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Asay S, Abramsohn EM, Winslow V, Jagai JS, Waxman E, Makelarski JA, Lindau ST. Food Insecurity and Community-Based Food Resources Among Caregivers of Hospitalized Children. Hosp Pediatr 2024; 14:520-531. [PMID: 38881356 PMCID: PMC11208882 DOI: 10.1542/hpeds.2023-007597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Children's hospitals are implementing interventions to connect families to community-based resources. This study describes food insecurity (FI) and food resource knowledge, need, and use among families with a hospitalized child. METHODS Between November 2020 and June 2022, 637 caregivers of hospitalized children in an urban 42-ZIP-code area were surveyed as part of a randomized controlled trial. The United States Department of Agriculture 18-item Household Food Security Survey was used to evaluate 12-month food security (food secure [score of 0=FS]; marginally secure [1-2=MFS]; insecure [3-18=FI]). Food resource knowledge, need, and use were described by food security status and examined using Cochran-Armitage tests. The distribution of local resources was obtained from a database and mapped by ZIP code. RESULTS Comparing FI (35.0%) with MFS (17.6%) and FS (47.4%) groups, the rates of resource knowledge were lower (70.2% vs 78.5%, 80.5%), and the rates of need (55.1% vs 30.6%, 14.2%) and use (55.3% vs 51.4%, 40.8%) were higher. Rates of food resource knowledge increased linearly with increasing food security (FI to MFS to FS; P = .008), whereas the rates of resource need (P < .001) and use (P = .001) decreased with increasing food security. There were 311 community-based organizations across 36 ZIP codes with participants (range/ZIP code = 0-20, median = 8). CONCLUSIONS Half of families with a hospitalized child experienced FI or MFS. Although families exhibited high food resource knowledge, nearly half of families with FI had unmet food needs or had never used resources.
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Affiliation(s)
- Spencer Asay
- University of Chicago Pritzker School of Medicine
| | | | | | | | | | | | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology
- Department of Medicine-Geriatrics and Palliative Medicine
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois
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Rangachari P, Thapa A, Sherpa DL, Katukuri K, Ramadyani K, Jaidi HM, Goodrum L. Characteristics of hospital and health system initiatives to address social determinants of health in the United States: a scoping review of the peer-reviewed literature. Front Public Health 2024; 12:1413205. [PMID: 38873294 PMCID: PMC11173975 DOI: 10.3389/fpubh.2024.1413205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 05/17/2024] [Indexed: 06/15/2024] Open
Abstract
Background Despite the incentives and provisions created for hospitals by the US Affordable Care Act related to value-based payment and community health needs assessments, concerns remain regarding the adequacy and distribution of hospital efforts to address SDOH. This scoping review of the peer-reviewed literature identifies the key characteristics of hospital/health system initiatives to address SDOH in the US, to gain insight into the progress and gaps. Methods PRISMA-ScR criteria were used to inform a scoping review of the literature. The article search was guided by an integrated framework of Healthy People SDOH domains and industry recommended SDOH types for hospitals. Three academic databases were searched for eligible articles from 1 January 2018 to 30 June 2023. Database searches yielded 3,027 articles, of which 70 peer-reviewed articles met the eligibility criteria for the review. Results Most articles (73%) were published during or after 2020 and 37% were based in Northeast US. More initiatives were undertaken by academic health centers (34%) compared to safety-net facilities (16%). Most (79%) were research initiatives, including clinical trials (40%). Only 34% of all initiatives used the EHR to collect SDOH data. Most initiatives (73%) addressed two or more types of SDOH, e.g., food and housing. A majority (74%) were downstream initiatives to address individual health-related social needs (HRSNs). Only 9% were upstream efforts to address community-level structural SDOH, e.g., housing investments. Most initiatives (74%) involved hot spotting to target HRSNs of high-risk patients, while 26% relied on screening and referral. Most initiatives (60%) relied on internal capacity vs. community partnerships (4%). Health disparities received limited attention (11%). Challenges included implementation issues and limited evidence on the systemic impact and cost savings from interventions. Conclusion Hospital/health system initiatives have predominantly taken the form of downstream initiatives to address HRSNs through hot-spotting or screening-and-referral. The emphasis on clinical trials coupled with lower use of EHR to collect SDOH data, limits transferability to safety-net facilities. Policymakers must create incentives for hospitals to invest in integrating SDOH data into EHR systems and harnessing community partnerships to address SDOH. Future research is needed on the systemic impact of hospital initiatives to address SDOH.
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Affiliation(s)
- Pavani Rangachari
- Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, CT, United States
| | - Alisha Thapa
- Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, CT, United States
| | - Dawa Lhomu Sherpa
- Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, CT, United States
| | - Keerthi Katukuri
- Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, CT, United States
| | - Kashyap Ramadyani
- Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, CT, United States
| | - Hiba Mohammed Jaidi
- Department of Population Health and Leadership, School of Health Sciences, University of New Haven, West Haven, CT, United States
| | - Lewis Goodrum
- Northeast Medical Group, Yale New Haven Health System, Stratford, CT, United States
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Graboyes EM, Lee SC, Lindau ST, Adams AS, Adjei BA, Brown M, Sadigh G, Incudine A, Carlos RC, Ramsey SD, Bangs R. Interventions addressing health-related social needs among patients with cancer. J Natl Cancer Inst 2024; 116:497-505. [PMID: 38175791 DOI: 10.1093/jnci/djad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
Health-related social needs are prevalent among cancer patients; associated with substantial negative health consequences; and drive pervasive inequities in cancer incidence, severity, treatment choices and decisions, and outcomes. To address the lack of clinical trial evidence to guide health-related social needs interventions among cancer patients, the National Cancer Institute Cancer Care Delivery Research Steering Committee convened experts to participate in a clinical trials planning meeting with the goal of designing studies to screen for and address health-related social needs among cancer patients. In this commentary, we discuss the rationale for, and challenges of, designing and testing health-related social needs interventions in alignment with the National Academy of Sciences, Engineering, and Medicine 5As framework. Evidence for food, housing, utilities, interpersonal safety, and transportation health-related social needs interventions is analyzed. Evidence regarding health-related social needs and delivery of health-related social needs interventions differs in maturity and applicability to cancer context, with transportation problems having the most maturity and interpersonal safety the least. We offer practical recommendations for health-related social needs interventions among cancer patients and the caregivers, families, and friends who support their health-related social needs. Cross-cutting (ie, health-related social needs agnostic) recommendations include leveraging navigation (eg, people, technology) to identify, refer, and deliver health-related social needs interventions; addressing health-related social needs through multilevel interventions; and recognizing that health-related social needs are states, not traits, that fluctuate over time. Health-related social needs-specific interventions are recommended, and pros and cons of addressing more than one health-related social needs concurrently are characterized. Considerations for collaborating with community partners are highlighted. The need for careful planning, strong partners, and funding is stressed. Finally, we outline a future research agenda to address evidence gaps.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Simon C Lee
- Department of Population Health, University of Kansas School of Medicine, Kansas City, KS, USA
- University of Kansas Cancer Center, University of Kansas, Kansas City, KS, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, IL, USA
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, The University of Chicago, Chicago, IL, USA
| | - Alyce S Adams
- Departments of Health Policy/Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Office of Cancer Health Equity and Community Engagement, Stanford Cancer Institute, Stanford Medicine, Stanford, CA, USA
| | - Brenda A Adjei
- Office of the Associate Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Mary Brown
- Adena Cancer Center, Hematology and Oncology, Chillicothe, OH, USA
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California-Irvine, Irvine, CA, USA
| | | | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Scott D Ramsey
- Department of Pharmacy, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, USA
| | - Rick Bangs
- SWOG Cancer Research Network, Portland, OR, USA
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Vaugoyeau E, Rambliere L, David M, Lemguarni H, Le Gac S, Pasquet-Cadre A, Rasli S, Ghosn J, Rozenbaum W, Bouvet E, Prioux M. Proof of concept of a sexual health outreach program led by community health workers in homeless hostels in the greater Paris region. Front Public Health 2024; 11:1305874. [PMID: 38283290 PMCID: PMC10811606 DOI: 10.3389/fpubh.2023.1305874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/12/2023] [Indexed: 01/30/2024] Open
Abstract
Context Homeless individuals face exacerbated risks of infectious diseases, including sexually transmitted infections (STIs). Programs led by Community Health Workers (CHWs) have demonstrated potential to enhance healthcare access for marginalized groups such as homeless families. This study aims to evaluate the feasibility and effectiveness of a novel CHW-based outreach program addressing sexual health issues among individuals residing in homeless hostels. Methods Twelve social homeless hostels in the greater Paris region were selected as program implementation sites. An outreach program was developed consisting of two interventions: sexual health workshops and STI screening sessions (HIV and hepatitis B and C) accompanied by individual interviews, both conducted by CHWs within each hostel over an 8-week period and scheduled weekly. Feasibility, participation and engagement were evaluated using complementary methods including qualitative field observations, semi-structured interviews and focus groups with CHWs, satisfaction questionnaires for participants, and quantitative outcome data collection of each intervention. Results A total of 80 program activities (workshops and screening sessions) were conducted. Among the participants, 542 women and 30 men engaged in workshops. During the 30 Rapid Diagnostic Testing sessions, 150 individuals underwent testing for HIV, hepatitis B, and/or hepatitis C. Positivity rates were 6.7% for hepatitis B and 0.9% for hepatitis C. No HIV infections were detected. Participant satisfaction rates were consistently high (>76%) across workshops. Qualitative analysis unveiled two critical axes influencing program feasibility and effectiveness: program organization and CHW involvement. Discussion This assessment of the program highlights its feasibility among a population that is difficult to reach through conventional healthcare efforts. The intervention's potential effectiveness is suggested by self- and CHW-reported improvements in sexual health literacy and high rates of referral to the healthcare system, as well as holistic well-being considerations. CHW involvement is a vital determinant of program success, as are robust coordination among stakeholders, deep understanding of the target population, and strong partner engagement. Conclusion This outreach program amplifies the voices of often-overlooked populations while empowering them to navigate health and social challenges. Although these workshops serve as lifelines for those frequently excluded from mainstream services, long-term improvements to the health and wellbeing of homeless populations will necessitate systemic governmental intervention.
