1
|
Crellin NE, Herlitz L, Sidhu MS, Ellins J, Georghiou T, Litchfield I, Massou E, Ng PL, Sherlaw‐Johnson C, Tomini SM, Vindrola‐Padros C, Walton H, Fulop NJ. Patient Characteristics Associated With Disparities in Engagement With and Experience of COVID-19 Remote Home Monitoring Services: A Mixed-Methods Evaluation. Health Expect 2024; 27:e14145. [PMID: 39092691 PMCID: PMC11295099 DOI: 10.1111/hex.14145] [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: 01/25/2024] [Revised: 05/29/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION The adoption of remote healthcare methods has been accelerated by the COVID-19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID-19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups. METHODS This was a mixed-methods study with survey and interview data collected from 28 services across England between February and June 2021. Surveys were conducted with staff and patients and carers receiving the service. Interviews with staff service leads, patients and carers were conducted in 17 sites. Quantitative data were analysed using univariate and multivariate methods, and qualitative data were analysed using thematic analysis. FINDINGS Survey responses were received from 292 staff and 1069 patients and carers. Twenty-three staff service leads, 59 patients and 3 carers were interviewed. Many service leads reported that they had considered inclusivity when adapting the service for their local population; strategies included widening the eligibility criteria, prioritising vulnerable groups and creating referral pathways. However, disparities were reported across patient groups in their experiences and engagement. Older patients reported the service to be less helpful (p = 0.004), were more likely to report a problem (p < 0.001) and had more difficulty in understanding information (p = 0.005). Health status (p = 0.004), ethnicity (p < 0.001), gender (p < 0.001) and employment (p = 0.007) were associated with differential engagement with monitoring, and minority ethnic groups reported more difficulty understanding service information (p = 0.001). Qualitative data found illness severity to be an important factor in the support required, and patients' living situation and social network affected whether they found the service reassuring. CONCLUSION Addressing health disparities must be a key focus in the design and delivery of remote care. Services should be tailored to match the needs of their local population, encourage access through collaboration and referral pathways with other services and monitor their inclusiveness. Involving patients and staff in service design can illuminate the diversity of patients' needs and experiences of care. PATIENT OR PUBLIC CONTRIBUTION The study team met with service user and public members of the BRACE PPI group and patient representatives from RSET in a series of workshops. Workshops informed study design, data collection tools, data interpretation and dissemination activities. Study documents (such as consent forms, topic guides, surveys and information sheets) were reviewed by PPI members; patient surveys and interview guides were piloted, and members also commented on the manuscript.
Collapse
Affiliation(s)
| | - Lauren Herlitz
- NIHR Children and Families Policy Research UnitUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Manbinder S. Sidhu
- School of Social Policy, Health Services Management Centre, College of Social SciencesUniversity of BirminghamBirminghamUK
| | - Jo Ellins
- School of Social Policy, Health Services Management Centre, College of Social SciencesUniversity of BirminghamBirminghamUK
| | | | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Efthalia Massou
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Pei Li Ng
- Department of Applied Health ResearchUniversity College LondonGower StreetLondonUK
| | | | - Sonila M. Tomini
- Department of Applied Health ResearchUniversity College LondonGower StreetLondonUK
| | | | - Holly Walton
- Department of Applied Health ResearchUniversity College LondonGower StreetLondonUK
| | - Naomi J. Fulop
- Department of Applied Health ResearchUniversity College LondonGower StreetLondonUK
| |
Collapse
|
2
|
Chow YP, Wong CW, Blair M, Choi T. Transition to work: A qualitative exploration of Australian-trained international dietetic graduates' career trajectories. J Hum Nutr Diet 2024. [PMID: 39011842 DOI: 10.1111/jhn.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Interest in the role of employability in student-dietitian transitions is increasing. However, little is known about the cross-cultural transition-to-work experience of Australian-trained dietetic graduates of international backgrounds, as well as strategies to optimise work-readiness. The present study aimed to explore graduates' career narratives and identify employability capitals that enabled successful transitions to work. METHODS A qualitative interpretive approach was employed via a cultural lens. Eighteen participants from five Asian countries who had graduated from an Australian university within 3-15 years, with work experience in Australia or in their respective home countries, took part in in-depth interviews. Thematic analysis was performed, guided by the graduate capitals based approach. RESULTS Transition-to-work was dynamic and non-linear; four themes and 12 subthemes identified: (1) upon graduation, participants felt ambivalent about their decision to either stay in Australia or return home, influenced by graduate visa restrictions, and individual perceptions of their ability to mobilise cultural strengths to gain employment; (2) to get a foot in the door, participants demonstrated resilience, embraced uncertainty and utilised social networks to increase employment opportunities in Australia and their home countries; (3) regardless of which country they worked, graduates reported struggling with their cross-cultural identities in the workplace; and (4) eventually, these graduates appreciated their ethnic capital, thrived in their work and extended a helping hand to their junior cross-cultural dietitians. CONCLUSIONS Initiatives facilitating connections to the host country and supporting cultural and ethnic capital development, along with ongoing research reviewing employability capital applications, will benefit cross-cultural dietetic graduates and the communities they potentially will serve.
Collapse
Affiliation(s)
- Ying Pik Chow
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Cho Wan Wong
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Merran Blair
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Tammie Choi
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| |
Collapse
|
3
|
Strechen I, Wilson P, Eltalhi T, Piche K, Tschida-Reuter D, Howard D, Sutor B, Tiong I, Herasevich S, Pickering B, Barwise A. Harnessing health information technology to promote equitable care for patients with limited English proficiency and complex care needs. Trials 2024; 25:450. [PMID: 38961501 PMCID: PMC11223355 DOI: 10.1186/s13063-024-08254-y] [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: 03/01/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Patients with language barriers encounter healthcare disparities, which may be alleviated by leveraging interpreter skills to reduce cultural, language, and literacy barriers through improved bidirectional communication. Evidence supports the use of in-person interpreters, especially for interactions involving patients with complex care needs. Unfortunately, due to interpreter shortages and clinician underuse of interpreters, patients with language barriers frequently do not get the language services they need or are entitled to. Health information technologies (HIT), including artificial intelligence (AI), have the potential to streamline processes, prompt clinicians to utilize in-person interpreters, and support prioritization. METHODS From May 1, 2023, to June 21, 2024, a single-center stepped wedge cluster randomized trial will be conducted within 35 units of Saint Marys Hospital & Methodist Hospital at Mayo Clinic in Rochester, Minnesota. The units include medical, surgical, trauma, and mixed ICUs and hospital floors that admit acute medical and surgical care patients as well as the emergency department (ED). The transitions between study phases will be initiated at 60-day intervals resulting in a 12-month study period. Units in the control group will receive standard care and rely on clinician initiative to request interpreter services. In the intervention group, the study team will generate a daily list of adult inpatients with language barriers, order the list based on their complexity scores (from highest to lowest), and share it with interpreter services, who will send a secure chat message to the bedside nurse. This engagement will be triggered by a predictive machine-learning algorithm based on a palliative care score, supplemented by other predictors of complexity including length of stay and level of care as well as procedures, events, and clinical notes. DISCUSSION This pragmatic clinical trial approach will integrate a predictive machine-learning algorithm into a workflow process and evaluate the effectiveness of the intervention. We will compare the use of in-person interpreters and time to first interpreter use between the control and intervention groups. TRIAL REGISTRATION NCT05860777. May 16, 2023.
Collapse
Affiliation(s)
- Inna Strechen
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN, USA.
| | - Patrick Wilson
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Targ Eltalhi
- Language Services, Mayo Clinic, Rochester, MN, USA
| | | | | | - Diane Howard
- Language Services Operations Administrator, Mayo Clinic, Rochester, MN, USA
| | - Bruce Sutor
- Department of Psychiatry and Psychology and Medical Director of Language Services, Mayo Clinic, Rochester, MN, USA
| | - Ing Tiong
- Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Svetlana Herasevich
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Brian Pickering
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Amelia Barwise
- Biomedical Ethics Research Program and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
4
|
Light SW, Sideman AB, Vela A, Wolf MS. Introducing a brain health literacy framework to promote health equity for Latinos: A discussion paper. PATIENT EDUCATION AND COUNSELING 2024; 124:108254. [PMID: 38493527 PMCID: PMC11070285 DOI: 10.1016/j.pec.2024.108254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Sophia W Light
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin, San Francisco, CA, USA; Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Alyssa Vela
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael S Wolf
- Center for Applied Health Research on Aging and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
5
|
Jackson JW, Hsu YJ, Zalla LC, Carson KA, Marsteller JA, Cooper LA, Investigators TRLP. Evaluating Effects of Multilevel Interventions on Disparity in Health and Healthcare Decisions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:407-420. [PMID: 38907802 PMCID: PMC11239607 DOI: 10.1007/s11121-024-01677-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 06/24/2024]
Abstract
In this paper, we introduce an analytic approach for assessing effects of multilevel interventions on disparity in health outcomes and health-related decision outcomes (i.e., a treatment decision made by a healthcare provider). We outline common challenges that are encountered in interventional health disparity research, including issues of effect scale and interpretation, choice of covariates for adjustment and its impact on effect magnitude, and the methodological challenges involved with studying decision-based outcomes. To address these challenges, we introduce total effects of interventions on disparity for the entire sample and the treated sample, and corresponding direct effects that are relevant for decision-based outcomes. We provide weighting and g-computation estimators in the presence of study attrition and sketch a simulation-based procedure for sample size determinations based on precision (e.g., confidence interval width). We validate our proposed methods through a brief simulation study and apply our approach to evaluate the RICH LIFE intervention, a multilevel healthcare intervention designed to reduce racial and ethnic disparities in hypertension control.
Collapse
Affiliation(s)
- John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA.
| | - Yea-Jen Hsu
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren C Zalla
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn A Carson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Baltimore, MD, USA
| | - Jill A Marsteller
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Baltimore, MD, USA
| | - Lisa A Cooper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, & Clinical Research, Baltimore, MD, USA
- Department of Health Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
6
|
McCord M, Fierman A, Sisco S, Canfield C, Manjunath S, Cohen N, Havens J, Wilcox W, Tomopoulos S, Albert MS, Abraham T, Charney A, Acri M, Piwnica-Worms K. A Two-Generation, Early Childhood Advanced Primary Care Model. Pediatrics 2024; 153:e2023062567. [PMID: 38444349 DOI: 10.1542/peds.2023-062567] [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] [Accepted: 11/13/2023] [Indexed: 03/07/2024] Open
Abstract
It is well recognized that early experiences produce long-term impacts on health outcomes, yet many children are at risk of not achieving their full potential because of health and service disparities related largely to poverty and racism. Although many pediatric primary care (PPC) models address these needs, most are isolated, add-on efforts that struggle to be scalable and sustainable. We describe 3-2-1 IMPACT (Integrated Model for Parents and Children Together), an initiative to transform the model of PPC delivered within New York City Health + Hospitals, the largest public hospital system in the United States, to address the full range of child and family needs in early childhood. Taking advantage of the frequent contact with PPC in the early years and linking to prenatal services, the model assesses family mental, social, and physical health needs and offers evidence-based parenting supports and integrated mental health services. Launching and sustaining the model in our large health system has required coalition building and sustained advocacy at the state, city, and health system levels. Long-term sustainability of the IMPACT model will depend on the implementation of early childhood-focused advanced payment models, on which we have made substantial progress with our major contracted Medicaid managed care plans. By integrating multiple interventions into PPC and prenatal care across a large public-healthcare system, we hope to synergize evidence-based and evidence-informed interventions that individually have relatively small effect sizes, but combined, could substantially improve child and maternal health outcomes and positively impact health disparities.
Collapse
Affiliation(s)
| | - Arthur Fierman
- New York University, Grossman School of Medicine, New York, New York
| | | | - Caitlin Canfield
- New York University, Grossman School of Medicine, New York, New York
| | - Sanjana Manjunath
- New York University, Grossman School of Medicine, New York, New York
| | | | - Jennifer Havens
- New York University, Grossman School of Medicine, New York, New York
| | | | - Suzy Tomopoulos
- New York University, Grossman School of Medicine, New York, New York
| | | | | | | | - Mary Acri
- New York University, Grossman School of Medicine, New York, New York
| | | |
Collapse
|
7
|
Scott MM, Ménard A, Sun AH, Murmann M, Ramzy A, Rasaputra P, Fleming M, Orosz Z, Huynh C, Welch V, Cooper-Reed A, Hsu AT. Building evidence to advance health equity: a systematic review on care-related outcomes for older, minoritised populations in long-term care homes. Age Ageing 2024; 53:afae059. [PMID: 38557665 PMCID: PMC10982852 DOI: 10.1093/ageing/afae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Advancing health equity requires more contextualised evidence. OBJECTIVES To synthesise published evidence using an existing framework on the origins of health disparities and determine care-related outcome disparities for residents of long-term care, comparing minoritised populations to the context-specific dominant population. DESIGN Systematic review. SUBJECTS Residents of 24-hour long-term care homes. METHODS The protocol was registered a priori with PROSPERO (CRD42021269489). Literature published between 1 January 2000 and 26 September 2021, was searched, including studies comparing baseline characteristics and outcomes in minoritised versus dominant populations. Dual screening, two-reviewer verification for extraction, and risk of bias assessments were conducted to ensure rigour. Studies were synthesized using a conceptual framework to contextualise evidence according to multi-level factors contributing to the development of care disparities. RESULTS Twenty-one of 34 included studies demonstrated disparities in care outcomes for minoritised groups compared to majority groups. Thirty-one studies observed differences in individual-level characteristics (e.g. age, education, underlying conditions) upon entry to homes, with several outcome disparities (e.g. restraint use, number of medications) present at baseline and remaining or worsening over time. Significant gaps in evidence were identified, particularly an absence of literature on provider information and evidence on the experience of intersecting minority identities that contribute to care-related outcome disparities in long-term care. CONCLUSION This review found differences in minoritised populations' care-related outcomes. The findings provide guidance for future health equity policy and research-supporting diverse and intersectional capacity building in long-term care.
