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Scheuer H, Conrick KM, Mills B, Solano E, Arbabi S, Bulger EM, Dotolo D, Vil CS, Vavilala MS, Rowhani-Rahbar A, Moore M. Improving post-injury follow-up survey response: incorporating automated modalities. Inj Epidemiol 2024; 11:46. [PMID: 39237998 PMCID: PMC11375847 DOI: 10.1186/s40621-024-00531-3] [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: 04/10/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Incorporating post-discharge data into trauma registries would allow for better research on patient outcomes, including disparities in outcomes. This pilot study tested a follow-up data collection process to be incorporated into existing trauma care systems, prioritizing low-cost automated response modalities. METHODS This investigation was part of a larger study that consisted of two protocols with two distinct cohorts of participants who experienced traumatic injury. Participants in both protocols were asked to provide phone, email, text, and mail contact information to complete follow-up surveys assessing patient-reported outcomes six months after injury. To increase follow-up response rates between protocol 1 and protocol 2, the study team modified the contact procedures for the protocol 2 cohort. Frequency distributions were utilized to report the frequency of follow-up response modalities and overall response rates in both protocols. RESULTS A total of 178 individuals responded to the 6-month follow-up survey: 88 in protocol 1 and 90 in protocol 2. After implementing new follow-up contact procedures in protocol 2 that relied more heavily on the use of automated modalities (e.g., email and text messages), the response rate increased by 17.9 percentage points. The primary response modality shifted from phone (72.7%) in protocol 1 to the combination of email (47.8%) and text (14.4%) in protocol 2. CONCLUSIONS Results from this investigation suggest that follow-up data can feasibly be collected from trauma patients. Use of automated follow-up methods holds promise to expand longitudinal data in the national trauma registry and broaden the understanding of disparities in patient experiences.
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Affiliation(s)
- Hannah Scheuer
- School of Social Work, University of Washington, Seattle, WA, USA.
| | - Kelsey M Conrick
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Brianna Mills
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Esther Solano
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, USA
| | - Eileen M Bulger
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, USA
| | - Danae Dotolo
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, USA
| | - Christopher St Vil
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA
- School of Social Work, University at Buffalo, Buffalo, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA
| | | | - Megan Moore
- School of Social Work, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA
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Barcelona V, Condon EM, Jacoby SF. Leveraging biosocial methods to examine and address structural determinants of health and promote health equity. Nurs Outlook 2024; 72:102195. [PMID: 38810533 PMCID: PMC11330731 DOI: 10.1016/j.outlook.2024.102195] [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: 01/14/2024] [Revised: 03/26/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Biosocial approaches in nursing research have largely focused on the ways that social determinants of health influence individual-level outcomes, including symptom management, family and social support, and educational interventions. PURPOSE Theoretical, methodological, and practical strategies are needed to expand current biosocial methods for nursing science and focus on upstream, structural determinants of health and the policies that underlie health inequities. METHODS This paper summarizes presentations given at the 2023 Council for the Advancement of Nursing Science Advanced Methods Conference, Biosocial Methods to Advance Health Equity, in a panel titled "Individual, community, systems and policy related to biosocial methods." DISCUSSION Nurses are uniquely positioned to examine upstream, structural determinants of health by leveraging expertise in biosocial methods, collaborating with interdisciplinary researchers and community members, and advocating for policy change. By conducting theory-grounded biosocial research, nurse researchers can significantly advance scientific knowledge and promote health equity for individuals and communities. CONCLUSION Nurse scientists are conducting research using biosocial methods and provide recommendations for expansion of this approach in the field.
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Affiliation(s)
| | - Eileen M Condon
- University of Connecticut School of Nursing, Storrs, CT; Department of Pediatrics, University of Connecticut School of Medicine, Storrs, CT
| | - Sara F Jacoby
- Department of Family and Community, University of Pennsylvania School of Nursing, Philadelphia, PA
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Perrin EM, Skinner AC, Sanders LM, Rothman RL, Schildcrout JS, Bian A, Barkin SL, Coyne-Beasley T, Delamater AM, Flower KB, Heerman WJ, Steiner MJ, Yin HS. The Injury Prevention Program to Reduce Early Childhood Injuries: A Cluster Randomized Trial. Pediatrics 2024; 153:e2023062966. [PMID: 38557871 PMCID: PMC11035157 DOI: 10.1542/peds.2023-062966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The American Academy of Pediatrics designed The Injury Prevention Program (TIPP) in 1983 to help pediatricians prevent unintentional injuries, but TIPP's effectiveness has never been formally evaluated. We sought to evaluate the impact of TIPP on reported injuries in the first 2 years of life. METHODS We conducted a stratified, cluster-randomized trial at 4 academic medical centers: 2 centers trained their pediatric residents and implemented TIPP screening and counseling materials at all well-child checks (WCCs) for ages 2 to 24 months, and 2 centers implemented obesity prevention. At each WCC, parents reported the number of child injuries since the previous WCC. Proportional odds logistic regression analyses with generalized estimating equation examined the extent to which the number of injuries reported were reduced at TIPP intervention sites compared with control sites, adjusting for baseline child, parent, and household factors. RESULTS A total of 781 parent-infant dyads (349 TIPP; 432 control) were enrolled and had sufficient data to qualify for analyses: 51% Hispanic, 28% non-Hispanic Black, and 87% insured by Medicaid. Those at TIPP sites had significant reduction in the adjusted odds of reported injuries compared with non-TIPP sites throughout the follow-up (P = .005), with adjusted odds ratios (95% CI) of 0.77 (0.66-0.91), 0.60 (0.44-0.82), 0.32 (0.16-0.62), 0.26 (0.12-0.53), and 0.27 (0.14-0.52) at 4, 6, 12, 18, and 24 months, respectively. CONCLUSIONS In this cluster-randomized trial with predominantly low-income, Hispanic, and non-Hispanic Black families, TIPP resulted in a significant reduction in parent-reported injuries. Our study provides evidence for implementing the American Academy of Pediatrics' TIPP in routine well-child care.
