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Fassas E, Fischer K, Schenkel S, David Gatz J, Gingold DB. Public Health Interventions in the Emergency Department: A Framework for Evaluation. West J Emerg Med 2024; 25:415-422. [PMID: 38801049 PMCID: PMC11112666 DOI: 10.5811/westjem.18316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 05/29/2024] Open
Abstract
Emergency departments (ED) in the United States serve a dual role in public health: a portal of entry to the health system and a safety net for the community at large. Public health officials often target the ED for public health interventions due to the perception that it is uniquely able to reach underserved populations. However, under time and resource constraints, emergency physicians and public health officials must make calculated decisions in choosing which interventions in their local context could provide maximal impact to achieve public health benefit. We identify how decisions regarding public health interventions are affected by considerations of cost, time, and available personnel, and further consider the role of local community needs, health department goals, and political environment. We describe a sample of ED-based public health interventions and demonstrate how to use a proposed framework to assess interventions. We posit a series of questions and variables to consider: local disease prevalence; ability of the ED to perform the intervention; relative efficacy of the ED vs community partnerships as the primary intervention location; and expected outcomes. In using this framework, clinicians should be empowered to improve the public health in their communities.
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Affiliation(s)
| | - Kyle Fischer
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - John David Gatz
- University of Maryland School of Medicine, Baltimore, Maryland
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2
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Mazurenko O, Hirsh AT, Harle CA, McNamee C, Vest JR. Health-related social needs information in the emergency department: clinician and patient perspectives on availability and use. BMC Emerg Med 2024; 24:45. [PMID: 38500019 PMCID: PMC10949703 DOI: 10.1186/s12873-024-00959-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Patient health-related social needs (HRSN) complicate care and drive poor outcomes in emergency department (ED) settings. This study sought to understand what HRSN information is available to ED physicians and staff, and how HRSN-related clinical actions may or may not align with patient expectations. METHODS We conducted a qualitative study using in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. We asked ED providers, ED staff, and ED patients from one health system in the mid-Western United Stated about HRSN information availability during an ED encounter, HRSN data collection, and HRSN data use. Interviews were recorded, transcribed, and analyzed using modified thematic approach. RESULTS We conducted 24 interviews (8 per group: ED providers, ED staff, and ED patients) from December 2022 to May 2023. We identified three themes: (1) Availability: ED providers and staff reported that HRSNs information is inconsistently available. The availability of HRSN data is influenced by patient willingness to disclose it during an encounter. (2) Collection: ED providers and staff preferred and predominantly utilized direct conversation with patients to collect HRSNs, despite other methods being available to them (e.g., chart review, screening questionnaires). Patients' disclosure preferences were based on modality and team member. (3) Use: Patients wanted to be connected to relevant resources to address their HRSNs. Providers and staff altered clinical care to account for or accommodate HRSNs. System-level challenges (e.g., limited resources) limited provider and staff ability to address patients HRSNs. CONCLUSIONS In the ED, HRSNs information was inconsistently available, collected, or disclosed. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. Accounting for such difference in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.
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Affiliation(s)
- Olena Mazurenko
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - Adam T Hirsh
- Department of Psychology, School of Science, Indiana University- Indianapolis, Indianapolis, IN, USA
| | - Christopher A Harle
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Cassidy McNamee
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Joshua R Vest
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Liu H, Li J, Zhu S, Zhang X, Zhang F, Zhang X, Zhao G, Zhu W, Zhou F. Long-term trends in incidence, mortality and burden of liver cancer due to specific etiologies in Hubei Province. Sci Rep 2024; 14:4924. [PMID: 38418596 PMCID: PMC10902496 DOI: 10.1038/s41598-024-53812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/05/2024] [Indexed: 03/01/2024] Open
Abstract
Liver cancer, a chronic non-communicable disease, represents a serious public health problem. Long-term trends in the burden of liver cancer disease are heterogeneous across regions. Incidence and mortality of liver cancer, based on the Global Burden of Disease, were collected from the Chinese Centre for Disease Control and Prevention. Age-period-cohort model was utilized to reveal the secular trends and estimate the age, period and cohort effects on primary liver cancer due to specific etiologies. Both the age-standardized incidence and mortality rate of liver cancer in Hubei province were on the rise, although there were discrepancies between gender groups. From age-period-cohort analysis, both incidence and mortality of liver cancer due to Hepatitis B virus were the highest in all age groups. The incidence of all liver cancer groups increased with time period in males, while this upward trend was observed in females only in liver cancer due to alcohol use group. Cohort effects indicated the disease burden of liver cancer decreased with birth cohorts. Local drifts showed that the incidence of liver cancer due to specific etiologies was increasing in the age group of males between 40 and 75 years old. The impact of an aging population will continue in Hubei Province. the disease burden of liver cancer will continue to increase, and personalized prevention policies must be adopted to address these changes.
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Affiliation(s)
- Hao Liu
- Institute of Chronic Disease Prevention and Cure, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Jun Li
- Institute of Health Inspection and Testing, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Xupeng Zhang
- Wuhan Changjiang New Area Center for Disease Control and Prevention, Wuhan, 430345, China
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Xiaowei Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Gaichan Zhao
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Wei Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Fang Zhou
- Institute of Chronic Disease Prevention and Cure, Hubei Provincial Center for Disease Control and Prevention, Wuhan, 430079, China.
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Simon L, Marsh R, Sanchez LD, Camargo C, Donoff B, Cardenas V, Manning W, Loo S, Cash RE, Samuels-Kalow ME. Mapping Oral health and Local Area Resources (MOLAR): protocol for a randomised controlled trial connecting emergency department patients with social and dental resources. BMJ Open 2023; 13:e078157. [PMID: 38072485 PMCID: PMC10729266 DOI: 10.1136/bmjopen-2023-078157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION There are substantial inequities in oral health access and outcomes in the USA, including by income and racial and ethnic identity. People with adverse social determinants of health (aSDoH), such as housing or food insecurity, are also more likely to have unmet dental needs. Many patients with dental problems present to the emergency department (ED), where minimal dental care or referral is usually available. Nonetheless, the ED represents an important point of contact to facilitate screening and referral for unmet oral health needs and aSDoH, particularly for patients who may not otherwise have access to care. METHODS AND ANALYSIS Mapping Oral health and Local Area Resources is a randomised controlled trial enrolling 2049 adult and paediatric ED patients with unmet oral health needs into one of three trial arms: (a) a standard handout of nearby dental and aSDoH resources; (b) a geographically matched listing of aSDoH resources and a search link for identification of geographically matched dental resources; or (c) geographically matched resources along with personalised care navigation. Follow-up at 3, 6, 9 and 12 months will evaluate oral health-related quality of life, linkage to resources and dental treatment, ED visits for dental problems and the association between linkage and neighbourhood resource density. ETHICS AND DISSEMINATION All sites share a single human subjects review board protocol which has been fully approved by the Mass General Brigham Human Subjects Review Board. Informed consent will be obtained from all adults and adult caregivers, and assent will be obtained from age-appropriate child participants. Results will demonstrate the impact of addressing aSDoH on oral health access and the efficacy of various forms of resource navigation compared with enhanced standard care. Our findings will facilitate sustainable, scalable interventions to identify and address aSDoH in the ED to improve oral health and reduce oral health inequities. TRIAL REGISTRATION NUMBER NCT05688982.