Collapse
Affiliation(s)
- Mary M Scott
- The Public Health Agency of Canada, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Alixe Ménard
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Annie H Sun
- Bruyere Research Institute, Ottawa, ON, Canada
| | - Maya Murmann
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
| | - Amy Ramzy
- Bruyere Research Institute, Ottawa, ON, Canada
| | | | - Michelle Fleming
- Bruyere Research Institute, Ottawa, ON, Canada
- Ontario Centres for Learning, Research and Innovation in Long-Term Care, Ottawa, ON, Canada
| | - Zsófia Orosz
- Bruyere Research Institute, Ottawa, ON, Canada
- Ontario Centres for Learning, Research and Innovation in Long-Term Care, Ottawa, ON, Canada
| | - Chau Huynh
- Bruyere Research Institute, Ottawa, ON, Canada
| | - Vivian Welch
- Bruyere Research Institute, Ottawa, ON, Canada
- The Campbell Collaboration, Philadelphia, PA, USA
| | | | - Amy T Hsu
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
- Ontario Centres for Learning, Research and Innovation in Long-Term Care, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
8
|
Bergstein VE, O'Sullivan LR, Levy KH, Vulcano E, Aiyer AA. Racial Disparities in 30-day Readmission After Orthopaedic Surgery: A 5-year National Surgical Quality Improvement Program Database Analysis. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00004. [PMID: 38437055 PMCID: PMC10906581 DOI: 10.5435/jaaosglobal-d-24-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/17/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Readmission rate after surgery is an important outcome measure in revealing disparities. This study aimed to examine how 30-day readmission rates and causes of readmission differ by race and specific injury areas within orthopaedic surgery. METHODS The American College of Surgeon-National Surgical Quality Improvement Program database was queried for orthopaedic procedures from 2015 to 2019. Patients were stratified by self-reported race. Procedures were stratified using current procedural terminology codes corresponding to given injury areas. Multiple logistic regression was done to evaluate associations between race and all-cause readmission risk, and risk of readmission due to specific causes. RESULTS Of 780,043 orthopaedic patients, the overall 30-day readmission rate was 4.18%. Black and Asian patients were at greater (OR = 1.18, P < 0.01) and lesser (OR = 0.76, P < 0.01) risk for readmission than White patients, respectively. Black patients were more likely to be readmitted for deep surgical site infection (OR = 1.25, P = 0.03), PE (OR = 1.64, P < 0.01), or wound disruption (OR = 1.45, P < 0.01). For all races, all-cause readmission was highest after spine procedures and lowest after hand/wrist procedures. CONCLUSIONS Black patients were at greater risk for overall, spine, shoulder/elbow, hand/wrist, and hip/knee all-cause readmission. Asian patients were at lower risk for overall, spine, hand/wrist, and hip/knee surgery all-cause readmission. Our findings can identify complications that should be more carefully monitored in certain patient populations.
Collapse
Affiliation(s)
- Victoria E. Bergstein
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Lucy R. O'Sullivan
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Kenneth H. Levy
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Ettore Vulcano
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| | - Amiethab A. Aiyer
- From the Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD (Ms. Bergstein, Ms. O’Sullivan, Dr. Aiyer); the Sophie Davis Biomedical Education Program, CUNY School of Medicine, New York, NY (Mr. Levy), and the Columbia University Orthopedics at Mount Sinai Medical Center, Miami Beach, FL (Dr. Vulcano)
| |
Collapse
|
9
|
Barwise AK, Curtis S, Diedrich DA, Pickering BW. Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives. J Am Med Inform Assoc 2024; 31:611-621. [PMID: 38099504 PMCID: PMC10873784 DOI: 10.1093/jamia/ocad224] [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: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Inpatients with language barriers and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Although in-person interpreters are particularly beneficial for these patients, they are underused. We plan to use machine learning predictive analytics to reliably identify patients with language barriers and complex medical needs to prioritize them for in-person interpreters. MATERIALS AND METHODS This qualitative study used stakeholder engagement through semi-structured interviews to understand the perceived risks and benefits of artificial intelligence (AI) in this domain. Stakeholders included clinicians, interpreters, and personnel involved in caring for these patients or for organizing interpreters. Data were coded and analyzed using NVIVO software. RESULTS We completed 49 interviews. Key perceived risks included concerns about transparency, accuracy, redundancy, privacy, perceived stigmatization among patients, alert fatigue, and supply-demand issues. Key perceived benefits included increased awareness of in-person interpreters, improved standard of care and prioritization for interpreter utilization; a streamlined process for accessing interpreters, empowered clinicians, and potential to overcome clinician bias. DISCUSSION This is the first study that elicits stakeholder perspectives on the use of AI with the goal of improved clinical care for patients with language barriers. Perceived benefits and risks related to the use of AI in this domain, overlapped with known hazards and values of AI but some benefits were unique for addressing challenges with providing interpreter services to patients with language barriers. CONCLUSION Artificial intelligence to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
Collapse
Affiliation(s)
- Amelia K Barwise
- Biomedical Ethics Research Program, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Susan Curtis
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN 55902, United States
| | - Daniel A Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
| | - Brian W Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55902, United States
| |
Collapse
|
10
|
Reboe-Benjamin M, Brindamour M, Leis K, Hanson J, Verity-Anderson L, Gomez M, Baerg M, Leis A. Refugees' Care Experiences, Self-Reported Health Outcomes and Transition to Mainstream Health Care After One Year at the Refugee Engagement and Community Health (REACH) Clinic. J Immigr Minor Health 2024; 26:101-109. [PMID: 37668808 PMCID: PMC10771348 DOI: 10.1007/s10903-023-01534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/06/2023]
Abstract
This study reports how refugees experienced care at an integrated clinic during their first year in Canada and how they transitioned to a community physician. A survey was completed by 75 Government Assisted Refugees followed at the REACH clinic between 2018 and 2020; 16 agreed to an additional interview. Regression modelling explored the relationship between "perceived health status at one year" and several independent variables. Qualitative thematic analysis provided context. Tailored access to care and enhanced communication through interpretation contributed to satisfaction with clinic services. A significant positive relationship was found between their perceived health status and frequency of visits (p < 0.042), and "doctors' advice about how to stay healthy" (p < 0.039). Interview findings highlighted the important role of settlement agencies, timing for a successful transition and physicians' support resources. While refugees benefit from attending integrated clinics, these should also prepare the care transition to community physicians. Targeted government funding and continued medical education could enhance refugees' transition experience.
Collapse
Affiliation(s)
- Monique Reboe-Benjamin
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Mahli Brindamour
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Refugee Engagement and Community Health (REACH) Clinic liaison the Saskatoon Community Clinic, Saskatoon, SK, Canada
| | - Karen Leis
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jacelyn Hanson
- Refugee Engagement and Community Health (REACH) Clinic liaison the Saskatoon Community Clinic, Saskatoon, SK, Canada
| | - Lori Verity-Anderson
- Refugee Engagement and Community Health (REACH) Clinic liaison the Saskatoon Community Clinic, Saskatoon, SK, Canada
| | - Maria Gomez
- Saskatoon Open Door Society, Saskatoon, SK, Canada
| | - Melanie Baerg
- Health & Case Coordination at Global Gathering Place, Saskatoon, SK, Canada
| | - Anne Leis
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| |
Collapse
|
11
|
Rolke L, White MJ. Improving the Effectiveness and Equity of Child Obesity Interventions. Pediatrics 2024; 153:e2023064453. [PMID: 38282539 DOI: 10.1542/peds.2023-064453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
| | - Michelle J White
- Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
12
|
Saidi F, Phanga T, Graybill LA, Mollan KR, Hill LM, Sibande W, Msowoya G, Thom A, Rosenberg NE, Freeborn K, Amico KR, Phiri S, Mutale W, Chi BH. Acceptability of a Combination Adherence Strategy to Support HIV Antiretroviral Therapy and Pre-exposure Prophylaxis Adherence During Pregnancy and Breastfeeding in Malawi. AIDS Behav 2023; 27:4022-4032. [PMID: 37392270 DOI: 10.1007/s10461-023-04116-x] [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] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
In two parallel pilot studies, we implemented a combination adherence intervention of patient-centered counselling and adherence supporter training, tailored to support HIV treatment (i.e., antiretroviral therapy) or prevention (i.e., pre-exposure prophylaxis, or PrEP) during pregnancy and breastfeeding. Using a mixed-methods approach, we evaluated the intervention's acceptability. We investigated engagement, satisfaction, and discussion content via survey to all 151 participants assigned to the intervention arm (51 women living with HIV, 100 PrEP-eligible women without HIV). We also conducted serial in-depth interviews with a subgroup (n = 40) at enrollment, three months, and six months. In the quantitative analysis, the vast majority reported high satisfaction with intervention components and expressed desire to receive it in the future, if made available. These findings were supported in the qualitative analysis, with favorable comments about counselor engagement, intervention content and types of support received from adherence supporters. Overall, these results demonstrate high acceptability and provide support for HIV status-neutral interventions for antiretroviral adherence.
Collapse
Affiliation(s)
- Friday Saidi
- University of North Carolina (UNC) Project Malawi, Bag A-104, Lilongwe, Malawi.
- Department of Obstetrics and Gynecology, Kamuzu University of Health Sciences, Lilongwe, Malawi.
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Twambilile Phanga
- University of North Carolina (UNC) Project Malawi, Bag A-104, Lilongwe, Malawi
| | - Lauren A Graybill
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Katie R Mollan
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Lauren M Hill
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Watson Sibande
- University of North Carolina (UNC) Project Malawi, Bag A-104, Lilongwe, Malawi
| | - Getrude Msowoya
- University of North Carolina (UNC) Project Malawi, Bag A-104, Lilongwe, Malawi
| | - Annie Thom
- University of North Carolina (UNC) Project Malawi, Bag A-104, Lilongwe, Malawi
| | - Nora E Rosenberg
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kellie Freeborn
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Wilbroad Mutale
- Department of Health Policy, University of Zambia School of Public Health, Lusaka, Zambia
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
13
|
Ramji R, Rämgård M, Carlson E, Shleev S, Awad E, Cirovic S, Kottorp A. Health and quality of life among women after participation in a CBPR-informed physical activity intervention: with a pandemic perspective. Sci Rep 2023; 13:17972. [PMID: 37863947 PMCID: PMC10589350 DOI: 10.1038/s41598-023-45239-4] [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: 06/13/2023] [Accepted: 10/17/2023] [Indexed: 10/22/2023] Open
Abstract
The lack of culturally and contextually oriented interventions promoting physical activity (PA) has led to increased physical inactivity among women living in disadvantaged neighbourhoods in Sweden. In this study one such intervention informed by community-based participatory research (CBPR) has been evaluated among 34 women from a disadvantaged neighbourhood before and during COVID-19. Health-related quality of life (HRQOL), behavioural and biomedical outcomes were assessed directly prior and post-intervention, followed by evaluations at 6-months and 18-months follow-up during COVID-19. The results revealed that HRQOL, particularly psychological, social, and environmental health significantly increased post-intervention compared to prior to intervention but reversed back at 6-months follow-up. Perceived health satisfaction and environmental health increased at 18-months follow-up during COVID-19. Participation in PA improved post-intervention and at 6-months follow-up. Everyday activities and fruit and vegetable intake continued to increase through all timepoints. Systolic blood pressure significantly decreased post-intervention and 6-months follow-up; blood flow rate increased significantly at all timepoints. Overall, the findings underscores the potential effectiveness of CBPR approaches in promoting and sustaining healthy lifestyles, even during acute situations such as the COVID-19. It may even serve as a future model for promoting health and addressing health disparities in similar groups.
