Matthew Reynolds

Electrophysiology

Brigham and Women's Hospital

About

Matthew Reynolds works in Electrophysiology affiliated with Brigham and Women's Hospital.

Matthew R. Reynolds, MD, MSc is a Professor of Medicine at UMass Chan Medical School based at Lahey Hospital and Medical Center, where he practices cardiac electrophysiology and serves as Director of Cardiac Arrhythmia Research. He is Director of Economics and Quality of Life Research at the Baim Institute for Clinical Research and an Adjunct Professor of Medicine at Tufts University School of Medicine. His research examines the impact of new cardiovascular technologies on healthcare costs and quality of life.

Research focus

Atrial Fibrillation ManagementCatheter AblationCost-Effectiveness of Cardiovascular TechnologiesImplantable Defibrillators and PacemakersTranscatheter Valve Replacement Outcomes

Impact

55 pubs · 490 cites · h-index 11

Training

MD
University of Pennsylvania Perelman School of Medicine
1996
MS
Harvard T.H. Chan School of Public Health
2000
BS
Cornell University
1992

Affiliations

Work Experience

Professor of Medicine

UMass Chan Medical School (Lahey Hospital and Medical Center) · 2018 - Present

Director of Economics and Quality of Life Research

Baim Institute for Clinical Research · 2000 - Present

Adjunct Professor of Medicine

Tufts University School of Medicine · 2010 - Present

Electrophysiologist and Director, Cardiac Arrhythmia Research

Lahey Hospital and Medical Center · 2004 - Present

Publications

Nicotine & Tobacco ResearchTan et al.Original Research

Key Informants’ Perceptions of Health Equity and Racial Justice Impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control

The Massachusetts legislature passed An Act Modernizing Tobacco Control in November 2019 to restrict retail sales of flavored commercially manufactured tobacco products including menthol products, increase penalties for violating the law's provisions, and provide health insurance coverage for tobacco treatment.

Translational Behavioral MedicineLiu et al.Original Research

Barriers and facilitators to address vaping in Massachusetts schools: a mixed-methods study of school-based stakeholders

We assessed vaping behaviors, environments, COVID-19 influences, and barriers and facilitators of existing approaches that address adolescent vaping in Massachusetts middle and high schools. Findings from this study will provide considerations for individual schools or districts as they advance adolescent vaping prevention and treatment efforts. We analyzed 310 open-ended comments from Massachusetts school administrators who completed a survey between November 2020 and January 2021. Further, we analyzed nine semi-structured interviews with administrators (e.g., principals, vice principals, school nurses) from Massachusetts school systems (n = 6) and school-based anti-tobacco advocates (n = 3); interviews took place between May and December 2021. Informed by Green's PRECEDE model, we conducted a framework analysis using deductive codes based on the model constructs (enabling, reinforcing, and predisposing factors) and inductive codes of key themes emerging from the interviews. Challenges to addressing adolescent vaping included staff capacity, funding, and lack of mental health and counseling supports. The COVID-19 pandemic was a major barrier to conducting usual in-person vaping programs, but also reduced student vaping at school due to new social distancing practices and bathroom use policies. Facilitators of vaping interventions included peer-led initiatives and parental involvement. Participants discussed the importance of educating adolescents on the harms of vaping and the move toward alternatives-to-suspension programs rather than disciplinary action. School-based anti-vaping program implementers-such as school districts, state departments of education, or local health departments-will need to leverage facilitators such as peer-led initiatives, alternatives-to-suspension approaches, and parental involvement, to increase the potential impact of these programs.