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Affiliation(s)
- Lisa Simon
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Regan Marsh
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Leon D Sanchez
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carlos Camargo
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bruce Donoff
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Vanessa Cardenas
- Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - William Manning
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie Loo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca E Cash
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Margaret E Samuels-Kalow
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Simon L, Cardenas V, Davila-Parrilla L, Marsh RH, Samuels-Kalow M. Challenges connecting emergency department patients with oral health care: A qualitative analysis of patients, emergency department clinicians, and dentists. J Am Dent Assoc 2023; 154:1087-1096.e4. [PMID: 38008526 PMCID: PMC10823431 DOI: 10.1016/j.adaj.2023.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/25/2023] [Accepted: 09/05/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Unmet dental need shares many risk factors with unmet health-related social needs (HRSN) such as housing and food security and are a common cause for seeking treatment at the emergency department (ED). METHODS The authors recruited a purposive sample of English-speaking and Spanish-speaking patients, ED clinicians at 3 urban EDs, and dentists from nearby communities to participate in qualitative interviews to explore barriers to and facilitators of screening for HRSN and unmet dental needs in the ED. Themes were identified from transcripts using a modified grounded theory approach. RESULTS Interviews were conducted with 25 ED patients, 19 ED clinicians, and 4 dentists. Four themes were identified: (1) a preference for formalized resources, which more frequently exist for HRSN than for oral health; (2) frequent use of ad hoc resources that are less reliable or structured, particularly for dental referral information; (3) limited knowledge of oral health care resources in the community; and (4) desire for more assistance with identifying and addressing resource needs for both HRSN and oral health. Patients were amenable to screening through a variety of modalities and felt it would be helpful, but clinicians emphasized the need for easier referral processes because of frequent failure to connect patients to oral health care. CONCLUSIONS More robust infrastructure and clinician support are needed to ensure successful referral and screening without undue provider burden for both medical and dental clinicians. PRACTICAL IMPLICATIONS Patients are amenable to screening for unmet oral health needs and HRSN in the ED, which may improve access to care.
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Bensken WP, McGrath BM, Gold R, Cottrell EK. Area-level social determinants of health and individual-level social risks: Assessing predictive ability and biases in social risk screening. J Clin Transl Sci 2023; 7:e257. [PMID: 38229891 PMCID: PMC10790234 DOI: 10.1017/cts.2023.680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction Area-level social determinants of health (SDoH) and individual-level social risks are different, yet area-level measures are frequently used as proxies for individual-level social risks. This study assessed whether demographic factors were associated with patients being screened for individual-level social risks, the percentage who screened positive for social risks, and the association between SDoH and patient-reported social risks in a nationwide network of community-based health centers. Methods Electronic health record data from 1,330,201 patients with health center visits in 2021 were analyzed using multilevel logistic regression. Associations between patient characteristics, screening receipt, and screening positive for social risks (e.g., food insecurity, housing instability, transportation insecurity) were assessed. The predictive ability of three commonly used SDoH measures (Area Deprivation Index, Social Deprivation Index, Material Community Deprivation Index) in identifying individual-level social risks was also evaluated. Results Of 244,155 (18%) patients screened for social risks, 61,414 (25.2%) screened positive. Sex, race/ethnicity, language preference, and payer were associated with both social risk screening and positivity. Significant health system-level variation in both screening and positivity was observed, with an intraclass correlation coefficient of 0.55 for social risk screening and 0.38 for positivity. The three area-level SDoH measures had low accuracy, sensitivity, and area under the curve when used to predict individual social needs. Conclusion Area-level SDoH measures may provide valuable information about the communities where patients live. However, policymakers, healthcare administrators, and researchers should exercise caution when using area-level adverse SDoH measures to identify individual-level social risks.
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Affiliation(s)
- Wyatt P. Bensken
- Department of Research, OCHIN,
Portland, OR, USA
- Quantitative Sciences Core, OCHIN,
Portland, OR, USA
| | - Brenda M. McGrath
- Department of Research, OCHIN,
Portland, OR, USA
- Quantitative Sciences Core, OCHIN,
Portland, OR, USA
| | - Rachel Gold
- Department of Research, OCHIN,
Portland, OR, USA
- Kaiser Permanente Center for Health Research,
Portland, OR, USA
| | - Erika K. Cottrell
- Department of Research, OCHIN,
Portland, OR, USA
- Oregon Health and Science University, Portland,
OR, USA
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Sudati IP, Monteiro RFL, Nasser AB, Rocha NACF, de Campos AC. Telehealth in paediatric physical therapy education: Strategies and perceptions of interns and caregivers of children with disabilities in Brazil. CLINICAL TEACHER 2023:e13653. [PMID: 37679054 DOI: 10.1111/tct.13653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023]
Abstract
AIMS To describe the implementation of paediatric rehabilitation telehealth at a physical therapy (PT) unit in Brazil during the COVID-19 pandemic and to describe the perception about this modality by two groups: (1) undergraduate PT students using telehealth during their clinical rotations in this unit and (2) the caregivers of children with disabilities receiving the services. METHODS Twenty-one PT interns (19 females; 25 ± 2 years of age) and seven caregivers (seven females; 40 ± 6 years of age) of seven children with disabilities (five females; 10 ± 4 years of age; five children diagnosed with cerebral palsy) responded to an online questionnaire about their experience with the telehealth programme. Participant attendance and frequency of objective responses were reported descriptively; open-ended responses were analysed qualitatively and grouped according to broad themes. RESULTS 71.4% of interns rated telehealth as an excellent or good experience, and 28.6% did not appreciate it. In addition, 28.6% of them thought that telehealth should be part of the mandatory internship. Regarding caregivers, 85.8% judged the telehealth programme as excellent or good. Both interns and caregivers cited pros and cons related to technology, professional resources, communication skills and caregiver-related aspects, among others. CONCLUSIONS Specific teaching strategies had to be utilised for implementation of telehealth. Despite being a novel modality for interns and caregivers, telehealth was well accepted.
