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Authors
Ghosal, Ritu
Gronowski, Ben
Fish, Daniel
Rinaldi, Joseph B.
Vartanian, Keri
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Funding
Funding for this research was provided by:
Providence Health and Services
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Article History
Received: 2 December 2025
Accepted: 11 May 2026
First Online: 20 May 2026
Declarations
Ethical approval and informed consent: The full study protocol was approved by Providence St. Joseph Health Institutional Review Board (IRB# 2020000467) and an additional protocol was approved for obtaining consent to access their EHR (IRB #2023000744). The study protocol conformed to the principles of the Declaration of Helsinki. A consent document was created with details of the project and information on the voluntary nature of data collection, confidentiality, privacy and risks associated with the study. The consent document was reviewed and approved by the IRB and uploaded to the Twistle platform before data collection began. Informed consent was received through the Twistle electronic platform for participation in MCD and subsequent consent to access their EHR. All study procedures adhered to the required guidelines. Participants provided informed consent for use of their de-identified data for use in reports on this study.
Competing interests: The authors declare no competing interests.