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Affiliation(s)
| | - Lison Rambliere
- Observatoire du Samusocial de Paris, Samusocial de Paris, Paris, France
| | - Manon David
- Pôle DELTA, Samusocial de Paris, Paris, France
| | | | | | | | - Samy Rasli
- Pôle DELTA, Samusocial de Paris, Paris, France
| | - Jade Ghosn
- COREVIH Île-de-France Nord, Paris, France
| | | | | | - Maëlle Prioux
- Pôle médical et soins, Samusocial de Paris, Paris, France
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Vasan A, Dalembert G, Garg A. An Antiracist Approach to Social Care Integration. Pediatrics 2024; 153:e2023062109. [PMID: 38058202 PMCID: PMC11212503 DOI: 10.1542/peds.2023-062109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Aditi Vasan
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab and Clinical Futures, Children’s Hospital of Philadelphia, Pennsylvania
| | - George Dalembert
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- PolicyLab and Clinical Futures, Children’s Hospital of Philadelphia, Pennsylvania
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, University of Massachusetts Chan School of Medicine, UMass Memorial Children’s Center, Worcester, Massachusetts
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Glasser NJ, Lindau ST, Wroblewski K, Abramsohn EM, Burnet DL, Fuller CM, Miller DC, O’Malley CA, Shiu E, Waxman E, Makelarski JA. Effect of a Social Care Intervention on Health Care Experiences of Caregivers of Hospitalized Children: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:1266-1275. [PMID: 37902777 PMCID: PMC10616767 DOI: 10.1001/jamapediatrics.2023.4596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/30/2023] [Indexed: 10/31/2023]
Abstract
Importance Health-related social risks (HRSRs), like food and housing insecurity, are stigmatized conditions that, when addressed in clinical settings, could inadvertently compromise health care experiences. Objective To test the noninferiority hypothesis that a low-intensity, high-scale social care intervention does not promote experiences of discrimination or diminish satisfaction with care compared to usual care. Design, Setting, and Participants This was a double-blind randomized clinical trial conducted from November 2020 to June 2022 with 12-month follow-up analyzing data obtained 1 week after baseline intervention at a 155-bed academic urban children's hospital with 5300 annual admissions. Participants were recruited from their children's hospital rooms during their children's inpatient hospital stays. Inclusion criteria were identifying as the primary caregiver of a child younger than 18 years who was hospitalized in the general, intensive care, or transplant units; living in 1 of 42 target zip codes; and consenting to receive text messages. Caregivers of healthy newborns and caregivers of children expected to be hospitalized for less than 24 hours or greater than 30 days were excluded. A total of 637 eligible parents and caregivers were enrolled. Interventions Participants were randomized to usual care or usual care plus CommunityRx, a low-intensity, universally delivered, electronic medical record-integrated social care assistance intervention providing personalized information about local resources alongside education about HRSRs and how to access additional support. Usual care included an admission brochure about hospital-based free food options and nonsystematic provision of resource information. Main Outcomes and Measures Experiences of discrimination, measured using the Discrimination in Medical Settings Scale (range 7-35; higher scores indicate more frequent discrimination) and satisfaction with hospital discharge 1 week postdischarge using Child HCAHPS (range 0-100; higher scores indicate higher satisfaction). The a priori noninferiority margins (control minus intervention) were -0.9 (discrimination) and 1.6 (satisfaction). Results Of 637 eligible caregiver participants, most identified as female (n = 600 [94.3%]), Black (n = 505 [79.4%]), and had household income less than $50 000 per year (n = 488 [78.5%]). One-third were experiencing food insecurity (n = 223). Half of participants reported discrimination experiences during the pediatric hospitalization (n = 259). Discrimination experiences among the intervention group were noninferior to those among the control group (mean [SD] score: control, 10.3 [4.7] vs intervention, 10.0 [4.6]; difference, 0.2; 90% CI, -0.5 to 0.9). Mean (SD) satisfaction with discharge was high (control, 84.2 [23.8] vs intervention, 81.9 [24.8]), but evidence was insufficient to support intervention noninferiority for this end point (difference, 2.3; 90% CI, -1.2 to 5.8). Food security status did not moderate the relationship between intervention and either outcome. Conclusions and Relevance The findings suggest that a universally delivered social care assistance intervention did not promote caregiver experiences of discrimination during a child's hospitalization but were inconclusive regarding satisfaction. Trial Registration ClinicalTrials.gov Identifier: NCT04171999.
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Affiliation(s)
- Nathaniel J. Glasser
- Department of Medicine, Section of General Internal Medicine, The University of Chicago, Chicago, Illinois
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
- Department of Medicine-Geriatrics and Palliative Medicine, The University of Chicago, Chicago, Illinois
| | - Kristen Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Emily M. Abramsohn
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
| | - Deborah L. Burnet
- Department of Medicine, Section of General Internal Medicine, The University of Chicago, Chicago, Illinois
| | - Charles M. Fuller
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
| | - Doriane C. Miller
- Department of Medicine, Section of General Internal Medicine, The University of Chicago, Chicago, Illinois
- Institute for Translational Medicine, The University of Chicago, Chicago, Illinois
| | - Christine A. O’Malley
- Department of Pediatrics, The University of Chicago, Chicago, Illinois
- Section of Neonatology, The University of Chicago, Chicago, Illinois
| | - Eva Shiu
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois
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Drewry MB, Yanguela J, Khanna A, O'Brien S, Phillips E, Bevel MS, McKinley MW, Corbie G, Dave G. A Systematic Review of Electronic Community Resource Referral Systems. Am J Prev Med 2023; 65:1142-1152. [PMID: 37286015 PMCID: PMC10696135 DOI: 10.1016/j.amepre.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Community Resource Referral Systems delivered electronically through healthcare information technology systems (e.g., electronic medical records) have become more common in efforts to address patients' unmet health-related social needs. Community Resource Referral System connects patients with social supports such as food assistance, utility support, transportation, and housing. This systematic review identifies barriers and facilitators that influence the Community Resource Referral System's implementation in the U.S. by identifying and synthesizing peer-reviewed literature over a 15-year period. METHODS This systematic review was conducted following PRISMA guidelines. A search was conducted on five scientific databases to capture the literature published between January 2005 and December 2020. Data analysis was conducted from August 2021 to July 2022. RESULTS This review includes 41 articles of the 2,473 initial search results. Included literature revealed that Community Resource Referral Systems functioned to address a variety of health-related social needs and were delivered in different ways. Integrating the Community Resource Referral Systems into clinic workflows, maintenance of community-based organization inventories, and strong partnerships between clinics and community-based organizations facilitated implementation. The sensitivity of health-related social needs, technical challenges, and associated costs presented as barriers. Overall, electronic medical records-integration and automation of the referral process was reported as advantageous for the stakeholders. DISCUSSION This review provides information and guidance for healthcare administrators, clinicians, and researchers designing or implementing electronic Community Resource Referral Systems in the U.S. Future studies would benefit from stronger implementation science methodological approaches. Sustainable funding mechanisms for community-based organizations, clear stipulations regarding how healthcare funds can be spent on health-related social needs, and innovative governance structures that facilitate collaboration between clinics and community-based organizations are needed to promote the growth and sustainability of Community Resource Referral Systems in the U.S.