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Affiliation(s)
| | | | - Ana Beatriz Nasser
- Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 110] [Impact Index Per Article: 110.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Ashe JJ, Baker MC, Alvarado CS, Alberti PM. Screening for Health-Related Social Needs and Collaboration With External Partners Among US Hospitals. JAMA Netw Open 2023; 6:e2330228. [PMID: 37610754 PMCID: PMC10448297 DOI: 10.1001/jamanetworkopen.2023.30228] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/15/2023] [Indexed: 08/24/2023] Open
Abstract
Importance In recent years, hospitals and health systems have reported increasing rates of screening for patients' individual and community social needs, but few studies have explored the national landscape of screening and interventions directed at addressing health-related social needs (HRSNs) and social determinants of health (SDOH). Objective To evaluate the associations of hospital characteristics and area-level socioeconomic indicators to quantify the presence and intensity of hospitals' screening practices, interventions, and collaborative external partnerships that seek to measure and ameliorate patients' HRSNs and SDOH. Design, Setting, and Participants This cross-sectional study used national data from the American Hospital Association Annual Survey Database for fiscal year 2020. General-service, acute-care, nonfederal hospitals were included in the study's final sample, representing nationally diverse hospital settings. Data were analyzed from July 2022 to February 2023. Exposures Organizational characteristics and area-level socioeconomic indicators. Main Outcomes and Measures The outcomes of interest were hospital-reported patient screening of and strategies to address 8 HRSNs and 14 external partnership types to address SDOH. Composite scores for screening practices and external partnership types were calculated, and ordinary least-square regression analyses tested associations of organizational characteristics with outcome measures. Results Of 2858 US hospital respondents (response rate, 67.0%), most hospitals (79.2%; 95% CI, 77.7%-80.7%) reported screening patients for at least 1 HRSN, with food insecurity or hunger needs (66.1%; 95% CI, 64.3%-67.8%) and interpersonal violence (66.4%; 95% CI, 64.7%-68.1%) being the most commonly screened social needs. Most hospitals (79.4%; 95% CI, 66.3%-69.7%) reported having strategies and programs to address patients' HRSNs; notably, most hospitals (52.8%; 95% CI, 51.0%-54.5%) had interventions for transportation barriers. Hospitals reported a mean of 4.03 (95% CI, 3.85-4.20) external partnership types to address SDOH and 5.69 (5.50-5.88) partnership types to address HRSNs, with local or state public health departments and health care practitioners outside of the health system being the most common. Hospitals with accountable care contracts (ACCs) and bundled payment programs (BPPs) reported higher screening practices (ACC: β = 1.03; SE = 0.13; BPP: β = 0.72; SE = 0.14), interventions (ACC: β = 1.45; SE = 0.12; BPP: β = 0.61; SE = 0.13), and external partnership types to address HRSNs (ACC: β = 2.07; SE = 0.23; BPP: β = 1.47; SE = 0.24) and SDOH (ACC: β = 2.64; SE = 0.20; BPP: β = 1.57; SE = 0.21). Compared with nonteaching, government-owned, and for-profit hospitals, teaching and nonprofit hospitals were also more likely to report more HRSN-directed activities. Patterns based on geographic and area-level socioeconomic indicators did not emerge. Conclusions and Relevance This cross-sectional study found that most US hospitals were screening patients for multiple HRSNs. Active participation in value-based care, teaching hospital status, and nonprofit status were the characteristics most consistently associated with greater overall screening activities and number of related partnership types. These results support previously posited associations about which types of hospitals were leading screening uptake and reinforce understanding of the role of hospital incentives in supporting health equity efforts.
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Affiliation(s)
- Jason J. Ashe
- Association of American Medical Colleges, Washington, District of Columbia
| | - Matthew C. Baker
- Association of American Medical Colleges, Washington, District of Columbia
| | - Carla S. Alvarado
- Association of American Medical Colleges, Washington, District of Columbia
| | - Philip M. Alberti
- Association of American Medical Colleges, Washington, District of Columbia
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Gutman CK, Thompson M, Gonzalez J, Fernandez R. Patient centered or provider centered? The inclusion of social determinants of health in emergency department billing and coding. Acad Emerg Med 2023; 30:882-884. [PMID: 36794328 PMCID: PMC10866376 DOI: 10.1111/acem.14698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Colleen K Gutman
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Meredith Thompson
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Juan Gonzalez
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rosemarie Fernandez
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
- Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, Florida, USA
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Hong H, Shankar KN, Thompson A, De La Vega PB, Koul R, Cleveland Manchanda EC, Jaiprasert S, Roberts S, Pina T, Anderson E, Lin J, Jacquet GA. Social Determinants of Health Screening at an Urban Emergency Department Urgent Care During COVID-19. West J Emerg Med 2023; 24:675-679. [PMID: 37527386 PMCID: PMC10393463 DOI: 10.5811/westjem.59068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/21/2023] [Indexed: 08/03/2023] Open
Abstract
INTRODUCTION Social determinants of health (SDoH) impact patients' health outcomes, yet screening methods in emergency departments (ED) are not consistent or standardized. The SDoH-related health disparities may have widened during the coronavirus 2019 (COVID-19) pandemic, especially among patients who primarily receive their medical care in EDs. We sought to identify SDoH among ED urgent care patients during the COVID-19 pandemic at an urban safety-net hospital, assess the impact of the pandemic on their SDoH, study the feasibility of SDoH screening and resource referrals, and identify preferred methods of resource referrals and barriers to accessing resources. METHODS Research assistants screened ED urgent care patients using a validated SDoH screener, inquiring about the impact of COVID-19 on their SDoH. A printed resource guide was provided. Two weeks later, a follow-up telephone survey assessed for barriers to resource connection and patients' preferred methods for resource referrals. This study was deemed exempt by our institutional review board. RESULTS Of the 418 patients presented with a screener, 414 (99.0%) patients completed the screening. Of those screened, 296 (71.5%) reported at least one adverse SDoH, most commonly education (38.7%), food insecurity (35.3%), and employment (31.0%). Housing insecurity was reported by 21.0%. Over half of patients (57.0%) endorsed COVID-19 affecting their SDoH. During follow-up, 156 of 234 (67%) attempted calls were successful and 36/156 (23.1%) reported attempting to connect with a resource, with most attempts made for stable housing (11.0%) and food (7.7%). Reasons for not contacting the provided resources included lack of time (37.8%) and forgetting to do so (26.3%). Patients preferred resource guides to be printed (34.0%) and sent via text message to their mobile devices (25.6%). CONCLUSION Many urgent care patients of this urban ED reported at least one adverse SDoH, the majority of which were exacerbated by the COVID-19 pandemic. This finding further emphasizes the need to allocate more resources to standardize and expand SDoH screening in EDs. Additionally, hospitals should increase availability of printed or electronic SDoH resource guides, resource navigators, and interpreters both during and after ED visits.
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Affiliation(s)
- Haeyeon Hong
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
- Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Andrew Thompson
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Rashmi Koul
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Emily C Cleveland Manchanda
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
- Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts
- American Medical Association, Center for Health Equity, Boston, Massachusetts
| | - Sorraya Jaiprasert
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Samantha Roberts
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Tyler Pina
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
| | - Emily Anderson
- Boston University School of Medicine, Boston, Massachusetts
| | - Jessica Lin
- Boston University School of Medicine, Boston, Massachusetts
| | - Gabrielle A Jacquet
- Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts
- Boston University School of Medicine, Department of Emergency Medicine, Boston, Massachusetts
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13
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Loo S, Anderson E, Lin JG, Smith P, Murray GF, Hong H, Jacquet GA, Koul R, Rosenmoss S, James T, Shankar KN, de la Vega PB. Evaluating a social risk screening and referral program in an urban safety-net hospital emergency department. J Am Coll Emerg Physicians Open 2023; 4:e12883. [PMID: 36704207 PMCID: PMC9871409 DOI: 10.1002/emp2.12883] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023] Open
Abstract
Objective The emergency department (ED) is an opportune venue to screen for unmet social needs and connect patients with social services. This quality improvement study incorporates both qualitative and quantitative data to examine unmet social needs among ED patients and program implementation. Methods From September 2020 to December 2021, an urban safety-net hospital adult ED implemented a social needs screening and referral program. Trained emergency staff screened eligible patients for 5 social needs (housing, food, transportation, utilities, employment), giving resource guides to patients who screened positive (THRIVE+). We collected screening data from the electronic health record, conducted semi-structured interviews with THRIVE+ patients and clinical staff, and directly observed discharge interactions. Results Emergency staff screened 58.5% of eligible patients for social risk. Of the screened patients, 27.0% reported at least 1 unmet social need. Of those, 74.8% requested assistance. Screened patients reported housing insecurity (16.3%) as the most prevalent unmet social need followed by food insecurity (13.3%) and unemployment (8.7%). Among interviewed patients, 57.1% recalled being screened, but only 24.5% recalled receiving resource guides. Patients who received guides reported little success connecting with resources and supported universal guide dissemination. Staff expressed preference for warm handoff to social services. Of 13 observed discharge interactions, clinical staff only discussed guides with 2 patients, with no positive endorsement of the guides in any observed interactions. Conclusions An ED social needs screening program can be moderately feasible and accepted. We identified housing as the most prevalent need. Significant gaps exist between screening and referral, with few patients receiving resources. Further training and workflow optimization are underway.
