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Beavis AL, Wethington SL, Yu R, Topel KM, Bielman ML, Olson S, Rositch AF. Differential utilization of the online patient portal for completion of health-related social needs screening during routine gynecologic cancer care. Cancer 2024. [PMID: 38943672 DOI: 10.1002/cncr.35376] [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: 09/18/2023] [Revised: 02/27/2024] [Accepted: 04/12/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Telehealth technologies offer efficient ways to deliver health-related social needs (HRSN) screening in cancer care, but these methods may not reach all populations. The authors examined patient characteristics associated with using an online patient portal (OPP) to complete HRSN screening as part of gynecologic cancer care. METHODS From June 2021 to June 2023, patients in a gynecologic oncology clinic completed validated HRSN screening questions either (1) using the OPP (independently before the visit) or (2) in person (verbally administered by clinic staff). The authors examined the prevalence of HRSN according to activated OPP status and, in a restricted subgroup, used stepwise multivariate Poisson regression to identify associations between patient and visit characteristics and using the OPP. RESULTS Of 1616 patients, 87.4% (n = 1413) had an activated OPP. Patients with inactive OPPs (vs. activated OPPs) more frequently reported two or more needs (10% vs 5%; p < .01). Of 986 patients in the restricted cohort, 52% used the OPP to complete screening. The final multivariable model indicated that patients were less likely to use the OPP if they were Black (vs. White; adjusted relative risk [aRR], 0.70; 95% confidence interval [CI], 0.59-0.83); not employed (vs. employed; aRR, 0.81; 95% CI, 0.68-0.97), or had low measures of OPP engagement (aRR, 0.80; 95% CI, 0.68-0.92). New versus established patients were 21% more likely to use the OPP (aRR, 1.21; 95% CI, 1.06-1.38). CONCLUSIONS Differential use of the OPP suggested that over-reliance on digital technologies could limit the ability to reach those populations that have social factors already associated with cancer outcome disparities. Cancer centers should consider using multiple delivery methods for HRSN screening to maximize reach to all populations.
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Affiliation(s)
- Anna L Beavis
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephanie L Wethington
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruoxi Yu
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kristin M Topel
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie L Bielman
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Olson
- Biostatistics, Epidemiology, and Data Management Core, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Yudkin JS, Messiah SE, Allicock MA, Barlow SE. Integration of e-Health Strategies for Post-COVID-19 Pandemic Pediatric Weight Management Programs. Telemed J E Health 2024; 30:321-330. [PMID: 37552819 DOI: 10.1089/tmj.2023.0068] [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: 08/10/2023] Open
Abstract
Background: The COVID-19 pandemic catalyzed a renewed urgency to address the obesity pandemic and accelerated the use of technology to treat pediatric obesity. Yet, there are significant incongruities between the existing literature on technology for obesity management and the current health care system that may lead to suboptimal outcomes and increased costs. This study reviewed the types of e-health strategies currently in use, highlighted inconsistencies and overlap in terminology, and identified future research directions in e-health for childhood obesity, including gaps in implementation science. Methods: This narrative literature review synthesized seminal articles from the literature, as well as recent articles, using PubMed and Google Scholar that focused on the use of technology in treating pediatric obesity. This inclusive strategy was intended to elucidate the heterogeneity in how different disciplines are using digital health terminology in pediatric obesity research. Results: Both the prevalence of e-health interventions and its associated terminology are increasing in the peer-reviewed literature, especially since the beginning of the COVID-19 pandemic. Yet, their definitions and usage are unstandardized, leading to a lack of cohesion in the research and between disciplines. There is a gap in implementation science outcomes, including reimbursement, that may significantly impact external validity and uptake. Conclusion: A more systematic and precise approach to researching e-health that can assess specific technologies and combinations of technologies, their short-term and long-term effect sizes, and feasibility can produce the necessary data that may lead to reimbursement policies and, ultimately, improved pediatric weight management outcomes.