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Affiliation(s)
- Maura B Drewry
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina.
| | - Juan Yanguela
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Anisha Khanna
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Sara O'Brien
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Ethan Phillips
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Malcolm S Bevel
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina; Augusta University, Department of Medicine, Augusta, Georgia
| | - Mary W McKinley
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Giselle Corbie
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
| | - Gaurav Dave
- The University of North Carolina at Chapel Hill, Center for Health Equity Research, Chapel Hill, North Carolina
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Gupta D, Self S, Thomas D, Supra J, Rudisill C. Understanding the Role of a Technology and EMR-based Social Determinants of Health Screening Tool and Community-based Resource Connections in Health Care Resource Utilization. Med Care 2023; 61:423-430. [PMID: 36729786 DOI: 10.1097/mlr.0000000000001800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Health systems are increasingly investing in social determinants of health (SDoH), but there is limited research on how such efforts impact health care resource use. This study presents pilot work on an SDoH screening and referral platform recently implemented in South Carolina's largest private nonprofit health system. OBJECTIVES To assess the feasibility and sustainability of SDoH screening and SDoH-related referrals in a large health system and examine how they affect health resource use. RESEARCH DESIGN Observational study using electronic medical records and SDoH screening data from June 1, 2019 to December 31, 2020. SUBJECTS Patients (18 y+) engaged in community health, inpatient case management, or ambulatory care and condition management programs. MEASURES We describe the use of SDoH screening by providers (community health workers, nurse case managers, and social workers) and SDoH referral volumes among patients. We use multivariate analyses to predict changes in emergency department visits, inpatient admission s (length of stay and volume), and primary care visits from referral volume, SDoH screening question responses, and patient characteristics (eg, comorbidities). RESULTS Of 2687 patients, 662 (24.6%) screened positive for 1 or more SDoH domains. SDoH screening performance remained consistent among providers over time. Six hundred fifty-eight (24.5%) patients received SDoH referrals. Patients receiving an increasing volume of referrals had decreasing primary care visits but their comorbidities moderated this effect. CONCLUSIONS The study provides initial descriptive information on SDoH needs, implementation of referrals and resource use, guiding SDoH screening implementation in population health, and care management programs.
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Affiliation(s)
- Deeksha Gupta
- Department of Health Promotion, Education, and Behavior
| | - Stella Self
- Department of Epidemiology/Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Darin Thomas
- Accountable Communities, Prisma Health, Greenville, SC
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Oster C, Skelton C, Leibbrandt R, Hines S, Bonevski B. Models of social prescribing to address non-medical needs in adults: a scoping review. BMC Health Serv Res 2023; 23:642. [PMID: 37316920 DOI: 10.1186/s12913-023-09650-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 06/05/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The health and wellbeing consequences of social determinants of health and health behaviours are well established. This has led to a growing interest in social prescribing, which involves linking people to services and supports in the community and voluntary sectors to address non-medical needs. However, there is considerable variability in approaches to social prescribing with little guidance on how social prescribing could be developed to reflect local health systems and needs. The purpose of this scoping review was to describe the types of social prescribing models used to address non-medical needs to inform co-design and decision-making for social prescribing program developers. METHODS We searched Ovid MEDLINE(R), CINAHL, Web of Science, Scopus, National Institute for Health Research Clinical Research Network, Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registry Platform, and ProQuest - Dissertations and Theses for articles and grey literature describing social prescribing programs. Reference lists of literature reviews were also searched. The searches were conducted on 2 August 2021 and yielded 5383 results following removal of duplicates. RESULTS 148 documents describing 159 social prescribing programs were included in the review. We describe the contexts in which the programs were delivered, the program target groups and services/supports to which participants were referred, the staff involved in the programs, program funding, and the use of digital systems. CONCLUSIONS There is significant variability in social prescribing approaches internationally. Social prescribing programs can be summarised as including six planning stages and six program processes. We provide guidance for decision-makers regarding what to consider when designing social prescribing programs.
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Affiliation(s)
- Candice Oster
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Claire Skelton
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Richard Leibbrandt
- College of Science & Engineering, Flinders University, Adelaide, SA, Australia
| | - Sonia Hines
- College of Medicine & Public Health, Flinders Rural and Remote Health, Flinders University, Alice Springs, Northern Territory, Australia
| | - Billie Bonevski
- College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
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Cheng AL, Leo AJ, Calfee RP, Dy CJ, Armbrecht MA, Abraham J. Multi-stakeholder perspectives regarding preferred modalities for mental health intervention delivered in the orthopedic clinic: a qualitative analysis. BMC Psychiatry 2023; 23:347. [PMID: 37208668 DOI: 10.1186/s12888-023-04868-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/13/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Although depressive and anxious symptoms negatively impact musculoskeletal health and orthopedic outcomes, a gap remains in identifying modalities through which mental health intervention can realistically be delivered during orthopedic care. The purpose of this study was to understand orthopedic stakeholders' perceptions regarding the feasibility, acceptability, and usability of digital, printed, and in-person intervention modalities to address mental health as part of orthopedic care. METHODS This single-center, qualitative study was conducted within a tertiary care orthopedic department. Semi-structured interviews were conducted between January and May 2022. Two stakeholder groups were interviewed using a purposive sampling approach until thematic saturation was reached. The first group included adult orthopedic patients who presented for management of ≥ 3 months of neck or back pain. The second group included early, mid, and late career orthopedic clinicians and support staff members. Stakeholders' interview responses were analyzed using deductive and inductive coding approaches followed by thematic analysis. Patients also performed usability testing of one digital and one printed mental health intervention. RESULTS Patients included 30 adults out of 85 approached (mean (SD) age 59 [14] years, 21 (70%) women, 12 (40%) non-White). Clinical team stakeholders included 22 orthopedic clinicians and support staff members out of 25 approached (11 (50%) women, 6 (27%) non-White). Clinical team members perceived a digital mental health intervention to be feasible and scalable to implement, and many patients appreciated that the digital modality offered privacy, immediate access to resources, and the ability to engage during non-business hours. However, stakeholders also expressed that a printed mental health resource is still necessary to meet the needs of patients who prefer and/or can only engage with tangible, rather than digital, mental health resources. Many clinical team members expressed skepticism regarding the current feasibility of scalably incorporating in-person support from a mental health specialist into orthopedic care. CONCLUSIONS Although digital intervention offers implementation-related advantages over printed and in-person mental health interventions, a subset of often underserved patients will not currently be reached using exclusively digital intervention. Future research should work to identify combinations of effective mental health interventions that provide equitable access for orthopedic patients. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO, 63110, USA.
| | - Ashwin J Leo
- Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Ryan P Calfee
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Christopher J Dy
- Division of Hand and Wrist, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Melissa A Armbrecht
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO, 63110, USA
| | - Joanna Abraham
- Department of Anesthesiology & Institute for Informatics, Washington University School of Medicine, 4990 Children's Place, St. Louis, MO, 63110, USA
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11
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Teggart K, Neil-Sztramko SE, Nadarajah A, Wang A, Moore C, Carter N, Adams J, Jain K, Petrie P, Alshaikhahmed A, Yugendranag S, Ganann R. Effectiveness of system navigation programs linking primary care with community-based health and social services: a systematic review. BMC Health Serv Res 2023; 23:450. [PMID: 37158878 PMCID: PMC10165767 DOI: 10.1186/s12913-023-09424-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes. METHODS Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction. RESULTS Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led (n = 10), health professional-led (n = 4), team-based (n = 6), or self-navigation with lay support as needed (n = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes. CONCLUSIONS There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.