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Affiliation(s)
- Stephanie Loo
- Department of Health Law, Policy, and ManagementBoston University School of Public HealthBostonMassachusettsUSA
| | - Emily Anderson
- Boston University School of MedicineBostonMassachusettsUSA
| | - Jessica G. Lin
- Boston University School of MedicineBostonMassachusettsUSA
| | - Perri Smith
- Department of General Internal MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Genevra F. Murray
- Department of Public Health Policy and Management, School of Global Public HealthNew York UniversityNew YorkNew YorkUSA
| | - Haeyeon Hong
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Gabrielle A. Jacquet
- Boston University School of MedicineBostonMassachusettsUSA,Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Rashmi Koul
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
| | | | - Thea James
- Boston University School of MedicineBostonMassachusettsUSA,Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Kalpana Narayan Shankar
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA,Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Pablo Buitron de la Vega
- Boston University School of MedicineBostonMassachusettsUSA,Department of General Internal MedicineBoston Medical CenterBostonMassachusettsUSA
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14
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Fazio D, Zuiderveen S, Guyet D, Reid A, Lalane M, McCormack RP, Wall SP, Shelley D, Mijanovich T, Shinn M, Doran KM. ED-Home: Pilot feasibility study of a targeted homelessness prevention intervention for emergency department patients with drug or unhealthy alcohol use. Acad Emerg Med 2022; 29:1453-1465. [PMID: 36268815 PMCID: PMC10440066 DOI: 10.1111/acem.14610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Housing insecurity is prevalent among emergency department (ED) patients. Despite a surge of interest in screening for patients' social needs including housing insecurity, little research has examined ED social needs interventions. We worked together with government and community partners to develop and pilot test a homelessness prevention intervention targeted to ED patients with drug or unhealthy alcohol use. METHODS We approached randomly sampled patients at an urban public hospital ED, May to August 2019. Adult patients were eligible if they were medically stable, not incarcerated, spoke English, had unhealthy alcohol or any drug use, and were not currently homeless but screened positive for risk of future homelessness using a previously developed risk screening tool. Participants received a three-part intervention: (1) brief counseling and referral to treatment for substance use delivered through a preexisting ED program; (2) referral to Homebase, an evidence-based community homelessness prevention program; and (3) up to three troubleshooting phone calls by study staff. Participants completed surveys at baseline and 6 months. RESULTS Of 2183 patients screened, 51 were eligible and 40 (78.4%) participated; one later withdrew, leaving 39 participants. Participants were diverse in age, gender, race, and ethnicity. Of the 32 participants reached at 6 months, most said it was very or extremely helpful to talk to someone about their housing situation (n = 23, 71.9%) at the baseline ED visit. Thirteen (40.6%) said their housing situation had improved in the past 6 months and 16 (50.0%) said it had not changed. Twenty participants (62.5%) had made contact with a Homebase office. Participants shared ideas of how to improve the intervention. CONCLUSIONS This pilot intervention was feasible and well received by participants though it required a large amount of screening to identify potentially eligible patients. Our findings will inform a larger future trial and may be informative for others seeking to develop similar interventions.
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Affiliation(s)
- Daniela Fazio
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA
| | - Sara Zuiderveen
- Homelessness Prevention Administration, NYC Human Resources Administration, New York, New York, USA
| | - Dana Guyet
- Homelessness Prevention Administration, NYC Human Resources Administration, New York, New York, USA
| | - Andrea Reid
- Homelessness Prevention Administration, NYC Human Resources Administration, New York, New York, USA
| | - Monique Lalane
- Bellevue Hospital, NYC Health + Hospitals, New York, New York, USA
| | - Ryan P McCormack
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA
| | - Stephen P Wall
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York, New York, USA
- Global Center for Implementation Science and Practice, NYU School of Global Public Health, New York, New York, USA
| | - Tod Mijanovich
- Department of Applied Statistics, Social Sciences, and Humanities, NYU Steinhardt School, New York, New York, USA
| | - Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee, USA
| | - Kelly M Doran
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA
- Department of Population Health, NYU School of Medicine, New York, New York, USA
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15
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Wormley K, Dickson D, Alter H, Njoku N, Imani P, Anderson E. Association of Social Needs and Housing Status Among Urban Emergency Department Patients. West J Emerg Med 2022; 23:802-810. [PMID: 36409947 PMCID: PMC9683759 DOI: 10.5811/westjem.2022.8.55705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 08/08/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction People experiencing homelessness have high rates of social needs when presenting for emergency department (ED) services, but less is known about patients with housing instability who do not meet the established definitions of homelessness. Methods We surveyed patients in an urban, safety-net ED from June–August 2018. Patients completed two social needs screening tools and responded to additional questions on housing. Housing status was determined using validated questions about housing stability. Results Of the 1,263 eligible patients, 758 (60.0%) completed the survey. Among respondents, 40% identified as Latinx, 39% Black, 15% White, 5% Asian, and 8% other race/ethnicities. The median age was 42 years (interquartile range [IQR]: 29–57). and 54% were male. Of the 758 patients who completed the survey, 281 (37.1%) were housed, 213 (28.1%) were unstably housed, and 264 (34.8%) were homeless. A disproportionate number of patients experiencing homelessness were male (63.3%) and Black (54.2%), P <0.001, and a disproportionate number of unstably housed patients were Latinx (56.8%) or were primarily Spanish speaking (49.3%), P <0.001. Social needs increased across the spectrum of housing from housed to unstably housed and homeless, even when controlling for demographic characteristics. Conclusion Over one in three ED patients experience homelessness, and nearly one in three are unstably housed. Notable disparities exist by housing status, and there is a clear increase of social needs across the housing spectrum. Emergency departments should consider integrating social screening tools for patients with unstable housing.
