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Maguire TK, Yoon S, Chen J. Collaborating for COVID-19: Hospital Health Information Exchange and Public Health Partnership. Telemed J E Health 2024; 30:108-117. [PMID: 37294562 PMCID: PMC10794829 DOI: 10.1089/tmj.2023.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/10/2023] Open
Abstract
Background: The coronavirus disease (COVID-19) pandemic highlighted the need for effective communication and information sharing among health care organizations and public health systems (PHSs). Health information exchange (HIE) plays a vital role in improving quality control and efficiency in hospital settings, particularly in underserved areas. Objective: This study aimed to investigate the variation of HIE availability among hospitals based on their collaboration with the PHS and affiliation with Accountable Care Organizations (ACOs) in 2020, as well as variation by community social determinants of health. Methods: The primary data set used for this study comprised the linked data set of the 2020 American Hospital Association (AHA) Annual Survey and the AHA Information Technology Supplement. The measures used included the hospital's participation in HIE networks, availability of data exchange, and HIE measures during the COVID-19 pandemic, including whether hospitals effectively received electronically transmitted information from outside providers for COVID-19 treatment. Results: The sample size of hospitals ranged from 1,316 to 1,436, depending on different outcomes related to HIE questions. Of the hospitals surveyed, ∼67% reported public health collaboration and ACO affiliation, while 7% reported neither. Hospitals without public health collaboration or ACO affiliation were more likely to be located in underserved areas. Compared with hospitals without public health collaboration or ACO affiliation, hospitals with both were 9% more likely to report the availability of electronically transmitted clinical information from outside providers and to participate in local and national HIE networks. Furthermore, these hospitals were 30% (marginal effect [ME] = 0.30, p < 0.001) more likely to report effective receipt of information from outside providers for COVID-19 treatment and 12% (ME = 0.12, p = 0.02) more likely to always/often receive clinical information for COVID-19 treatment electronically. Conclusions: Hospital collaboration with the PHS and ACO affiliation are associated with greater availability of electronic health data, particularly during the COVID-19 pandemic.
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Affiliation(s)
- Teagan Knapp Maguire
- Department of Health Policy and Management and School of Public Health, University of Maryland, College Park, Maryland, USA
- Hospital And Public health InterdisciPlinarY Research (HAPPY) Laboratory, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Sunjung Yoon
- Department of Health Policy and Management and School of Public Health, University of Maryland, College Park, Maryland, USA
- Hospital And Public health InterdisciPlinarY Research (HAPPY) Laboratory, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Jie Chen
- Department of Health Policy and Management and School of Public Health, University of Maryland, College Park, Maryland, USA
- Hospital And Public health InterdisciPlinarY Research (HAPPY) Laboratory, School of Public Health, University of Maryland, College Park, Maryland, USA
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Gondi S, Chokshi DA. Cities as Platforms for Population Health: Past, Present, and Future. Milbank Q 2023; 101:242-282. [PMID: 37096598 PMCID: PMC10126988 DOI: 10.1111/1468-0009.12612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/12/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points
Cities have long driven innovation in public health in response to shifting trends in the burden of disease for populations. Today, the challenges facing municipal health departments include the persistent prevalence of chronic disease and deeply entrenched health inequities, as well as the evolving threats posed by climate change, political gridlock, and surging behavioral health needs.
Surmounting these challenges will require generational investment in local public health infrastructure, drawn both from new governmental allocation and from innovative financing mechanisms that allow public health agencies to capture more of the value they create for society.
Additional funding must be paired with the local development of public health data systems and the implementation of evidence‐based strategies, including community health workers and the co‐localization of clinical services and social resources as part of broader efforts to bridge the gap between public health and health care.
Above all, advancing urban health demands transformational public policy to tackle inequality and reduce poverty, to address racism as a public health crisis, and to decarbonize infrastructure. One strategy to help achieve these ambitious goals is for cities to organize into coalitions that harness their collective power as a force to improve population health globally.