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Affiliation(s)
- Kylie Teggart
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Abbira Nadarajah
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Amy Wang
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Caroline Moore
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Nancy Carter
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Janet Adams
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Kamal Jain
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Penelope Petrie
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Aref Alshaikhahmed
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Shreya Yugendranag
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, 1280 Main St. W, Hamilton, ON, HSC 3N25L8S 4K1, Canada.
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12
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Vu M, Boyd K, De Marchis EH, Garnache BG, Gottlieb LM, Gross CP, Lee NK, Lindau ST, Mun S, Winslow VA, Makelarski JA. Perceived Appropriateness of Assessing for Health-related Socioeconomic Risks Among Adult Patients with Cancer. CANCER RESEARCH COMMUNICATIONS 2023; 3:521-531. [PMID: 37020993 PMCID: PMC10069714 DOI: 10.1158/2767-9764.crc-22-0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/17/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
Cancer treatment can trigger or exacerbate health-related socioeconomic risks (HRSR; food/housing insecurity, transportation/utilities difficulties, and interpersonal violence). The American Cancer Society and National Cancer Institute recommend HRSR screening and referral, but little research has examined the perceptions of patients with cancer on the appropriateness of HRSR screening in healthcare settings. We examined whether HRSR status, desire for assistance with HRSRs, and sociodemographic and health care-related factors were associated with perceived appropriateness of HRSR screening in health care settings and comfort with HRSR documentation in electronic health records (EHR). A convenience sample of adult patients with cancer at two outpatient clinics completed self-administered surveys. We used χ 2 and Fisher exact tests to test for significant associations. The sample included 154 patients (72% female, 90% ages 45 years or older). Thirty-six percent reported ≥1 HRSRs and 27% desired assistance with HRSRs. Overall, 80% thought it was appropriate to assess for HRSRs in health care settings. The distributions of HRSR status and sociodemographic characteristics were similar among people who perceived screening to be appropriate and those who did not. Participants who perceived screening as appropriate were three times as likely to report prior experience with HRSR screening (31% vs. 10%, P = 0.01). Moreover, 60% felt comfortable having HRSRs documented in the EHR. Comfort with EHR documentation of HRSRs was significantly higher among patients desiring assistance with HRSRs (78%) compared with those who did not (53%, P < 0.01). While initiatives for HRSR screening are likely to be seen by patients with cancer as appropriate, concerns may remain over electronic documentation of HRSRs. Significance National organizations recommend addressing HRSRs such as food/housing insecurity, transportation/utilities difficulties, and interpersonal violence among patients with cancer. In our study, most patients with cancer perceived screening for HRSRs in clinical settings as appropriate. Meanwhile, concerns may remain over the documentation of HRSRs in EHRs.
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Affiliation(s)
- Milkie Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kelly Boyd
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Emilia H. De Marchis
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Bridgette G. Garnache
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Laura M. Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Cary P. Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, Connecticut
- National Clinician Scholars Program, Yale University, New Haven, Connecticut
| | - Nita K. Lee
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
- Department of Medicine-Geriatrics, The University of Chicago Medicine, Chicago, Illinois
- Comprehensive Cancer Center, The University of Chicago Medicine, Chicago, Illinois
| | - Sophia Mun
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, Connecticut
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Victoria A. Winslow
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Jennifer A. Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
- College of Education and Health Services, Benedictine University, Lisle, Illinois
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Ngongo WM, Peterson J, Lipiszko D, Gard LA, Wright KM, Parzuchowski AS, Ravenna PA, Cooper AJ, Persell SD, O'Brien MJ, Goel MS. Examining How Social Risk Factors Are Integrated Into Clinical Settings Using Existing Data: A Scoping Review. Ann Fam Med 2023; 21:S68-S74. [PMID: 36849484 PMCID: PMC9970670 DOI: 10.1370/afm.2932] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 03/01/2023] Open
Abstract
PURPOSE Integrating social care into clinical care requires substantial resources. Use of existing data through a geographic information system (GIS) has the potential to support efficient and effective integration of social care into clinical settings. We conducted a scoping literature review characterizing its use in primary care settings to identify and address social risk factors. METHODS In December 2018, we searched 2 databases and extracted structured data for eligible articles that (1) described the use of GIS in clinical settings to identify and/or intervene on social risks, (2) were published between December 2013 and December 2018, and (3) were based in the United States. Additional studies were identified by examining references. RESULTS Of the 5,574 articles included for review, 18 met study eligibility criteria: 14 (78%) were descriptive studies, 3 (17%) tested an intervention, and 1 (6%) was a theoretical report. All studies used GIS to identify social risks (increase awareness); 3 studies (17%) described interventions to address social risks, primarily by identifying relevant community resources and aligning clinical services to patients' needs. CONCLUSIONS Most studies describe associations between GIS and population health outcomes; however, there is a paucity of literature regarding GIS use to identify and address social risk factors in clinical settings. GIS technology may assist health systems seeking to address population health outcomes through alignment and advocacy; its current application in clinical care delivery is infrequent and largely limited to referring patients to local community resources.
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Affiliation(s)
- Wivine M Ngongo
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonna Peterson
- Galter Health Sciences Library & Learning Center, Northwestern University, Chicago, Illinois
| | - Dawid Lipiszko
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren A Gard
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katherine M Wright
- Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Paul A Ravenna
- Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew J Cooper
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen D Persell
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Center for Primary Care Innovation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew J O'Brien
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mita Sanghavi Goel
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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14
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Cheng AL, Leo AJ, Calfee RP, Dy CJ, Armbrecht MA, Abraham J. Multi-stakeholder perspectives regarding preferred modalities for mental health intervention delivered in the orthopedic clinic: A qualitative analysis. RESEARCH SQUARE 2023:rs.3.rs-2327095. [PMID: 36778298 PMCID: PMC9915768 DOI: 10.21203/rs.3.rs-2327095/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although depressive and anxious symptoms negatively impact musculoskeletal health and orthopedic outcomes, a gap remains in identifying modalities through which mental health intervention can realistically be delivered during orthopedic care. The purpose of this study was to understand orthopedic stakeholders' perspectives regarding the feasibility, acceptability, and usability of digital, printed, and in-person intervention modalities to address mental health as part of orthopedic care. METHODS This single-center, qualitative study was conducted within the orthopedic department of a tertiary care center. Semi-structured interviews were conducted between January and May 2022. Two stakeholder groups were interviewed using a purposive sampling approach until thematic saturation was reached. The first group included adult orthopedic patients who presented for management of ≥ 3 months of neck or back pain. The second group included early, mid, and late career orthopedic clinicians and support staff members. Stakeholders' interview responses were analyzed using deductive and inductive coding approaches followed by thematic analysis. Patients also performed usability testing of one digital and one printed mental health intervention. RESULTS Patients included 30 adults out of 85 approached (mean (SD) age 59 (14) years, 21 (70%) women, 12 (40%) non-White). Clinical team stakeholders included 22 orthopedic clinicians and support staff members out of 25 approached (11 (50%) women, 6 (27%) non-White). Clinical team members perceived a digital mental health intervention to be feasible and scalable to implement, and many patients appreciated that the digital modality offered privacy, immediate access to resources, and the ability to engage during non-business hours. However, stakeholders also expressed that a printed mental health resource is still necessary to meet the needs of patients who prefer and/or can only engage with tangible, rather than digital, mental health resources. Many clinical team members expressed skepticism regarding the current feasibility of scalably incorporating in-person mental health support into orthopedic care. CONCLUSIONS Although digital intervention offers implementation-related advantages over printed and in-person mental health interventions, a subset of often underserved patients will not currently be reached using exclusively digital intervention. Future research should work to identify combinations of effective mental health interventions that provide equitable access for orthopedic patients. TRIAL REGISTRATION Not applicable.
