks' gestation from May 1, 2015, to April 30, 2018, and admitted to 25 tertiary neonatal intensive care units across China within 7 days of birth. A multilevel mixed-effects logistic regression model was constructed to estimate the propensity score for the likelihood of DAMA for each infant. Infants who were not DAMA were then matched to DAMA infants with the closest propensity score on a 1:1 ratio by using a nearest neighbor greedy matching algorithm without replacement. Incidences of neonatal outcomes were then calculated among the matched non-DAMA infants to simulate the outcomes of DAMA infants. Statistical analyses were performed from August 16, 2020, to September 26, 2020.
Discharge against medical advice, which was defined as termination of treatment and discharge before the treating physicians recommended discharge.
Survival and survival without major morbidity.
The study enrolled a total of 14 083 infants (8141 boys [57.8%]) with a median gestational age of 30.1 weeks (interquartile range [IQR], 29.0-31.1 weeks) and a median birth weight of 1400 g (IQR, 1170-1600 g). Overall, 1876 of 14 083 very preterm infants (13.3%; 95% CI, 12.8%-13.9%) were DAMA, of whom 1367 of 1876 (72.9%; 95% CI, 70.8%-74.8%) required intensive care on discharge. A total of 1473 DAMA infants were successfully matched to 1473 non-DAMA infants. Overall, 1211 of 1473 matched non-DAMA infants (82.2%; 95% CI, 80.2%-84.1%) survived to discharge. The survival rates were 68.3% (95% CI, 62.4%-73.7%) for infants at 26 to 27 weeks' gestation, 84.1% (95% CI, 80.7%-87.0%) for infants 28 to 29 weeks' gestation, and 92.4% (95% CI, 90.0%-94.2%) for infants at 30 to 31 weeks' gestation. A total of 872 of 1473 matched non-DAMA infants (59.2%; 95% CI, 56.7%-61.7%) survived without any major morbidity.
The results of this cohort study suggest that very preterm infants who are DAMA from neonatal intensive care units may have intact survival if complete care is provided. Efforts to reduce DAMA may be associated with improved outcomes of very preterm infants in China.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2021.13197</identifier><identifier>PMID: 34137828</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>China ; Cohort Studies ; Comorbidity ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature, Diseases - mortality ; Infant, Premature, Diseases - physiopathology ; Infant, Premature, Diseases - therapy ; Intensive care ; Intensive Care Units, Pediatric - statistics & numerical data ; Male ; Mortality ; Newborn babies ; Patient Discharge - statistics & numerical data ; Premature babies ; Survival Rate</subject><ispartof>JAMA network open, 2021-06, Vol.4 (6), p.e2113197-e2113197</ispartof><rights>2021. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a418t-28ee2b938b5fa65aa885e0fef42ce4bb15177e4746d1d601ea80a1734e09dcc73</citedby><cites>FETCH-LOGICAL-a418t-28ee2b938b5fa65aa885e0fef42ce4bb15177e4746d1d601ea80a1734e09dcc73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,861,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34137828$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jiang, Siyuan</creatorcontrib><creatorcontrib>Huang, Xiangyuan</creatorcontrib><creatorcontrib>Zhang, Lan</creatorcontrib><creatorcontrib>Han, Junyan</creatorcontrib><creatorcontrib>Yang, Yi</creatorcontrib><creatorcontrib>Wang, Weiping</creatorcontrib><creatorcontrib>Lee, Shoo K</creatorcontrib><creatorcontrib>Yan, Weili</creatorcontrib><creatorcontrib>Cao, Yun</creatorcontrib><creatorcontrib>Reduction of Infection in Neonatal Intensive Care Units Using the Evidence-Based Practice for Improving Quality (REIN-EPIQ) Study Group</creatorcontrib><title>Estimated Survival and Major Comorbidities of Very Preterm Infants Discharged Against Medical Advice vs Treated With Intensive Care in China</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>A significant proportion of very preterm infants (<32 weeks' gestation) are discharged against medical advice (DAMA) from neonatal intensive care units in China. There is minimal information available on the potential outcomes of providing complete care before discharge in these infants.
To describe potential neonatal outcomes of DAMA in very preterm infants if they receive complete care based on estimates derived from a group of propensity score-matched infants who are not DAMA.
This cohort study enrolled all infants born at between 24 and 31 weeks' gestation from May 1, 2015, to April 30, 2018, and admitted to 25 tertiary neonatal intensive care units across China within 7 days of birth. A multilevel mixed-effects logistic regression model was constructed to estimate the propensity score for the likelihood of DAMA for each infant. Infants who were not DAMA were then matched to DAMA infants with the closest propensity score on a 1:1 ratio by using a nearest neighbor greedy matching algorithm without replacement. Incidences of neonatal outcomes were then calculated among the matched non-DAMA infants to simulate the outcomes of DAMA infants. Statistical analyses were performed from August 16, 2020, to September 26, 2020.
Discharge against medical advice, which was defined as termination of treatment and discharge before the treating physicians recommended discharge.
Survival and survival without major morbidity.