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Affiliation(s)
- Eliana M. Perrin
- Department of Pediatrics, Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lee M. Sanders
- Departments of Pediatrics and Health Policy, Stanford University School of Medicine, Palo Alto, California
| | | | | | | | - Shari L. Barkin
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia
| | - Tamera Coyne-Beasley
- Departments of Pediatrics and Internal Medicine, University of Alabama-Birmingham, Birmingham, Alabama
| | - Alan M. Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Kori B. Flower
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Michael J. Steiner
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University Grossman School of Medicine, New York, New York
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Scheuer H, Conrick KM, Mills B, Solano E, Arbabi S, Bulger EM, Dotolo D, Vil CS, Vavilala MS, Rowhani-Rahbar A, Moore M. Improving Post-Injury Follow-up Survey Response: Incorporating Automated Modalities. RESEARCH SQUARE 2024:rs.3.rs-4248769. [PMID: 38746358 PMCID: PMC11092863 DOI: 10.21203/rs.3.rs-4248769/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Incorporating post-discharge data into trauma registries would allow for better research on patient outcomes, including disparities in outcomes. This pilot study tested a follow-up data collection process to be incorporated into existing trauma care systems, prioritizing low-cost automated response modalities. Methods This investigation was part of a larger study that consisted of two protocols with two distinct cohorts of participants who experienced traumatic injury. Participants in both protocols were asked to provide phone, email, text, and mail contact information to complete follow-up surveys assessing patient-reported outcomes six months after injury. To increase follow-up response rates between protocol 1 and protocol 2, the study team modified the contact procedures for the protocol 2 cohort. Frequency distributions were utilized to report the frequency of follow-up response modalities and overall response rates in both protocols. Results A total of 178 individuals responded to the 6-month follow-up survey: 88 in protocol 1 and 90 in protocol 2. After implementing new follow-up contact procedures in protocol 2 that relied more heavily on the use of automated modalities (e.g., email and text messages), the response rate increased by 17.9 percentage points. The primary response modality shifted from phone (72.7%) in protocol 1 to the combination of email (47.8%) and text (14.4%) in protocol 2. Conclusions Results from this investigation suggest that follow-up data can feasibly be collected from trauma patients. Use of automated follow-up methods holds promise to expand longitudinal data in the national trauma registry and broaden the understanding of disparities in patient experiences.
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Conrick KM, Mills B, Fuentes M, Graves JM, St. Vil C, Vavilala MS, Bulger EM, Arbabi S, Rowhani-Rahbar A, Moore M. Identifying Common Data Elements to Achieve Injury-related Health Equity Across the Lifespan: A Consensus-Driven Approach. Health Equity 2024; 8:249-253. [PMID: 38595933 PMCID: PMC11002320 DOI: 10.1089/heq.2023.0044] [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: 01/08/2024] [Indexed: 04/11/2024] Open
Abstract
Background Limited availability and poor quality of data in medical records and trauma registries impede progress to achieve injury-related health equity across the lifespan. Methods We used a Nominal Group Technique (NGT) in-person workgroup and a national web-based Delphi process to identify common data elements (CDE) that should be collected. Results The 12 participants in the NGT workgroup and 23 participants in the national Delphi process identified 10 equity-related CDE and guiding lessons for research on collection of these data. Conclusions These high-priority CDE define a detailed, equity-oriented approach to guide research to achieve injury-related health equity across the lifespan.