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15
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Divakar A, James K, Mayorga A, Michelson KN. Availability of bereavement support following traumatic pediatric death in a large metropolitan area. DEATH STUDIES 2023:1-9. [PMID: 36708153 DOI: 10.1080/07481187.2023.2170492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Following an unexpected pediatric death, survivors undergo unique trauma. Medical examiners (MEs) evaluate most of these deaths. We evaluated the bereavement support available to survivors in the Chicagoland area following a pediatric death. We had two goals: to characterize the available bereavement support options and compare the locations (by zip code) of support groups with the locations (by zip code) in which pediatric ME cases occurred. We identified 48 organizations that provided bereavement support services at 74 locations in the summer and fall of 2020. Locations by zip codes in which the largest number of ME cases occurred did not have support groups. Locations in which more ME cases occurred generally had lower-income populations and a greater proportion of Black or Hispanic residents. Bereavement support following pediatric death is inadequate and unevenly distributed across the Chicagoland area.
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Affiliation(s)
- Annika Divakar
- School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - K James
- Greater Illinois Pediatric Palliative Care Coalition, Chicago, Illinois, USA
- Missing Pieces, Chicago, Illinois, USA
| | - A Mayorga
- Cook County Medical Examiner's Office, Chicago, Illinois, USA
| | - K N Michelson
- School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Missing Pieces, Chicago, Illinois, USA
- Critical Care, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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16
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Hotton AL, Ozik J, Kaligotla C, Collier N, Stevens A, Khanna AS, MacDonell MM, Wang C, LePoire DJ, Chang YS, Martinez-Moyano IJ, Mucenic B, Pollack HA, Schneider JA, Macal C. Impact of changes in protective behaviors and out-of-household activities by age on COVID-19 transmission and hospitalization in Chicago, Illinois. Ann Epidemiol 2022; 76:165-173. [PMID: 35728733 PMCID: PMC9212859 DOI: 10.1016/j.annepidem.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Even with an efficacious vaccine, protective behaviors (social distancing, masking) are essential for preventing COVID-19 transmission and could become even more important if current or future variants evade immunity from vaccines or prior infection. METHODS We created an agent-based model representing the Chicago population and conducted experiments to determine the effects of varying adult out-of-household activities (OOHA), school reopening, and protective behaviors across age groups on COVID-19 transmission and hospitalizations. RESULTS From September-November 2020, decreasing adult protective behaviors and increasing adult OOHA both substantially impacted COVID-19 outcomes; school reopening had relatively little impact when adult protective behaviors and OOHA were maintained. As of November 1, 2020, a 50% reduction in young adult (age 18-40) protective behaviors resulted in increased latent infection prevalence per 100,000 from 15.93 (IQR 6.18, 36.23) to 40.06 (IQR 14.65, 85.21) and 19.87 (IQR 6.83, 46.83) to 47.74 (IQR 18.89, 118.77) with 15% and 45% school reopening. Increasing adult (age ≥18) OOHA from 65% to 80% of prepandemic levels resulted in increased latent infection prevalence per 100,000 from 35.18 (IQR 13.59, 75.00) to 69.84 (IQR 33.27, 145.89) and 38.17 (IQR 15.84, 91.16) to 80.02 (IQR 30.91, 186.63) with 15% and 45% school reopening. Similar patterns were observed for hospitalizations. CONCLUSIONS In areas without widespread vaccination coverage, interventions to maintain adherence to protective behaviors, particularly among younger adults and in out-of-household settings, remain a priority for preventing COVID-19 transmission.
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Affiliation(s)
- Anna L. Hotton
- Department of Medicine, University of Chicago, Chicago, IL,Corresponding author: Department of Medicine, University of Chicago, 5837 N Maryland Ave, Chicago, IL, 60637
| | - Jonathan Ozik
- Argonne National Laboratory, Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, Northwestern Argonne Institute for Science and Engineering, Evanston, IL
| | | | - Nick Collier
- Argonne National Laboratory, Lemont, IL, Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL
| | - Abby Stevens
- Department of Statistics, University of Chicago, Chicago, IL
| | - Aditya S. Khanna
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Margaret M. MacDonell
- Radiological, Chemical and Environmental Risk Analysis (RACER), Environmental Science Division (EVS), Argonne National Laboratory, Lemont, IL
| | - Cheng Wang
- RACER EVS, Argonne National Laboratory, Lemont, IL, Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL
| | | | - Young-Soo Chang
- Department of Climate and Earth System Science (CESS), EVS, Argonne National Laboratory, Lemont, IL
| | - Ignacio J. Martinez-Moyano
- Argonne National Laboratory, Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, Northwestern Argonne Institute for Science and Engineering, Evanston, IL
| | | | - Harold A. Pollack
- Crown School of Social Work Policy and Practice, University of Chicago, Chicago, IL
| | - John A. Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL
| | - Charles Macal
- Argonne National Laboratory, Consortium for Advanced Science and Engineering, University of Chicago, Chicago, IL, Northwestern Argonne Institute for Science and Engineering, Evanston, IL
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Beidler LB, Razon N, Lang H, Fraze TK. "More than just giving them a piece of paper": Interviews with Primary Care on Social Needs Referrals to Community-Based Organizations. J Gen Intern Med 2022; 37:4160-4167. [PMID: 35426010 PMCID: PMC9708990 DOI: 10.1007/s11606-022-07531-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary care practices are responding to calls to incorporate patients' social risk factors, such as housing, food, and economic insecurity, into clinical care. Healthcare likely relies on the expertise and resources of community-based organizations to improve patients' social conditions, yet little is known about the referral process. OBJECTIVE To characterize referrals to community-based organizations by primary care practices. DESIGN Qualitative study using semi-structured interviews with healthcare administrators responsible for social care efforts in their organization. PARTICIPANTS Administrators at 50 diverse US healthcare organizations with efforts to address patients' social risks. MAIN MEASURES Approaches used in primary care to implement social needs referral to community-based organizations. RESULTS Interviewed administrators reported that social needs referrals were an essential element in their social care activities. Administrators described the ideal referral programs as placing limited burden on care teams, providing patients with customized referrals, and facilitating closed-loop referrals. We identified three key challenges organizations experience when trying to implement the ideal referrals program: (1) developing and maintaining resources lists; (2) aligning referrals with patient needs; and (3) measuring the efficacy of referrals. Collectively, these challenges led to organizations relying on staff to manually develop and update resource lists and, in most cases, provide patients with generic referrals. Administrators not only hoped that referral platforms may help overcome some of these barriers, but also reported implementation challenges with platforms including inconsistent buy-in and use across staff; integration with electronic health records; management and prioritization of resources; and alignment with other organizations in their market. CONCLUSION AND RELEVANCE Referrals to community-based organizations were used in primary care to improve patients' social conditions, but despite strong motivations, interviewees reported challenges providing tailored and up-to-date information to patients.
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Affiliation(s)
- Laura B Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, USA
| | - Na'amah Razon
- Family and Community Medicine, University of California, Davis, Davis, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA
| | | | - Taressa K Fraze
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA.
- Family and Community Medicine, University of California, San Francisco, 3333 California Street, Suite 465, San Francisco, CA, 94118, USA.
- Healthforce Center, University of California, San Francisco, San Francisco, USA.
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Levasseur M, Naud D, Presse N, Delli-Colli N, Boissy P, Cossette B, Couturier Y, Cadieux Genesse J. Aging all over the place: a multidisciplinary framework that considers place and life trajectories of older adults within their communities. QUALITY IN AGEING AND OLDER ADULTS 2022. [DOI: 10.1108/qaoa-07-2021-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This conceptual paper aims to describe aging all over the place (AAOP), a federative framework for action, research and policy that considers older adults’ diverse experiences of place and life trajectories, along with person-centered care.