Collapse
Affiliation(s)
- Rathi Ramji
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden.
| | - Margareta Rämgård
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden
| | - Elisabeth Carlson
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden
| | - Sergey Shleev
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden
| | - Eman Awad
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden
| | - Stefan Cirovic
- Department of Biomedical Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden
| | - Anders Kottorp
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms Gata 25, 20506, Malmö, Sweden
| |
Collapse
|
14
|
Antoine DG, Manogue S, Blue J, Irvin R, Irvin N. Addressing Stigma by Increasing Empathy Toward Vulnerable Populations in Preprofessional Trainees: Impacts of the Generation Tomorrow Summer Health Disparities Scholars Program. J Acquir Immune Defic Syndr 2023; 94:S47-S52. [PMID: 37707848 PMCID: PMC10513746 DOI: 10.1097/qai.0000000000003262] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Creating empathetic health care professionals is critical to addressing the health equity challenges of today, particularly because it relates to vulnerable populations. METHODS To assess the impact of the Johns Hopkins Center for AIDS Research Generation Tomorrow Summer Health Disparities Scholars (GTSHDS) program on students' empathy toward individuals living with substance use disorder and differential impact on empathy related to the COVID-19 pandemic, the Attitudes towards Mental Illness Questionnaire (AMIQ), an assessment of stigmatizing attitudes, was administered. Preprogram and postprogram participation AMIQ survey data were compared using paired t tests to explore changes within the program year. Unpaired t tests were used to characterize differences between the mean scores across the 2 student cohorts. RESULTS Both GTSHDS cohorts displayed postprogram increase in empathy. Mean 2019 cohort AMIQ scores shifting from -1.4 (SD 2.01) to -0.8 (SD 2.35) (P = 0.54), and the 2022 cohort shifting from -3.67 (SD 2.01) to -3 (SD 1.61) (P = 0.79). On average, individual scores improved by 2.2 (SD 1.65) points in the 2019 cohort and 2.4 (SD 1.86) points in the 2022 cohort (P = 0.83). Although these were not statistically significant, they suggested a trend toward more empathy. CONCLUSIONS Preliminary data suggest that programs such as GTSHDS that expose students to various aspects of health care principles can prepare future health care professionals in a manner that may reduce health care disparities. Future research with larger population sizes is needed to understand the impacts of the curriculum on empathy and related concepts to achieving health equity.
Collapse
Affiliation(s)
- Denis G. Antoine
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sean Manogue
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jasmine Blue
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Risha Irvin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nathan Irvin
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
15
|
McKenna BG, Knight AK, Smith AK, Corwin EJ, Carter SE, Palmer RHC, Dunlop AL, Brennan PA. Infant epigenetic aging moderates the link between Black maternal childhood trauma and offspring symptoms of psychopathology. Dev Psychopathol 2023:1-13. [PMID: 37771149 DOI: 10.1017/s0954579423001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Although offspring of women exposed to childhood trauma exhibit elevated rates of psychopathology, many children demonstrate resilience to these intergenerational impacts. Among the variety of factors that likely contribute to resilience, epigenetic processes have been suggested to play an important role. The current study used a prospective design to test the novel hypothesis that offspring epigenetic aging - a measure of methylation differences that are associated with infant health outcomes - moderates the relationship between maternal exposure to childhood adversity and offspring symptomatology. Maternal childhood adversity was self-reported during pregnancy via the ACEs survey and the CTQ, which assessed total childhood trauma as well as maltreatment subtypes (i.e., emotional, physical, and sexual abuse). Offspring blood samples were collected at or shortly after birth and assayed on a DNA methylation microarray, and offspring symptomatology was assessed with the CBCL/1.5-5 when offspring were 2-4 years old. Results indicated that maternal childhood trauma, particularly sexual abuse, was predictive of offspring symptoms (ps = 0.003-0.03). However, the associations between maternal sexual abuse and offspring symptomatology were significantly attenuated in offspring with accelerated epigenetic aging. These findings further our understanding of how epigenetic processes may contribute to and attenuate the intergenerational link between stress and psychopathology.
Collapse
Affiliation(s)
| | - Anna K Knight
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | | | - Sierra E Carter
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Anne L Dunlop
- School of Nursing, Emory University, Atlanta, GA, USA
| | | |
Collapse
|
16
|
Siddiqi A, Monton O, Woods A, Masroor T, Fuller S, Owczarzak J, Yenokyan G, Cooper LA, Freund KM, Smith TJ, Kutner JS, Colborn KL, Joyner R, Elk R, Johnston FM. Dissemination and Implementation of a Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC): a study protocol for a hybrid type 1 randomized controlled trial. BMC Palliat Care 2023; 22:139. [PMID: 37718442 PMCID: PMC10506196 DOI: 10.1186/s12904-023-01250-0] [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: 08/09/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND There are persistent racial and ethnic health disparities in end-of-life health outcomes in the United States. African American patients are less likely than White patients to access palliative care, enroll in hospice care, have documented goals of care discussions with their healthcare providers, receive adequate symptom control, or die at home. We developed Community Health Worker Intervention for Disparities in Palliative Care (DeCIDE PC) to address these disparities. DeCIDE PC is an integrated community health worker (CHW) palliative care intervention that uses community health workers (CHWs) as care team members to enhance the receipt of palliative care for African Americans with advanced cancer. The overall objectives of this study are to (1) assess the effectiveness of the DeCIDE PC intervention in improving palliative care outcomes amongst African American patients with advanced solid organ malignancy and their informal caregivers, and (2) develop generalizable knowledge on how contextual factors influence implementation to facilitate dissemination, uptake, and sustainability of the intervention. METHODS We will conduct a multicenter, randomized, assessor-blind, parallel-group, pragmatic, hybrid type 1 effectiveness-implementation trial at three cancer centers across the United States. The DeCIDE PC intervention will be delivered over 6 months with CHW support tailored to the individual needs of the patient and caregiver. The primary outcome will be advance care planning. The treatment effect will be modeled using logistic regression. The secondary outcomes are quality of life, quality of communication, hospice care utilization, and patient symptoms. DISCUSSION We expect the DeCIDE PC intervention to improve integration of palliative care, reduce multilevel barriers to care, enhance clinic and patient linkage to resources, and ultimately improve palliative care outcomes for African American patients with advanced cancer. If found to be effective, the DeCIDE PC intervention may be a transformative model with the potential to guide large-scale adoption of promising strategies to improve palliative care use and decrease disparities in end-of-life care for African American patients with advanced cancer in the United States. TRIAL REGISTRATION Registered on ClinicalTrials.gov (NCT05407844). First posted on June 7, 2022.
Collapse
Affiliation(s)
- Amn Siddiqi
- Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Olivia Monton
- Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Alison Woods
- Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Taleaa Masroor
- Department of Surgery, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Shannon Fuller
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Jill Owczarzak
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - Lisa A Cooper
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
- Johns Hopkins University School of Nursing, 525 N Wolfe Street, Baltimore, MD, 21205, USA
- Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-515, Baltimore, MD, 21287, USA
| | - Karen M Freund
- Department of Medicine, Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - Thomas J Smith
- Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD, 21287, USA
| | - Jean S Kutner
- Department of Medicine, University of Colorado School of Medicine, 12401 E 17th Ave, Aurora, CO, 80045, USA
| | - Kathryn L Colborn
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
| | - Robert Joyner
- Richard A. Henson Research Institute, TidalHealth Peninsula Regional, 100 East Carroll Street, Salisbury, MD, 21801, USA
| | - Ronit Elk
- Department of Medicine, University of Alabama at Birmingham, 933 19th Street S, Birmingham, AL, 35205, USA
| | - Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, 600 N Wolfe Street, Blalock 606, Baltimore, MD, 21287, USA.
| |
Collapse
|
17
|
Das A, Dixit S, Kumar Barik M, Ghosal J, Babu B, Bal M, Ranjit M. Knowledge and perception related to sickle cell disease among tribal community, India: A mixed-method study. J Natl Med Assoc 2023; 115:441-453. [PMID: 37407379 DOI: 10.1016/j.jnma.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a public health problem. In absence of a pan-country intervention program in India, SCD prevalence is ascending without control. Since knowledge and perception of a community is a prerequisite for developing an intervention strategy, the current study was designed to assess it in a high SCD burden tribal-dominated district of Odisha. METHODS A mixed-method study combining qualitative and quantitative methods was conducted in the Kandhamal district, Odisha, India. A cross-sectional survey was conducted among randomly selected 1600 individuals, using a pre-tested questionnaire and 26 in-depth interviews were conducted with key informants. RESULTS Although 74.2% of the participants in the studied area had heard about the disease, only 13.6% know the cause of the disease. 69% had the knowledge to opt for modern medication. However, treatment compliance was poor, patients resort to using medications only during the crisis stage. Individuals who had knowledge about disease aetiology got to know about SCD from lived experiences of themselves, close relatives, or villagers and rarely from health workers. The community members had no clarity regarding which health centre to be approached for routine medication and management of SCD crisis. CONCLUSION The area is endemic for SCD, yet, the community lacks knowledge about the cause and treatment modality of the disease. In addition, currently there is no government-run intervention programme for screening and management of SCD related morbidity. Hence, a community based intervention strategy needs to be implemented urgently for enhancing the knowledge, perception, and aptitude related to SCD.
Collapse
Affiliation(s)
- Arundhuti Das
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India
| | - Sujata Dixit
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India
| | - Manas Kumar Barik
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India
| | - Jyoti Ghosal
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India
| | - Bontha Babu
- Indian Council of Medical Research, Ansari Nagar, New Delhi- 110029
| | - Madhusmita Bal
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India.
| | - Manoranjan Ranjit
- Indian Council of Medical Research-Regional Medical Research Centre, Chandreashekharpur, Bhubaneswar-751023, Odisha, India.
| |
Collapse
|
18
|
Fulop NJ, Walton H, Crellin N, Georghiou T, Herlitz L, Litchfield I, Massou E, Sherlaw-Johnson C, Sidhu M, Tomini SM, Vindrola-Padros C, Ellins J, Morris S, Ng PL. A rapid mixed-methods evaluation of remote home monitoring models during the COVID-19 pandemic in England. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-151. [PMID: 37800997 DOI: 10.3310/fvqw4410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background Remote home monitoring services were developed and implemented for patients with COVID-19 during the pandemic. Patients monitored blood oxygen saturation and other readings (e.g. temperature) at home and were escalated as necessary. Objective To evaluate effectiveness, costs, implementation, and staff and patient experiences (including disparities and mode) of COVID-19 remote home monitoring services in England during the COVID-19 pandemic (waves 1 and 2). Methods A rapid mixed-methods evaluation, conducted in two phases. Phase 1 (July-August 2020) comprised a rapid systematic review, implementation and economic analysis study (in eight sites). Phase 2 (January-June 2021) comprised a large-scale, multisite, mixed-methods study of effectiveness, costs, implementation and patient/staff experience, using national data sets, surveys (28 sites) and interviews (17 sites). Results Phase 1 Findings from the review and empirical study indicated that these services have been implemented worldwide and vary substantially. Empirical findings highlighted that communication, appropriate information and multiple modes of monitoring facilitated implementation; barriers included unclear referral processes, workforce availability and lack of administrative support. Phase 2 We received surveys from 292 staff (39% response rate) and 1069 patients/carers (18% response rate). We conducted interviews with 58 staff, 62 patients/carers and 5 national leads. Despite national roll-out, enrolment to services was lower than expected (average enrolment across 37 clinical commissioning groups judged to have completed data was 8.7%). There was large variability in implementation of services, influenced by patient (e.g. local population needs), workforce (e.g. workload), organisational (e.g. collaboration) and resource (e.g. software) factors. We found that for every 10% increase in enrolment to the programme, mortality was reduced by 2% (95% confidence interval: 4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1.8% (-1.2% to 4.9%). None of these results are statistically significant. We found slightly longer hospital lengths of stay associated with virtual ward services (adjusted incidence rate ratio 1.05, 95% confidence interval 1.01 to 1.09), and no statistically significant impact on subsequent COVID-19 readmissions (adjusted odds ratio 0.95, 95% confidence interval 0.89 to 1.02). Low patient enrolment rates and incomplete data may have affected chances of detecting possible impact. The mean running cost per patient varied for different types of service and mode; and was driven by the number and grade of staff. Staff, patients and carers generally reported positive experiences of services. Services were easy to deliver but staff needed additional training. Staff knowledge/confidence, NHS resources/workload, dynamics between multidisciplinary team members and patients' engagement with the service (e.g. using the oximeter to record and submit readings) influenced delivery. Patients and carers felt services and human contact received reassured them and were easy to engage with. Engagement was conditional on patient, support, resource and service factors. Many sites designed services to suit the needs of their local population. Despite adaptations, disparities were reported across some patient groups. For example, older adults and patients from ethnic minorities reported more difficulties engaging with the service. Tech-enabled models helped to manage large patient groups but did not completely replace phone calls. Limitations Limitations included data completeness, inability to link data on service use to outcomes at a patient level, low survey response rates and under-representation of some patient groups. Future work Further research should consider the long-term impact and cost-effectiveness of these services and the appropriateness of different models for different groups of patients. Conclusions We were not able to find quantitative evidence that COVID-19 remote home monitoring services have been effective. However, low enrolment rates, incomplete data and varied implementation reduced our chances of detecting any impact that may have existed. While services were viewed positively by staff and patients, barriers to implementation, delivery and engagement should be considered. Study registration This study is registered with the ISRCTN (14962466). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31) and NHSEI and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 13. See the NIHR Journals Library website for further project information. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.