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Affiliation(s)
- Kelsey M. Conrick
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Brianna Mills
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Molly Fuentes
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Janessa M. Graves
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- College of Nursing, Washington State University, Spokane, Washington, USA
| | | | - Monica S. Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Eileen M. Bulger
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
- Department of Trauma Surgery, Harborview Medical Center, Seattle, Washington, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington, USA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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Thompson HJ, Moore MM. Letter to the Editor: Race and Ethnicity Are Social Constructs and Do Not Underpin Pathophysiological Processes. J Neurotrauma 2024; 41:1005-1006. [PMID: 38115647 DOI: 10.1089/neu.2023.0590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Affiliation(s)
- Hilaire J Thompson
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Megan M Moore
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
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Soltani A, Edward Harrison J, Ryder C, Flavel J, Watson A. Police and hospital data linkage for traffic injury surveillance: A systematic review. ACCIDENT; ANALYSIS AND PREVENTION 2024; 197:107426. [PMID: 38183692 DOI: 10.1016/j.aap.2023.107426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
This systematic review examines studies of traffic injury that involved linkage of police crash data and hospital data and were published from 1994 to 2023 worldwide in English. Inclusion and exclusion criteria were the basis for selecting papers from PubMed, Web of Science, and Scopus, and for identifying additional relevant papers using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and supplementary snowballing (n = 60). The selected papers were reviewed in terms of research objectives, data items and sample size included, temporal and spatial coverage, linkage methods and software tools, as well as linkage rates and most significant findings. Many studies found that the number of clinically significant road injury cases was much higher according to hospital data than crash data. Under-estimation of cases in crash data differs by road user type, pedestrian cases commonly being highly under-counted. A limited number of the papers were from low- and middle-income countries. The papers reviewed lack consistency in what was reported and how, which limited comparability.
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Affiliation(s)
- Ali Soltani
- Injury Studies, FHMRI, Bedford Park, Flinders University, SA 5042, Australia; Urban Planning Department, Shiraz University, Shiraz, Iran.
| | | | - Courtney Ryder
- Injury Studies, FHMRI, Bedford Park, Flinders University, SA 5042, Australia; George Institute for Global Health, Newtown, NSW 2042, Australia; School of Population Health, UNSW, Kensington, NSW 2052, Australia.
| | - Joanne Flavel
- Injury Studies, FHMRI, Bedford Park, Flinders University, SA 5042, Australia; Stretton Institute, University of Adelaide, SA 5005, Australia.
| | - Angela Watson
- The Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Qld 4000, Australia; School of Public Health & Social Work, Queensland University of Technology, Qld 4000, Australia.
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Furlan JC. Racial and Ethnical Discrepancies and Similarities in the Epidemiology, Survival, and Neurological Outcomes After Acute Traumatic Spinal Cord Injury: A Retrospective Cohort Study Using Data from the NASCIS-1 Trial. Top Spinal Cord Inj Rehabil 2023; 29:88-102. [PMID: 38174140 PMCID: PMC10759859 DOI: 10.46292/sci23-00055s] [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] [Indexed: 01/05/2024]
Abstract
Background Little is known about the impact of race/ethnicity on the clinical and neurological outcomes after acute traumatic spinal cord injury (tSCI). Objectives This study examined the influence of race/ethnicity on the individuals' survival and neurological recovery within the first year after tSCI. Methods The 306 cases enrolled in the First National Acute Spinal Cord Injury Study (NASCIS-1) were grouped as African American individuals (n = 84), non-Hispanic White individuals (n = 159), and other races/ethnicities that included Hispanic individuals (n = 60) and Asian individuals (n = 3). Outcome measures included survival and neurological recovery within the first year after tSCI. Data analyses were adjusted for major potential confounders. Results There were 39 females and 267 males with mean age of 31 years who mostly sustained cervical severe tSCI after motor vehicle accidents or falls. The three groups were comparable regarding sex distribution, level and severity of tSCI, level of consciousness at admission, and total received dose of methylprednisolone. African American individuals were significantly older than non-Hispanic White individuals (p = .0238). African American individuals and individuals of other races/ethnicities more often had a tSCI with open wound caused by missile and water-related accidents than non-Hispanic White individuals (p < .0001). Survival rates within the first year after tSCI were comparable among the three groups (p = .3191). Among the survivors, there were no significant differences among the three groups regarding motor and pinprick and light-touch sensory recovery (p > .0500). Conclusions The results of this study suggest that, while there were few differences among the racial/ethnical groups regarding the epidemiology of tSCI, race/ethnicity did not influence survival rate or neurological recovery within the first year post-tSCI.