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Affiliation(s)
- Joshua S Yudkin
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, Texas, USA
| | - Sarah E Messiah
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, Texas, USA
- Center for Pediatric Population Health, School of Public Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
- Department of Pediatrics, McGovern Medical School, Houston, Texas, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marlyn A Allicock
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, Texas, USA
- Center for Pediatric Population Health, School of Public Health, The University of Texas Health Science Center at Houston, Dallas, Texas, USA
| | - Sarah E Barlow
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Children's Medical Center Dallas, Dallas, Texas, USA
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Glasgow L, Clayton M, Honeycutt A, Bayer EM, Plescia M, Holtgrave PL, Hacker K. Key insights on multisector community partnerships from real-world efforts to address social determinants of health. EVALUATION AND PROGRAM PLANNING 2023; 99:102298. [PMID: 37187118 DOI: 10.1016/j.evalprogplan.2023.102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/24/2023] [Accepted: 04/29/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE To better understand and inform how multisector community partnerships (MCPs) perform meaningful work to prevent chronic disease and advance health equity by addressing social determinants of health (SDOH). METHODS We conducted a rapid retrospective evaluation of SDOH initiatives implemented within the past three years by 42 established MCPs across the United States. The mixed methods evaluation included document review and coding of available outcomes data, virtual discussions, and Prevention Impacts Simulation Model (PRISM) analysis. RESULTS All 42 MCPs built community capacity for addressing SDOH through new or strengthened data systems, leveraged resources, or engaged residents, for example. Most MCPs (N = 38, 90%) reported contributions to community changes that promote healthy living. More than half of the MCPs (N = 22) reported health outcomes data for their SDOH initiatives, including improved health behaviors and clinical outcomes. Based on reach data provided by 27 MCPs, PRISM analysis results suggest that sustained initiatives could save over $633 million in productivity and medical costs cumulatively through 20 years. CONCLUSIONS With sufficient technical assistance and funding resources, MCPs are a key component of the public health strategy to address SDOH.
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Affiliation(s)
- LaShawn Glasgow
- RTI International, 3040 E. Cornwallis Rd, Research Triangle, NC 27709, USA.
| | - Megan Clayton
- RTI International, 3040 E. Cornwallis Rd, Research Triangle, NC 27709, USA
| | - Amanda Honeycutt
- RTI International, 3040 E. Cornwallis Rd, Research Triangle, NC 27709, USA
| | - Erin M Bayer
- The Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA 22202, USA
| | - Marcus Plescia
- The Association of State and Territorial Health Officials, 2231 Crystal Drive, Suite 450, Arlington, VA 22202, USA
| | - Peter L Holtgrave
- National Association of County and City Health Officials, 1201 I St NW, #400, Washington DC 20005, USA
| | - Karen Hacker
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, NE, Atlanta, GA 30341, USA
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Lancaster E, Byrd K, Ai Y, Lee J. Socioeconomic status correlations with confirmed COVID-19 cases and SARS-CoV-2 wastewater concentrations in small-medium sized communities. ENVIRONMENTAL RESEARCH 2022; 215:114290. [PMID: 36096171 PMCID: PMC9458761 DOI: 10.1016/j.envres.2022.114290] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 08/16/2022] [Accepted: 09/04/2022] [Indexed: 06/15/2023]
Abstract
Over two years into the COVID-19 pandemic, it is apparent that some populations across the world are more susceptible than others to SARS-CoV-2 infection and spread. Understanding how populations with varying demographic patterns are impacted by COVID-19 may highlight which factors are most important in targeting to combat global suffering. The first objective of this study was to investigate the association of various socioeconomic status (SES) parameters and confirmed COVID-19 cases in the state of Ohio, USA. This study examines the largest and capital city of Ohio (Columbus) and various small-medium-sized communities. The second objective was to determine the relationship between SES parameters and community-level SARS-CoV-2 concentrations using municipal wastewater samples from each city's respective wastewater treatment plants from August 2020 to January 2021. SES parameters include population size, median income, poverty, race/ethnicity, education, health care access, types of COVID-19 testing sites, and social vulnerability index. Statistical analysis results show that confirmed (normalized and/or non-normalized) COVID-19 cases were negatively associated with White percentage and registered hospitals, and positively associated with registered physicians and various COVID-19 testing sites. Wastewater viral concentrations were negatively associated with poverty, and positively associated with median income, community health centers, and onsite rapid testing locations. Additional analyses conclude that population is a significant factor in determining COVID-19 cases and SARS-CoV-2 wastewater concentrations. Results indicate that community healthcare parameters relate to a negative health outcome (COVID-19) and that demographic parameters can be associated with community-level SARS-CoV-2 wastewater concentrations. As the first study that examines the association between socioeconomic parameters and SARS-CoV-2 wastewater concentrations as well as confirmed COVID-19 cases, it is apparent that social determinants have an impact in determining the health burden of small-medium sized Ohioan cities. This study design and innovative approach are scalable and applicable for endemic and pandemic surveillance across the world.