Collapse
Affiliation(s)
- Naomi J Fulop
- Department of Applied Health Research, University College London, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, UK
| | | | | | - Lauren Herlitz
- Department of Applied Health Research, University College London, UK
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Efthalia Massou
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | - Manbinder Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Sonila M Tomini
- Department of Applied Health Research, University College London, UK
| | | | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Pei Li Ng
- Department of Applied Health Research, University College London, UK
| |
Collapse
|
19
|
FASHAW‐WALTERS SHEKINAHA, RAHMAN MOMOTAZUR, GEE GILBERT, MOR VINCENT, RIVERA‐HERNANDEZ MARICRUZ, FORD CERON, THOMAS KALIS. Potentially More Out of Reach: Public Reporting Exacerbates Inequities in Home Health Access. Milbank Q 2023; 101:527-559. [PMID: 36961089 PMCID: PMC10262386 DOI: 10.1111/1468-0009.12616] [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: 05/31/2022] [Revised: 11/14/2022] [Accepted: 01/03/2023] [Indexed: 03/25/2023] Open
Abstract
Policy Points Public reporting is associated with both mitigating and exacerbating inequities in high-quality home health agency use for marginalized groups. Ensuring equitable access to home health requires taking a closer look at potentially inequitable policies to ensure that these policies are not inadvertently exacerbating disparities as home health public reporting potentially does. Targeted federal, state, and local interventions should focus on raising awareness about the five-star quality ratings among marginalized populations for whom inequities have been exacerbated. CONTEXT Literature suggests that public reporting of quality may have the unintended consequence of exacerbating disparities in access to high-quality, long-term care for older adults. The objective of this study is to evaluate the impact of the home health five-star ratings on changes in high-quality home health agency use by race, ethnicity, income status, and place-based factors. METHODS We use data from the Outcome and Assessment Information Set, Medicare Enrollment Files, Care Compare, and American Community Survey to estimate differential access to high-quality home health agencies between July 2014 and June 2017. To estimate the impact of the home health five-star rating introduction on the use of high-quality home health agencies, we use a longitudinal observational pretest-posttest design. FINDINGS After the introduction of the home health five-star ratings in 2016, we found that adjusted rates of high-quality home health agency use increased for all home health patients, except for Hispanic/Latine and Asian American/Pacific Islander patients. Additionally, we found that the disparity in high-quality home health agency use between low-income and higher-income home health patients was exacerbated after the introduction of the five-star quality ratings. We also observed that patients within predominantly Hispanic/Latine neighborhoods had a significant decrease in their use of high-quality home health agencies, whereas patients in predominantly White and integrated neighborhoods had a significant increase in high-quality home health agency use. Other neighborhoods experience a nonsignificant change in high-quality home health agency use. CONCLUSIONS Policymakers should be aware of the potential unintended consequences for implementing home health public reporting, specifically for Hispanic/Latine, Asian American/Pacific Islander, and low-income home health patients, as well as patients residing in predominantly Hispanic/Latine neighborhoods. Targeted interventions should focus on raising awareness around the five-star ratings.
Collapse
Affiliation(s)
| | - MOMOTAZUR RAHMAN
- Center for Gerontology and Healthcare ResearchSchool of Public HealthBrown University
- School of Public HealthBrown University
| | - GILBERT GEE
- Fielding School of Public HealthUniversity of California at Los Angeles
| | - VINCENT MOR
- Center for Gerontology and Healthcare ResearchSchool of Public HealthBrown University
- School of Public HealthBrown University
- US Department of Veterans Affairs Medical CenterCenter of Innovation in Long‐Term Services and Supports
| | - MARICRUZ RIVERA‐HERNANDEZ
- Center for Gerontology and Healthcare ResearchSchool of Public HealthBrown University
- School of Public HealthBrown University
| | - CERON FORD
- School of Public HealthUniversity of Minnesota
| | - KALI S. THOMAS
- Center for Gerontology and Healthcare ResearchSchool of Public HealthBrown University
- School of Public HealthBrown University
- US Department of Veterans Affairs Medical CenterCenter of Innovation in Long‐Term Services and Supports
| |
Collapse
|
20
|
Dong Z, Ji M, Shan Y, Xu X, Xing Z. Functional Health Literacy Among Chinese Populations and Associated Factors: Latent Class Analysis. JMIR Form Res 2023; 7:e43348. [PMID: 37115594 PMCID: PMC10182450 DOI: 10.2196/43348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 03/11/2023] [Accepted: 03/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Poor functional health literacy has been found to be independently associated with poor self-assessed health, poor understanding of one's health condition and its management, and higher use of health services. Given the importance of functional health literacy, it is necessary to assess the overall status of functional health literacy in the general public. However, the literature review shows that no studies of functional health literacy have been conducted among the Chinese population in China. OBJECTIVE This study aimed to classify Chinese populations into different functional health literacy clusters and ascertain significant factors closely associated with low functional health literacy to provide some implications for health education, medical research, and public health policy making. METHODS We hypothesized that the participants' functional health literacy levels were associated with various demographic characteristics. Therefore, we designed a four-section questionnaire including the following information: (1) age, gender, and education; (2) self-assessed disease knowledge; (3) 3 validated health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, the eHealth Literacy Scale, and the 6-item General Health Numeracy Test); and (4) health beliefs and self-confidence measured by the Multidimensional Health Locus of Control Scales Form B. Using randomized sampling, we recruited survey participants from Qilu Hospital affiliated to Shandong University, China. The questionnaire was administered via wenjuanxing. A returned questionnaire was valid only when all question items included were answered, according to our predefined validation criterion. All valid data were coded according to the predefined coding schemes of Likert scales with different point (score) ranges. Finally, we used latent class analysis to classify Chinese populations into clusters of different functional health literacy and identify significant factors closely associated with low functional health literacy. RESULTS All data in the 800 returned questionnaires proved valid according to the predefined validation criterion. Applying latent class analysis, we classified Chinese populations into low (n=292, 36.5%), moderate-to-adequate (n=286, 35.7%), and low-to-moderate (n=222, 27.8%) functional health literacy groups and identified five factors associated with low communicative health literacy: (1) male gender (aged 40-49 years), (2) lower educational attainment (below diploma), (3) age between 38 and 68 years, (4) lower self-efficacy, and (5) belief that staying healthy was a matter of luck. CONCLUSIONS We classified Chinese populations into 3 functional health literacy groups and identified 5 factors associated with low functional health literacy. These associated factors can provide some implications for health education, medical research, and health policy making.
Collapse
Affiliation(s)
- Zhaogang Dong
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Ji'nan, China
| | - Meng Ji
- School of Languages and Cultures, The University of Sydney, Sydney, Australia
| | - Yi Shan
- School of Foreign Studies, Nantong University, Nantong, China
| | - Xiaofei Xu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Ji'nan, China
| | - Zhaoquan Xing
- Department of Urology, Qilu Hospital of Shandong University, Ji'nan, China
| |
Collapse
|
21
|
Healthcare Equity in Pediatric Otolaryngology. Otolaryngol Clin North Am 2022; 55:1287-1299. [DOI: 10.1016/j.otc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
22
|
Robinson A, O'Brien N, Sile L, Guraya HK, Govind T, Harris V, Pilkington G, Todd A, Husband A. Recommendations for community pharmacy to improve access to medication advice for people from ethnic minority communities: A qualitative person-centred codesign study. Health Expect 2022; 25:3040-3052. [PMID: 36161966 DOI: 10.1111/hex.13611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/11/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Medicines-centred consultations are vital to support medicine effectiveness and optimize health outcomes for patients. However, inequalities negatively impact ethnic minority populations when accessing medicines advice. It is important to identify opportunities to improve access for these communities however, knowledge of how best to achieve this is lacking; this study will generate recommendations to improve access to medicines advice from community pharmacies for people from ethnic minority communities. METHODS A series of codesign workshops, with four groups of patient-stakeholders, were conducted between September-November 2021; they took place in-person or via video call (adhering to COVID-19 restrictions). Existing evidence-based perceptions affecting access to medicines advice were critiqued and recommendations were generated, by use of reflexive thematic analysis, to improve access for ethnic minority patients. The workshops were audio-recorded and transcribed verbatim. QSR NVivo (Version 12) facilitated data analysis. RESULTS Twelve participants were recruited using purposive sampling; including eight UK citizens, two asylum seekers and two participants in receipt of residency visas. In total, four different ethnic minority groups were represented. Each participant took part in a first and second workshop to share and cocreate recommendations to improve access to medicines advice in community pharmacies. Three recommendations were developed and centred on: (i) delivering and providing culturally competent medicines advice; (ii) building awareness of accessing medicines advice from community pharmacies; and (iii) enabling better discussions with patients from ethnic minority communities. CONCLUSIONS These recommendations have the potential to support community pharmacy services to overcome ethnic inequalities affecting medicines advice; service commissioners should consider these findings to best meet the needs of ethnic minority patients. Cultural competence training for community pharmacy staff could support the creation of pharmacies as inclusive healthcare settings. Collaborative working with ethnic minority communities could enable specific tailoring of medicines-centred services to best meet their needs. PATIENT OR PUBLIC CONTRIBUTION The National Institute for Health Research (NIHR) and Newcastle University Patient and Public Involvement and Engagement group had extensive input in the study design and conceptualization. Seven patient champions were appointed to the steering group to ensure that the research was conducted, and findings were reported, with cultural competence. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Anna Robinson
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola O'Brien
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Laura Sile
- Alumni, School of Pharmacy, Liverpool John Moores University, Liverpool, UK
| | | | - Thorrun Govind
- Chair of the English Pharmacy Board, Royal Pharmaceutical Society, London, UK
| | - Vicki Harris
- Connected Voice Haref, Higham House, Newcastle upon Tyne, UK
| | - Guy Pilkington
- West End Family Health Primary Care Network, Cruddas Park Surgery, Newcastle upon Tyne, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andy Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
23
|
Butler CR, Sharma RK, Eneanya ND, Bernacki GM, Ghuman JK, Curtis JR, O'Hare AM. Differences Among Racial and Ethnic Minority Groups in the Unmet Existential and Supportive Care Needs of People Receiving Dialysis. JAMA Intern Med 2022; 182:992-995. [PMID: 35816354 PMCID: PMC9274444 DOI: 10.1001/jamainternmed.2022.1677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This cohort study examines differences regarding existential and supportive care needs for patients with kidney disease between individuals of racial and ethnic minority groups compared with White individuals.
Collapse
Affiliation(s)
- Catherine R Butler
- Kidney Research Institute and Department of Medicine, Division of Nephrology, University of Washington, Seattle.,Veterans Affairs Health Services Research & Development Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Rashmi K Sharma
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Nwamaka D Eneanya
- Palliative and Advanced Illness Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Gwen M Bernacki
- Department of Medicine, Division of Cardiology, University of Washington and Veterans Administration Puget Sound Geriatric Research Education and Clinical Center, Seattle
| | - Jasleen K Ghuman
- Kidney Research Institute and Department of Medicine, Division of Nephrology, University of Washington, Seattle
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle.,Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
| | - Ann M O'Hare
- Kidney Research Institute and Department of Medicine, Division of Nephrology, University of Washington, Seattle.,Veterans Affairs Health Services Research & Development Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| |
Collapse
|
24
|
Szefler SJ, Cicutto L, Brewer SE, Gleason M, McFarlane A, DeCamp LR, Brinton JT, Huebschmann AG. Applying dissemination and implementation research methods to translate a school-based asthma program. J Allergy Clin Immunol 2022; 150:535-548. [PMID: 35569568 PMCID: PMC9590448 DOI: 10.1016/j.jaci.2022.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022]
Abstract
Our school-based asthma program has reduced asthma exacerbations for youth with health disparities in the Denver metropolitan area, due partly to addressing social determinants of health, such as access to health care and medications. Dissemination and implementation (D&I) science approaches accelerate the translation of evidence-based programs into routine practice. D&I methods are being applied more commonly to improve health equity. The purpose of this publication was to give an overview of D&I research methods, using our school-based asthma program as an example. To successfully scale out our program across the state of Colorado, we are applying a D&I framework that guides the adaptation of our existing implementation approach to better meet our stakeholders' local context-the Exploration, Preparation, Implementation, Sustainment framework. In a pragmatic trial design, we will evaluate the outcomes of implementing the program across 5 Colorado regions, with attention to health equity, using a second commonly used D&I framework-Reach, Effectiveness, Adoption, Implementation, and Maintenance. Our central hypothesis is that our program will have broad and equitable reach to eligible students (primary outcome) and will reduce asthma attacks and symptoms. This D&I approach accelerates dissemination of our program and is an applicable process for translating other effective allergy/asthma programs to address asthma and allergy-related disparities.