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Affiliation(s)
- Julio C. Furlan
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Conrick KM, Mills B, Schreuder AB, Wardak W, Vil CS, Dotolo D, Bulger EM, Arbabi S, Vavilala MS, Moore M, Rowhani-Rahbar A. Disparities in Misclassification of Race and Ethnicity in Electronic Medical Records Among Patients with Traumatic Injury. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01783-3. [PMID: 37702973 DOI: 10.1007/s40615-023-01783-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/11/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
Systems-level barriers to self-reporting of race and ethnicity reduce the integrity of data entered into the medical record and trauma registry among patients with injuries, limiting research assessing the burden of racial disparities. We sought to characterize misclassification of self-identified versus hospital-recorded racial and ethnic identity data among 10,513 patients with traumatic injuries. American Indian/Alaska Native patients (59.9%) and Native Hawaiian/Pacific Islander patients (52.4%) were most likely to be misclassified. Most Hispanic/Latin(x) patients preferred to only be identified as Hispanic/Latin(x) (73.2%) rather than a separate race category (e.g., White). Incorrect identification of race/ethnicity also has substantial implications for the perceived demographics of patient population; according to the medical record, 82.3% of the population were White, although only 70.6% were self-identified as White. The frequency of misclassification of race and ethnicity for persons of color limits research validity on racial and ethnic injury disparities.
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Affiliation(s)
- Kelsey M Conrick
- University of Washington School of Social Work, 4101 15th Ave. NE, Seattle, WA, 98105, USA.
| | - Brianna Mills
- Department of Epidemiology, University of Washington School of Public Health, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Astrid B Schreuder
- Department of Quality Improvement, Harborview Medical Center, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Wanna Wardak
- Harborview Injury Prevention and Research Center, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Christopher St Vil
- University at Buffalo School of Social Work, Harborview Injury Prevention and Research Center, Michael Rd., Buffalo, NY, 14215, USA
| | - Danae Dotolo
- University of Washington School of Social Work, Harborview Injury Prevention and Research Center, 4101 15th Ave. NE, Seattle, WA, 98105, USA
| | - Eileen M Bulger
- Harborview Injury Prevention and Research Center, Harborview Medical Center Department of Trauma Surgery, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Saman Arbabi
- Harborview Injury Prevention and Research Center, Harborview Medical Center Department of Trauma Surgery, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Monica S Vavilala
- University of Washington Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, 325 9th Ave., Box 359960, Seattle, WA, 98104, USA
| | - Megan Moore
- University of Washington School of Social Work, Harborview Injury Prevention and Research Center, 4101 15th Ave. NE, Seattle, WA, 98105, USA
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific St., Seattle, WA, 98195, USA
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10
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Conrick KM, Mills B, St Vil C, Dotolo D, Solano E, Bulger EM, Arbabi S, Herrenkohl M, Vavilala MS, Rowhani-Rahbar A, Moore M. Centering patient perspectives to achieve injury-related health equity in trauma care systems: Improving trauma registry data. Injury 2023; 54:110847. [PMID: 37301651 DOI: 10.1016/j.injury.2023.110847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Limitations in current data collection systems for patients who experience traumatic injury limit researchers' ability to identify and address disparities in injury and outcomes. We sought to develop and test a patient-centered data-collection system for equity-related data indicators that was acceptable to racially and ethnically diverse patients being treated for traumatic injuries. METHODS Health equity indicators included in this study were race and ethnicity, language, education, employment, housing, and injury address. We conducted interviews with 245 racially and ethnically diverse trauma patients who were treated at a level-1 trauma center in the US in 2019-2020. We first interviewed 136 patients to develop a culturally resonant process and options for the health equity indicators to be added to a revised data collection system for the electronic medical record. English and Spanish interviews were audio-recorded and transcribed verbatim; qualitative analysis was used to assess patient preferences. We then pilot tested the revised data collection system with an additional 109 trauma patients to assess acceptability. Acceptability was defined as having more than 95% of participants self-identify with one of the proposed options for race/ethnicity, language, education, employment, and housing. Injury address (to identify geographic disparities) was pre-defined as acceptable if at least 85% of participants could identify exact address, cross streets, a landmark or business, or zip code of injury. RESULTS A revised data collection system, including culturally resonant indicators and a process to be used by patient registrars to collect health equity data, was pilot tested, refined, and considered acceptable. Culturally resonant question phrasing/answer options for race/ethnicity, language, education, employment, housing status, and injury address were identified as acceptable. CONCLUSIONS We identified a patient-centered data collection system for health equity measures with racially and ethnically diverse patients who have experienced traumatic injury. This system has the potential to increase data quality and accuracy, which is critical to quality improvement efforts and for researchers seeking to identify groups most impacted by racism and other structural barriers to equitable health outcomes and effective intervention points.
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Affiliation(s)
- Kelsey M Conrick
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA 98105, United States; Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Brianna Mills
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Christopher St Vil
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; School of Social Work, University at Buffalo, 685 Baldy Hall, University at Buffalo, North Campus, Buffalo, NY 14260-1050, United States.
| | - Danae Dotolo
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA 98105, United States; Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Esther Solano
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Eileen M Bulger
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; Department of Trauma Surgery, Harborview Medical Center, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Saman Arbabi
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; Department of Trauma Surgery, Harborview Medical Center, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Madeline Herrenkohl
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Monica S Vavilala
- Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States; Department of Anesthesiology and Pain Medicine, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, United States.
| | - Megan Moore
- School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA 98105, United States; Harborview Injury Prevention & Research Center, University of Washington, Box 359960 325 Ninth Ave, Seattle, WA 98104, United States.