Journal of Palliative MedicineVaughn et al.Retrospective Study

Factors Associated with Health Care Utilization at the End of Life for Patients with Acute Myeloid Leukemia

Background: Patients (≥60 years) with acute myeloid leukemia (AML) often receive intense health care utilization at the end of life (EOL). However, factors associated with their health care use at the EOL are unknown. Methods: We conducted a secondary analysis of 168 deceased patients with AML within the United States. We assessed quality of life (QOL) (Functional-Assessment-Cancer-Therapy-Leukemia), and psychological distress (Hospital-Anxiety-and-Depression Scale [HADS]; Patient-Health-Questionnaire-9 [PHQ-9]) at diagnosis. We used multivariable logistic regression models to examine the association between patient-reported factors and the following outcomes: (1) hospitalizations in the last 7 days of life, (2) receipt of chemotherapy in the last 30 days of life, and (3) hospice utilization. Results: About 66.7% (110/165) were hospitalized in the last 7 days of life, 51.8% (71/137) received chemotherapy in the last 30 days of life, and 40.7% (70/168) utilized hospice. In multivariable models, higher education (odds ratio [OR] = 1.54, p = 0.006) and elevated baseline depression symptoms (PHQ-9: OR = 1.09, p = 0.028) were associated with higher odds of hospitalization in the last seven days of life, while higher baseline QOL (OR = 0.98, p = 0.009) was associated with lower odds of hospitalization at the EOL. Higher baseline depression symptoms were associated with receipt of chemotherapy at the EOL (HADS-Depression: OR = 1.10, p = 0.042). Higher education was associated with lower hospice utilization (OR = 0.356, p = 0.024). Conclusions: Patients with AML who are more educated, with higher baseline depression symptoms and lower QOL, were more likely to experience high health care utilization at the EOL. These populations may benefit from interventions to optimize the quality of their EOL care.

Blood AdvancesAmonoo et al.Cross-Sectional Study

Coping strategies in patients with acute myeloid leukemia

Patients diagnosed with acute myeloid leukemia (AML) face sudden-onset life-threatening disease that requires intensive treatments. Although their early disease trajectory is characterized by significant, toxic side effects, limited data are available describing coping strategies among patients with AML and how these inform patient-reported outcomes. We used cross-sectional secondary data analyses to describe coping in 160 patients with newly diagnosed high-risk AML. The Brief COPE, Hospital Anxiety and Depression Scale, Post-Traumatic Stress Disorder Checklist-Civilian Version, and Functional Assessment of Cancer Therapy-Leukemia were used at time of AML diagnosis to measure coping strategies, psychological distress, and quality of life (QOL), respectively. The median split method for distribution of coping domains and multivariate regression models were used to assess the relationship between coping and patient-reported outcomes. Participants (median age, 64.4 years) were mostly non-Hispanic White (86.3%), male (60.0%), and married (73.8%). Most (51.9%) had high utilization of approach-oriented coping strategies, whereas 38.8% had high utilization of avoidant coping strategies. At time of diagnosis, use of approach-oriented coping was associated with less psychological distress (anxiety, β = -0.262, P = .002; depression symptoms, β = -0.311, P < .001; and posttraumatic distress disorder symptoms, β = -0.596, P = .006) and better QOL (β = 1.491, P = .003). Use of avoidant coping was associated with more psychological distress (anxiety, β = 0.884, P < .001; depression symptoms, β = 0.697, P < .001; and posttraumatic distress disorder symptoms, β = 3.048, P < .001) and worse QOL (β = -5.696, P < .001). Patients with high-risk AML use various approach-oriented and avoidant coping strategies at time of diagnosis. Use of approach-oriented coping strategies was associated with less psychological distress and better QOL, suggesting a possible target for supportive oncology interventions.