Design/methodology/approach
The framework was developed through group discussions, followed by an appraisal of aging models and validation during workshops with experts, including older adults.
Findings
Every residential setting and location where older adults go should be considered a “place,” flexible and adaptable enough so that aging in place becomes aging all over the place. Health-care professionals, policymakers and researchers are encouraged to collaborate around four axes: biopsychosocial health and empowerment; welcoming, caring, mobilized and supportive community; spatiotemporal life and care trajectories; and out-of-home care and services. When consulted, a Seniors Committee showed appreciation for flexible person-centered care, recognition of life transitions and care trajectories and meaningfulness of the name.
Social implications
Population aging and the pandemic call for intersectoral actions and for stakeholders beyond health care to act as community leaders. AAOP provides opportunities to connect environmental determinants of health and person-centered care.
Originality/value
Building on the introduction of an ecological experience of aging, AAOP broadens the concept of care as well as the political and research agenda by greater integration of community and clinical actions. AAOP also endeavors to avoid patronizing older adults and to engage society in strengthening circles of benevolence surrounding older adults, regardless of their residential setting. AAOP’s applicability is evidenced by existing projects that share its approach.
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Steeves-Reece AL, Totten AM, Broadwell KD, Richardson DM, Nicolaidis C, Davis MM. Social Needs Resource Connections: A Systematic Review of Barriers, Facilitators, and Evaluation. Am J Prev Med 2022; 62:e303-e315. [PMID: 35078672 PMCID: PMC9850790 DOI: 10.1016/j.amepre.2021.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/20/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Healthcare organizations increasingly are screening patients for social needs (e.g., food, housing) and referring them to community resources. This systematic mixed studies review assesses how studies evaluate social needs resource connections and identifies patient- and caregiver-reported factors that may inhibit or facilitate resource connections. METHODS Investigators searched PubMed and CINAHL for articles published from October 2015 to December 2020 and used dual review to determine inclusion based on a priori selection criteria. Data related to study design, setting, population of interest, intervention, and outcomes were abstracted. Articles' quality was assessed using the Mixed Methods Appraisal Tool. Data analysis was conducted in 2021. RESULTS The search identified 34 articles from 32 studies. The authors created a taxonomy of quantitative resource connection measures with 4 categories: whether participants made contact with resources, received resources, had their social needs addressed, or rated some aspect of their experience with resources. Barriers to resource connections were inadequacy, irrelevancy, or restrictiveness; inaccessibility; fears surrounding stigma or discrimination; and factors related to staff training and resource information sharing. Facilitators were referrals' relevancy, the degree of support and simplicity embedded within the interventions, and interventions being comprehensive and inclusive. DISCUSSION This synthesis of barriers and facilitators indicates areas where healthcare organizations may have agency to improve the efficacy of social needs screening and referral interventions. The authors also recommend that resource connection measures be explicitly defined and focus on whether participants received new resources and whether their social needs were addressed.
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Affiliation(s)
- Anna Louise Steeves-Reece
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon.
| | - Annette Marie Totten
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon; Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, Oregon; Department of Medical Informatics & Clinical Epidemiology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Katherine DuBose Broadwell
- Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Dawn Michele Richardson
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, Oregon; Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Melinda Marie Davis
- Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon; Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health & Science University, Portland, Oregon; Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon
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Liu PY, Beck AF, Lindau ST, Holguin M, Kahn RS, Fleegler E, Henize AW, Halfon N, Schickedanz A. A Framework for Cross-Sector Partnerships to Address Childhood Adversity and Improve Life Course Health. Pediatrics 2022; 149:e2021053509O. [PMID: 35503315 PMCID: PMC9549524 DOI: 10.1542/peds.2021-053509o] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Childhood adversity and its structural causes drive lifelong and intergenerational inequities in health and well-being. Health care systems increasingly understand the influence of childhood adversity on health outcomes but cannot treat these deep and complex issues alone. Cross-sector partnerships, which integrate health care, food support, legal, housing, and financial services among others, are becoming increasingly recognized as effective approaches address health inequities. What principles should guide the design of cross-sector partnerships that address childhood adversity and promote Life Course Health Development (LCHD)? The complex effects of childhood adversity on health development are explained by LCHD concepts, which serve as the foundation for a cross-sector partnership that optimizes lifelong health. We review the evolution of cross-sector partnerships in health care to inform the development of an LCHD-informed partnership framework geared to address childhood adversity and LCHD. This framework outlines guiding principles to direct partnerships toward life course-oriented action: (1) proactive, developmental, and longitudinal investment; (2) integration and codesign of care networks; (3) collective, community and systemic impact; and (4) equity in praxis and outcomes. Additionally, the framework articulates foundational structures necessary for implementation: (1) a shared cross-sector theory of change; (2) relational structures enabling shared leadership, trust, and learning; (3) linked data and communication platforms; and (4) alternative funding models for shared savings and prospective investment. The LCHD-informed cross-sector partnership framework presented here can be a guide for the design and implementation of cross-sector partnerships that effectively address childhood adversity and advance health equity through individual-, family-, community-, and system-level intervention.
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Affiliation(s)
- Patrick Y. Liu
- Center for Healthier Children, Families, and Communities
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Andrew F. Beck
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology and The University of Chicago, Chicago, Illinois
- Section of Geriatrics and Palliative Medicine, Department of Medicine, The University of Chicago, Chicago, Illinois
| | - Monique Holguin
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Robert S. Kahn
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Neal Halfon
- Center for Healthier Children, Families, and Communities
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Adam Schickedanz
- Center for Healthier Children, Families, and Communities
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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21
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Vasan A, Darko O, Fortin K, Scribano PV, Kenyon CC. Community Resource Connection for Pediatric Caregivers With Unmet Social Needs: A Qualitative Study. Acad Pediatr 2022; 22:461-469. [PMID: 34571255 PMCID: PMC8942862 DOI: 10.1016/j.acap.2021.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Pediatric health systems are increasingly screening caregivers for unmet social needs. However, it remains unclear how best to connect families with unmet needs to available and appropriate community resources. We aimed to explore caregivers' perceived barriers to and facilitators of community resource connection. METHODS We conducted semistructured interviews with caregivers of pediatric patients admitted to one inpatient unit of an academic quaternary care children's hospital. All caregivers who screened positive for one or more unmet social needs on a tablet-based screener were invited to participate in an interview. Interviews were recorded, transcribed, and coded by 2 independent coders using content analysis, resolving discrepancies by consensus. Interviews continued until thematic saturation was achieved. RESULTS We interviewed 28 of 31 eligible caregivers. Four primary themes emerged. First, caregivers of children with complex chronic conditions felt that competing priorities related to their children's medical care often made it more challenging to establish connection with resources. Second, caregivers cited burdensome application and enrollment processes as a barrier to resource connection. Third, caregivers expressed a preference for geographically tailored, web-based resources, rather than paper resources. Last, caregivers expressed a desire for ongoing longitudinal support in establishing and maintaining connections with community resources after their child's hospital discharge. CONCLUSION Pediatric caregivers with unmet social needs reported competing priorities and burdensome application processes as barriers to resource connection. Electronic resources can help caregivers identify locally available services, but longitudinal supports may also be needed to ensure caregivers can establish and maintain linkages with these services.