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Magee T, Peters C, Jacobsen SM, Nees D, Dunford B, Ford AI, Vassar M. Inequities in the treatment of opioid use disorder: A scoping review. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209082. [PMID: 37271346 DOI: 10.1016/j.josat.2023.209082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Given the lack of access to evidenced-based OUD treatment and the corresponding overdose crisis, researchers must evaluate and report health care inequities involving the treatment of OUD. Additionally, clinicians should be aware of these inequities in the treatment of patients. METHODS We carried out a scoping review of the literature regarding health inequities in treatment for OUD in July 2022. The study team retrieved articles published between 2016 and 2021 from MEDLINE and Ovid Embase. After authors received training, screening and data extraction were performed in masked, duplicate fashion. The team screened a total of 3673 titles and abstracts, followed by 172 articles for full-text review. The inequities that we examined were race/ethnicity, sex or gender, income, under-resourced/rural, occupational status, education level, and LGBTQ+. We used Stata 17.0 (StataCorp, LLC, College Station, TX) to summarize data and statistics of the studies within our sample. RESULTS A total of 44 studies evaluating inequities in OUD treatment met inclusion criteria. The most common inequity that studies examined was race/ethnicity (34/44 [77.27 %] studies), followed by under-resourced/rural (19/44 [43.18 %] studies), and sex or gender (18/44 [40.91 %] studies). LGBTQ+ (0/44 [0.0 %] studies) was not reported in the included studies. Our results indicate that many historically marginalized populations experience inequities related to access and outcomes in OUD treatment. The included studies in our scoping review occasionally demonstrated inconsistent findings. CONCLUSIONS Gaps exist within the literature on health inequities in treatment for OUD. The most examined inequities were race/ethnicity, under-resourced/rural and sex or gender, while studies did not examine LGBTQ+ status. Future research should aim to advance and supplement literature investigating health inequities in OUD treatment to ensure inclusive, patient-centered care.
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Affiliation(s)
- Trevor Magee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States.
| | - Caleb Peters
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Samuel M Jacobsen
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Danya Nees
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Bryan Dunford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Alicia Ito Ford
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
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12
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Liu Y, Wolkin AF, Kresnow MJ, Schroeder T. Addressing health disparities using multiply imputed injury surveillance data. Int J Equity Health 2023; 22:126. [PMID: 37400819 DOI: 10.1186/s12939-023-01940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Assessing disparities in injury is crucial for injury prevention and for evaluating injury prevention strategies, but efforts have been hampered by missing data. This study aimed to show the utility and reliability of the injury surveillance system as a trustworthy resource for examining disparities by generating multiple imputed companion datasets. METHODS We employed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) for the period 2014-2018. A comprehensive simulation study was conducted to identify the appropriate strategy for addressing missing data limitations in NEISS-AIP. To evaluate the imputation performance more quantitatively, a new method based on Brier Skill Score (BSS) was developed to assess the accuracy of predictions by different approaches. We selected the multiple imputations by fully conditional specification (FCS MI) to generate the imputed companion data to NEISS-AIP 2014-2018. We further assessed health disparities systematically in nonfatal assault injuries treated in U.S. hospital emergency departments (EDs) by race and ethnicity, location of injury and sex. RESULTS We found for the first time that significantly higher age-adjusted nonfatal assault injury rates for ED visits per 100,000 population occurred among non-Hispanic Black persons (1306.8, 95% Confidence Interval [CI]: 660.1 - 1953.5), in public settings (286.3, 95% CI: 183.2 - 389.4) and for males (603.5, 95% CI: 409.4 - 797.5). We also observed similar trends in age-adjusted rates (AARs) by different subgroups for non-Hispanic Black persons, injuries occurring in public settings, and for males: AARs of nonfatal assault injury increased significantly from 2014 through 2017, then declined significantly in 2018. CONCLUSIONS Nonfatal assault injury imposes significant health care costs and productivity losses for millions of people each year. This study is the first to specifically look at health disparities in nonfatal assault injuries using multiply imputed companion data. Understanding how disparities differ by various groups may lead to the development of more effective initiatives to prevent such injury.
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Affiliation(s)
- Yang Liu
- Division of Injury Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Amy F Wolkin
- Division of Injury Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marcie-Jo Kresnow
- Division of Injury Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Schroeder
- Division of Hazard and Injury Data Systems, U.S. Consumer Product Safety Commission, Bethesda, MD, USA
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Jacoby SF. Home Owners' Loan Corporation Maps and Place-Based Injury Risks: A Complex History. Am J Public Health 2023; 113:356-358. [PMID: 36888953 PMCID: PMC10003505 DOI: 10.2105/ajph.2023.307242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Sara F Jacoby
- Sara F. Jacoby is with the School of Nursing, University of Pennsylvania, Philadelphia
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Chalmers K, Parameswaran R, Dussault N, Farnan J, Oyola S, Carter K. Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:3244-3278. [PMID: 35658735 DOI: 10.1177/08862605221104522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors' mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors' future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.
