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McSorley AM, Cui B, Kim J, Kuhn R. Gaps in U.S. Public Health Monitoring and Surveillance Systems in Puerto Rico. Am J Prev Med 2024; 66:551-558. [PMID: 37931723 DOI: 10.1016/j.amepre.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Puerto Rico (PR) has an ambiguous status within Centers for Disease Control and Prevention (CDC) public health monitoring and surveillance systems. However, as a U.S. territory, PR relies on federal health resource allocation processes that are informed by these data sources. This study sought to quantify the coverage of PR within CDC-supported systems compared with the 50 states, describe coverage across critical system-types, and assess the availability of data collection instruments in Spanish. METHODS This cross-sectional observational study employed the method of data curation by identifying, collecting, and categorizing data primarily from web-based sources maintained by the CDC. Data were originally collected and coded from August 2021 to March 2022 and reviewed by two additional coders from October 2022 to March 2023. Each curated system was assessed to determine coverage of PR across five system-types (probability-based, case-based, administrative, registry, and multiple-source) compared with the 50 states. The availability of data collection instruments in Spanish was also assessed. RESULTS Of 93 active CDC-supported systems assessed, results revealed that PR was not covered in 54% of CDC-supported systems. Comparatively, inclusive coverage of all 50 states was only lacking in 33% of CDC-supported systems. Of the 32 CDC-supported systems in PR that could be coded for language, only 53% had data collection instruments in Spanish. CONCLUSIONS There are significant gaps in the coverage of PR within CDC-supported systems. Future efforts must be made to identify the reasons for this exclusion and increase the territory's representation within these essential public health data systems.
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Affiliation(s)
- Anna-Michelle McSorley
- Center for Anti-Racism, Social Justice and Public Health, School of Global Public Health, New York University, New York, New York.
| | - Betty Cui
- Center for Anti-Racism, Social Justice and Public Health, School of Global Public Health, New York University, New York, New York
| | - Jinwoo Kim
- Center for Anti-Racism, Social Justice and Public Health, School of Global Public Health, New York University, New York, New York
| | - Randall Kuhn
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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2
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Silver SR, Sweeney MH, Sanderson WT, Pana-Cryan R, Steege AL, Quay B, Carreón T, Flynn MA. Assessing the role of social determinants of health in health disparities: The need for data on work. Am J Ind Med 2024; 67:129-142. [PMID: 38103002 PMCID: PMC10842318 DOI: 10.1002/ajim.23557] [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: 09/29/2023] [Revised: 11/15/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Work is a key social determinant of health. Without the collection of work-related information in public health data systems, the role of social determinants in creating and reinforcing health disparities cannot be fully assessed. METHODS The Centers for Disease Control and Prevention (CDC) maintains or supports a number of public health surveillance and health monitoring systems, including surveys, case-based disease and exposure systems, vital status records, and administrative data systems. We evaluated a convenience sample of these systems for inclusion of information in three work-related domains: employment status, industry and occupation, and working conditions. RESULTS While 12 of 39 data systems were identified as collecting work-related data, this information was often minimal (e.g., only employment status), restricted to a subset of respondents, or only gathered periodically. Information on working conditions was particularly sparse. CONCLUSION Historically, the limited and inconsistent collection of work-related information in public health data systems has hindered understanding of the role work plays in health disparities. Current CDC data modernization efforts present opportunities to enhance the identification and mitigation of health disparities by prioritizing inclusion of an expanded set of work-related data elements.
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Affiliation(s)
- Sharon R Silver
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Health Informatics Branch, Cincinnati, Ohio, USA
| | - Marie H Sweeney
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Health Informatics Branch, Cincinnati, Ohio, USA
| | - Wayne T Sanderson
- Department of Biosystems and Agricultural Engineering, Southeast Center for Agricultural Health and Injury Prevention, Central Appalachian Regional Education Research Center, College of Agriculture Food and Environment, University of Kentucky, Lexington, Kentucky, USA
| | - Regina Pana-Cryan
- National Institute for Occupational Safety and Health, Economic Research and Support Office, Washington, District of Columbia, USA
| | - Andrea L Steege
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Health Informatics Branch, Cincinnati, Ohio, USA
| | - Brian Quay
- National Institutes of Health (work performed at NIOSH), Bethesda, MD, USA
| | - Tania Carreón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Michael A Flynn
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Prey Dawson J, Finn H, Chittalia AZ, Vawdrey DK. Analyzing Patient-Provided Responses to Improve Collection of Health Equity Data Elements. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:569-578. [PMID: 38222420 PMCID: PMC10785944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Self-report is purported to be the gold standard for collecting demographic information. Many entry forms include a free-text "write-in" option in addition to structured responses. Balancing the flexibility of free-text with the value of collecting data in a structured format is a challenge if the data are to be useful for measuring and mitigating health disparities. While much work has been done to improve collection of race and ethnicity information, how to best collect data related to sexual and gender minority status and military veteran status has been less commonly studied. We analyzed 3,381 patient-provided free-text responses collected via a patient portal for gender identity, sexual orientation, pronouns, and veteran experiences. We identified common responses to better understand our patient population and help improve future iterations of data collection tools.