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Affiliation(s)
- Emma Lancaster
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA; Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Kendall Byrd
- Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Yuehan Ai
- Department of Food Science & Technology, The Ohio State University, Columbus, OH, USA
| | - Jiyoung Lee
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA; Environmental Sciences Graduate Program, The Ohio State University, Columbus, OH, USA; Department of Food Science & Technology, The Ohio State University, Columbus, OH, USA; Infectious Diseases Institute, The Ohio State University, Columbus, OH, USA.
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5
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Gautam D, Sandhu S, Kutzer K, Blanchard L, Xu J, Sotelo Munoz V, Dennis E, Drake C, Crowder C, Eisenson H, Prvu Bettger J. Training student volunteers as community resource navigators to address patients' social needs: A curriculum toolkit. Front Public Health 2022; 10:966872. [PMID: 36203701 PMCID: PMC9531674 DOI: 10.3389/fpubh.2022.966872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/26/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Few resources are available to train students to provide patients assistance for obtaining needed community-based services. This toolkit outlines a curriculum to train student volunteers to become "community resource navigators" to serve patients via telephone at partner health sites. Methods University students co-designed the Help Desk navigator program and training for volunteer navigators as part of an academic-community partnership with a local Federally Qualified Health Center (FQHC). The multi-modal curricula consisted of five components: didactic instruction on social determinants of health and program logistics, mock patient calls and documentation, observation of experienced navigator interaction with patients, supervised calls with real patients, and homework assignments. In 2020, training materials were adapted for virtual delivery due to the COVID-19 pandemic. Trainees completed a survey after completion to provide qualitative feedback on the training and preparedness. Results The training was offered for the first cohort of 11 student volunteer navigators in 2019, revised and then offered for 13 undergraduate and nursing students over 6 weeks in 2020. In the training evaluation, trainees described the new knowledge and skills gained from the training, the long-term benefits toward their educational and professional career goals, and helpful interactive delivery of the training. Trainees also highlighted areas for improvement, including more time learning about community resources and practicing challenging patient conversations. Conclusions Our peer-to-peer, multi-modal training prepares student volunteers to become community resource navigators. Student, eager for meaningful clinical experiences, are an untapped resource that can help patients with their social needs.
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Affiliation(s)
- Diwas Gautam
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Sahil Sandhu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States,*Correspondence: Sahil Sandhu
| | - Kate Kutzer
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Lillian Blanchard
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Jacqueline Xu
- Sanford School of Public Policy, Duke University, Durham, NC, United States
| | | | - Erika Dennis
- Duke University School of Nursing, Durham, NC, United States
| | - Connor Drake
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | | | | | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
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Aparicio Betancourt M, Duarte-Díaz A, Vall-Roqué H, Seils L, Orrego C, Perestelo-Pérez L, Barrio-Cortes J, Beca-Martínez MT, Molina Serrano A, Bermejo-Caja CJ, González-González AI. Global Healthcare Needs Related to COVID-19: An Evidence Map of the First Year of the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10332. [PMID: 36011970 PMCID: PMC9408445 DOI: 10.3390/ijerph191610332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/10/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has exposed gaps and areas of need in health systems worldwide. This work aims to map the evidence on COVID-19-related healthcare needs of adult patients, their family members, and the professionals involved in their care during the first year of the pandemic. We searched the databases MEDLINE, Embase, and Web of Science. Two reviewers independently screened titles and abstracts and assessed full texts for eligibility. Disagreements were resolved by consensus. Descriptive data were extracted and inductive qualitative content analysis was used to generate codes and derive overarching themes. Thirty-six studies met inclusion criteria, with the majority reporting needs from the perspective of professionals (35/36). Professionals' needs were grouped into three main clusters (basic, occupational, and psycho-socio-emotional needs); patients' needs into four (basic, healthcare, psycho-socio-emotional, and other support needs); and family members' needs into two (psycho-socio-emotional and communication needs). Transversal needs across subgroups were also identified and grouped into three main clusters (public safety, information and communication, and coordination and support needs). This evidence map provides valuable insight on COVID-19-related healthcare needs. More research is needed to assess first-person perspectives of patients and their families, examine whether needs differ by country or region, and evaluate how needs have evolved over time.