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Affiliation(s)
- Kristen Chalmers
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
| | - Ramya Parameswaran
- 166668University of California San Francisco Health, San Francisco, CA, USA
| | - Nicole Dussault
- Duke University Medical Center, 169103Duke University, Durham, NC, USA
| | - Jeanne Farnan
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
- Department of Medicine, 2462University of Chicago, Chicago, Il, USA
| | - Sonia Oyola
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
- Department of Family Medicine, 2462University of Chicago, Chicago, Il, USA
| | - Keme Carter
- Division of Biological Sciences, 12246University of Chicago Pritzker School of Medicine, Chicago, Il, USA
- Department of Medicine, 2462University of Chicago, Chicago, Il, USA
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Trinidad S, Kotagal M. Social determinants of health as drivers of inequities in pediatric injury. Semin Pediatr Surg 2022; 31:151221. [PMID: 36347129 DOI: 10.1016/j.sempedsurg.2022.151221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A child's social determinants of health (SDH), including their neighborhood environment, insurance status, race and ethnicity, English language proficiency and geographic location, all significantly impact their risk of injury and outcomes after injury. Children from socioeconomically disadvantaged neighborhoods experience overall higher rates of injury and different types of injuries, including higher rates of motor vehicle-, firearm-, and violence-related injuries. Similarly, children with public insurance or no insurance, as a proxy for lower socioeconomic status, experience higher rates of injuries including firearm-related injuries and non-accidental trauma, with overall worse outcomes. Race and associated racism also impact a child's risk of injury and care received after injury. Black children, Hispanic children, and those from other minority groups disproportionately experience socioeconomic disadvantage with sequelae of injury risk as described above. Even after controlling for socioeconomic status, there are still notable disparities with further evidence of racial inequities and bias in pediatric trauma care after injury. Finally, where a child lives geographically also significantly impacts their risk of injury and available care after injury, with differences based on whether a child lives in a rural or urban area and the degree of state laws regarding injury prevention. There are clear inequities based on a child's SDH, most predominantly in a child's risk of injury and the types of injuries they experience. These injuries are preventable and the SDH provide potential upstream targets in injury prevention efforts.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children...s Hospital Medical Center, Cincinnati, Ohio.
| | - Meera Kotagal
- Assistant Professor, Division of General and Thoracic Surgery, Director, Trauma Services, Director, Pediatric Surgery Global Health Program, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States.
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Miles A, Tanenbaum B, Thompson-Ricci S. Transforming injury prevention for youth (TrIPY): an intersectionality model for youth injury prevention. Inj Prev 2022; 28:564-569. [DOI: 10.1136/ip-2022-044619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022]
Abstract
Injury is deadly and expensive, and rates are increasing. The cost of injury is not only a financial burden; individuals, families and communities suffer the human costs of physical and emotional injury. For children and youth in Canada, injuries are the leading cause of death and disability. However, the risk of preventable injury is not equal for all youth. The transforming injury prevention for youth (TrIPY) model aims to recognise and remediate these inequities by applying an intersectionality lens to injury prevention programming. TrIPY conceptualises injury prevention programming through an intersectionality lens. The model was developed with diverse youth in mind, and the intended users include injury prevention practitioners, partners, stakeholders, communities and decision-makers. TrIPY was designed using a transformative perspective and built on core concepts within public health, injury prevention, intersectionality, gender analysis, youth risk, health equity, and systems of privilege and oppression. TrIPY helps to analyse intersecting inequities along multiple dimensions, to improve injury prevention programmes for diverse youth with unique identities, skills and lived experiences. The end goal of implementing an intersectionality model within injury prevention is to find out who is being missed in order to address existing inequities concerning youth injury. No matter what a person’s unique social location or lived experience, they will have the opportunity to be included in prevention programming. Developing injury prevention programmes through an intersectionality lens is needed to better understand the factors that interact to influence an individual’s risk for injury. There is a need to explore the unique experiences of youth at the intersection of various identity factors, including gender, race and ethnicity, and socioeconomic status. With this knowledge, prevention programmes can be more culturally responsive, gender transformative, inclusive, accessible and engaging for diverse groups of youth.