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Affiliation(s)
| | - Heather Finn
- Steele Institute for Health Innovation, Geisinger, Danville, Pennsylvania
| | | | - David K Vawdrey
- Steele Institute for Health Innovation, Geisinger, Danville, Pennsylvania
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Kurlandsky KE, Stein AB, Hambidge SJ, Weintraub ES, Williams JTB. Reporting of Race and Ethnicity in the Vaccine Safety Datalink, 2011-2022. Am J Prev Med 2024; 66:182-184. [PMID: 37669731 PMCID: PMC10864037 DOI: 10.1016/j.amepre.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023]
Affiliation(s)
| | - Amy B Stein
- Ambulatory Care Services, Denver Health, Denver, Colorado
| | | | - Eric S Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kurlander D, Lam AG, Dawson-Hahn E, de Acosta D. Advocating for language equity: a community-public health partnership. Front Public Health 2023; 11:1245849. [PMID: 37915815 PMCID: PMC10616868 DOI: 10.3389/fpubh.2023.1245849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/05/2023] [Indexed: 11/03/2023] Open
Abstract
In the United States, 21.5% of individuals aged 5 or older speak a language other than English at home and 8.2% have Limited English Proficiency (LEP). LEP individuals experience healthcare disparities, including lower access to healthcare services, poorer health outcomes, and higher levels of uninsurance. The COVID-19 pandemic highlighted and exacerbated these health disparities and unmet healthcare needs. In Alameda County (CA), where 46% of foreign-born residents speak a language other than English at home, community-based organizations have been crucial in providing translated materials and one-on-one support to ensure LEP residents receive critical COVID-19 updates and services. Refugee and Immigrant Collaborative for Empowerment (RICE) is a multilingual coalition of seven Alameda County community-based organizations led by the Korean Community Center of the East Bay (KCCEB). During the COVID-19 pandemic, RICE expanded its public health role to fill service and information gaps, advocate on behalf of LEP groups, and build a linguistically and culturally responsive public health safety network. This community case study describes a three-part advocacy-focused intervention that RICE undertook from September 2021 to October 2022. It included (1) a community needs survey, (2) a landscape assessment of the Alameda County Health Department's (ACPHD) communication materials and online platforms, and (3) relationship building with the ACPHD. The community survey revealed differences across LEP subgroups and highlighted the importance of gathering data disaggregated by language preference. The landscape assessment allowed RICE to understand the ACPHD's decision-making process and develop data-informed advocacy requests on behalf of LEP communities. Effective communication and coordination between RICE and the ACPHD shortened the feedback loop between public health authorities and LEP communities and laid the groundwork for the RICE organizations to be part of the ACPHD's future decision making. Data disaggregation, language equity-based advocacy, and cross-sector collaboration were critical ingredients in RICE's intervention. RICE's partnership and relationship of mutual accountability with the ACPHD may provide a useful model for other community-based organizations and public health departments seeking to form similar partnerships.
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Affiliation(s)
- Dana Kurlander
- Korean Community Center of the East Bay, San Leandro, CA, United States
| | - Amy G. Lam
- Korean Community Center of the East Bay, San Leandro, CA, United States
| | - Elizabeth Dawson-Hahn
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Diego de Acosta
- National Resource Center for Refugees, Immigrants, and Migrants, University of Minnesota, Minneapolis, MN, United States
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Dawson-Hahn E, Fredkove W, Karim S, Mohamed F, Abudiab S, de Acosta D, Ebengho S, Garcia Y, Hoffman S, Keaveney M, Mann E, Thomas C, Yu K, Yun K. Perspectives of public health organizations partnering with refugee, immigrant, and migrant communities for comprehensive COVID-19 case investigation and contact tracing. Front Public Health 2023; 11:1218306. [PMID: 37732101 PMCID: PMC10508845 DOI: 10.3389/fpubh.2023.1218306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/17/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives To understand public health organizations' experiences providing comprehensive COVID-19 case investigation and contact tracing, and related promising practices with refugee, immigrant and migrant communities. Methods We interviewed public health professionals (September 2020 to February 2021) from local and state health departments using a geographically stratified, purposive sampling approach. A multidisciplinary team at the National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM) conducted a thematic analysis of the data. Results Six themes were identified: understanding community and public health context, cultivating relationships, ensuring linguistic and cultural concordance, communicating intentionally, evolving response, and implementing equity. The interconnection of themes and promising practices is explored. Conclusion As public health continues to learn from and build upon COVID-19 response experiences, the thematic findings and potential promising practices identified in this project may foster proactive, community-engaged solutions for public health, and other organizations working and partnering with refugee, immigrant, and migrant communities. Implementing these findings with COVID-19 into current and future public health crisis responses may improve public health, collaborations with refugee, immigrant, and migrant communities, and staff wellbeing.