The study enrolled a total of 14 083 infants (8141 boys [57.8%]) with a median gestational age of 30.1 weeks (interquartile range [IQR], 29.0-31.1 weeks) and a median birth weight of 1400 g (IQR, 1170-1600 g). Overall, 1876 of 14 083 very preterm infants (13.3%; 95% CI, 12.8%-13.9%) were DAMA, of whom 1367 of 1876 (72.9%; 95% CI, 70.8%-74.8%) required intensive care on discharge. A total of 1473 DAMA infants were successfully matched to 1473 non-DAMA infants. Overall, 1211 of 1473 matched non-DAMA infants (82.2%; 95% CI, 80.2%-84.1%) survived to discharge. The survival rates were 68.3% (95% CI, 62.4%-73.7%) for infants at 26 to 27 weeks' gestation, 84.1% (95% CI, 80.7%-87.0%) for infants 28 to 29 weeks' gestation, and 92.4% (95% CI, 90.0%-94.2%) for infants at 30 to 31 weeks' gestation. A total of 872 of 1473 matched non-DAMA infants (59.2%; 95% CI, 56.7%-61.7%) survived without any major morbidity.
The results of this cohort study suggest that very preterm infants who are DAMA from neonatal intensive care units may have intact survival if complete care is provided. Efforts to reduce DAMA may be associated with improved outcomes of very preterm infants in China.</description><subject>China</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Gestational Age</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Infant, Premature, Diseases - mortality</subject><subject>Infant, Premature, Diseases - physiopathology</subject><subject>Infant, Premature, Diseases - therapy</subject><subject>Intensive care</subject><subject>Intensive Care Units, Pediatric - statistics & numerical data</subject><subject>Male</subject><subject>Mortality</subject><subject>Newborn babies</subject><subject>Patient Discharge - statistics & numerical data</subject><subject>Premature babies</subject><subject>Survival Rate</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkc1u1DAUhSMEolXbV0AWbNjM4N_YYTcKBSq1olILLC0nvul4mNhT2wnqO_DQuNMWoa6uF-ece32-qnpL8JJgTD5szGg85N8h_go78EuKKVkSRhr5ojqkQvIFU1i8_O99UJ2ktMEYU0xYU4vX1QHjhElF1WH15zRlN5oMFl1NcXaz2SLjLbowmxBRG8YQO2dddpBQGNAPiHfoMkKGOKIzPxifE_rkUr828aZkrG6M8ymjC7CuL1ErO7se0JzQdYT9lp8ur4szg09uBtSaCMh51K6dN8fVq8FsE5w8zqPq--fT6_br4vzbl7N2db4wnKi8oAqAdg1TnRhMLYxRSgAeYOC0B951RBApgUteW2JrTMAobIhkHHBj-16yo-r9Q-4uhtsJUtZj-QJst6XZMCVNBaesZo0URfrumXQTpujLdZrWdemQ4b3q44OqjyGlCIPexdJqvNME63ts-hk2fY9N77EV85vHFVM3gv1nfYLE_gJaTpm0</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Jiang, Siyuan</creator><creator>Huang, Xiangyuan</creator><creator>Zhang, Lan</creator><creator>Han, Junyan</creator><creator>Yang, Yi</creator><creator>Wang, Weiping</creator><creator>Lee, Shoo K</creator><creator>Yan, Weili</creator><creator>Cao, Yun</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20210601</creationdate><title>Estimated Survival and Major Comorbidities of Very Preterm Infants Discharged Against Medical Advice vs Treated With Intensive Care in China</title><author>Jiang, Siyuan ; Huang, Xiangyuan ; Zhang, Lan ; Han, Junyan ; Yang, Yi ; Wang, Weiping ; Lee, Shoo K ; Yan, Weili ; Cao, Yun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a418t-28ee2b938b5fa65aa885e0fef42ce4bb15177e4746d1d601ea80a1734e09dcc73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>China</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Gestational Age</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Infant, Premature, Diseases - mortality</topic><topic>Infant, Premature, Diseases - physiopathology</topic><topic>Infant, Premature, Diseases - therapy</topic><topic>Intensive care</topic><topic>Intensive Care Units, Pediatric - statistics & numerical data</topic><topic>Male</topic><topic>Mortality</topic><topic>Newborn babies</topic><topic>Patient Discharge - statistics & numerical data</topic><topic>Premature babies</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jiang, Siyuan</creatorcontrib><creatorcontrib>Huang, Xiangyuan</creatorcontrib><creatorcontrib>Zhang, Lan</creatorcontrib><creatorcontrib>Han, Junyan</creatorcontrib><creatorcontrib>Yang, Yi</creatorcontrib><creatorcontrib>Wang, Weiping</creatorcontrib><creatorcontrib>Lee, Shoo K</creatorcontrib><creatorcontrib>Yan, Weili</creatorcontrib><creatorcontrib>Cao, Yun</creatorcontrib><creatorcontrib>Reduction of Infection in Neonatal Intensive Care Units Using the Evidence-Based Practice for Improving Quality (REIN-EPIQ) Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jiang, Siyuan</au><au>Huang, Xiangyuan</au><au>Zhang, Lan</au><au>Han, Junyan</au><au>Yang, Yi</au><au>Wang, Weiping</au><au>Lee, Shoo K</au><au>Yan, Weili</au><au>Cao, Yun</au><aucorp>Reduction of Infection in Neonatal Intensive Care Units Using the Evidence-Based Practice for Improving Quality (REIN-EPIQ) Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Estimated Survival and Major Comorbidities of Very Preterm Infants Discharged Against Medical Advice vs Treated With Intensive Care in China</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>4</volume><issue>6</issue><spage>e2113197</spage><epage>e2113197</epage><pages>e2113197-e2113197</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>A significant proportion of very preterm infants (<32 weeks' gestation) are discharged against medical advice (DAMA) from neonatal intensive care units in China. There is minimal information available on the potential outcomes of providing complete care before discharge in these infants.