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Lennon NH, Carmichael AE, Qualters JR. Health equity guiding frameworks and indices in injury: A review of the literature. JOURNAL OF SAFETY RESEARCH 2022; 82:469-481. [PMID: 36031278 PMCID: PMC10569058 DOI: 10.1016/j.jsr.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In early 2021, CDC released the CORE Health Equity Strategy, which resolves to integrate a comprehensive health equity approach to the work of the Agency. One priority of the Injury Center's Division of Injury Prevention is to move health equity research in injury forward. The purpose of this research is to perform an initial exploration of health equity guiding frameworks and indices to better understand which of these has been applied to injury research topics. METHODS A PubMed and CINAHL search of meta-analysis and systematic review articles was conducted from January 1998 through April 2022. Articles of any type and additional frameworks/indices were also identified from staff knowledge of the literature. Books were also considered, where accessible. The following areas were reviewed for each resource: population addressed, guiding framework/index, other health equity variables, gaps identified, and whether the articles addressed an injury topic. FINDINGS The PubMed/CINAHL search produced 230 articles, and an additional 29 articles and 8 books were added from previous knowledge of the literature, resulting in a total of 267 resources for review. There were 60 frameworks/indices compiled that were relevant to health equity. Out of all the resources, three reported on an injury topic and used the PROGRESS-Plus framework, the WHO Social Determinants of Health Conceptual Framework, and a social-ecological framework. CONCLUSIONS This study found there were many frameworks/indices for measuring health equity; however, there were few injury-related meta-analysis and systematic review articles. Some frameworks/indices may be more appropriate than others for measuring health equity in injury topic areas, depending on which social determinants of health (SDOHs) they address. PRACTICAL APPLICATIONS Measuring health equity in injury and other public health research areas can help build a foundation of evidence. Moving forward, injury researchers can consider the frameworks/indices identified through this study in their health equity injury research.
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Affiliation(s)
- Natalie H Lennon
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA 30341, USA; Oak Ridge Associated Universities (ORAU), Division of Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Andrea E Carmichael
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA 30341, USA
| | - Judith R Qualters
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, GA 30341, USA
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Improving Data Collection and Abstraction to Assess Health Equity in Trauma Care. J Med Syst 2022; 46:21. [PMID: 35260929 DOI: 10.1007/s10916-022-01804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
Abstract
Current trauma registries suffer from inconsistent collection of data needed to assess health equity. To identify barriers/facilitators to collecting accurate equity-related data elements, we assessed perspectives of national stakeholders, Emergency Department (ED) registration, and Trauma Registry staff. We conducted a Delphi process with experts in trauma care systems and key informant interviews and focus groups with ED patient registration and trauma registry staff at a regional Level I trauma center. Topics included data collection process, barriers/facilitators for equity-related data collection, electronic health record (EHR) entry, trauma registry abstraction, and strategies to overcome technology limitations. Responses were qualitatively analyzed and triangulated with observations of ED and trauma registry staff workflow. Expert-identified barriers to consistent data collection included lack of staff investment in changes and lack of national standardization of data elements; facilitators were simplicity, quality improvement checks, and stakeholder investment in modifying existing technology to collect equity elements. ED staff reported experiences with patients reacting suspiciously to queries regarding race and ethnicity. Cultural resonance training, a script to explain equity data collection, and allowing patients to self-report sensitive items using technology were identified as potential facilitators. Trauma registry staff reported lack of discrete fields, and a preference for auto-populated and designated EHR fields. Identified barriers and facilitators of collection and abstraction of equity-related data elements from multiple stakeholders provides a framework for improving data collection. Successful implementation will require standardized definitions, staff training, use of existing technology for patient self-report, and discrete fields for added elements.
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Zatzick D, Moloney K, Palinkas L, Thomas P, Anderson K, Whiteside L, Nehra D, Bulger E. Catalyzing the Translation of Patient-Centered Research Into United States Trauma Care Systems: A Case Example. Med Care 2021; 59:S379-S386. [PMID: 34228020 PMCID: PMC8263139 DOI: 10.1097/mlr.0000000000001564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The expedient translation of research findings into sustainable intervention procedures is a longstanding health care system priority. The Patient-Centered Outcomes Research Institute (PCORI) has facilitated the development of "research done differently," with a central tenet that key stakeholders can be productively engaged throughout the research process. Literature review revealed few examples of whether, as originally posited, PCORI's innovative stakeholder-driven approach could catalyze the expedient translation of research results into practice. OBJECTIVES This narrative review traces the historical development of an American College of Surgeons Committee on Trauma (ACS/COT) policy guidance, facilitated by evidence supplied by the PCORI-funded studies evaluating the delivery of patient-centered care transitions. Key elements catalyzing the guidance are reviewed, including the sustained engagement of ACS/COT policy