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Affiliation(s)
- Elizabeth Dawson-Hahn
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM), University of Minnesota, Minneapolis, MN, United States
| | - Windy Fredkove
- National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM), University of Minnesota, Minneapolis, MN, United States
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Sayyeda Karim
- National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM), University of Minnesota, Minneapolis, MN, United States
| | | | - Seja Abudiab
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Diego de Acosta
- National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM), University of Minnesota, Minneapolis, MN, United States
| | - Sabrina Ebengho
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Yesenia Garcia
- Seattle Children’s Research Division, Seattle, WA, United States
| | - Sarah Hoffman
- National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM), University of Minnesota, Minneapolis, MN, United States
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Megan Keaveney
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Erin Mann
- National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM), University of Minnesota, Minneapolis, MN, United States
| | - Christine Thomas
- National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM), University of Minnesota, Minneapolis, MN, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Kimberly Yu
- National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM), University of Minnesota, Minneapolis, MN, United States
| | - Katherine Yun
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Torres CIH, Gold R, Kaufmann J, Marino M, Hoopes MJ, Totman MS, Aceves B, Gottlieb LM. Social Risk Screening and Response Equity: Assessment by Race, Ethnicity, and Language in Community Health Centers. Am J Prev Med 2023; 65:286-295. [PMID: 36990938 PMCID: PMC10652909 DOI: 10.1016/j.amepre.2023.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Little has previously been reported about the implementation of social risk screening across racial/ethnic/language groups. To address this knowledge gap, the associations between race/ethnicity/language, social risk screening, and patient-reported social risks were examined among adult patients at community health centers. METHODS Patient- and encounter-level data from 2016 to 2020 from 651 community health centers in 21 U.S. states were used; data were extracted from a shared Epic electronic health record and analyzed between December 2020 and February 2022. In adjusted logistic regression analyses stratified by language, robust sandwich variance SE estimators were applied with clustering on patient's primary care facility. RESULTS Social risk screening occurred at 30% of health centers; 11% of eligible adult patients were screened. Screening and reported needs varied significantly by race/ethnicity/language. Black Hispanic and Black non-Hispanic patients were approximately twice as likely to be screened, and Hispanic White patients were 28% less likely to be screened than non-Hispanic White patients. Hispanic Black patients were 87% less likely to report social risks than non-Hispanic White patients. Among patients who preferred a language other than English or Spanish, Black Hispanic patients were 90% less likely to report social needs than non-Hispanic White patients. CONCLUSIONS Social risk screening documentation and patient reports of social risks differed by race/ethnicity/language in community health centers. Although social care initiatives are intended to promote health equity, inequitable screening practices could inadvertently undermine this goal. Future implementation research should explore strategies for equitable screening and related interventions.
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Affiliation(s)
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente and OCHIN, Inc., Portland, Oregon
| | | | - Miguel Marino
- Department of Family Medicine, OHSU, Portland, Oregon
| | | | - Molly S Totman
- Quality, Community Care Cooperative, Boston, Massachusetts
| | - Benjamín Aceves
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Heintzman J, Dinh D, Lucas JA, Byhoff E, Crookes DM, April-Sanders A, Kaufmann J, Boston D, Hsu A, Giebultowicz S, Marino M. Answering calls for rigorous health equity research: a cross-sectional study leveraging electronic health records for data disaggregation in Latinos. Fam Med Community Health 2023; 11:e001972. [PMID: 37173093 PMCID: PMC10186452 DOI: 10.1136/fmch-2022-001972] [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] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Country of birth/nativity information may be crucial to understanding health equity in Latino populations and is routinely called for in health services literature assessing cardiovascular disease and risk, but is not thought to co-occur with longitudinal, objective health information such as that found in electronic health records (EHRs). METHODS We used a multistate network of community health centres to describe the extent to which country of birth is recorded in EHRs in Latinos, and to describe demographic features and cardiovascular risk profiles by country of birth. We compared geographical/demographic/clinical characteristics, from 2012 to 2020 (9 years of data), of 914 495 Latinos recorded as US-born, non-US-born and without a country of birth recorded. We also described the state in which these data were collected. RESULTS Country of birth was collected for 127 138 Latinos in 782 clinics in 22 states. Compared with those with a country of birth recorded, Latinos without this record were more often uninsured and less often preferred Spanish. While covariate adjusted prevalence of heart disease and risk factors were similar between the three groups, when results were disaggregated to five specific Latin countries (Mexico, Guatemala, Dominican Republic, Cuba, El Salvador), significant variation was observed, especially in diabetes, hypertension and hyperlipidaemia. CONCLUSIONS In a multistate network, thousands of non-US-born, US-born and patients without a country of birth recorded had differing demographic characteristics, but clinical variation was not observed until data was disaggregated into specific country of origin. State policies that enhance the safety of immigrant populations may enhance the collection of health equity related data. Rigorous and effective health equity research using Latino country of birth information paired with longitudinal healthcare information found in EHRs might have significant potential for aiding clinical and public health practice, but it depends on increased, widespread and accurate availability of this information, co-occurring with other robust demographic and clinical data nativity.