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Affiliation(s)
- Aditi Vasan
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (A Vasan and CC Kenyon), Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania (A Vasan and CC Kenyon), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania (A Vasan, O Darko, K Fortin, PV Scribano, and CC Kenyon), Philadelphia, Pa.
| | - Olivia Darko
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kristine Fortin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Philip V. Scribano
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Chén C. Kenyon
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA,Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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22
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Smits JAJ, Zvolensky MJ, Rosenfield D, Brown RA, Otto MW, Dutcher CD, Papini S, Freeman SZ, DiVita A, Perrone A, Garey L. Community-based smoking cessation treatment for adults with high anxiety sensitivity: a randomized clinical trial. Addiction 2021; 116:3188-3197. [PMID: 34033178 PMCID: PMC10091508 DOI: 10.1111/add.15586] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/02/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS People with anxiety disorders are more likely to smoke and less likely to succeed when they try to quit. Anxiety sensitivity may underlie both phenomena, such that people with high anxiety sensitivity react to interoceptive distress by avoidance. This study aimed to test the efficacy of an exercise program that induced interoceptive distress and thereby created tolerance to this distress in a safe environment. DESIGN, SETTING AND PARTICIPANTS Randomized clinical trial at four YMCA branches in Austin, Texas, USA. Participants [n = 150; 130 (86.7%) white; 101 (67.3%) female; meanage = 38.6, standard deviation (SD)age = 10.4] were adult, daily smokers with high anxiety sensitivity motivated to quit smoking, who reported no regular moderate-intensity exercise. INTERVENTIONS Participants were assigned a YMCA personal trainer who guided them through a 15-week intervention aerobic exercise program. Participants assigned to the personalized intervention trained at 60-85% of their heart rate reserve (HRR), whereas participants assigned to the control intervention trained at 20-40% of their HRR. Participants in both groups received standard behavioral support and nicotine replacement therapy. MEASUREMENTS The primary outcome was biologically verified 7-day point prevalence abstinence (PPA) at 6-month follow-up. FINDINGS Sixty-one per cent of participants were available at the 6-month follow-up. PPA at 6 months was higher in the personalized intervention than the control intervention [27.6 versus 14.8%; odds ratio (OR) = 2.20, 95% confidence interval (CI) = 1.28, 3.80, P = 0.005], assuming missing at random. Anxiety sensitivity declined in both groups with no evidence that this differed between groups. CONCLUSIONS An exercise program of high intensity increased abstinence from smoking in people with high anxiety sensitivity, but may not have done so by reducing anxiety sensitivity.
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Affiliation(s)
- Jasper A J Smits
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | | | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Richard A Brown
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Christina D Dutcher
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Santiago Papini
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Slaton Z Freeman
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Annabelle DiVita
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Alex Perrone
- Institute for Mental Health Research and Department of Psychology, The University of Texas at Austin, Austin, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
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23
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Lindau ST, Makelarski JA, Kaligotla C, Abramsohn EM, Beiser DG, Chou C, Collier N, Huang ES, Macal CM, Ozik J, Tung EL. Building and experimenting with an agent-based model to study the population-level impact of CommunityRx, a clinic-based community resource referral intervention. PLoS Comput Biol 2021; 17:e1009471. [PMID: 34695116 PMCID: PMC8568099 DOI: 10.1371/journal.pcbi.1009471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/04/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022] Open
Abstract
CommunityRx (CRx), an information technology intervention, provides patients with a personalized list of healthful community resources (HealtheRx). In repeated clinical studies, nearly half of those who received clinical "doses" of the HealtheRx shared their information with others ("social doses"). Clinical trial design cannot fully capture the impact of information diffusion, which can act as a force multiplier for the intervention. Furthermore, experimentation is needed to understand how intervention delivery can optimize social spread under varying circumstances. To study information diffusion from CRx under varying conditions, we built an agent-based model (ABM). This study describes the model building process and illustrates how an ABM provides insight about information diffusion through in silico experimentation. To build the ABM, we constructed a synthetic population ("agents") using publicly-available data sources. Using clinical trial data, we developed empirically-informed processes simulating agent activities, resource knowledge evolution and information sharing. Using RepastHPC and chiSIM software, we replicated the intervention in silico, simulated information diffusion processes, and generated emergent information diffusion networks. The CRx ABM was calibrated using empirical data to replicate the CRx intervention in silico. We used the ABM to quantify information spread via social versus clinical dosing then conducted information diffusion experiments, comparing the social dosing effect of the intervention when delivered by physicians, nurses or clinical clerks. The synthetic population (N = 802,191) exhibited diverse behavioral characteristics, including activity and knowledge evolution patterns. In silico delivery of the intervention was replicated with high fidelity. Large-scale information diffusion networks emerged among agents exchanging resource information. Varying the propensity for information exchange resulted in networks with different topological characteristics. Community resource information spread via social dosing was nearly 4 fold that from clinical dosing alone and did not vary by delivery mode. This study, using CRx as an example, demonstrates the process of building and experimenting with an ABM to study information diffusion from, and the population-level impact of, a clinical information-based intervention. While the focus of the CRx ABM is to recreate the CRx intervention in silico, the general process of model building, and computational experimentation presented is generalizable to other large-scale ABMs of information diffusion.
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Affiliation(s)
- Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, United States of America
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, United States of America
- Department of Medicine, Section of Geriatrics & Palliative Medicine, University of Chicago, Chicago, Illinois, United States of America
- Bucksbaum Institute for Clinical Excellence, University of Chicago, Chicago, Illinois, United States of America
| | - Jennifer A. Makelarski
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, United States of America
| | - Chaitanya Kaligotla
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, United States of America
- Beedie School of Business, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Emily M. Abramsohn
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, United States of America
| | - David G. Beiser
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, Alabama, United States of America
| | - Nicholson Collier
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, United States of America
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America
| | - Elbert S. Huang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Charles M. Macal
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, United States of America
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, United States of America
- Consortium for Advanced Science and Engineering, University of Chicago, Chicago, Illinois, United States of America
| | - Elizabeth L. Tung
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
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24
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Fischer A, Conigliaro J, Allicock S, Kim EJ. Examination of social determinants of health among patients with limited English proficiency. BMC Res Notes 2021; 14:299. [PMID: 34353369 PMCID: PMC8340469 DOI: 10.1186/s13104-021-05720-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of this study is to examine the prevalence of social needs by English proficiency using data from Northwell Health’s social determinants of health screening program. The screening program evaluates 12 domains of social needs: material need, employment, medical-legal assistance, health insurance, public benefits, health literacy, transportation, medical care, utilities, housing quality, food security, and housing insecurity. We have identified patients to have limited English proficiency if they have selected a language other than English as their primary language. Results The study population includes 92,958 individuals; of these, 83,445 (89.8%) patients are English proficient, and 9513 (10.2%) patients have limited English proficiency. A higher percentage of patients with limited English proficiency has social needs, including material need, employment, medical-legal assistance, health insurance, public benefit, health literacy, medical care, utility bill, poor housing quality, and food insecurity (all p-values < 0.05). In multivariable logistic regression models adjusting for sociodemographic information, LEP status (odds ratio = 1.36 [1.25–1.49]) has been associated with having social needs. These findings suggest that system-wide SDH screening and referral programs should identify ways to ensure capturing social needs among patients with limited English proficiency. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05720-7.
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Affiliation(s)
- Austin Fischer
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA
| | - Joseph Conigliaro
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA.,Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, 600 Community Drive Suite 403, Manhasset, NY, 11030, USA
| | - Shaun Allicock
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA.,Northwell Health, 5 Dakota Dr, New Hyde Park, NY, 11042, USA
| | - Eun Ji Kim
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA. .,Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, 600 Community Drive Suite 403, Manhasset, NY, 11030, USA.