Journal of Palliative MedicineJohnson et al.Cohort Study

End-of-Life Care for Older Adults with Aggressive Non-Hodgkin Lymphoma

Background: Aggressive non-Hodgkin lymphoma (NHL) commonly affects older adults and is often treated with intensive therapies. Receipt of intensive therapies and absence of a clear transition between the curative and palliative phases of treatment yield prognostic uncertainty and risk for poor end-of-life (EOL) outcomes. However, data regarding the EOL outcomes of this population are lacking. Methods: We conducted a retrospective analysis of adults ≥65 years with aggressive NHL treated with systemic therapy at Massachusetts General Hospital from April 2000 to July 2020 who subsequently died. We abstracted patient and clinical characteristics and EOL outcomes from the medical record. Using multivariable logistic regression, we examined factors associated with hospitalization within 30 days of death and hospice utilization. Results: Among 91 patients (median age = 75 years; 37.4% female), 70.3% (64/91) were hospitalized, 34.1% (31/91) received systemic therapy, and 23.3% (21/90) had an intensive care unit admission within 30 days of death. The rates of palliative care consultation and hospice utilization were 47.7% (42/88) and 39.8% (35/88), respectively. More than half of patients (51.6%, 47/91) died in a hospital or health care facility. In multivariable analysis, elevated lactic acid dehydrogenase was associated with risk of hospitalization within 30 days of death (odds ratio [OR] 3.61, p = 0.014). Palliative care consultation (OR 4.45, p = 0.005) was associated with a greater likelihood of hospice utilization, whereas hypoalbuminemia (OR 0.29, p = 0.026) was associated with a lower likelihood of hospice utilization. Conclusions: Older adults with aggressive NHL often experience high health care utilization and infrequently utilize hospice care at the EOL. Our findings underscore the need for interventions to optimize the quality of EOL care for this population.

Journal of Drugs in DermatologyReynolds et al.Diagnostic Study

Atopic Dermatitis: A Review of Current Diagnostic Criteria and a Proposed Update to Management

The diagnosis of atopic dermatitis (AD) remains primarily a clinical diagnosis, in which several clinical signs and symptoms including pruritus, the presence and location of skin lesions, and a personal or family history of atopic conditions are used to facilitate a diagnosis. In recent decades, several well-established sets of criteria have been developed to aid diagnosis. With increased awareness of AD and the recent development of systemic immunomodulators to treat the condition, there exists a need to further define and consolidate the current diagnostic criteria while refining our current understanding of the clinical features of AD. We propose a novel, simplified set of criteria that comprises the clinical features generally considered to be essential for a confirmed diagnosis of AD, together with features previously regarded as having less clinical significance. It is essential, however, that any refinements to the diagnostic criteria for AD are made alongside regular updates of treatment guidelines so that these also reflect current developments. In this regard, the current guidelines in the United States are lacking and should be updated. J Drugs Dermatol. 2020;19(3): doi:10.36849/JDD.2020.4737 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

BMJ Quality & SafetyReynolds et al.Original Research

Improving feedback on junior doctors’ prescribing errors: mixed-methods evaluation of a quality improvement project

BACKGROUND: Prescribing errors occur in up to 15% of UK inpatient medication orders. However, junior doctors report insufficient feedback on errors. A barrier preventing feedback is that individual prescribers often cannot be clearly identified on prescribing documentation. AIM: To reduce prescribing errors in a UK hospital by improving feedback on prescribing errors. INTERVENTIONS: We developed three linked interventions using plan-do-study-act cycles: (1) name stamps for junior doctors who were encouraged to stamp or write their name clearly when prescribing; (2) principles of effective feedback to support pharmacists to provide feedback to doctors on individual prescribing errors and (3) fortnightly prescribing advice emails that addressed a common and/or serious error. IMPLEMENTATION AND EVALUATION: Interventions were introduced at one hospital site in August 2013 with a second acting as control. Process measures included the percentage of inpatient medication orders for which junior doctors stated their name. Outcome measures were junior doctors' and pharmacists' perceptions of current feedback provision (evaluated using quantitative pre-questionnaires and post-questionnaires and qualitative focus groups) and the prevalence of erroneous medication orders written by junior doctors between August and December 2013. RESULTS: The percentage of medication orders for which junior doctors stated their name increased from about 10% to 50%. Questionnaire responses revealed a significant improvement in pharmacists' perceptions but no significant change for doctors. Focus group findings suggested increased doctor engagement with safe prescribing. Interrupted time series analysis showed no difference in weekly prescribing error rates between baseline and intervention periods, compared with the control site. CONCLUSION: Findings suggest improved experiences around feedback. However, attempts to produce a measurable reduction in prescribing errors are likely to need a multifaceted approach of which feedback should form part.