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Affiliation(s)
- John Heintzman
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Dang Dinh
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer A Lucas
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Elena Byhoff
- Department of Medicine, University of Massachusetts, Boston, Massachusetts, USA
| | - Danielle M Crookes
- College of Social Sciences and Humanities, Northeastern University, Boston, Massachusetts, USA
| | | | - Jorge Kaufmann
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Audree Hsu
- California University of Science and Medicine, Colton, California, USA
| | | | - Miguel Marino
- Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
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Nguyen DT, Nguyen C, Pintor JK, Huynh TB. Stakeholders' Perspectives on the Feasibility of Adopting a Healthy Nail Salon Recognition Program in Philadelphia: A Qualitative Study. Ann Work Expo Health 2023; 67:320-329. [PMID: 36585841 PMCID: PMC10015804 DOI: 10.1093/annweh/wxac092] [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: 08/27/2022] [Accepted: 12/02/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The California Healthy Nail Salon Recognition Program is a statewide initiative to incentivize nail salons to adopt occupational health and safety best practices such as the use of safer nail products without certain harmful chemicals, ventilation systems upgrade, proper personal protective equipment use, and staff training. This public policy intervention is in response to the call to protect nail care workers, mostly women of color, who bear a disproportionate burden of chemical exposure at work. Because there is an interest to adopt a similar program in the Greater Philadelphia region, we conducted this formative research to document stakeholders' perspectives on the feasibility of adopting a Healthy Nail Salon Recognition Program in Philadelphia. METHODS We conducted semi-structured interviews with a purposive sample of 31 stakeholders in Philadelphia in 2021. Using the Consolidated Framework for Implementation Science as our theoretical framework, we developed the interview guide and analysed the data using qualitative research methods to identify key facilitators and barriers. RESULTS Key facilitating themes were perceived need and benefits of program to improve workers' health and working conditions, and willingness of stakeholders to leverage their organizational resources. Barriers included perceived high cost and time commitment from salon owners and employees, lack of funding and implementation leaders at the city government, community members' willingness to be visible and advocate for the program affected by the stigmas of being immigrant workers, and fear of interacting with authorities, as well as the impact of COVID-19 pandemic. CONCLUSIONS Our results suggest successful adoption of a Healthy Nail Salon Recognition Program in Philadelphia will require outreach within the community to raise awareness of the benefits of the program and close partnership with community-based organizations to facilitate mutual understanding between the authorities and the ethnically diverse nail salon communities.
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Affiliation(s)
- Duong T Nguyen
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Chau Nguyen
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Jessie K Pintor
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Tran B Huynh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
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Hunt LS, Sullivan EE, Susa J, Chaufournier R, Joseph C, Phillips RS, Meisinger K. Using Rapid-Cycle Change to Improve COVID-19 Vaccination Strategy in Primary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2902. [PMID: 36833600 PMCID: PMC9957472 DOI: 10.3390/ijerph20042902] [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: 12/16/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
During the COVID-19 pandemic, misinformation and distrust exacerbated disparities in vaccination rates by race and ethnicity throughout the United States. Primary care, public health systems, and community health centers have shifted their vaccination outreach strategies toward these disparate, unvaccinated populations. To support primary care, we developed the SAVE Sprint model for implementing rapid-cycle change to improve vaccination rates by overcoming community outreach barriers and workforce limitations. Participants were recruited for the 10-week SAVE Sprint program through partnerships with the National Association of Community Health Centers (NACHC) and the Resilient American Communities (RAC) Initiative. The majority of the participants were from community health centers. Data were evaluated during the program through progress reports and surveys, and interviews conducted three months post-intervention were recorded, coded, and analyzed. The SAVE Sprint model of rapid-cycle change exceeded participants' expectations and led to improvements in patient education and vaccination among their vulnerable populations. Participants reported building new skills and identifying strategies for targeting specific populations during a public health emergency. However, participants reported that planning for rapid-pace change and trust-building with community partners prior to a health care crisis is preferable and would make navigating an emergency easier.