Collapse
Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado Breathing Institute, Aurora, Colo; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo.
| | - Lisa Cicutto
- National Jewish Health, Aurora, Colo; Clinical Science and College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Sarah E Brewer
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Family Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Melanie Gleason
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado Breathing Institute, Aurora, Colo
| | | | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo; Latino Research and Policy Center, Colorado School of Public Health, Aurora, Colo
| | - John T Brinton
- Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colo; Children's Hospital Colorado Breathing Institute, Aurora, Colo
| | - Amy G Huebschmann
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Anschutz Medical Campus, Aurora, Colo; Department of Medicine, Division of General Internal Medicine, University of Colorado, Aurora, Colo; Ludeman Family Center for Women's Health Research, Aurora, Colo
| |
Collapse
|
25
|
Starr LT, Ulrich C, Perez GA, Aryal S, Junker P, O’Connor NR, Meghani SH. Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation. Am J Hosp Palliat Care 2022; 39:619-632. [PMID: 34318700 PMCID: PMC8795236 DOI: 10.1177/10499091211034383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Palliative care consultation to discuss goals-of-care ("PCC") may mitigate end-of-life care disparities. OBJECTIVE To compare hospitalization and cost outcomes by race and ethnicity among PCC patients; identify predictors of hospice discharge and post-discharge hospitalization utilization and costs. METHODS This secondary analysis of a retrospective cohort study assessed hospice discharge, do-not-resuscitate status, 30-day readmissions, days hospitalized, ICU care, any hospitalization cost, and total costs for hospitalization with PCC and hospitalization(s) post-discharge among 1,306 Black/African American, Latinx, White, and Other race PCC patients at a United States academic hospital. RESULTS In adjusted analyses, hospice enrollment was less likely with Medicaid (AOR = 0.59, P = 0.02). Thirty-day readmission was less likely among age 75+ (AOR = 0.43, P = 0.02); more likely with Medicaid (AOR = 2.02, P = 0.004), 30-day prior admission (AOR = 2.42, P < 0.0001), and Black/African American race (AOR = 1.57, P = 0.02). Future days hospitalized was greater with Medicaid (Coefficient = 4.49, P = 0.001), 30-day prior admission (Coefficient = 2.08, P = 0.02), and Black/African American race (Coefficient = 2.16, P = 0.01). Any future hospitalization cost was less likely among patients ages 65-74 and 75+ (AOR = 0.54, P = 0.02; AOR = 0.53, P = 0.02); more likely with Medicaid (AOR = 1.67, P = 0.01), 30-day prior admission (AOR = 1.81, P = 0.0001), and Black/African American race (AOR = 1.40, P = 0.02). Total future hospitalization costs were lower for females (Coefficient = -3616.64, P = 0.03); greater with Medicaid (Coefficient = 7388.43, P = 0.01), 30-day prior admission (Coefficient = 3868.07, P = 0.04), and Black/African American race (Coefficient = 3856.90, P = 0.04). Do-not-resuscitate documentation (48%) differed by race. CONCLUSIONS Among PCC patients, Black/African American race and social determinants of health were risk factors for future hospitalization utilization and costs. Medicaid use predicted hospice discharge. Social support interventions are needed to reduce future hospitalization disparities.
Collapse
Affiliation(s)
- Lauren T. Starr
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Connie Ulrich
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine,
Philadelphia, Pennsylvania
| | - G. Adriana Perez
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Subhash Aryal
- BECCA (Biostatistics * Evaluation * Collaboration *
Consultation * Analysis) Lab, University of Pennsylvania School of Nursing,
Philadelphia, Pennsylvania
| | | | - Nina R. O’Connor
- University of Pennsylvania Perelman School of Medicine,
Philadelphia, Pennsylvania
| | - Salimah H. Meghani
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| |
Collapse
|
26
|
Soleimani J, Marquez A, Fathma S, Weister TJ, Barwise AK. Detecting professional interpreter use among patients with limited English proficiency: Derivation and validation study. SAGE Open Med 2022; 10:20503121221098146. [PMID: 35600712 PMCID: PMC9118401 DOI: 10.1177/20503121221098146] [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: 07/16/2021] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The objective of this derivation and validation study was to develop and validate a search strategy algorithm to detect patients who used professional interpreter services. Methods: We identified all adults who had at least one intensive care unit admission during their hospital stay across the Mayo Clinic Enterprise between 1 January 2015 and 30 June 2020. Three random subsets of 100 patients were extracted from 60,268 patients to develop the search strategy algorithm. Two physician reviewers conducted gold standard manual chart review and any discrepancies were resolved by a third reviewer. These results were compared with the search strategy algorithm each time it was refined. Sensitivity and specificity were calculated during each phase by comparing the search strategy results to the reference gold standard for both derivation cohorts and the final validation cohort. Results: The first search strategy resulted in a sensitivity of 100% and a specificity of 89%. The second revised search strategy achieved a sensitivity of 100% and a specificity of 87%. The final version of the search strategy was applied to the validation subset and sensitivity and specificity were 100% and 89%, respectively. Conclusion: We derived and validated a search strategy algorithm to assess interpreter use among hospitalized patients. Using a search strategy algorithm with high sensitivity and specificity can reduce the time required to abstract data from the electronic medical records compared with manual data abstraction.
Collapse
Affiliation(s)
- Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Amelia Barwise, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Alberto Marquez
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sawsan Fathma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy J Weister
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
27
|
Robinson A, Sile L, Govind T, Guraya HK, O'Brien N, Harris V, Pilkington G, Todd A, Husband A. 'He or she maybe doesn't know there is such a thing as a review': A qualitative investigation exploring barriers and facilitators to accessing medication reviews from the perspective of people from ethnic minority communities. Health Expect 2022; 25:1432-1443. [PMID: 35384182 PMCID: PMC9327850 DOI: 10.1111/hex.13482] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Regular reviews of medications, including prescription reviews and adherence reviews, are vital to support pharmacological effectiveness and optimize health outcomes for patients. Despite being more likely to report a long‐term illness that requires medication when compared to their white counterparts, individuals from ethnic minority communities are less likely to engage with regular medication reviews, with inequalities negatively affecting their access. It is important to understand what barriers may exist that impact the access of those from ethnic minority communities and to identify measures that may act to facilitate improved service accessibility for these groups. Methods Semi‐structured interviews were conducted between June and August 2021 using the following formats as permitted by governmental COVID‐19 restrictions: in person, over the telephone or via video call. Perspectives on service accessibility and any associated barriers and facilitators were discussed. Interviews were audio‐recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Health Research Authority (ref: 21/HRA/1426). Results In total 20 participants from ethnic minority communities were interviewed; these participants included 16 UK citizens, 2 refugees and 2 asylum seekers, and represented a total of 5 different ethnic groups. Three themes were developed from the data regarding the perceived barriers and facilitators affecting access to medication reviews and identified approaches to improve the accessibility of such services for ethnic minority patients. These centred on (1) building knowledge and understanding about medication reviews; (2) delivering medication review services; and (3) appreciating the lived experience of patients. Conclusion The results of this study have important implications for addressing inequalities that affect ethnic minority communities. Involving patients and practitioners to work collaboratively in coproduction approaches could enable better design, implementation and delivery of accessible medication review services that are culturally competent. Patient or Public Contribution The National Institute for Health Research Applied Research Collaboration and Patient and Public Involvement and Engagement group at Newcastle University supported the study design and conceptualization. Seven patient champions inputted to ensure that the research was conducted, and the findings were reported, with cultural sensitivity.
Collapse
Affiliation(s)
- Anna Robinson
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura Sile
- School of Pharmacy, Faculty of Medical Sciences, Liverpool John Moores University, Liverpool, UK
| | - Thorrun Govind
- Chair of the English Pharmacy Board, Royal Pharmaceutical Society, London, UK
| | | | - Nicola O'Brien
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Vicki Harris
- Connected Voice Haref, Higham House, Newcastle upon Tyne, UK
| | - Guy Pilkington
- West End Family Health Primary Care Network, Newcastle upon Tyne, UK
| | - Adam Todd
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andy Husband
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
28
|
Chaudhary AMD, Naveed S, Saboor S, Safdar B, Azeem MW, Khosa F. Gender and Racial Disparities among US Psychiatry Residents: A Review of Trends. Psychiatr Q 2022; 93:97-105. [PMID: 33586128 DOI: 10.1007/s11126-021-09888-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
Diversity provides better patient outcomes, reduces physician burnout, and therefore lessens the burden of the healthcare system. In this study, we explore the gender and racial trends in the recruitment of medical graduates into US psychiatry residency programs. Retrospective data analysis was performed utilizing the data from the Accreditation Council for Graduate Medical Education (ACGME) Data's annual Resource Books from the year 2007 to 2018. Demographic data, including gender and race, were extracted for psychiatry residents. Gender was categorized as Male, Female, and Not Reported. Race/ethnicity was categorized as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black/African-American (Non-Hispanic), Native American/Alaskan, Others (not in the aforementioned categories), and Unknown. Female psychiatry residents relatively decreased by 2.6% whereas male psychiatry residents relatively increased by 15.5% from 2007 to 2018. Between the years 2011 and 2018, there was a relative increase in African American/Black and Native American/Alaskan psychiatry residents by 5.5% and 1%, respectively, whereas the Asian/Pacific Islanders, White (Non-Hispanic), and Hispanic/Latino psychiatry residents relatively decreased by 5.1%, 2.3%, and 1.7%, respectively. Despite the overall increase of women and ethnic minorities in US medical schools, women and racial minorities remain significantly under-represented in psychiatry residency programs in the US.
Collapse
Affiliation(s)
| | - Sadiq Naveed
- Institute of Living, 200 Retreat Ave, Hartford, CT, 06102, USA.
| | | | - Beenish Safdar
- Mather Hospital Northwell Health, Port Jefferson, NY, USA
| | | | - Faisal Khosa
- University of British Columbia, Vancouver, Canada
| |
Collapse
|
29
|
Yoo W. Addressing the Social Determinants of Health in South Korea: Moderating Role of mHealth Technologies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031871. [PMID: 35162893 PMCID: PMC8834917 DOI: 10.3390/ijerph19031871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
Abstract
Mobile health (mHealth) technologies may reduce or widen health inequalities. Despite the extensive literature in support of both of these contrasting views, little attention has been paid to the role of mHealth technologies with regard to social strata and health in the context of South Korea, a country with one of the highest usages of smartphones worldwide. This study examined the effects of social determinants on health self-efficacy and health status and explored how mHealth technologies moderate the impacts of social determinants on health outcomes. Data were collected via online surveys from 29 July to 3 August 2021. Survey data from 1187 Korean adults showed that men had higher levels of health self-efficacy than women. The higher an individual’s education level, the greater their subjective health status. Individuals with higher levels of monthly household income, social capital, and healthcare quality reported higher levels of health self-efficacy and superior health status. The use of mHealth technologies moderated the associations between social determinants and health outcomes. Specifically, monthly household income and social capital had smaller effects on health self-efficacy and health status among those who used higher levels of mHealth technologies. Among higher users of mHealth technologies, females reported better health status than males, while men showed better health status than women in the low-user group. These findings highlight the effectiveness of mHealth technologies in addressing health disparities.
Collapse
Affiliation(s)
- Woohyun Yoo
- Department of Mass Communication & Institute of Social Sciences, Incheon National University, 119 Academy-ro, Yeonsu-gu, Incheon 22012, Korea
| |
Collapse
|
30
|
Bringing Care to Underserved and Vulnerable Patient Populations: Meeting Patients Where They Are. Med Care 2022; 60:1-2. [PMID: 34882108 DOI: 10.1097/mlr.0000000000001671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
31
|
Price JL, Bruce MA, Adinoff B. Addressing Structural Racism in Psychiatry With Steps to Improve Psychophysiologic Research. JAMA Psychiatry 2022; 79:70-74. [PMID: 34613345 DOI: 10.1001/jamapsychiatry.2021.2663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The American Medical Association has acknowledged the public health threat posed by racism in medicine. While clinicians in psychiatry have echoed the sentiment, the research community has largely been silent. Current understanding of the biological domains that underlie psychiatric disorders was historically established by studying White populations, often leaving widely used treatments ineffective for Asian, Black, Hispanic, Indigenous, and other racial and ethnic minority individuals. This article addresses how undersampling of racial and ethnic minority individuals has led to overgeneralized physiological findings, the implications for development of psychiatric treatments, and steps to improve service to racially diverse communities. OBSERVATIONS Three primary observations regarding differences associated with race and ethnicity have been addressed in the existing psychiatric research: misdiagnosis, medication nonadherence, and treatment efficacy and expression of adverse effects. While cultural factors have been discussed as potential factors associated with these differences, a lack of understanding of physiologic systems may be foundational to each of these issues. Recent evidence points to race differences in psychophysiological measures, likely attributed to factors including the lived experience of racism as opposed to inherent biological differences. This mounting evidence supports a reassessment of existing work to examine potential divergent patterns within racial and ethnic groups. The following strategies may improve understanding of the influence of racism on physiology, allowing clinicians to better address psychiatric symptoms and improve existing treatment approaches. Thus, psychiatric researchers need to (1) understand the historic and current terminology for race and ethnicity and use appropriate terms and categories as defined by sociologists, population health experts, and databases while respecting individuals' right to self-identify, (2) refine research questions, and (3) reexamine research data to determine whether patterns observed in largely White populations can extend to other groups. To appropriately implement these steps, researchers must accept the discomfort that accompanies growth, invite scientists from diverse backgrounds to participate, and use resources to increase diversity in recruitment of study participants. This will require a commitment from funding agencies to provide adequate support to recruit and investigate large, diverse samples. CONCLUSIONS AND RELEVANCE To create more suitable medical treatments and improve the quality of care received by those with psychiatric conditions, further discussion is needed surrounding the physiologic toll that racism has had on multiple generations of racial and ethnic minority groups and how that may alter responsivity to biobehavioral interventions. To better inform psychiatric research, the resources provided must be expanded, basic physiologic studies should be replicated with more diverse samples and adequate analyses, and psychiatry scientists must reconsider approaches to clinical research.