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Affiliation(s)
- Mariana Aparicio Betancourt
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), 38109 El Rosario, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
| | - Helena Vall-Roqué
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
| | - Laura Seils
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), 38109 El Rosario, Spain
| | - Jaime Barrio-Cortes
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
- Fundación para la Investigación e Innovación Biosanitaria en Atención Primaria, 28003 Madrid, Spain
| | | | | | - Carlos Jesús Bermejo-Caja
- Unidad de Apoyo Técnico Dirección Técnica de Sistemas de información, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, 28035 Madrid, Spain
- Departamento de Enfermería. Universidad Autónoma de Madrid, 28034 Madrid, Spain
| | - Ana Isabel González-González
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
- Unidad de Innovación y Proyectos Internacionales, Dirección General de Investigación, Docencia y Documentación, Consejería de Sanidad, 28034 Madrid, Spain
- Institute of General Practice, Goethe University, 60323 Frankfurt, Germany
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Cole MB, Nguyen KH, Byhoff E, Murray GF. Screening for Social Risk at Federally Qualified Health Centers: A National Study. Am J Prev Med 2022; 62:670-678. [PMID: 35459451 PMCID: PMC9035213 DOI: 10.1016/j.amepre.2021.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Federally Qualified Health Centers serve 29.8 million low-income patients across the U.S., many of whom have unaddressed social risks. In 2019, for the first time, data on social risk screening capabilities were collected from every U.S. Federally Qualified Health Center. The objectives of this study were to describe the national rates of social risk screening capabilities across Federally Qualified Health Centers, identify organizational predictors of screening, and assess between-state heterogeneity. METHODS Using a 100% sample of U.S. Federally Qualified Health Centers (N=1,384, representing 29.8 million patients) from the 2019 Uniform Data System, the primary outcome was whether a Federally Qualified Health Center collected data on patients' social risk factors (yes/no). Summary statistics on the rates of social risk screening capabilities were generated in aggregate and by state. Linear probability models were then used to estimate the relationship between the probability of social risk screening and 7 key Federally Qualified Health Center characteristics (e.g., Federally Qualified Health Center size, Medicaid MCO contract, Medicaid accountable care organization presence). Data were analyzed in 2020‒2021. RESULTS Most (71%) Federally Qualified Health Centers collected social risk data, with a between-state variation. The most common screener was the Protocol for Responding to and Assessing Patients' Assets Risks and Experiences (43% of Federally Qualified Health Centers that screened), whereas 22% collected social risk data using a nonstandardized screener. After adjusting for other characteristics, Federally Qualified Health Centers with social risk screening capabilities served more total patients, were more likely to be located in a state with a Medicaid accountable care organization, and were less likely to have an MCO contract. CONCLUSIONS There has been widespread adoption of social risk screening tools across U.S. Federally Qualified Health Centers, but between-state disparities exist. Targeting social risk screening resources to smaller Federally Qualified Health Centers may increase the adoption of screening tools.
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Affiliation(s)
- Megan B Cole
- Department of Health Law, Policy, & Management, Boston University School of Public Health, Boston, Massachusetts.
| | - Kevin H Nguyen
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Elena Byhoff
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Genevra F Murray
- Division of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
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Thomas C, Sandhu S, Li J, Sanders GD, Prvu Bettger J. Developing the Next Generation of Leaders in Health Policy and Management: Lessons From an Undergraduate Student-Led Organization. Front Public Health 2022; 10:855712. [PMID: 35372252 PMCID: PMC8971563 DOI: 10.3389/fpubh.2022.855712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/24/2022] [Indexed: 11/20/2022] Open
Abstract
As health care continues to evolve, training the next generation of healthcare leaders is more important than ever. However, many university undergraduate students are not directly exposed to topics such as health policy and management within their coursework or co-curricular engagements. At Duke University, we developed the Student Collaborative on Health Policy (SCOHP) as an inter-disciplinary health policy hub that offers opportunities for learning, engagement, and leadership in the healthcare-related fields for students of all academic backgrounds. We see opportunity for similar student-led groups to be established by student leaders at other institutions, increasing interaction with experts, mentorship and the accessibility of experiential education, service, and leadership in the health care sector.