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Affiliation(s)
- Lindsay S. Hunt
- Meadows Mental Health Policy Institute, Dallas, TX 75214, USA
| | - Erin E. Sullivan
- Sawyer Business School, Suffolk University, Boston, MA 02108, USA
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Jordan Susa
- Sawyer Business School, Suffolk University, Boston, MA 02108, USA
| | | | | | - Russell S. Phillips
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Kirsten Meisinger
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, USA
- Cambridge Health Alliance, Cambridge, MA 02143, USA
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Lemos D, Sosa P, Vallejo E. Latinx Race and Ethnicity Data Gaps: The HACER Campaign and a Call to Action. Am J Public Health 2022; 112:1412-1415. [PMID: 36103689 PMCID: PMC9480462 DOI: 10.2105/ajph.2022.307056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Diana Lemos
- Diana Lemos is with the American Medical Association (AMA), Chicago, IL. Paulina Sosa is founder/CEO of Latinx Voces, LLC, San Antonio, TX, and a doctoral candidate with John Hopkins Bloomberg School of Public Health, Baltimore, MD. Edward Vallejo is founder/epidemiologist at PublicHealthMaps, Washington, DC. Note. The thoughts expressed in this article are those of the authors and do not necessarily represent official AMA policy
| | - Paulina Sosa
- Diana Lemos is with the American Medical Association (AMA), Chicago, IL. Paulina Sosa is founder/CEO of Latinx Voces, LLC, San Antonio, TX, and a doctoral candidate with John Hopkins Bloomberg School of Public Health, Baltimore, MD. Edward Vallejo is founder/epidemiologist at PublicHealthMaps, Washington, DC. Note. The thoughts expressed in this article are those of the authors and do not necessarily represent official AMA policy
| | - Edward Vallejo
- Diana Lemos is with the American Medical Association (AMA), Chicago, IL. Paulina Sosa is founder/CEO of Latinx Voces, LLC, San Antonio, TX, and a doctoral candidate with John Hopkins Bloomberg School of Public Health, Baltimore, MD. Edward Vallejo is founder/epidemiologist at PublicHealthMaps, Washington, DC. Note. The thoughts expressed in this article are those of the authors and do not necessarily represent official AMA policy
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12
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Chuey MR, Hung MC, Srivastav A, Lu PJ, Nguyen KH, Williams WW, Lainz AR. Influenza vaccination coverage among adults by nativity, race/ethnicity, citizenship, and language of the interview - United States, 2012-2013 through 2017-2018 influenza seasons. Am J Infect Control 2022; 50:497-502. [PMID: 34520788 DOI: 10.1016/j.ajic.2021.09.003] [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: 08/04/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Approximately 20,000 people died from influenza in the US in the 2019-2020 season. The best way to prevent influenza is to receive the influenza vaccine. Persons who are foreign-born experience disparities in access to, and utilization of, preventative healthcare, including vaccination. METHODS National Health Interview Survey data were analyzed to assess differences in influenza vaccination coverage during the 2012-2013 through 2017-2018 influenza seasons among adults by nativity, citizenship status of foreign-born persons, race/ethnicity, and language of the interview. RESULTS Influenza vaccination coverage increased significantly during the study period for US-born adults but did not change significantly among foreign-born racial/ethnic groups except for increases among foreign-born Hispanic adults. Coverage for foreign-born adults, those who completed an interview in a non-English language, and non-US citizens, had lower vaccination coverage during most influenza seasons studied, compared with US-born, English-interviewed, and US-citizen adults, respectively. CONCLUSIONS Strategies to improve influenza vaccination uptake must consider foreign-born adults as an underserved population in need of focused, culturally-tailored outreach. Achieving high influenza vaccination coverage among the foreign-born population will help reduce illness among the essential workforce, achieve national vaccination goals, and reduce racial and ethnic disparities in vaccination coverage in the US.