Collapse
Affiliation(s)
- Julianne L Price
- Department of Kinesiology and Health, Center of Alcohol and Substance Use Studies, Rutgers University, New Brunswick, New Jersey
| | - Marino A Bruce
- Program for Research on Faith, Justice, and Health, Department of Behavioral and Social Sciences, University of Houston College of Medicine, Houston, Texas
| | - Bryon Adinoff
- Anschutz Medical Campus, University of Colorado, Denver
| |
Collapse
|
32
|
Robinson A, Elarbi M, Todd A, Husband A. A qualitative exploration of the barriers and facilitators affecting ethnic minority patient groups when accessing medicine review services: Perspectives of healthcare professionals. Health Expect 2021; 25:628-638. [PMID: 34951087 PMCID: PMC8957739 DOI: 10.1111/hex.13410] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/29/2021] [Accepted: 12/07/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Healthcare inequalities and ethnicity are closely related. Evidence has demonstrated that patients from ethnic minority groups are more likely to report a long‐term illness than their white counterparts; yet, in some cases, minority groups have reported poorer adherence to prescribed medicines and may be less likely to access medicine services. Knowledge of the barriers and facilitators that impact ethnic minority access to medicine services is required to ensure that services are fit for purpose to meet and support the needs of all. Methods Semistructured interviews with healthcare professionals were conducted between October and December 2020, using telephone and video call‐based software. Perspectives on barriers and facilitators were discussed. Interviews were audio‐recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Newcastle University Faculty of Medical Sciences Ethics Committee. Results Eighteen healthcare professionals were interviewed across primary, secondary and tertiary care settings; their roles spanned medicine, pharmacy and dentistry. Three themes were developed from the data regarding the perceived barriers and facilitators affecting access to medicine services for ethnic minority patients. These centred around patient expectations of health services; appreciating cultural stigma and acceptance of certain health conditions; and individually addressing communication and language needs. Conclusion This study provides much‐needed evidence relating to the barriers and facilitators impacting minority ethnic communities when seeking medicine support. The results of this study have important implications for the delivery of person‐centred care. Involving patients and practitioners in coproduction approaches could enable the design and delivery of culturally sensitive and accessible medicine services. Patient or Public Contribution The Patient and Public Involvement and Engagement (PPIE) group at Newcastle University had extensive input in the design and concept of this study before the research was undertaken. Throughout the work, a patient champion (Harpreet Guraya) had input in the project by ensuring that the study was conducted, and the findings were reported, with cultural sensitivity.
Collapse
Affiliation(s)
- Anna Robinson
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Muna Elarbi
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Andy Husband
- School of Pharmacy, Newcastle University, Newcastle Upon Tyne, UK.,Institute of Population Health Sciences, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
33
|
Mi Familia Entera: Contraceptive Use Among Spanish-Speaking Mothers of Young Children. Matern Child Health J 2021; 26:139-148. [PMID: 34845572 DOI: 10.1007/s10995-021-03300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To characterize contraceptive method use and satisfaction among Spanish-speaking Latina immigrants who attend their child's well care visit. METHODS Spanish-speaking women whose youngest child was ≤ 4 years old completed an orally-administered Spanish-language survey in a pediatric clinic (N = 194). Survey items were based on previously published contraceptive use assessments among diverse populations. We used chi-square and Fisher exact test to describe maternal characteristics by contraceptive method effectiveness categories: Tier 1, most effective methods (hormonal implant, intrauterine device, tubal ligation, and vasectomy); Tier 2, very effective methods (hormonal injection, oral contraceptive pill, hormonal patch, and hormonal ring); Tier 3, effective methods (condoms), and no method. RESULTS 34% of women were using a Tier 1 method, 40% were using a Tier 2 method, and 17% had unmet contraceptive need (no pregnancy intention, no birth control); 84% were satisfied with their current method and 82% of women were uninsured. Tier 2 method or no method users were more likely than women using a Tier 1 method to have children < 9 months old (X2 (6, N = 190) = 20.4, p = .002). CONCLUSIONS Latina immigrants with young children who attend their child's pediatric visit are mostly using effective contraceptives and are satisfied with their method. A culturally supportive medical home and access to no-cost long-acting reversible contraceptives through a temporary private grant likely contributed to high contraceptive use and satisfaction in our study. Describing maternal contraceptive use among Latina immigrant mothers can inform future equitable, culturally tailored, approaches to pediatric maternal contraceptive need screening.
Collapse
|
34
|
Zhao J, Han X, Zheng Z, Nogueira L, Lu AD, Nathan PC, Yabroff KR. Racial/Ethnic Disparities in Childhood Cancer Survival in the United States. Cancer Epidemiol Biomarkers Prev 2021; 30:2010-2017. [PMID: 34593561 DOI: 10.1158/1055-9965.epi-21-0117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/17/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Non-white patients with childhood cancer have worse survival than Non-Hispanic (NH) White patients for many childhood cancers in the United States. We examined the contribution of socioeconomic status (SES) and health insurance on racial/ethnic disparities in childhood cancer survival. METHODS We used the National Cancer Database to identify NH White, NH Black, Hispanic, and children of other race/ethnicities (<18 years) diagnosed with cancer between 2004 and 2015. SES was measured by the area-level social deprivation index (SDI) at patient residence and categorized into tertiles. Health insurance coverage at diagnosis was categorized as private, Medicaid, and uninsured. Cox proportional hazard models were used to compare survival by race/ethnicity. We examined the contribution of health insurance and SES by sequentially adjusting for demographic and clinical characteristics (age group, sex, region, metropolitan statistical area, year of diagnosis, and number of conditions other than cancer), health insurance, and SDI. RESULTS Compared with NH Whites, NH Blacks and Hispanics had worse survival for all cancers combined, leukemias and lymphomas, brain tumors, and solid tumors (all P < 0.05). Survival differences were attenuated after adjusting for health insurance and SDI separately; and further attenuated after adjusting for insurance and SDI together. CONCLUSIONS Both SES and health insurance contributed to racial/ethnic disparities in childhood cancer survival. IMPACT Improving health insurance coverage and access to care for children, especially those with low SES, may mitigate racial/ethnic survival disparities.
Collapse
Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia.
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Amy D Lu
- The University of Toronto, Toronto, Ontario, Canada
| | - Paul C Nathan
- The University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Division of Hematology/Oncology, Toronto, Ontario, Canada
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| |
Collapse
|
35
|
Durand MA, Lamouroux A, Redmond NM, Rotily M, Bourmaud A, Schott AM, Auger-Aubin I, Frachon A, Exbrayat C, Balamou C, Gimenez L, Grosclaude P, Moumjid N, Haesebaert J, Massy HD, Bardes J, Touzani R, Diant LBEF, Casanova C, Seitz JF, Mancini J, Delpierre C. Impact of a health literacy intervention combining general practitioner training and a consumer facing intervention to improve colorectal cancer screening in underserved areas: protocol for a multicentric cluster randomized controlled trial. BMC Public Health 2021; 21:1684. [PMID: 34530800 PMCID: PMC8444501 DOI: 10.1186/s12889-021-11565-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of cancer burden worldwide. In France, it is the second most common cause of cancer death after lung cancer. Systematic uptake of CRC screening can improve survival rates. However, people with limited health literacy (HL) and lower socioeconomic position rarely participate. Our aim is to assess the impact of an intervention combining HL and CRC screening training for general practitioners (GPs) with a pictorial brochure and video targeting eligible patients, to increase CRC screening and other secondary outcomes, after 1 year, in several underserved geographic areas in France. METHODS We will use a two-arm multicentric randomized controlled cluster trial with 32 GPs primarily serving underserved populations across four regions in France with 1024 patients recruited. GPs practicing in underserved areas (identified using the European Deprivation Index) will be block-randomized to: 1) a combined intervention (HL and CRC training + brochure and video for eligible patients), or 2) usual care. Patients will be included if they are between 50 and 74 years old, eligible for CRC screening, and present to recruited GPs. The primary outcome is CRC screening uptake after 1 year. Secondary outcomes include increasing knowledge and patient activation. After trial recruitment, we will conduct semi-structured interviews with up to 24 GPs (up to 8 in each region) and up to 48 patients (6 to 12 per region) based on data saturation. We will explore strategies that promote the intervention's sustained use and rapid implementation using Normalization Process Theory. We will follow a community-based participatory research approach throughout the trial. For the analyses, we will adopt a regression framework for all quantitative data. We will also use exploratory mediation analyses. We will analyze all qualitative data using a framework analysis guided by Normalization Process Theory. DISCUSSION Limited HL and its impact on the general population is a growing public health and policy challenge worldwide. It has received limited attention in France. A combined HL intervention could reduce disparities in CRC screening, increase screening rates among the most vulnerable populations, and increase knowledge and activation (beneficial in the context of repeated screening). TRIAL REGISTRATION Registry: ClinicalTrials.gov. TRIAL REGISTRATION NUMBER 2020-A01687-32 . Date of registration: 17th November 2020.
Collapse
Affiliation(s)
- Marie-Anne Durand
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.,The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA.,Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
| | - Aurore Lamouroux
- Assistance Publique - Hôpitaux de Marseille, Marseille, France.,Comité Départemental d'Éducation pour la Santé de Vaucluse (CoDES 84), Avignon, France
| | - Niamh M Redmond
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.
| | - Michel Rotily
- Assistance Publique - Hôpitaux de Marseille, Marseille, France.,EA 3279: Aix-Marseille Université, CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | | | | | | | - Adèle Frachon
- Département de Médecine Générale, Université de Paris, Paris, France
| | - Catherine Exbrayat
- Centre Régional de Coordination du Dépistage des Cancers (CRCDC-AuRA), Auvergne-Rhônes-Alpes, Saint Étienne, Cedex 02, France
| | - Christian Balamou
- Centre Régional de Coordination du Dépistage des Cancers (CRCDC-AuRA), Auvergne-Rhônes-Alpes, Saint Étienne, Cedex 02, France
| | - Laëtitia Gimenez
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.,Faculté de Médecine - Département Universitaire de Médecine Générale, Toulouse, France
| | - Pascale Grosclaude
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France.,Institut Claudius Regaud, IUCT-O, Registre des cancers du Tarn, Toulouse, F-31059, France
| | - Nora Moumjid
- P2S EA4129, Centre Léon Bérard, Université Lyon 1, Lyon, France
| | | | - Helene Delattre Massy
- Centre Régional de Coordination du Dépistage des Cancers d'Ile de France (CRCDC-IDF), Paris, France
| | - Julia Bardes
- Centre Régional de Coordination du Dépistage des Cancers d'Ile de France (CRCDC-IDF), Paris, France
| | - Rajae Touzani
- Institut Paoli Calmettes, SESSTIM UMR1252, Marseille, France.,Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" group, Hôpital Timone, Marseille, France
| | | | - Clémence Casanova
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" group, Hôpital Timone, Marseille, France
| | - Jean François Seitz
- Service d'Hépato-Gastroentérologie, Hôpital Timone, Assistance Publique Hôpitaux Marseille & Aix-Marseille-Université, Marseille, France.,Centre Régional de Coordination du Dépistage des Cancers Provence-Alpes-Côte d'Azur (CRCDC-PACA), Marseille, France
| | - Julien Mancini
- Aix-Marseille Université, APHM, INSERM, IRD, SESSTIM, "Cancer, Biomedicine & Society" group, Hôpital Timone, Marseille, France
| | - Cyrille Delpierre
- CERPOP, INSERM UMR1295, Université Toulouse III Paul Sabatier, Inserm, UPS, Toulouse, France
| |
Collapse
|
36
|
Verhey R, Chitiyo C, Mboweni SN, Chiriseri E, Chibanda D, Healey A, Wagenaar B, Araya R. Optimising implementation strategies of the first scaleup of a primary care psychological intervention for common mental disorders in Sub-Saharan Africa: a mixed methods study protocol for the optimised Friendship Bench (OptFB). BMJ Open 2021; 11:e045481. [PMID: 34518246 PMCID: PMC8438921 DOI: 10.1136/bmjopen-2020-045481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Common mental disorders (CMDs) are a leading cause of disability globally. CMDs are highly prevalent in Zimbabwe and have been addressed by an evidence-based, task-shifting psychological intervention called the Friendship Bench (FB). The task-shifted FB programme guides clients through problem-solving therapy. It was scaled up across 36 implementation sites in Zimbabwe in 2016. METHODS AND ANALYSIS This study will employ a mixed-method framework. It aims to: (1) use quantitative survey methodologies organised around the Reach, Effectiveness, Adoption and Implementation and Maintenance evaluation framework to assess the current scaleup of the FB intervention and classify 36 clinics according to levels of performance; (2) use qualitative focus group discussions and semistructured interviews organised around the Consolidated Framework for Implementation Research to analyse determinants of implementation success, as well as elucidate heterogeneity in implementation strategies through comparing high-performing and low-performing clinics; and (3) use the results from aims 1 and 2 to develop strategies to optimise the Friendship Bench intervention and apply this model in a cluster randomised controlled trial to evaluate potential improvements among low-performing clinics. The trial will be registered with the Pan African Clinical Trial Registry (www.pactr.org). The planned randomised controlled trial for the third research aim will be registered after completing aims one and two because the intervention is dependent on knowledge generated during these phases. ETHICS AND DISSEMINATION The research protocol received full authorisation from the Medical Research Council of Zimbabwe (MRCZ A/242). It is anticipated that changes in data collection tools and consent forms will take place at all three phases of the study and approval from MRCZ will be sought. All interview partners will be asked for informed consent. The research team will prioritise open-access publications to disseminate research results.