Clinical EpidemiologyPanaccio et al.cohort

Recent-onset AF is linked to ~3.4-fold higher risk of CV hospitalization.

Recent-onset atrial fibrillation is associated with a markedly high burden of incident cardiovascular comorbidity, driving substantial increases in hospitalizations and all-cause mortality.

BMC Health Services ResearchReynolds et al.Cohort Study

A descriptive exploratory study of how admissions caused by medication-related harm are documented within inpatients’ medical records

BACKGROUND: Adverse drug reactions, poor patient adherence and errors, here collectively referred to as medication-related harm (MRH), cause around 2.7-8.0% of UK hospital admissions. Communication gaps between successive healthcare providers exist, but little is known about how MRH is recorded in inpatients' medical records. We describe the presence and quality of MRH documentation for patients admitted to a London teaching hospital due to MRH. Additionally, the international classification of disease 10th revision (ICD-10) codes attributed to confirmed MRH-related admissions were studied to explore appropriateness of their use to identify these patients. METHODS: Clinical pharmacists working on an admissions ward in a UK hospital identified patients admitted due to suspected MRH. Six different data sources in each patient's medical record, including the discharge summary, were subsequently examined for MRH-related information. Each data source was examined for statements describing the MRH: symptom and diagnosis, identification of the causative agent, and a statement of the action taken or considered. Statements were categorised as 'explicit' if unambiguous or 'implicit' if open to interpretation. ICD-10 codes attributed to confirmed MRH cases were recorded. RESULTS: Eighty-four patients were identified over 141 data collection days; 75 met our inclusion criteria. MRH documentation was generally present (855 of 1307 statements were identified; 65%), and usually explicit (705 of 855; 82%). The causative agent had the lowest proportion of explicit statements (139 of 201 statements were explicit; 69%). For two (3%) discharged patients, the causal agent was documented in their paper medical record but not on the discharge summary. Of 64 patients with a confirmed MRH diagnosis at discharge, only six (9%) had a MRH-related ICD-10 code. CONCLUSIONS: Availability of information in the paper medical record needs improving and communication of MRH-related information could be enhanced by using explicit statements and documenting reasons for changing medications. ICD-10 codes underestimate the true occurrence of MRH.

BMJ Quality & SafetyFranklin et al.Original Research

The effect of the electronic transmission of prescriptions on dispensing errors and prescription enhancements made in English community pharmacies: a naturalistic stepped wedge study

OBJECTIVES: To compare prevalence and types of dispensing errors and pharmacists' labelling enhancements, for prescriptions transmitted electronically versus paper prescriptions. DESIGN: Naturalistic stepped wedge study. SETTING: 15 English community pharmacies. INTERVENTION: Electronic transmission of prescriptions between prescriber and pharmacy. MAIN OUTCOME MEASURES: Prevalence of labelling errors, content errors and labelling enhancements (beneficial additions to the instructions), as identified by researchers visiting each pharmacy. RESULTS: Overall, we identified labelling errors in 5.4% of 16,357 dispensed items, and content errors in 1.4%; enhancements were made for 13.6%. Pharmacists also edited the label for a further 21.9% of electronically transmitted items. Electronically transmitted prescriptions had a higher prevalence of labelling errors (7.4% of 3733 items) than other prescriptions (4.8% of 12,624); OR 1.46 (95% CI 1.21 to 1.76). There was no difference for content errors or enhancements. The increase in labelling errors was mainly accounted for by errors (mainly at one pharmacy) involving omission of the indication, where specified by the prescriber, from the label. A sensitivity analysis in which these cases (n=158) were not considered errors revealed no remaining difference between prescription types. CONCLUSIONS: We identified a higher prevalence of labelling errors for items transmitted electronically, but this was predominantly accounted for by local practice in a single pharmacy, independent of prescription type. Community pharmacists made labelling enhancements to about one in seven dispensed items, whether electronically transmitted or not. Community pharmacists, prescribers, professional bodies and software providers should work together to agree how items should be dispensed and labelled to best reap the benefits of electronically transmitted prescriptions. Community pharmacists need to ensure their computer systems are promptly updated to help reduce errors.