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Lion KC, Faro EZ, Coker TR. All Quality Improvement Is Health Equity Work: Designing Improvement to Reduce Disparities. Pediatrics 2022; 149:184820. [PMID: 35230431 DOI: 10.1542/peds.2020-045948e] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
Quality improvement (QI) can be a critical means by which to achieve equity in health and health care. QI efforts, however, often fail to be designed and implemented through the lens of health equity. In this article, we will discuss the current state of the intersection between QI and health equity, then lay out specific steps researchers and practitioners can take to ensure that their QI work reduces, rather than increases or maintains, existing disparities. These steps include first, understanding existing disparities and, second, utilizing community engagement to ensure that QI enhances health equity. Before embarking on QI work, QI practitioners should first examine their metric of interest by patient characteristics, starting with race and ethnicity, language, and markers of access to care and socioeconomic status. Developing an understanding of existing disparities relevant to the QI project will ensure that the QI interventions can be designed to be most effective in the disadvantaged populations, thus increasing the likelihood that the intervention reduces existing disparities. In designing QI interventions, practitioners must also plan engagement with stakeholder populations ahead of time, to carefully understand their needs and priorities and how best to address them through QI efforts.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington, Seattle, Washington.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Elissa Z Faro
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington, Seattle, Washington.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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Flynn MA, Check P, Steege AL, Sivén JM, Syron LN. Health Equity and a Paradigm Shift in Occupational Safety and Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:349. [PMID: 35010608 PMCID: PMC8744812 DOI: 10.3390/ijerph19010349] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 01/01/2023]
Abstract
Despite significant improvements in occupational safety and health (OSH) over the past 50 years, there remain persistent inequities in the burden of injuries and illnesses. In this commentary, the authors assert that addressing these inequities, along with challenges associated with the fundamental reorganization of work, will require a more holistic approach that accounts for the social contexts within which occupational injuries and illnesses occur. A biopsychosocial approach explores the dynamic, multidirectional interactions between biological phenomena, psychological factors, and social contexts, and can be a tool for both deeper understanding of the social determinants of health and advancing health equity. This commentary suggests that reducing inequities will require OSH to adopt the biopsychosocial paradigm. Practices in at least three key areas will need to adopt this shift. Research that explicitly examines occupational health inequities should do more to elucidate the effects of social arrangements and the interaction of work with other social determinants on work-related risks, exposures, and outcomes. OSH studies regardless of focus should incorporate inclusive methods for recruitment, data collection, and analysis to reflect societal diversity and account for differing experiences of social conditions. OSH researchers should work across disciplines to integrate work into the broader health equity research agenda.
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Affiliation(s)
- Michael A Flynn
- Occupational Health Equity Program, National Institute for Occupational Safety and Health, 1090 Tusculum Ave., Cincinnati, OH 45226, USA
| | - Pietra Check
- Occupational Health Equity Program, National Institute for Occupational Safety and Health, 1090 Tusculum Ave., Cincinnati, OH 45226, USA
| | - Andrea L Steege
- Occupational Health Equity Program, National Institute for Occupational Safety and Health, 1090 Tusculum Ave., Cincinnati, OH 45226, USA
| | - Jacqueline M Sivén
- Occupational Health Equity Program, National Institute for Occupational Safety and Health, 1090 Tusculum Ave., Cincinnati, OH 45226, USA
| | - Laura N Syron
- Occupational Health Equity Program, National Institute for Occupational Safety and Health, 1090 Tusculum Ave., Cincinnati, OH 45226, USA
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Kress AC, Asberry A, Taillepierre JD, Johns MM, Tucker P, Penman-Aguilar A. Collection of Data on Sex, Sexual Orientation, and Gender Identity by U.S. Public Health Data and Monitoring Systems, 2015-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12189. [PMID: 34831945 PMCID: PMC8621287 DOI: 10.3390/ijerph182212189] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/28/2022]
Abstract
We aimed to assess Centers for Disease Control and Prevention (CDC) data systems on the extent of data collection on sex, sexual orientation, and gender identity as well as on age and race/ethnicity. Between March and September 2019, we searched 11 federal websites to identify CDC-supported or -led U.S. data systems active between 2015 and 2018. We searched the systems' website, documentation, and publications for evidence of data collection on sex, sexual orientation, gender identity, age, and race/ethnicity. We categorized each system by type (disease notification, periodic prevalence survey, registry/vital record, or multiple sources). We provide descriptive statistics of characteristics of the identified systems. Most (94.1%) systems we assessed collected data on sex. All systems collected data on age, and approximately 80% collected data on race/ethnicity. Only 17.7% collected data on sexual orientation and 5.9% on gender identity. Periodic prevalence surveys were the most common system type for collecting all the variables we assessed. While most U.S. public health data and monitoring systems collect data disaggregated by sex, age, and race/ethnicity, far fewer do so for sexual orientation or gender identity. Standards and examples exist to aid efforts to collect and report these vitally important data. Additionally important is increasing accessibility and appropriately tailored dissemination of reports of these data to public health professionals and other collaborators.
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Affiliation(s)
- Alissa C. Kress
- Office of Women’s Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
| | - Asia Asberry
- Department of Health Promotion and Behavior, University of Georgia College of Public Health, Athens, GA 30602, USA;
| | - Julio Dicent Taillepierre
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (J.D.T.); (A.P.-A.)
| | - Michelle M. Johns
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, Atlanta, GA 30329, USA;
| | - Pattie Tucker
- Office of Women’s Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA;
| | - Ana Penman-Aguilar
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; (J.D.T.); (A.P.-A.)