Collapse
Affiliation(s)
- Ruth Verhey
- Research Support Centre, University of Zimbabwe, Harare, Harare, Zimbabwe
- Friendship Bench Zimbabwe, Harare, Zimbabwe
| | - Charmaine Chitiyo
- Research Support Centre, University of Zimbabwe, Harare, Harare, Zimbabwe
- Friendship Bench Zimbabwe, Harare, Zimbabwe
| | - Sandra Ngonidzashe Mboweni
- Research Support Centre, University of Zimbabwe, Harare, Harare, Zimbabwe
- Friendship Bench Zimbabwe, Harare, Zimbabwe
| | | | - Dixon Chibanda
- Research Support Centre, University of Zimbabwe, Harare, Harare, Zimbabwe
- Friendship Bench Zimbabwe, Harare, Zimbabwe
- Global Mental Health, London School of Hygiene and Tropical Medicine, LSHTM, London, UK
| | | | - Bradley Wagenaar
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of global health, University of Washington, Seattle, Washington, USA
| | - Ricardo Araya
- IOPPN, King's College London, London, UK
- Centre for Global Mental Health and Primary Care Research, London, UK
| |
Collapse
|
37
|
Cooper JN, Koppera S, Boss EF, Lind MN. Differences in Tonsillectomy Utilization by Race/Ethnicity, Type of Health Insurance, and Rurality. Acad Pediatr 2021; 21:1031-1036. [PMID: 33207221 DOI: 10.1016/j.acap.2020.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Tonsillectomy is one of the most common pediatric surgical procedures. In previous decades, large geographic variation and racial disparities in its use have been reported. We aimed to compare contemporary rates of pediatric tonsillectomy utilization in the United States by child race/ethnicity, type of health insurance, and metropolitan/nonmetropolitan residence. METHODS We performed a cross-sectional study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project State Ambulatory Surgery and Services Databases and State Inpatient Databases of 8 US states. We included all children aged <15 years who underwent tonsillectomy in 2013 to 2017. Annual population-level tonsillectomy rates across states and sociodemographic groups overall and by surgical indication were calculated using US Census data. Negative binomial regression models were used to compare rates between groups. RESULTS In all states evaluated, tonsillectomy utilization was higher in non-Hispanic white children than non-Hispanic black or Hispanic children, higher in publicly insured than privately insured children, and higher in children residing in nonmetropolitan areas as compared to metropolitan areas (all P < .05). Tonsillectomy use was highest among white children from nonmetropolitan areas, both overall and for each indication (all P < .05). CONCLUSIONS Tonsillectomy utilization is higher in US children who are white, publicly insured, and who live in nonmetropolitan areas. Future research should identify multilevel factors, such as those at the patient, family, primary care provider, otolaryngologist, health care delivery system, interpersonal and community levels, that explain these differences in utilization in order to improve the appropriateness and equity of tonsillectomy use in children.
Collapse
Affiliation(s)
- Jennifer N Cooper
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital (JN Cooper and S Koppera), Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine (JN Cooper), Columbus, Ohio; Division of Epidemiology, The Ohio State University College of Public Health (JN Cooper), Columbus, Ohio.
| | - Swapna Koppera
- Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital (JN Cooper and S Koppera), Columbus, Ohio
| | - Emily F Boss
- Department of Otolaryngology, Johns Hopkins University School of Medicine (EF Boss), Baltimore, Md
| | - Meredith N Lind
- Department of Otolaryngology, Nationwide Children's Hospital (MN Lind), Columbus, Ohio; Department of Otolaryngology, The Ohio State University College of Medicine (MN Lind), Columbus, Ohio
| |
Collapse
|
38
|
Moreira CC. Developing cultural competency and maximizing its effect in vascular surgery. J Vasc Surg 2021; 74:76S-85S. [PMID: 34303463 DOI: 10.1016/j.jvs.2021.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Carla C Moreira
- Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI.
| |
Collapse
|
39
|
Health professionals' identified barriers to trans healthcare: a qualitative interview study. Br J Gen Pract 2021; 71:e941-e947. [PMID: 34133317 PMCID: PMC8544119 DOI: 10.3399/bjgp.2021.0179] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/06/2021] [Indexed: 01/12/2023] Open
Abstract
Background Trans and gender-diverse people face multiple barriers within health care. Primary care practitioners are key to providing health care to trans and gender-diverse people but they often lack training in, and understanding of, trans identities and healthcare options. Few studies have examined health professionals’ understanding of the barriers that exist in health care for trans and gender-diverse people. Aim To map out barriers to providing good-quality health care to trans and gender-diverse people, and explore ways to address them. Design and setting A qualitative interview study involving 20 health professionals working with young trans and gender-diverse people. Method Participants were recruited through purposive and snowball sampling. Data were generated using semi-structured qualitative interviews. A thematic analysis involved coding and categorising data using NVivo (version 12) software and further conceptual analysis in which developing themes were identified. Results Four barrier domains to good-quality care for trans and gender-diverse people were identified: structural (related to lack of guidelines, long waiting times, and shortage of specialist centres); educational (based on lack of training on trans health); cultural and social (reflecting negative attitudes towards trans people); and technical (related to information systems and technology). Conclusion There is an urgent need to address the barriers trans and gender-diverse people face in health care. Structural-level solutions include health policy, professional education, and standards; at the practice level, GPs can act as potential drivers of change in addressing the cultural and technical barriers to better meet the needs of their trans and gender-diverse patients.
Collapse
|
40
|
Bhambhani Y, Gallo L. Developing and Adapting a Mindfulness-Based Group Intervention for Racially and Economically Marginalized Patients in the Bronx. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
41
|
Arrington LA, Edie AH, Sewell CA, Carter BM. Launching the Reduction of Peripartum Racial/Ethnic Disparities Bundle: A Quality Improvement Project. J Midwifery Womens Health 2021; 66:526-533. [PMID: 33913616 DOI: 10.1111/jmwh.13235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Health care organizations have a responsibility to reduce racial and ethnic perinatal health disparities. In the United States, Black women experience the worst perinatal outcomes. The process for successfully addressing this problem in clinical practice remains unclear. PROCESS A community hospital implemented components of the Alliance for Innovation on Maternal Health Reduction of Peripartum Racial/Ethnic Disparities Patient Safety Bundle. The purpose was to collect and share perinatal disparities data, increase staff awareness of perinatal racial and ethnic disparities, and engage staff to address these disparities at the project site. Perinatal care data were reviewed by race and ethnicity and results were shared with staff. Staff were engaged through a series of activities including a Health Equity Party, implicit bias workshop, Snack and Learn sessions, online modules, 2 grand rounds, and the establishment of a Health Equity Committee. OUTCOMES Racial and/or ethnic disparities were identified for perinatal outcomes and experience of care indicators including rates of cesarean birth, newborn mortality, and 30-day readmission. Of the staff 137 (65.9%) participated in project activities. The majority of participants were registered nurses (n = 82). Certified nurse-midwives (n = 10) were the profession with the highest rate of attendance (83.3%). Staff developed 26 new recommendations to address racial and ethnic disparities in care. After project implementation, mean scores of High Provider Attribution, an indicator of readiness to address health disparities, increased from preimplementation scores (P = .01). There was also a significant increase in the number of staff who reported engaging in activities to address the health care needs of racial and ethnic minority patients (P < .001). DISCUSSION This quality improvement project demonstrated that interventions at the health care organization level can be effective in influencing health care providers and staff to address racial and ethnic perinatal disparities.
Collapse
Affiliation(s)
- Lauren Anita Arrington
- Department of Midwifery and Women's Health, Frontier Nursing University, Hyden, Kentucky.,Department of Obstetrics and Gynecology, University of Maryland St. Joseph Medical Center, Towson, Maryland
| | | | - Catherine Angela Sewell
- Department of Obstetrics and Gynecology, University of Maryland St. Joseph Medical Center, Towson, Maryland.,Division of Urology, Obstetrics and Gynecology, Center for Drug Evaluation Research, US Food and Drug Administration, Silver Spring, Maryland
| | | |
Collapse
|
42
|
Bozorgi P, Eberth JM, Eidson JP, Porter DE. Facility Attractiveness and Social Vulnerability Impacts on Spatial Accessibility to Opioid Treatment Programs in South Carolina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4246. [PMID: 33923748 PMCID: PMC8073603 DOI: 10.3390/ijerph18084246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/20/2022]
Abstract
Opioid dependence and opioid-related mortality have been increasing in recent years in the United States. Available and accessible treatments may result in a reduction of opioid-related mortality. This work describes the geographic variation of spatial accessibility to opioid treatment programs (OTPs) and identifies areas with poor access to care in South Carolina. The study develops a new index of access that builds on the two-step floating catchment area (2SFCA) method, and has three dimensions: a facility attractiveness index, defined by services rendered incorporated into the Huff Model; a facility catchment area, defined as a function of facility attractiveness to account for variable catchment size; and a Social Vulnerability Index (SVI) to account for nonspatial factors that mitigate or compound the impacts of spatial access to care. Results of the study indicate a significant variation in access to OTPs statewide. Spatial access to OTPs is low across the entire state except for in a limited number of metropolitan areas. The majority of the population with low access (85%) live in areas with a moderate-to-high levels of social vulnerability. This research provides more realistic estimates of access to care and aims to assist policymakers in better targeting disadvantaged areas for OTP program expansion and resource allocation.
Collapse
Affiliation(s)
- Parisa Bozorgi
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- South Carolina Department of Health and Environmental Control (SCDHEC), Columbia, SC 29201, USA;
| | - Jan M. Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA;
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Jeannie P. Eidson
- South Carolina Department of Health and Environmental Control (SCDHEC), Columbia, SC 29201, USA;
| | - Dwayne E. Porter
- Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| |
Collapse
|
43
|
Sastow DL, Jiang SY, Tangel VE, Matthews KC, Abramovitz SE, Oxford-Horrey CM, White RS. Patient race and racial composition of delivery unit associated with disparities in severe maternal morbidity: a multistate analysis 2007-2014. Int J Obstet Anesth 2021; 47:103160. [PMID: 33931312 DOI: 10.1016/j.ijoa.2021.103160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 03/06/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND High Black-serving delivery units and high hospital safety-net burden have been associated with poorer patient outcomes. We examine these hospital-level factors and their association with severe maternal morbidity (SMM), independently and as effect modifiers of patient-level factors. METHODS Using the 2007-2014 State Inpatient Databases (Florida, New York, California, Maryland, Kentucky), we analyzed delivery hospitalizations. We constructed generalized linear mixed models with patient- and hospital-level variables (Black-serving delivery units: high: top 5th percentile; medium: 5th-25th percentile; low: bottom 75th percentile; hospital safety-net burden status defined by insurance status) and report adjusted odds ratios (aOR) and 99% confidence intervals (CI). We repeated our mixed models with stratification and interaction analysis. RESULTS 6 879 332 delivery hospitalizations were included in the analysis. Deliveries at high (aOR 1.83; 99% CI 1.34 to2.50) or medium (aOR 1.27; 99% CI 1.10 to 1.46) Black-serving delivery units were more likely to have SMM than deliveries at low Black-serving delivery units. Hospital safety-net burden was not significantly associated with SMM. In stratified models by hospital category, deliveries of Black women were associated with an increase in SMM compared with deliveries of White women in all hospital categories. In interaction models, Black women giving birth in high Black-serving delivery units had more than twice the odds of White women in low Black-serving delivery units of experiencing SMM (aOR 2.42; 99% CI 1.90 to 3.08). CONCLUSION The patient racial/ethnic composition of the delivery unit is associated with adjusted-odds of SMM, both independently and interactively with individual patient race.