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Affiliation(s)
- Kadia Wormley
- Department of Emergency Medicine, Alameda Health System, Oakland, California
| | - Drusia Dickson
- Department of Emergency Medicine, Alameda Health System, Oakland, California
| | - Harrison Alter
- Department of Emergency Medicine, Alameda Health System, Oakland, California; Andrew Levitt Center for Social Emergency Medicine, Berkeley, California
| | - Ndidi Njoku
- Howard University College of Medicine, Washington, DC
| | - Partow Imani
- University of California Berkeley, School of Public Health, Berkeley, California
| | - Erik Anderson
- Department of Emergency Medicine, Alameda Health System, Oakland, California; Substance Use Disorder Treatment Program, Alameda Health System, Oakland, California
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16
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Wilson MP, Waliski A, Thompson RG. Feasibility of Peer-Delivered Suicide Safety Planning in the Emergency Department: Results From a Pilot Trial. Psychiatr Serv 2022; 73:1087-1093. [PMID: 35502515 DOI: 10.1176/appi.ps.202100561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The emergency department (ED) is an important site for suicide prevention efforts, and safety planning has been identified as a best practice for suicide prevention among ED patients at increased suicide risk. However, few ED clinicians are prepared to assess suicide risk or guide patients in the creation of safety plans. This study was a pilot randomized controlled trial of the feasibility, acceptability, and preliminary effects of safety planning by individuals with lived experience of suicide attempt or of severe suicidal ideation but without medical training (i.e., peers) in the ED. METHODS Patients at risk for suicide in a general ED were randomly assigned to receive peer-delivered or mental health provider–delivered safety planning. Intervention feasibility measures included ED length of stay, safety plan completeness, and safety plan quality. Acceptability measures included patient satisfaction. Preliminary effects were assessed as number of ED returns within the 3 months after the ED visit. RESULTS Data from 31 participants were available for analysis. Compared with participants with provider-delivered safety planning, participants with peer-delivered safety planning had similar ED lengths of stay, higher safety plan completeness, and higher safety plan quality. Acceptability of the safety planning process was similar for the two groups. Compared with participants receiving provider-delivered safety planning, participants receiving peer-delivered planning had significantly fewer ED visits during the subsequent 3 months than during the 3 months preceding the ED visit. CONCLUSIONS Peer-delivered safety planning is feasible and acceptable and may result in fewer return ED visits. These findings provide preliminary support for peer-delivered safety planning in the ED.
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Affiliation(s)
- Michael P Wilson
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
| | - Angie Waliski
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
| | - Ronald G Thompson
- Division of Research and Evidence-Based Medicine and Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, Department of Emergency Medicine (Wilson), and Center for Health Services Research, Department of Psychiatry (Waliski, Thompson), University of Arkansas for Medical Sciences (UAMS), Little Rock; Department of Health Services Research and Development, Central Arkansas Veteran's Healthcare system, Little Rock (Waliski)
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17
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Byrne T, Hoang M, Montgomery AE, Johns E, Shinn M, Mijanovich T, Culhane D, Doran KM. Performance of 2 Single-Item Screening Questions to Identify Future Homelessness Among Emergency Department Patients. JAMA Netw Open 2022; 5:e2226691. [PMID: 35969399 PMCID: PMC9379745 DOI: 10.1001/jamanetworkopen.2022.26691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite increasing interest in assessing patient social needs in health care settings, there has been little research examining the performance of housing-related screening questions. OBJECTIVE To examine the performance of 2 single-item screening questions assessing emergency department (ED) patients' self-perceived risk of future homelessness. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted among a randomly selected sample of adult ED patients from 2016 to 2017 in a public hospital ED in New York City. Data were analyzed from September 2019 through October 2021. EXPOSURES Responses on patient surveys conducted at the baseline ED visit for 2 single-item screening questions on self-perceived risk for future housing instability and homelessness were collected. One question asked patients if they were worried about having stable housing in the next 2 months, and the other question asked them to rate the likelihood that they would enter a homeless shelter in the next 6 months. OUTCOMES Homeless shelter entry 2, 6, and 12 months after an ED visit, assessed using shelter administrative data in the study city, which was linked with participant baseline survey responses. RESULTS There were 1919 study participants (976 [51.0%] men and 931 [48.6%] women among 1915 individuals with gender data; 700 individuals aged 31-50 years [36.5%] among 1918 individuals with age data; 1126 Hispanic or Latinx individuals [59.0%], 368 non-Hispanic Black individuals [19.3%], and 225 non-Hispanic White individuals [11.8%] among 1908 individuals with race and ethnicity data). Within 2, 6, and 12 months of the ED visit, 45 patients (2.3%), 66 patients (3.4%), and 95 patients (5.0%) had entered shelter, respectively. For both single-item screening questions, participants who answered affirmatively had significantly higher likelihood of future shelter entry at each time point examined (eg, at 2 months: 31 participants responding yes [6.5%] vs 14 participants responding no [1.0%] to the question concerning being worried about having stable housing in the next 2 months). Sensitivity of the screening questions ranged from 0.27 to 0.69, specificity from 0.76 to 0.97, positive predictive value from 0.07 to 0.27, and area under the receiver operating characteristic curve from 0.62 to 0.72. CONCLUSIONS AND RELEVANCE This study found that 2 single-item screening questions assessing ED patient self-perceived risk of future housing instability and homelessness had adequate to good performance in identifying risk for future shelter entry. Such single-item screening questions should be further tested before broad adoption.
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Affiliation(s)
- Thomas Byrne
- School of Social Work, Boston University, Boston, Massachusetts
| | - Mindy Hoang
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ann Elizabeth Montgomery
- School of Public Health, University of Alabama at Birmingham, Birmingham
- Birmingham Veterans Affairs Health Care System, Birmingham, Alabama
| | - Eileen Johns
- New York City Center for Innovation through Data Intelligence, New York, New York
| | - Marybeth Shinn
- Department of Human and Organizational Development, Peabody College, Vanderbilt University, Nashville, Tennessee
| | - Tod Mijanovich
- Department of Applied Statistics, Social Sciences, and Humanities, New York University Steinhardt School, New York, New York
| | - Dennis Culhane
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Kelly M. Doran
- Department of Emergency Medicine, New York University School of Medicine, New York, New York
- Department of Population Health, New York University School of Medicine, New York, New York
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18
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Assaf RR, Assaf RD, Barber Doucet H, Graff D. Pediatric emergency department organization and social care practices among U.S. fellowship programs. AEM EDUCATION AND TRAINING 2022; 6:AET210791. [PMID: 35982713 PMCID: PMC9366751 DOI: 10.1002/aet2.10791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Background Social care has become increasingly relevant to the emergency physician and includes activities that address health-related social risk and social needs. The literature has consistently documented substantial health care provider challenges in incorporating social care into routine practice. Yet, interventions on the health care organizational level hold promise to bring about more widespread, sustainable impact. Methods This study was a subanalysis of the 2021 National Social Care Practices Survey data set among pediatric emergency medicine (PEM) program directors (PDs) and fellows. The purpose was to investigate the association between health care organizational factors and PEM physician social care practices and perceptions among PEM PDs and fellows. We performed binary and ordinal logistic regressions of organizational factors and five specific PEM physician social care perspective and practice outcomes. Results The sample population included 153 physicians-44 PDs (49% response rate) and 109 fellows (28%). PDs and fellows with access to a social care systematic workflow in their pediatric emergency department (PED) had higher odds of comfort assessing social risk (odds ratio [OR] 2.1%, 95% confidence interval [CI] 1.1-4.0), valuation of social care (OR 3.2, 95% CI 1.3-7.9), preparedness to assist families (OR 2.4, 95% CI 1.1-5.2), screening tendency (OR 2.2, 95% CI 1.1-4.5), and ability to refer to community resources (OR 2.3, 95% CI 1.2-4.6). A similarly directed, but less pronounced pattern was noted with access to a community resource database for referrals and 24-h access to a social worker in the PED. Conclusions PED organizational factors-particularly access to a social care systematic workflow-appear positively associated with PEM physician practices and perceptions of social care delivery. Further research is under way to advance understanding of PEM training factors in social care.