stakeholders who have the capacity to invoke system-level implementation strategies, such as regulatory mandates linked to verification site visits. Other key elements, including the encouragement of patient stakeholder voice in policy decisions and the incorporation of end-of-study policy summits in pragmatic comparative effectiveness trial design, are discussed. CONCLUSIONS Informed by comparative effectiveness trials, ACS/COT policy has expedited introduction of the patient-centered care construct into US trauma care systems. A comparative health care systems conceptual framework for transitional care which incorporates Research Lifecycle, pragmatic clinical trial and implementation science models is articulated. When combined with Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE), employed as a targeted implementation strategy, this approach may accelerate the sustainable delivery of high-quality patient-centered care transitions for US trauma care systems.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Lawrence Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, CA
| | - Peter Thomas
- Powers Pyles Sutter and Verville PC, Washington, DC
| | - Kristina Anderson
- The Koshka Foundation and Department of Psychiatry and Behavioral Sciences
| | | | - Deepika Nehra
- Surgery, University of Washington School of Medicine, Seattle, WA
| | - Eileen Bulger
- Surgery, University of Washington School of Medicine, Seattle, WA
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20
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Baker C, Chinaka O, Stewart EC. The time is now: why we must identify and address health disparities in sport and recreation injury. Inj Epidemiol 2021; 8:25. [PMID: 34120655 PMCID: PMC8200301 DOI: 10.1186/s40621-021-00320-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Social and structural determinants of health (SDOH) are the conditions in which individuals are born, live, learn, work, play, worship, and age. These drivers of health are integral in contextualizing the understanding and prevention of sport and recreation injury (SRI), and recognizing their impact is necessary to provide a complete and accurate picture of health and health outcomes related to injury. MAIN: Reducing disparities and achieving equity in sports and recreation is possible in part by improving data collection methodologies and utilization. Often, many SDOH have considerable effect on SRI. Although SRI epidemiology frequently examines differences by sex, there is limited inclusion of factors such as socioeconomic status, housing, gender, and food security, in sport specific data sources or in analysis of sport recreation and injury using other sources (e.g. administrative data). The ongoing dual epidemics in the United States - racism and COVID-19 - have emphasized the importance of having and utilizing SDOH data to reduce the burden of injury and disproportionate effects on our diverse population. CONCLUSION Moving forward, to address disparities in SRI, SDOH must be included as a part of research priorities, health related goals, and policies. This difference can be made in developing consistency in data collection and utilization. This will provide an accurate picture of the intersections and interdisciplinary changes required to design the best approach to problems to develop solutions. Future data collection and utilization should prioritize SDOH.
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Affiliation(s)
- Charlotte Baker
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA.
| | - Oziomachukwu Chinaka
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, USA
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Karateev AE, Lila AM, Zagorodnii NV, Amirdzhanova VN, Pogozheva EL, Filatova ES, Nesterenko VA. [Control of pain in the early post-traumatic period in the outpatient practice. Results of the multi-center observational study RAPTOR (Rational Analgesia PostTraumatic: an Observational Research)]. TERAPEVT ARKH 2020; 92:69-77. [PMID: 32598778 DOI: 10.26442/00403660.2020.05.000678] [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: 06/04/2020] [Indexed: 12/26/2022]
Abstract
AIM Evaluate the frequency, nature and course of PTP, as well as the effectiveness and safety of NSAIDs in PTP in real clinical practice. MATERIALS AND METHODS The assessment of the condition and need for NSAIDs (original meloxicam) in 1115 outpatient patients who suffered a fracture of the radius (32.2%), injury to the knee (35.2%) or ligaments of the ankle (32.6%); women/men 51.5 and 48.5%, average age 46.915.5 years. We evaluated the dynamics of pain intensity (on a numerical rating scale NRS 010) at rest and during movement, the preservation of moderate and severe pain, as well as the development of adverse drugs reactions (ADR) to NSAIDs 48 weeks after injury. RESULTS The average intensity of pain during movement decreased from 7.031.66 to 2.211.38 (p0.001), at rest from 4.462.07 to 0.710.989 (p0.001). The number of people with pain severity 4 in the NRS in 48 weeks after the radius fracture, injury of the knee and ligaments of ankle was 21.0, 16.9 and 11.9%, with moderate or severe impairment of the injured limb 40.4, 26.2 and 16.3%, respectively. The need for taking NSAIDs up to 7 days was noted in 43.3%, 714 days-in 41.8%, more than 2 weeks or constantly in 14.9% of patients. Weak or moderate ADR were observed in 20.8% of patients, mainly dyspepsia and hypertension. Discontinuation of NSAIDs due to ADR was required in only 2.6% of patients. Pain retention 4 in NRS was associated with initially expressed pain (7 in NRS) OR 2.75 (95% CI 0.834.13; p0.001) and the presence of osteoarthritis of knee and/or hip OR 1.56 (95% CI 1.032.34; p=0.039). CONCLUSION PTP decreases rapidly in most patients after a radius fracture, injury of the knee, and ankle ligament injury while taking the original meloxicam. However, in a significant part of patients, moderate or severe PTP persists after 48 weeks, which requires prolonged analgesic therapy and active rehabilitation.
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Affiliation(s)
| | - A M Lila
- Nasonova Research Institute of Rheumatology
| | - N V Zagorodnii
- Priorova National Medical Research Center of Traumatology and Orthopedics
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