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Affiliation(s)
- Charlotte Thomas
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Sahil Sandhu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Sahil Sandhu
| | - Josee Li
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Gillian D. Sanders
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Janet Prvu Bettger
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States
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Hatchell KE, Canavan CR, D’cruze T, Suresh A, Dev A, Boardman M, Kennedy MA. The Impact of the COVID-19 Pandemic on Food Insecurity in Northern New England Primary and Prenatal Care Settings. J Prim Care Community Health 2022; 13:21501319221106626. [PMID: 35712859 PMCID: PMC9210087 DOI: 10.1177/21501319221106626] [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] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Food insecurity (FI) is associated with adverse health outcomes across the lifespan. Primary care and prenatal practices can identify and address FI among patients through screening and interventions. It is unclear how practices and communities responded to FI during the COVID-19 pandemic, and how the pandemic may have impacted practices' FI strategies. We aimed to understand how practices providing primary care or prenatal care in northern New England experienced changes in FI during the COVID-19 pandemic. METHODS We conducted a web-based survey of clinicians and staff from 43 unique practices providing primary care or prenatal care in northern New England. RESULTS Most practices (59.5%) reported at least 1 new food program in the practice or community since the pandemic began. Practices reporting new practice- or community-based food programs were more likely to be rural, federally qualified health centers, and have greater confidence in practice and community capacity to address FI (chi-square tests, P < .05). CONCLUSION Results suggest that practices and surrounding communities in northern New England responded to FI during the pandemic by increasing food support programs. Future work is needed to examine the impact of food programs initiated during the pandemic and determine optimal strategies for practices to address FI among patients.
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Affiliation(s)
| | - Chelsey R. Canavan
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Arvind Suresh
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Alka Dev
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
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Integrated Health and Social Care in the United States: A Decade of Policy Progress. Int J Integr Care 2021; 21:9. [PMID: 34785994 PMCID: PMC8570194 DOI: 10.5334/ijic.5687] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction: Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. Policy practice: This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice. Discussion and Conclusion: National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors.
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11
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Lian T, Kutzer K, Gautam D, Eisenson H, Crowder JC, Esmaili E, Sandhu S, Trachtman L, Prvu Bettger J, Drake C. Factors Associated with Patients' Connection to Referred Social Needs Resources at a Federally Qualified Health Center. J Prim Care Community Health 2021; 12:21501327211024390. [PMID: 34120507 PMCID: PMC8202269 DOI: 10.1177/21501327211024390] [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] [Indexed: 11/20/2022] Open
Abstract
Introduction: In an effort to improve health outcomes and promote health equity, healthcare systems have increasingly begun to screen patients for unmet social needs and refer them to relevant social services and community-based organizations. This study aimed to identify factors associated with the successful connection (ie, services started) to social needs resources, as well as factors associated with an attempt to connect as a secondary, intermediate outcome. Methods: This retrospective cohort study included patients who had been screened, referred, and subsequently reached for follow-up navigation from March 2019 to December 2020, as part of a social needs intervention at a federally qualified health center (FQHC). Measures included demographic and social needs covariates collected during screening, as well as resource-related covariates that characterized the referred resources, including service domain (area of need addressed), service site (integration relative to the FQHC), and access modality (means of accessing services). Results: Of the 501 patients in the analytic sample, 32.7% had started services with 1 or more of their referred resources within 4 weeks of the initial referral, and 63.3% had at least attempted to contact 1 referred resource, whether or not they were able to start services. Receiving a referral to resources that patients could access via phone call or drop-in visit, as opposed to resources that required additional appointments or applications prior to accessing services, was associated with increased odds (aOR 1.95, 95% CI 1.05, 3.61) of connection success, after adjusting for age, sex, race, ethnicity, education, number of social needs, and resource-related characteristics. This study did not find statistically significant associations between connection attempt and any variable included in adjusted analyses. Conclusion: These findings suggest that referral pathways may influence the success of patients’ connection to social needs resources, highlighting opportunities for more accessible solutions to addressing patients’ unmet social needs.
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Affiliation(s)
- Tyler Lian
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kate Kutzer
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | - Diwas Gautam
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | | | | | | | - Sahil Sandhu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, USA
| | | | - Janet Prvu Bettger
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA.,Duke Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Connor Drake
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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