To describe potential neonatal outcomes of DAMA in very preterm infants if they receive complete care based on estimates derived from a group of propensity score-matched infants who are not DAMA.
This cohort study enrolled all infants born at between 24 and 31 weeks' gestation from May 1, 2015, to April 30, 2018, and admitted to 25 tertiary neonatal intensive care units across China within 7 days of birth. A multilevel mixed-effects logistic regression model was constructed to estimate the propensity score for the likelihood of DAMA for each infant. Infants who were not DAMA were then matched to DAMA infants with the closest propensity score on a 1:1 ratio by using a nearest neighbor greedy matching algorithm without replacement. Incidences of neonatal outcomes were then calculated among the matched non-DAMA infants to simulate the outcomes of DAMA infants. Statistical analyses were performed from August 16, 2020, to September 26, 2020.
Discharge against medical advice, which was defined as termination of treatment and discharge before the treating physicians recommended discharge.
Survival and survival without major morbidity.
The study enrolled a total of 14 083 infants (8141 boys [57.8%]) with a median gestational age of 30.1 weeks (interquartile range [IQR], 29.0-31.1 weeks) and a median birth weight of 1400 g (IQR, 1170-1600 g). Overall, 1876 of 14 083 very preterm infants (13.3%; 95% CI, 12.8%-13.9%) were DAMA, of whom 1367 of 1876 (72.9%; 95% CI, 70.8%-74.8%) required intensive care on discharge. A total of 1473 DAMA infants were successfully matched to 1473 non-DAMA infants. Overall, 1211 of 1473 matched non-DAMA infants (82.2%; 95% CI, 80.2%-84.1%) survived to discharge. The survival rates were 68.3% (95% CI, 62.4%-73.7%) for infants at 26 to 27 weeks' gestation, 84.1% (95% CI, 80.7%-87.0%) for infants 28 to 29 weeks' gestation, and 92.4% (95% CI, 90.0%-94.2%) for infants at 30 to 31 weeks' gestation. A total of 872 of 1473 matched non-DAMA infants (59.2%; 95% CI, 56.7%-61.7%) survived without any major morbidity.
The results of this cohort study suggest that very preterm infants who are DAMA from neonatal intensive care units may have intact survival if complete care is provided. Efforts to reduce DAMA may be associated with improved outcomes of very preterm infants in China.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>34137828</pmid><doi>10.1001/jamanetworkopen.2021.13197</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2574-3805 |
| ispartof | JAMA network open, 2021-06, Vol.4 (6), p.e2113197-e2113197 |
| issn | 2574-3805 2574-3805 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2542363975 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | China Cohort Studies Comorbidity Female Gestational Age Humans Infant, Newborn Infant, Premature, Diseases - mortality Infant, Premature, Diseases - physiopathology Infant, Premature, Diseases - therapy Intensive care Intensive Care Units, Pediatric - statistics & numerical data Male Mortality Newborn babies Patient Discharge - statistics & numerical data Premature babies Survival Rate |
| title | Estimated Survival and Major Comorbidities of Very Preterm Infants Discharged Against Medical Advice vs Treated With Intensive Care in China |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T00%3A36%3A36IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Estimated%20Survival%20and%20Major%20Comorbidities%20of%20Very%20Preterm%20Infants%20Discharged%20Against%20Medical%20Advice%20vs%20Treated%20With%20Intensive%20Care%20in%20China&rft.jtitle=JAMA%20network%20open&rft.au=Jiang,%20Siyuan&rft.aucorp=Reduction%20of%20Infection%20in%20Neonatal%20Intensive%20Care%20Units%20Using%20the%20Evidence-Based%20Practice%20for%20Improving%20Quality%20(REIN-EPIQ)%20Study%20Group&rft.date=2021-06-01&rft.volume=4&rft.issue=6&rft.spage=e2113197&rft.epage=e2113197&rft.pages=e2113197-e2113197&rft.issn=2574-3805&rft.eissn=2574-3805&rft_id=info:doi/10.1001/jamanetworkopen.2021.13197&rft_dat=%3Cproquest_cross%3E2667823075%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2667823075&rft_id=info:pmid/34137828&rfr_iscdi=true |