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Gharpure R, Marsh ZA, Tack DM, Collier SA, Strysko J, Ray L, Payne DC, Garcia-Williams AG. Disparities in Incidence and Severity of Shigella Infections Among Children-Foodborne Diseases Active Surveillance Network (FoodNet), 2009-2018. J Pediatric Infect Dis Soc 2021; 10:782-788. [PMID: 34145878 PMCID: PMC8744073 DOI: 10.1093/jpids/piab045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Shigella infections are an important cause of diarrhea in young children and can result in severe complications. Disparities in Shigella infections are well documented among US adults. Our objective was to characterize disparities in incidence and severity of Shigella infections among US children. METHODS We analyzed laboratory-diagnosed Shigella infections reported to FoodNet, an active, population-based surveillance system in 10 US sites, among children during 2009-2018. We calculated the incidence rate stratified by sex, age, race/ethnicity, Shigella species, and disease severity. Criteria for severe classification were hospitalization, bacteremia, or death. The odds of severe infection were calculated using logistic regression. RESULTS During 2009-2018, 10 537 Shigella infections were reported in children and 1472 (14.0%) were severe. The incidence rate was 9.5 infections per 100 000 child-years and the incidence rate of severe infections was 1.3 per 100 000 child-years. Incidence was highest among children aged 1-4 years (19.5) and lowest among children aged 13-17 years (2.3); however, children aged 13-17 years had the greatest proportion of severe infections (21.2%). Incidence was highest among Black (16.2 total; 2.3 severe), Hispanic (13.1 total; 2.3 severe), and American Indian/Alaska Native (15.2 total; 2.5 severe) children. Infections caused by non-sonnei species had higher odds of severity than infections caused by Shigella sonnei (adjusted odds ratio 2.58; 95% confidence interval 2.12-3.14). CONCLUSIONS The incidence and severity of Shigella infections among US children vary by age, race/ethnicity, and Shigella species, warranting investigation of unique risk factors among pediatric subpopulations.
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Affiliation(s)
- Radhika Gharpure
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary A. Marsh
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danielle M. Tack
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A. Collier
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonathan Strysko
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Logan Ray
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Daniel C. Payne
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amanda G. Garcia-Williams
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Michelogiannakis D, Gajendra S, Pathagunti SR, Sayers MS, Newton JT, Zhou Z, Feng C, Rossouw PE. Patients' and parents' expectations of orthodontic treatment in university settings. Am J Orthod Dentofacial Orthop 2021; 159:443-452. [PMID: 33568276 DOI: 10.1016/j.ajodo.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 01/01/2020] [Accepted: 02/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The primary aim was to compare patients' and parents' orthodontic treatment expectations at the Eastman Institute for Oral Health, University of Rochester, Rochester, NY (UR) in the United States. Secondary aims were to assess the association between sociodemographic factors and UR participants' expectations; and compare participants' expectations between UR, Academic Centre for Dentistry Amsterdam (ACTA) and King's College Dental Hospital, London, United Kingdom (KC) (previously published data). METHODS One hundred and forty participants [70 patients and one of their parents (n = 70)] completed a validated questionnaire (10 questions) to measure orthodontic treatment expectations before screening at the Orthodontic Department at UR. Various sociodemographic factors were assessed. The paired t test (for continuous responses) and the Fisher exact test (for categorical responses) were used to compare UR patients' and parents' responses. Two-sample t test and the Fisher exact test were used to compare participants' responses among sociodemographic groups. One-way analysis of variance followed by the Tukey test, and the Fisher exact test were used to compare participants' responses between UR, and ACTA and KC (data collected from previous publications). A multiplicity correction was performed to control the false discovery rate. RESULTS Patients at UR expected less check-up and diagnosis, and less discussion about treatment at the initial visit, more dietary restrictions, and less improvement in smile esthetics and social confidence with orthodontic treatment than parents. Participants' responses differed by sociodemographic factors at UR and between UR, ACTA, and KC. CONCLUSIONS Expectations of orthodontic treatment differ between patients and their parents, are associated with sociodemographic factors, and vary among United States and European University centers.
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Affiliation(s)
- Dimitrios Michelogiannakis
- Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.