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Affiliation(s)
| | - Dave A Chokshi
- New York University Grossman School of Medicine and City University of New York Graduate School of Public Health and Health Policy
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Thomas B, O'Meara P, Edvardsson K, McCann D, Spelten E. Perpetrator and situational characteristics associated with security alerts in regional Australian emergency departments. BMC Emerg Med 2022; 22:48. [PMID: 35331156 PMCID: PMC8943498 DOI: 10.1186/s12873-022-00608-6] [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: 07/23/2021] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Workplace violence is a regular feature of emergency departments (ED) and reported to be increasing in frequency and severity. There is a paucity of data from regional EDs in Australia. The aim of this study was to identify the perpetrator and situational characteristics associated with security alerts in regional emergency departments. Methods This retrospective descriptive study was conducted in two regional Australian hospital EDs. All incident reports, hospital summary spreadsheets, and patient medical records associated with a security alert over a two-year period (2017 - 2019) were included. The situational and perpetrator characteristics associated with security alerts in the ED were recorded. Results One hundred fifty-one incidents were reported in the two-year period. Incidents most frequently occurred on late shifts and in an ED cubicle. Most incidents included multiple disciplines such as ED staff and paramedics, police and psychiatric services. One hundred twenty-five incidents had sufficient information to categorise the perpetrators. Mental and behavioural disorders (MBD) were the most frequent perpetrator characteristic present in security alerts (n = 102, 81.6%) and were associated with increased severity of incidents. MBDs other than psychoactive substance use (PSU) were associated with 59.2% (n = 74) of incidents and 66.7% (n = 18) of injuries. PSU was associated with 42.4% (n = 53) of incidents. Following PSU and MBDs other than PSU, repeat perpetrators were the next most prominent perpetrator category (24.8% n = 31) and were almost always associated with an MBD (93.5% n = 29). Conclusions Violence incidents in the ED are often complex, patients present with multiple issues and are managed across disciplines. Interventions need to extend from one size fits all approaches to targeting specific perpetrator groups. Since MBDs are one of the most significant perpetrator factors, interventions focussing on this characteristic are needed to address workplace violence in EDs.
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Affiliation(s)
- Brodie Thomas
- La Trobe Rural Health School, La Trobe University, Mildura, Australia.
| | - Peter O'Meara
- Department of Paramedicine, Monash University, Frankston, Australia
| | - Kristina Edvardsson
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia.,Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Damhnat McCann
- School of Nursing, University of Tasmania, Launceston, Australia
| | - Evelien Spelten
- La Trobe Rural Health School, La Trobe University, Mildura, Australia
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Monti K, Bachi K, Gray M, Mahajan V, Sweeney G, Oprescu A, Munjal KG, Hurd YL, Lim S. Data mining-based clinical profiles of substance use-related emergency department utilizers. Am J Emerg Med 2022; 53:104-111. [PMID: 35007871 PMCID: PMC8844240 DOI: 10.1016/j.ajem.2021.12.059] [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: 08/30/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Substance-use is a prevalent presentation to the emergency department (ED); however, the clinical characterization of patients who are treated and discharged without admission for further treatment is under-investigated. The study aims to define and characterize the clinical profiles of this patient population. METHODS Patients' presentations were examined by clinical data mining (chart review) of ED records of substance use-related events of individuals discharged without admission for further treatment. Records (N = 199) from three major hospitals in New York City from March and June 2017 were randomly sampled with primary diagnosis of alcohol, opioid-related and other psychoactive substance-use presentations. Qualitative thematic coding of clinical presentation with inter-rater reliability was performed. Quantitative distinctive validity tested independence through Pearson's chi-squared and analysis of variance using Fisher's F-test. RESULTS Six distinct clinical profiles were identified, including, High Utilizers (chronically intoxicated with comorbid health conditions) (36.7%), Single Episode (20.1%), Service Request (14.1%), Altered Mental Status (13.6%), Overdose (9.0%), and Withdrawal (7.5%). The profiles differed (p < 0.05) in age, housing status, payor, mode of arrival, referral source, index visit time, prescribed treatment, triage acuity level, psychiatric history, and medical history. Differences (p < 0.05) between groups across clinical profiles in age and pain level at triage were observed. CONCLUSIONS The identified clinical profiles represent the broad spectrum and complex nature of substance use-related ED utilization, highlighting critical factors of psychosocial and mental-health comorbidities. These findings provide a preliminary foundation to support person-centered interventions to decrease substance use-related ED utilization and to increase engagement/linkage of patients to addiction treatment.