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25
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Lindau ST, Makelarski JA, Abramsohn EM, Beiser DG, Boyd K, Huang ES, Paradise K, Tung EL. Sharing information about h
ealth‐related
resources: Observations from a community resource referral intervention trial in a predominantly African American/Black community. J Assoc Inf Sci Technol 2021. [DOI: 10.1002/asi.24560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stacy Tessler Lindau
- Department of Obstetrics and Gynecology The University of Chicago Chicago Illinois USA
- Department of Medicine – Geriatrics The University of Chicago Chicago Illinois USA
| | | | - Emily M. Abramsohn
- Department of Obstetrics and Gynecology The University of Chicago Chicago Illinois USA
| | - David G. Beiser
- Section of Emergency Medicine, Department of Medicine The University of Chicago Chicago Illinois USA
| | - Kelly Boyd
- Department of Obstetrics and Gynecology The University of Chicago Chicago Illinois USA
| | - Elbert S. Huang
- Section of General Internal Medicine, Department of Medicine The University of Chicago Chicago Illinois USA
| | - Kelsey Paradise
- Department of Obstetrics and Gynecology The University of Chicago Chicago Illinois USA
| | - Elizabeth L. Tung
- Section of General Internal Medicine, Department of Medicine The University of Chicago Chicago Illinois USA
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26
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Rogers JR, Lee J, Zhou Z, Cheung YK, Hripcsak G, Weng C. Contemporary use of real-world data for clinical trial conduct in the United States: a scoping review. J Am Med Inform Assoc 2021; 28:144-154. [PMID: 33164065 DOI: 10.1093/jamia/ocaa224] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Real-world data (RWD), defined as routinely collected healthcare data, can be a potential catalyst for addressing challenges faced in clinical trials. We performed a scoping review of database-specific RWD applications within clinical trial contexts, synthesizing prominent uses and themes. MATERIALS AND METHODS Querying 3 biomedical literature databases, research articles using electronic health records, administrative claims databases, or clinical registries either within a clinical trial or in tandem with methodology related to clinical trials were included. Articles were required to use at least 1 US RWD source. All abstract screening, full-text screening, and data extraction was performed by 1 reviewer. Two reviewers independently verified all decisions. RESULTS Of 2020 screened articles, 89 qualified: 59 articles used electronic health records, 29 used administrative claims, and 26 used registries. Our synthesis was driven by the general life cycle of a clinical trial, culminating into 3 major themes: trial process tasks (51 articles); dissemination strategies (6); and generalizability assessments (34). Despite a diverse set of diseases studied, <10% of trials using RWD for trial process tasks evaluated medications or procedures (5/51). All articles highlighted data-related challenges, such as missing values. DISCUSSION Database-specific RWD have been occasionally leveraged for various clinical trial tasks. We observed underuse of RWD within conducted medication or procedure trials, though it is subject to the confounder of implicit report of RWD use. CONCLUSION Enhanced incorporation of RWD should be further explored for medication or procedure trials, including better understanding of how to handle related data quality issues to facilitate RWD use.
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Affiliation(s)
- James R Rogers
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Junghwan Lee
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Ziheng Zhou
- Institute of Human Nutrition, Columbia University, New York, New York, USA
| | - Ying Kuen Cheung
- Department of Biostatistics, Columbia University, New York, New York, USA, and
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA.,Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
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27
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Abramsohn EM, Paradise KM, Glover CM, Benjamins M, Douglas L, Jerome J, Kim ML, Kostas T, Mata D, Padron F, Shah RC, Lindau ST. CommunityRx: Optimizing a Community Resource Referral Intervention for Minority Dementia Caregivers. J Appl Gerontol 2021; 41:113-123. [PMID: 33834890 DOI: 10.1177/07334648211005594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Community resource referral systems have been implemented into care settings that serve persons with dementia but with little input from caregivers. Focus groups were conducted with African American, Hispanic, and Asian caregivers to describe their preferences for community resource referral information. Caregivers discussed the significance of a community resource list for dementia caregiving and self-care and articulated strategies for effective information delivery during a medical visit. Most caregivers acknowledged that resource needs change with progression of dementia, but no patterns emerged with regard to preference for information delivered incrementally based on disease stage or all at once. Hispanic and Asian caregivers felt that resource information should specify service providers' language and cultural capabilities. All caregivers agreed that delivery by a member of the care team with knowledge of dementia-specific resources would be most effective. Optimal delivery of community resource referrals is caregiver-centered and customizable to individual and subgroup preferences.
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Affiliation(s)
| | | | - Crystal M Glover
- Rush University Medical Center, Chicago, IL, USA.,Rush Alzheimer's Disease Center, Chicago, IL, USA
| | | | | | | | | | | | - David Mata
- Sinai Urban Health Institute, Chicago, IL, USA
| | | | - Raj C Shah
- Rush University Medical Center, Chicago, IL, USA.,Rush Alzheimer's Disease Center, Chicago, IL, USA
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28
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Abramsohn E, DePumpo M, Boyd K, Brown T, Garrett MF, Kho A, Navalkha C, Paradise K, Lindau ST. Implementation of Community-Based Resource Referrals for Cardiovascular Disease Self-Management. Ann Fam Med 2020; 18:486-495. [PMID: 33168676 PMCID: PMC7708286 DOI: 10.1370/afm.2583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/13/2020] [Accepted: 03/09/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Describe primary care practices' implementation of CommunityRx-H3, a community resource referral intervention that utilized practice facilitators to support cardiovascular disease (CVD) prevention quality improvement. METHODS Qualitative focus groups were conducted with practice facilitators to elicit perceptions of practices' experiences with CommunityRx-H3, practice-level factors affecting, and practice facilitator strategies to promote implementation. Qualitative data were analyzed using directed content analysis. The Consolidated Framework for Implementation Research was applied deductively to organize and interpret findings. RESULTS Fourteen of all 19 practice facilitators participated. Practice facilitators perceived that staff attitudes about connecting patients to community resources for CVD were largely positive. Practices were already using a range of non-systematic strategies to refer to community resources. Practice-level factors that facilitated CommunityRx-H3 implementation included clinician "champions," engaged practice managers, and a practice culture that valued community resources. Implementation barriers included a practice's unwillingness to integrate the intervention into existing workflows, limited staff capacity to complete the resource inventory, and unavailability or cost of materials needed to print the resource referral list ("HealtheRx-H3"). Practice facilitator strategies to promote implementation included supporting ongoing customization of the HealtheRx-H3 and material support. Practice facilitators felt implementation would be improved by integration of CommunityRx-H3 with electronic medical record workflows and alternative methods for engaging practices in the implementation process. CONCLUSIONS Practice facilitators are increasingly being utilized by primary care practices to support quality improvement interventions and, as shown here, can also play an important role in implementation science. This study yields insights to improve implementation of community resource referral solutions to support primary care CVD prevention efforts.
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Affiliation(s)
| | | | - Kelly Boyd
- The University of Chicago, Chicago, Illinois
| | - Tiffany Brown
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Milton F Garrett
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Abel Kho
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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29
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Palakshappa D, Benefield AJ, Furgurson KF, Harley MG, Bundy R, Moses A, Taxter AJ, Bensinger AS, Cao X, Denizard-Thompson N, Rosenthal GE, Miller DP. Feasibility of Mobile Technology to Identify and Address Patients' Unmet Social Needs in a Primary Care Clinic. Popul Health Manag 2020; 24:385-392. [PMID: 32924796 DOI: 10.1089/pop.2020.0059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Mobile health tools may overcome barriers to social needs screening; however, there are limited data on the feasibility of using these tools in clinical settings. The objective was to determine the feasibility of using a mobile health system to screen for patients' social needs. In one large primary care clinic, the authors tested a tablet-based system that screens patients for social needs, transmits results to the electronic health record, and alerts providers. All adult patients presenting for a nonurgent visit were eligible. The authors evaluated the feasibility of the system and conducted follow-up surveys to determine acceptability and if patients accessed resources through the process. All providers were surveyed. Of the 252 patients approached, 219 (86.9%) completed the screen. Forty-three (19.6%) required assistance with the tablet, and 150 (68.5%) screened positive for at least 1 unmet need (food, housing, or transportation). Of the 150, 103 (68.7%) completed a follow-up survey. The majority agreed that people would learn to use the tablet quickly. Forty-eight patients (46.6%) reported contacting at least 1 community organization through the process. Of the 27 providers, 23 (85.2%) completed a survey and >70% agreed the system would result in patients having better access to resources. It was feasible to use a tablet-based system to screen for social needs. Clinics considering using mobile tools will need to determine how to screen patients who may need assistance with the tool and how to connect patients to resources through the system based on the burden of unmet needs.
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Affiliation(s)
- Deepak Palakshappa
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew J Benefield
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katherine F Furgurson
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael G Harley
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Richa Bundy
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam Moses
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alysha J Taxter
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Andrew S Bensinger
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Xiangkun Cao
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nancy Denizard-Thompson
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gary E Rosenthal
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David P Miller
- Department of Internal Medicine and Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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