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Affiliation(s)
- Raymen Rammy Assaf
- Harbor University of California Los Angeles (UCLA) Medical CenterLos AngelesCaliforniaUSA
| | | | - Hannah Barber Doucet
- Hasbro Children's HospitalAlpert Medical School at Brown UniversityProvidenceRhode IslandUSA
| | - Danielle Graff
- Norton Children's HospitalUniversity of Louisville, School of MedicineLouisvilleKentuckyUSA
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19
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Cole MB, Nguyen KH, Byhoff E, Murray GF. Screening for Social Risk at Federally Qualified Health Centers: A National Study. Am J Prev Med 2022; 62:670-678. [PMID: 35459451 PMCID: PMC9035213 DOI: 10.1016/j.amepre.2021.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Federally Qualified Health Centers serve 29.8 million low-income patients across the U.S., many of whom have unaddressed social risks. In 2019, for the first time, data on social risk screening capabilities were collected from every U.S. Federally Qualified Health Center. The objectives of this study were to describe the national rates of social risk screening capabilities across Federally Qualified Health Centers, identify organizational predictors of screening, and assess between-state heterogeneity. METHODS Using a 100% sample of U.S. Federally Qualified Health Centers (N=1,384, representing 29.8 million patients) from the 2019 Uniform Data System, the primary outcome was whether a Federally Qualified Health Center collected data on patients' social risk factors (yes/no). Summary statistics on the rates of social risk screening capabilities were generated in aggregate and by state. Linear probability models were then used to estimate the relationship between the probability of social risk screening and 7 key Federally Qualified Health Center characteristics (e.g., Federally Qualified Health Center size, Medicaid MCO contract, Medicaid accountable care organization presence). Data were analyzed in 2020‒2021. RESULTS Most (71%) Federally Qualified Health Centers collected social risk data, with a between-state variation. The most common screener was the Protocol for Responding to and Assessing Patients' Assets Risks and Experiences (43% of Federally Qualified Health Centers that screened), whereas 22% collected social risk data using a nonstandardized screener. After adjusting for other characteristics, Federally Qualified Health Centers with social risk screening capabilities served more total patients, were more likely to be located in a state with a Medicaid accountable care organization, and were less likely to have an MCO contract. CONCLUSIONS There has been widespread adoption of social risk screening tools across U.S. Federally Qualified Health Centers, but between-state disparities exist. Targeting social risk screening resources to smaller Federally Qualified Health Centers may increase the adoption of screening tools.
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Affiliation(s)
- Megan B Cole
- Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, Massachusetts.
| | - Kevin H Nguyen
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Elena Byhoff
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Genevra F Murray
- Division of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
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20
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ICD-10 Z-Code Health-Related Social Needs and Increased Healthcare Utilization. Am J Prev Med 2022; 62:e232-e241. [PMID: 34865935 DOI: 10.1016/j.amepre.2021.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Health-related social needs are known drivers of health and health outcomes, yet work to date to examine health-related social needs using ICD-10 Z-codes remains limited. This study seeks to evaluate the differences in the prevalence of conditions as well as utilization and cost between patients with and without health-related social needs. METHODS Using the 2017 Florida State Emergency Department and State Inpatient Databases, this study identified patients with documented health-related social needs using ICD-10 Z-codes. The prevalence ratio was calculated for 14 conditions that are the leading causes of mortality and economic costs. In addition, ratios for the median total number of negative health events and total annual costs between patients with health-related social needs and those without health-related social needs across these conditions were calculated. Data analysis was conducted in 2021. RESULTS Of 4,477,772 patients, 46,081 (1.0%) had documented health-related social needs and had 4 times the negative health events and 9.3 times the total annual costs. Trends of increased negative health events and costs were seen across all examined conditions; patients with health-related social needs had 2.5-3.5 times the negative health events and 2-18 times greater total costs. The biggest difference in negative health events was seen in patients with unintentional injuries and depression and psychoses (3.5 times for patients with health-related social needs), whereas the biggest difference in total costs was for unintentional injuries (18.4 times for patients with health-related social needs). CONCLUSIONS This study shows the increased prevalence of numerous high-priority conditions as well as increased utilization and costs among patients with documented health-related social needs.
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21
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TAIRA BREENAR, KIM HYUNG, PRODIGUE KARLATLATELPA, GUTIERREZ‐PALOMINOS LEILANI, ALEMAN ALEXIS, STEINBERG LEORA, TCHAKALIAN GREGORY, YADAV KABIR, TUCKER‐SEELEY REGINALD. A Mixed Methods Evaluation of Interventions to Meet the Requirements of California Senate Bill 1152 in the Emergency Departments of a Public Hospital System. Milbank Q 2022; 100:464-491. [DOI: 10.1111/1468-0009.12563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- BREENA R. TAIRA
- Olive View–UCLA Medical Center Sylmar California
- David Geffen UCLA School of Medicine Los Angeles California
| | - HYUNG KIM
- Olive View–UCLA Medical Center Sylmar California
- David Geffen UCLA School of Medicine Los Angeles California
| | | | | | - ALEXIS ALEMAN
- Olive View–UCLA Medical Center Sylmar California
- David Geffen UCLA School of Medicine Los Angeles California
- Charles Drew University Los Angeles California
| | | | | | - KABIR YADAV
- David Geffen UCLA School of Medicine Los Angeles California
- Harbor‐UCLA Medical Center Torrance California
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22
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Holcomb J, Oliveira LC, Highfield L, Hwang KO, Giancardo L, Bernstam EV. Predicting health-related social needs in Medicaid and Medicare populations using machine learning. Sci Rep 2022; 12:4554. [PMID: 35296719 PMCID: PMC8927567 DOI: 10.1038/s41598-022-08344-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/03/2022] [Indexed: 01/02/2023] Open
Abstract
Providers currently rely on universal screening to identify health-related social needs (HRSNs). Predicting HRSNs using EHR and community-level data could be more efficient and less resource intensive. Using machine learning models, we evaluated the predictive performance of HRSN status from EHR and community-level social determinants of health (SDOH) data for Medicare and Medicaid beneficiaries participating in the Accountable Health Communities Model. We hypothesized that Medicaid insurance coverage would predict HRSN status. All models significantly outperformed the baseline Medicaid hypothesis. AUCs ranged from 0.59 to 0.68. The top performance (AUC = 0.68 CI 0.66–0.70) was achieved by the “any HRSNs” outcome, which is the most useful for screening prioritization. Community-level SDOH features had lower predictive performance than EHR features. Machine learning models can be used to prioritize patients for screening. However, screening only patients identified by our current model(s) would miss many patients. Future studies are warranted to optimize prediction of HRSNs.