International Journal of Clinical PharmacyFranklin et al.Pilot Study

Community pharmacists’ interventions with electronic prescriptions in England: an exploratory study

BACKGROUND: Prescribing errors in primary care are problematic. The electronic prescription service (EPS) is an English electronic system linking prescribing, dispensing and reimbursement, designed to rectify some of the problems associated with paper-based prescribing. OBJECTIVE: To document the numbers and types of interventions made by community pharmacists and their staff using EPS release 2 (EPSR2), compare these with those made for other prescription types, and comment on potential effects of EPSR2 on pharmacy practice. METHODS: We invited staff in 15 community pharmacies to record problems encountered arising from failures in prescribing, dispensing or supply systems for prescribed medication, for a 2 week period. RESULTS: Eight pharmacies participated, of which five used EPSR2. These pharmacies reported 69 problems with 68 prescriptions (median 7.5 problems per pharmacy, range 2-22). A total of 33 problems were clinical in nature and 6 were organisational or logistical in origin. Thirty unsigned prescriptions were reported, all non-EPSR2. Of the 69 problems, eight were primarily related to EPSR2 functionality. CONCLUSION: EPSR2 should reduce the number of unsigned prescriptions in circulation. However, prescribers should avoid the use of Latin abbreviations that cannot be interpreted directly by patients, and consider the compatibility of regularly prescribed items with the NHS dictionary of medicines and devices.

Postgraduate Medical JournalFranklin et al.Cohort Study

Prescribing errors in hospital inpatients: a three-centre study of their prevalence, types and causes

AIM: To compare the prevalence and causes of prescribing errors in newly written medication orders and how quickly they were rectified, in three NHS organisations. METHODS: Errors in newly written inpatient and discharge medication orders were recorded in Spring/Summer 2009 by ward pharmacists on medical admissions and surgical wards, as well as the number of erroneous doses administered (or omitted) before errors were corrected. Logistic regression analysis was used to explore the effects of ward (nested within organisation) and clinical specialty, and whether the pharmacist had checked the patient's medication history during data collection. Causes were explored using semistructured interviews with key informants. RESULTS: Overall, 1025 prescribing errors were identified in 974 of 6605 medication orders (14.7%, 95% confidence interval (CI) 13.8% to 15.6%). A mean of 0.9 doses were administered (or omitted) before each error was corrected (range 0-11), with differences between specialties and organisations. The error rate on medical admissions wards (16.3%) was significantly higher than that on surgical wards (12.2%), but this was accounted for by the higher proportion of prescribing being on admission, where omission of patients' usual medication was often identified. There were significant differences among wards (and organisations). Contributing factors included lack of feedback on errors, poor documentation and communication of prescribing decisions, and lack of information about patients' medication histories from primary care. CONCLUSIONS: There were variations among wards, organisations and specialties in error rates and how quickly they were rectified. Exploring reasons for differences between organisations may be useful in identifying best practice and potential solutions.

About

Matthew Reynolds works in Electrophysiology affiliated with Brigham and Women's Hospital.

Research focus

Atrial Fibrillation ManagementCatheter AblationCost-Effectiveness of Cardiovascular TechnologiesImplantable Defibrillators and PacemakersTranscatheter Valve Replacement Outcomes