| | - Sangeeta Gajendra
- Division of Community Dentistry and Oral Disease Prevention, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Srinivasa Reddy Pathagunti
- Division of Community Dentistry and Oral Disease Prevention, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Mark Stewart Sayers
- Orthodontic Department, Queen Mary's Hospital Sidcup, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jonathon Tim Newton
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Zhirou Zhou
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Changyong Feng
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Paul Emile Rossouw
- Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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Using Event-Based Web-Scraping Methods and Bidirectional Transformers to Characterize COVID-19 Outbreaks in Food Production and Retail Settings. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-77211-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Rubenstein BL, Campbell S, Meyers AR, Crum DA, Mitchell CS, Hutson J, Williams DL, Senesie SS, Gilani Z, Reynolds S, Alba B, Tavitian S, Billings K, Saintus L, Martin SB, Mainzer H. Factors That Might Affect SARS-CoV-2 Transmission Among Foreign-Born and U.S.-Born Poultry Facility Workers - Maryland, May 2020. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:1906-1910. [PMID: 33332291 PMCID: PMC7745955 DOI: 10.15585/mmwr.mm6950a5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Owodunni OP, Haut ER, Shaffer DL, Hobson DB, Wang J, Yenokyan G, Kraus PS, Aboagye JK, Florecki KL, Webster KLW, Holzmueller CG, Streiff MB, Lau BD. Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: Is there a differential effect by race? PLoS One 2020; 15:e0227339. [PMID: 31945085 PMCID: PMC6964816 DOI: 10.1371/journal.pone.0227339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/16/2019] [Indexed: 11/19/2022] Open
Abstract
Background Racial disparities are common in healthcare. Venous thromboembolism (VTE) is a leading cause of preventable harm, and disparities observed in prevention practices. We examined the impact of a patient-centered VTE education bundle on the non-administration of preventive prophylaxis by race. Methods A post-hoc, subset analysis (stratified by race) of a larger nonrandomized trial. Pre-post comparisons analysis were conducted on 16 inpatient units; study periods were October 2014 through March 2015 (baseline) and April through December 2015 (post-intervention). Patients on 4 intervention units received the patient-centered, nurse educator-led intervention if the electronic health record alerted a non-administered dose of VTE prophylaxis. Patients on 12 control units received no intervention. We compared the conditional odds of non-administered doses of VTE prophylaxis when patient refusal was a reason for non-administration, stratified by race. Results Of 272 patient interventions, 123 (45.2%) were white, 126 (46.3%) were black, and 23 (8.5%) were other races. A significant reduction was observed in the odds of non-administration of prophylaxis on intervention units compared to control units among patients who were black (OR 0.61; 95% CI, 0.46–0.81, p<0.001), white (OR 0.57; 95% CI, 0.44–0.75, p<0.001), and other races (OR 0.50; 95% CI, 0.29–0.88, p = 0.015). Conclusion Our finding suggests that the patient education materials, developed collaboratively with a diverse group of patients, improved patient’s understanding and the importance of VTE prevention through prophylaxis. Quality improvement interventions should examine any differential effects by patient characteristics to ensure disparities are addressed and all patients experience the same benefits.
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Affiliation(s)
- Oluwafemi P. Owodunni
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Elliott R. Haut
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Dauryne L. Shaffer
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
| | - Deborah B. Hobson
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
- Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Peggy S. Kraus
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
| | - Jonathan K. Aboagye
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Katherine L. Florecki
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Kristen L. W. Webster
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Christine G. Holzmueller
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
| | - Michael B. Streiff
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
- Division of Hematology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
| | - Brandyn D. Lau
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
- Division of Health Sciences Informatics, The Johns Hopkins Hospital, Baltimore, Maryland, United States of America
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Szaflarski M, Bauldry S. The Effects of Perceived Discrimination on Immigrant and Refugee Physical and Mental Health. ACTA ACUST UNITED AC 2019; 19:173-204. [PMID: 31178652 DOI: 10.1108/s1057-629020190000019009] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose Discrimination has been identified as a major stressor and influence on immigrant health. This study examined the role of perceived discrimination in relation to other factors, in particular, acculturation, in physical and mental health of immigrants and refugees. Methodology/approach Data for US adults (18+ years) were derived from the National Epidemiologic Survey on Alcohol and Related Conditions. Mental and physical health was assessed with SF-12. Acculturation and perceived discrimination were assessed with multidimensional measures. Structural equation models were used to estimate the effects of acculturation, stressful life effects, perceived discrimination, and social support on health among immigrants and refugees. Findings Among first-generation immigrants, discrimination in health care had a negative association with physical health while discrimination in general had a negative association with mental health. Social support had positive associations with physical and mental health and mediated the association of discrimination to health. There were no significant associations between discrimination and health among refugees, but the direction and magnitude of associations were similar to those for first-generation immigrants. Implications Efforts aiming at reducing discrimination and enhancing integration/social support for immigrants are likely to help with maintaining and protecting immigrants' health and well-being. Further research using larger samples of refugees and testing moderating effects of key social/psychosocial variables on immigrant health outcomes is warranted. Originality/value This study used multidimensional measures of health, perceived discrimination, and acculturation to examine the pathways between key social/psychosocial factors in health of immigrants and refugees at the national level. This study included possibly the largest national sample of refugees.
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Affiliation(s)
- Magdalena Szaflarski
- Department of Sociology, University of Alabama at Birmingham, HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152
| | - Shawn Bauldry
- Department of Sociology, Purdue University, 700 W. State Street, Stone 326 B, West Lafayette, IN 47907
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Infectious Disease Threats and Opportunities for Prevention. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 24:503-505. [DOI: 10.1097/phh.0000000000000910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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