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Affiliation(s)
- Jennifer Holcomb
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 1200 Pressler St, Houston, TX, 77030, USA.,Sinai Urban Health Institute, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA
| | - Luis C Oliveira
- The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics, 7000 Fannin, Houston, TX, 77030, USA.,Houston Methodist Academic Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Linda Highfield
- Departments of Management, Policy, and Community Health and Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 1200 Pressler St, Houston, TX, 77030, USA.,Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P and Katherine G McGovern Medical School, 6410 Fannin, Houston, TX, 77030, USA
| | - Kevin O Hwang
- Center for Healthcare Quality and Safety at UTHealth/Memorial Hermann, The University of Texas Health Science Center at Houston (UTHealth) John P and Katherine G McGovern Medical School, 6410 Fannin, Houston, TX, 77030, USA
| | - Luca Giancardo
- Center for Precision Health, The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics, 7000 Fannin, Houston, TX, 77030, USA
| | - Elmer Victor Bernstam
- The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics, 7000 Fannin, Houston, TX, 77030, USA. .,Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P and Katherine G McGovern Medical School, 6410 Fannin, Houston, TX, 77030, USA.
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23
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Macias‐Konstantopoulos W, Ciccolo G, Muzikansky A, Samuels‐Kalow M. A pilot mixed‐methods randomized controlled trial of verbal versus electronic screening for adverse social determinants of health. J Am Coll Emerg Physicians Open 2022; 3:e12678. [PMID: 35224551 PMCID: PMC8847702 DOI: 10.1002/emp2.12678] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wendy Macias‐Konstantopoulos
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
- Center for Social Justice and Health Equity Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Gia Ciccolo
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Alona Muzikansky
- Biostatistics Center, Division of Clinical Research, Mass General Research Institute Massachusetts General Hospital Boston Massachusetts USA
| | - Margaret Samuels‐Kalow
- Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USA
- Harvard Medical School Boston Massachusetts USA
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24
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Gettel CJ, Voils CI, Bristol AA, Richardson LD, Hogan TM, Brody AA, Gladney MN, Suyama J, Ragsdale LC, Binkley CL, Morano CL, Seidenfeld J, Hammouda N, Ko KJ, Hwang U, Hastings SN, Bellolio MF, Biese K, Binkley C, Bott N, Brody A, Carpenter C, Clark S, Dresden MS, Forrester S, Gerson L, Gettel C, Goldberg E, Greenberg A, Hammouda N, Han J, Hastings SN, Hogan T, Hung W, Hwang U, Kayser J, Kennedy M, Ko K, Lesser A, Linton E, Liu S, Malsch A, Matlock D, McFarland F, Melady D, Morano C, Morrow‐Howell N, Nassisi D, Nerbonne L, Nyamu S, Ohuabunwa U, Platts‐Mills T, Ragsdale L, Richardson L, Ringer T, Rosen A, Rosenberg M, Shah M, Skains R, Skees S, Souffront K, Stabler L, Sullivan C, Suyama J, Vargas S, Camille Vaughan E, Voils C, Wei D, Wexler N. Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement. Acad Emerg Med 2021; 28:1430-1439. [PMID: 34328674 DOI: 10.1111/acem.14360] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions. METHODS GEAR engaged 49 interdisciplinary stakeholders, derived clinical questions, and conducted searches of electronic databases to identify ED discharge care transition interventions in older adult populations. Informed by the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) framework, data extraction and synthesis of included studies included the degree that intervention components addressed social needs and their association with patient outcomes. GEAR convened a consensus conference to identify topics of highest priority for future care transitions research. RESULTS Our search identified 248 unique articles addressing care transition interventions in older adult populations. Of these, 17 individual care transition intervention studies were included in the current literature synthesis. Overall, common care transition interventions included coordination efforts, comprehensive geriatric assessments, discharge planning, and telephone or in-person follow-up. Fourteen of the 17 care transition intervention studies in older adults specifically addressed at least one social need within the PRAPARE framework, most commonly related to access to food, medicine, or health care. No care transition intervention addressing social needs in older adult populations consistently reduced subsequent health care utilization or other patient-centered outcomes. GEAR stakeholders identified that determining optimal outcome measures for ED-home transition interventions was the highest priority area for future care transitions research. CONCLUSIONS ED care transition intervention studies in older adults frequently address at least one social need component and exhibit variation in the degree of success on a wide array of health care utilization outcomes.
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Affiliation(s)
- Cameron J. Gettel
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- National Clinician Scholars Program Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA
| | - Corrine I. Voils
- William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Lynne D. Richardson
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
- Department of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York New York USA
- Institute for Health Equity Research Icahn School of Medicine at Mount Sinai New York New York USA
| | - Teresita M. Hogan
- Department of Medicine Section of Emergency Medicine The University of Chicago School of Medicine Chicago Illinois USA
| | - Abraham A. Brody
- Hartford Institute for Geriatric Nursing New York University Rory Meyers College of Nursing New York New York USA
| | - Micaela N. Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
| | - Joe Suyama
- Department of Emergency Medicine University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Luna C. Ragsdale
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
- Department of Emergency Medicine Durham VA Health Care System Durham North Carolina USA
| | - Christine L. Binkley
- Department of Emergency Medicine University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Carmen L. Morano
- School of Social Welfare University at AlbanyState University of New York Albany New York USA
| | - Justine Seidenfeld
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
| | - Nada Hammouda
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Kelly J. Ko
- West Health Institute La Jolla California USA
| | - Ula Hwang
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- Geriatrics Research, Education, and Clinical Center James J. Peters VAMC Bronx New York USA
| | - Susan N. Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
- Department of Medicine Duke University School of Medicine Durham NC USA
- Geriatric Research, Education, and Clinical Center Durham VA Health Care System Durham North Carolina USA
- Center for the Study of Human Aging and Development Duke University School of Medicine Durham North Carolina USA
- Department of Population Health Sciences Duke University School of Medicine Durham North Carolina USA
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25
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Franks NM, Gipson K, Kaltiso SA, Osborne A, Heron SL. The Time Is Now: Racism and the Responsibility of Emergency Medicine to Be Antiracist. Ann Emerg Med 2021; 78:577-586. [PMID: 34175155 PMCID: PMC8487015 DOI: 10.1016/j.annemergmed.2021.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 01/18/2023]
Abstract
The COVID-19 pandemic has shed light on the ongoing pandemic of racial injustice. In the context of these twin pandemics, emergency medicine organizations are declaring that "Racism is a Public Health Crisis." Accordingly, we are challenging emergency clinicians to respond to this emergency and commit to being antiracist. This courageous journey begins with naming racism and continues with actions addressing the intersection of racism and social determinants of health that result in health inequities. Therefore, we present a social-ecological framework that structures the intentional actions that emergency medicine must implement at the individual, organizational, community, and policy levels to actively respond to this emergency and be antiracist.