Collapse
Affiliation(s)
- D L Sastow
- Icahn School of Medicine at Mount Sinai, Department of Education, New York, NY, USA
| | - S Y Jiang
- Weill Cornell Medicine, Center for Perioperative Outcomes, Department of Anesthesiology, New York, NY, USA
| | - V E Tangel
- Weill Cornell Medicine, Center for Perioperative Outcomes, Department of Anesthesiology, New York, NY, USA
| | - K C Matthews
- Weill Cornell Medicine, Department of Obstetrics and Gynecology, New York, NY, USA
| | - S E Abramovitz
- Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA
| | - C M Oxford-Horrey
- Weill Cornell Medicine, Department of Obstetrics and Gynecology, New York, NY, USA
| | - R S White
- Weill Cornell Medicine, Department of Anesthesiology, New York, NY, USA.
| |
Collapse
|
44
|
Ma GX, Bhimla A, Zhu L, Beeber M, Aczon F, Tan Y, Quinn SB, Khan O, Gadegbeku CA. Development of an Intervention to Promote Physical Activity and Reduce Dietary Sodium Intake for Preventing Hypertension and Chronic Disease in Filipino Americans. J Racial Ethn Health Disparities 2021; 8:283-292. [PMID: 32495306 PMCID: PMC7710586 DOI: 10.1007/s40615-020-00781-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
Hypertension is a common chronic health condition affecting Filipino Americans. This pilot study examined the feasibility of addressing high rates of hypertension among Filipino Americans through the implementation of a culturally tailored education intervention. Filipino Americans living in the Greater Philadelphia Area were recruited through community-based organizations for participation and were engaged using a community-based participatory research (CBPR) framework. The study included pre- and post-intervention blood pressure measurements, self-reported body mass index, and questionnaires about physical activity and salt intake. The intervention to promote physical activity and reduce salt intake was conducted through two educational sessions and was accompanied by follow-up at 3 months and by the collection of urine samples for 24-h urinary sodium intake biomarker analysis. Following intervention, a non-statistically significant decrease in urine sodium was observed in both the intervention and the control groups. For systolic blood pressure, a reduction of 12.6 mmHg and an increase in 5.3 mmHg was observed in the intervention and control groups, respectively. Diastolic pressure decreased 3.8 mmHg for the intervention group and increased 5.6 mmHg among controls. The culturally tailored education intervention reported here represents a promising tool for blood pressure reduction in high-risk ethnic populations. The methods used were effective for the recruitment and retention of ethnic minorities in a community-based setting.
Collapse
Affiliation(s)
- Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA.
- Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
| | - Aisha Bhimla
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA
| | - Maayan Beeber
- Hunter College, The City University of New York (CUNY), New York, NY, USA
| | - Ferdinand Aczon
- Filipino American Society of South Jersey Inc., Mount Laurel, NJ, 08084, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA
| | - Sally Boyle Quinn
- Division of Nephrology, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| | - Omar Khan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, 3440 N Broad St., Suite 320, Kresge East Bldg, Philadelphia, PA, 19140, USA
| | - Crystal A Gadegbeku
- Division of Nephrology, Temple University School of Medicine, Philadelphia, PA, 19140, USA
| |
Collapse
|
45
|
Jackson JW. Meaningful Causal Decompositions in Health Equity Research: Definition, Identification, and Estimation Through a Weighting Framework. Epidemiology 2021; 32:282-290. [PMID: 33394809 PMCID: PMC8478117 DOI: 10.1097/ede.0000000000001319] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Causal decomposition analyses can help build the evidence base for interventions that address health disparities (inequities). They ask how disparities in outcomes may change under hypothetical intervention. Through study design and assumptions, they can rule out alternate explanations such as confounding, selection bias, and measurement error, thereby identifying potential targets for intervention. Unfortunately, the literature on causal decomposition analysis and related methods have largely ignored equity concerns that actual interventionists would respect, limiting their relevance and practical value. This article addresses these concerns by explicitly considering what covariates the outcome disparity and hypothetical intervention adjust for (so-called allowable covariates) and the equity value judgments these choices convey, drawing from the bioethics, biostatistics, epidemiology, and health services research literatures. From this discussion, we generalize decomposition estimands and formulae to incorporate allowable covariate sets (and thereby reflect equity choices) while still allowing for adjustment of non-allowable covariates needed to satisfy causal assumptions. For these general formulae, we provide weighting-based estimators based on adaptations of ratio-of-mediator-probability and inverse-odds-ratio weighting. We discuss when these estimators reduce to already used estimators under certain equity value judgments, and a novel adaptation under other judgments.
Collapse
Affiliation(s)
- John W Jackson
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Center for Health Equity, Baltimore, MD
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, MD
| |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW Disparities in health outcomes are a well documented and worrisome part of our health care system. These disparities persist in spite of, and are occasionally exacerbated by, new technologies that are intended to improve health care. This results in a "digital divide" in which populations that have poorer health outcomes continue to have poorer health outcomes despite technological improvements. RECENT FINDINGS In many ways, the digitical divide is already shrinking via improved access to internet and technology/process improvements. For example, people with schizophrenia, PTSD, and bipolar disorder have had their care successfully augmented by new technology. However, problems persist- being impoverished, female, and black all correlate with decreased probability of completing a telehealth visit, and millions of americans have insufficient internet access to complete telehealth visits. We must continue to utilize new technology in health care to improve outcomes, but we must also be wary to ensure those outcomes are equitable across different populations.
Collapse
|
47
|
Cunningham A, Crittendon D, Konys C, Mills G, Casola A, Kelly S, Arenson C. Critical Race Theory as a Lens for Examining Primary Care Provider Responses to Persistently-Elevated HbA1c. J Natl Med Assoc 2020; 113:297-300. [PMID: 33342549 DOI: 10.1016/j.jnma.2020.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/28/2020] [Accepted: 11/27/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Clinical inertia remains a persistent problem in the treatment of diabetes in clinical care. Primary care provider behavior is thought to be a significant contributor to diabetes clinical inertia. This study used the lens of Critical Race Theory to examine whether provider's diabetes management activities differ by patient race and frame implications for future research. METHODS Chart abstractors retrospectively reviewed a random sample of charts from primary care patients with persistently-elevated HbA1c to assess providers' diabetes management activities in the subsequent year. Provider activities aligned with the American Diabetes Association's standards of medical care and included HbA1c test ordering, documentation of patient medication adherence, counseling on lifestyle modification, lifestyle modification referral, endocrinologist participation in care, and medication titration. Differences in provider actions by patient race (Black, white, or other) were examined using chi-square tests. RESULTS A total of 188 patient charts were reviewed. For all provider actions, there were statistically-significant differences by patient race. Black patients were least likely to be counseled on dietary changes (72.0%) or physical activity (57.7%) by their primary care provider, but most likely to be referred to an outside specialist for this counseling (46.2%). Black patients were also least likely to have medication adjustments made (72%). DISCUSSION Study findings showed an association between provider diabetes management behaviors and patient race, Future studies showed explore providers' racial beliefs, attitudes and clinical decision-making, and patients' experiences with historical exclusion from medical care and racism in healthcare encounters In addition, more research is needed to explore the role of structural racism in clinical inertia.
Collapse
Affiliation(s)
- Amy Cunningham
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
| | - Denine Crittendon
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Casey Konys
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Geoffrey Mills
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Allison Casola
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Samantha Kelly
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Christine Arenson
- Department of Family & Community Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
48
|
Constante HM, Bastos JL. Mapping the Margins in Health Services Research: How Does Race Intersect With Gender and Socioeconomic Status to Shape Difficulty Accessing HealthCare Among Unequal Brazilian States? INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:155-166. [PMID: 33323017 DOI: 10.1177/0020731420979808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research on healthcare inequities has centralized whether marginalized racial, gender, or socioeconomic (SES) groups are afforded equitable access to care, yet scant investigations have focused on how race intersects with other social statuses to shape difficulty accessing health services. Contextual specificity has also been under-researched in this field of knowledge. Data from 59,249 respondents 18 years of age and over from the 2013 Brazilian National Health Survey were analyzed using multilevel regressions models. We test 3 hypotheses: racial, gender, and socioeconomically oppressed groups are each more likely to report difficulty accessing health services (H1); compared to high-SES white men, low-SES Black women report expressively higher frequencies of the outcome (H2); and intersectional healthcare inequities are larger among low-SES Brazilian states (H3). Partially supporting H1 and H2, results suggest that race and SES, but not gender, are each strong predictors of difficulty accessing healthcare, with low-SES Black respondents facing the highest odds of reporting this outcome. Although H3 was not supported, intersectional groups residing in low-SES Brazilian states were more likely to report difficulty accessing healthcare. This study demonstrated that, together with contextual specificity, the intersections of race with other axes of marginalization should be at the forefront of research and policy addressing healthcare inequities.
Collapse
Affiliation(s)
- Helena Mendes Constante
- Federal University of Santa Catarina, Campus Universitário, Trindade, Florianópolis, Santa Catarina, Brazil
| | - João Luiz Bastos
- Federal University of Santa Catarina, Campus Universitário, Trindade, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
49
|
Barwise A, Yeow ME, Partain DK. The Premise and Development of CHECK IN-Check-In for Exchange of Clinical and Key Information to Enhance Palliative Care Discussions for Patients With Limited English Proficiency. Am J Hosp Palliat Care 2020; 38:533-538. [PMID: 33295185 DOI: 10.1177/1049909120979982] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Communication regarding serious illness is challenging in most circumstances. Patients with Limited English Proficiency (LEP) have unique language and cultural needs that often require collaboration with a trained medical interpreter, especially when the clinical encounter involves serious illness decision making or elucidation of patient goals, preferences, and values. Although there is mounting evidence to support interpreter/clinician huddles before a serious illness communication encounter, no current initiatives exist to operationalize this evidence. We are currently in the process of developing, evaluating, and implementing a formal interpreter/clinician huddle process to promote high quality care for patients with LEP. Our huddle guide, called the Check-In for Exchange of Clinical and Key Information (CHECK-IN), is designed to facilitate collaboration between an interpreter and clinician during a serious illness encounter by prompting exchange of relevant sociocultural and clinical information between clinicians and interpreters.
Collapse
Affiliation(s)
- Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, 4352Mayo Clinic, Rochester, MN, USA
| | - Mei-Ean Yeow
- Department of General Internal Medicine, Center for Palliative Medicine, 6915Mayo Clinic, Rochester, MN, USA
| | - Daniel K Partain
- Department of General Internal Medicine, Center for Palliative Medicine, 6915Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
50
|
Eakin MN, Zaeh S, Eckmann T, Ruvalcaba E, Rand CS, Hilliard ME, Riekert KA. Effectiveness of a Home- and School-Based Asthma Educational Program for Head Start Children With Asthma: A Randomized Clinical Trial. JAMA Pediatr 2020; 174:1191-1198. [PMID: 33016987 PMCID: PMC7536623 DOI: 10.1001/jamapediatrics.2020.3375] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Asthma is the most common chronic childhood disease, with Black children experiencing worse morbidity and mortality. It is important to evaluate the effectiveness of efficacious interventions in community settings that have the greatest likelihood of serving at-risk families. OBJECTIVE To evaluate the effectiveness of a multilevel home- and school (Head Start)-based asthma educational program compared with a Head Start-based asthma educational program alone in improving asthma outcomes in children. DESIGN, SETTING, AND PARTICIPANT This randomized clinical trial included 398 children with asthma enrolled in Head Start preschool programs in Baltimore, Maryland, and their primary caregivers. Participants were recruited from April 1, 2011, to November 31, 2016, with final data collection ending December 31, 2017. Data were analyzed from March 18 to August 30, 2018. INTERVENTIONS Asthma Basic Care (ABC) family education combined with Head Start asthma education compared with Head Start asthma education alone. MAIN OUTCOMES AND MEASURES Asthma control as measured by the Test for Respiratory and Asthma Control in Kids (TRACK) score. RESULTS Among the 398 children included in the analysis (247 boys [62.1%]; mean [SD] age, 4.2 [0.7] years), the ABC plus Head Start program improved asthma control (β = 6.26; 95% CI, 1.77 to 10.75; P < .001), reduced courses of oral corticosteroids (β = -0.61; 95% CI, -1.13 to -0.09; P = .02), and reduced hospitalizations (odds ratio, 0.36; 95% CI, 0.21-0.61; P < .001) during a 12-month period. CONCLUSION AND RELEVANCE In this randomized clinical trial, combined family and preschool asthma educational interventions improved asthma control and reduced courses of oral corticosteroids and hospitalizations. Multilevel interventions implemented in community settings that serve low-income minority families may be key to reducing disparities in asthma outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01519453.
Collapse
Affiliation(s)
- Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Sandra Zaeh
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Thomas Eckmann
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Ruvalcaba
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Cynthia S. Rand
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland
| | - Marisa E. Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Kristin A. Riekert
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|