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Affiliation(s)
- Kristina Monti
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keren Bachi
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Madeline Gray
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vibhor Mahajan
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Gabrielle Sweeney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anna Oprescu
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kevin G. Munjal
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yasmin L. Hurd
- Addiction Institute of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY,Corresponding author at: Hess Center for Science and Medicine Building, 10th Floor Room 105 Office, 1470 Madison Avenue, Box 1639, New York, NY 10029-6574
| | - Sabina Lim
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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Feuerstein-Simon R, Lowenstein M, Sharma M, Dupuis R, Luna Marti X, Cannuscio CC. Local health departments and the implementation of evidence-based policies to address opioid overdose mortality. Subst Abus 2020; 41:468-474. [PMID: 32213045 DOI: 10.1080/08897077.2019.1709250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the context of the opioid overdose crisis, local health departments are on the front lines, coordinating programs and services and translating state and federal policies into community action. While media reports describe growth of Overdose Education and Naloxone Distribution (OEND) programs among local health departments, little is known about program features, scope, and target populations. Methods: We surveyed health departments in 180 United States counties with high overdose mortality rates. Results: Among health officials from 54 counties (30% response), many counties reported implementation of evidence-based practices, with a high degree of programmatic variation. The majority of responding health departments (94%) conducted overdose education and naloxone distribution (OEND) programs. Programs were heterogeneous in scale, with a reported median of 250 naloxone kits (range 1-25,000 kits) acquired for community distribution. In addition, four in five respondents were aware of their state's standing order policy for increasing naloxone access. While the majority of respondents reported county-level availability of at least one form of evidence-based medications to treat opioid use disorder (MOUD), many reported no availability of buprenorphine (33%) or methadone (43%). Conclusions: Local health departments are vital to reducing opioid overdose mortality, and many are implementing relevant evidence-based practices. To support further adoption of potentially life-saving strategies, health departments need adequate funding and staffing as well as policies and guidelines to support implementation.
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Affiliation(s)
- Rachel Feuerstein-Simon
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Margaret Lowenstein
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghana Sharma
- Master of Public Health Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roxanne Dupuis
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Xochitl Luna Marti
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carolyn C Cannuscio
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Barath D, Chen J. Integrating local health departments to reduce suicide-related emergency department visits among people with substance use disorders - Evidence from the state of Maryland. Prev Med 2019; 129:105825. [PMID: 31473219 PMCID: PMC6864273 DOI: 10.1016/j.ypmed.2019.105825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
Individuals with a substance use disorder (SUD) are six times as likely than those without a SUD to attempt suicide, however just 18% of the SUD population has received treatment. One of the barriers to treatment is appropriate and timely mental health services. This resulted in a substantial increase in emergency department (ED) visits related to SUD and suicide. This study sought to determine if the number of suicide-related ED visits for patients with SUD is associated with the types of mental health activities provided by their local health department (LHD). Specifically, we examined whether patients with a SUD aged 18-64 experienced reductions in suicide-related ED visits when their LHD directly engaged in mental health activities, such as (1) primary prevention for mental illness or (2) mental health services. Using linked datasets for 2012 from the National Profile of Local Health Departments, U.S. Census data, Area Health Resource File, and Maryland's State Emergency Department Databases (SEDD), we employed multivariable logistic regressions and instrumental variable models to examine this association. After adjusting for the endogeneity of LHDs' activity measures and controlling for individual-, hospital-, LHD-, and county-level characteristics, results demonstrated patients with a SUD experienced a 6% and 5% reduction in suicide-related ED visits when their LHD directly provided primary prevention for mental illness and mental health services, respectively. The results are small but significant, with robust standard errors. This study suggests LHDs may be key players in preventing suicide-related ED visits among the SUD population.
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Affiliation(s)
- Deanna Barath
- University of Maryland, 4200 Valley Drive, Suite 3310, College Park, MD 20742, United States of America.
| | - Jie Chen
- University of Maryland, 4200 Valley Drive, Suite 3310, College Park, MD 20742, United States of America.
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