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Affiliation(s)
- Nicole M Franks
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA.
| | - Katrina Gipson
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Sheri-Ann Kaltiso
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Anwar Osborne
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Sheryl L Heron
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
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26
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Doran KM, Johns E, Zuiderveen S, Shinn M, Dinan K, Schretzman M, Gelberg L, Culhane D, Shelley D, Mijanovich T. Development of a homelessness risk screening tool for emergency department patients. Health Serv Res 2021; 57:285-293. [PMID: 34608999 DOI: 10.1111/1475-6773.13886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To develop a screening tool to identify emergency department (ED) patients at risk of entering a homeless shelter, which could inform targeting of interventions to prevent future homelessness episodes. DATA SOURCES Linked data from (1) ED patient baseline questionnaires and (2) citywide administrative homeless shelter database. STUDY DESIGN Stakeholder-informed predictive modeling utilizing ED patient questionnaires linked with prospective shelter administrative data. The outcome was shelter entry documented in administrative data within 6 months following the baseline ED visit. Exposures were responses to questions on homelessness risk factors from baseline questionnaires. DATA COLLECTION/EXTRACTION METHODS Research assistants completed questionnaires with randomly sampled ED patients who were medically stable, not in police/prison custody, and spoke English or Spanish. Questionnaires were linked to administrative data using deterministic and probabilistic matching. PRINCIPAL FINDINGS Of 1993 ED patients who were not homeless at baseline, 5.6% entered a shelter in the next 6 months. A screening tool consisting of two measures of past shelter use and one of past criminal justice involvement had 83.0% sensitivity and 20.4% positive predictive value for future shelter entry. CONCLUSIONS Our study demonstrates the potential of using cross-sector data to improve hospital initiatives to address patients' social needs.
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Affiliation(s)
- Kelly M Doran
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA.,Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Eileen Johns
- NYC Center for Innovation through Data Intelligence, New York, New York, USA
| | - Sara Zuiderveen
- Prevention and Housing Support, Homelessness Prevention Administration, NYC Human Resources Administration, New York, New York, USA
| | - Marybeth Shinn
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Kinsey Dinan
- Office of Research and Policy Innovation, NYC Department of Social Services, New York, New York, USA
| | - Maryanne Schretzman
- NYC Center for Innovation through Data Intelligence, New York, New York, USA
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.,Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Dennis Culhane
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Donna Shelley
- Public Health Policy and Management, NYU School of Global Public Health, New York, New York, USA
| | - Tod Mijanovich
- Applied Statistics and Health Policy, Department of Applied Statistics, Social Science, and Humanities, NYU Steinhardt School, New York, New York, USA
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27
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Schneider A, Riedlinger D, Pigorsch M, Holzinger F, Deutschbein J, Keil T, Möckel M, Schenk L. Self-reported health and life satisfaction in older emergency department patients: sociodemographic, disease-related and care-specific associated factors. BMC Public Health 2021; 21:1440. [PMID: 34289829 PMCID: PMC8296655 DOI: 10.1186/s12889-021-11439-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/30/2021] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Self-reported health (SRH) and life satisfaction (LS) are patient-reported outcomes (PROs) that independently predict mortality and morbidity in older adults. Emergency department (ED) visits due to serious health problems or accidents might pose critical life events for patients. This study aimed (a) to characterize older patients' SRH and LS during the distinct event of an ED stay, and (b) to analyze concomitant associations of PROs with ED patients' sociodemographic, disease-specific and care-related variables. METHODS Study personnel recruited mostly older ED patients from three disease groups during a two-year period (2017-2019) in eight EDs in central Berlin, Germany, in the context of the health services research network EMANet. Cross-sectional data from the baseline patient survey and associated secondary data from hospital information systems were analyzed. Multilevel linear regression models with random intercept were applied to assess concomitant associations with SRH (scale: 0 (worst) to 100 (best)) and LS (scale: 0 (not at all satisfied) to 10 (completely satisfied)) as outcomes, including sensitivity analyses. RESULTS The final sample comprised N = 1435 participants. Mean age was 65.18 (SD: 16.72) and 50.9% were male. Mean ratings of SRH were 50.10 (SD: 23.62) while mean LS scores amounted to 7.15 (SD: 2.50). Better SRH and higher LS were found in patients with cardiac symptoms (SRH: β = 4.35, p = .036; LS: β = 0.53, p = .006). Worse SRH and lower LS were associated with being in need of nursing care (SRH: β = - 7.52, p < .001; LS: β = - 0.59, p = .003) and being unemployed (SRH: β = - 8.54, p = .002; LS: β = - 1.27, p < .001). Sex, age, number of close social contacts, and hospital stays in the previous 6 months were additionally related to the outcomes. Sensitivity analyses largely supported results of the main sample. CONCLUSIONS SRH and LS were associated with different sociodemographic and disease-related variables in older ED patients. Nursing care dependency and unemployment emerged as significant factors relating to both outcomes. Being able to identify especially vulnerable patients in the ED setting might facilitate patient-centered care and prevent negative health outcomes. However, further longitudinal research needs to analyze trajectories in both outcomes and suitable intervention possibilities in the ED setting. TRIAL REGISTRATION EMANet sub-studies were registered separately: German Clinical Trials Register (EMAAge: DRKS00014273, registration date: May 16, 2018; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014273; EMACROSS: DRKS00011930, registration date: April 25, 2017; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011930); ClinicalTrials.gov (EMASPOT: NCT03188861, registration date: June 16, 2017; https://clinicaltrials.gov/ct2/show/NCT03188861?term=NCT03188861&draw=2&rank=1).
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Affiliation(s)
- Anna Schneider
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany.
| | - Dorothee Riedlinger
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Mareen Pigorsch
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Berlin, Germany
| | - Johannes Deutschbein
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Thomas Keil
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany.,University of Wuerzburg, Institute of Clinical Epidemiology and Biometry, Wuerzburg, Germany.,State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Berlin, Germany
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28
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Kulie P, Steinmetz E, Johnson S, McCarthy ML. A health-related social needs referral program for Medicaid beneficiaries treated in an emergency department. Am J Emerg Med 2021; 47:119-124. [PMID: 33799141 DOI: 10.1016/j.ajem.2021.03.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Social determinants of health (SDH) play an important role in health outcomes. This study sought to evaluate the effectiveness of a SDH screening and health-related social needs (HRSNs) referral program in an emergency department (ED) setting with adult Medicaid beneficiaries. METHODS Between November 2016 and March 2017 we enrolled adult Medicaid patients in a prospective cohort study. Research assistants (RAs) completed an SDH screening survey with participants and asked them if they needed assistance with HRSNs related to medical, behavioral health, wellness, housing, food, legal and job training issues. RAs referred participants to community-based organizations (CBO) for their top three HRSNs. Patients referred to at least one CBO were phoned a month later to determine whether their HRSN was addressed and CBOs also reported their assistance rates within four months of the ED visit. RESULTS Of the 505 patients enrolled, 69% were female, 82% completed high school, and 57% reported working. Most participants (85%) requested assistance for at least one HRSN. Almost half (44%) received referrals to three different agencies. Help with housing (70%), medical issues (51%), and finding food (42%) were the most common. Among the 430 subjects referred to ≥1 agency, 76% completed the follow-up interview. Few patients reported receiving help from the referral agencies (5% for a wellness program to 15% for medical services). Referral agencies generally reported even lower assistance rates (0% for job training to 17% for medical services). CONCLUSION The majority of adult Medicaid patients treated in our ED wanted assistance with one or more HRSN. The passive referral system we implemented resulted in few patients receiving assistance from the referral agency, regardless of whether measured by self-report or by agency.
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Affiliation(s)
- Paige Kulie
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, DC, United States of America.
| | - Erika Steinmetz
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
| | - Samuel Johnson
- Tulane University School of Medicine, Tulane University, New Orleans, LA, United States of America
| | - Melissa L McCarthy
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America
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