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Matos J, Gallifant J, Chowdhury A, Economou-Zavlanos N, Charpignon ML, Gichoya J, Celi LA, Nazer L, King H, Wong AKI. A Clinician's Guide to Understanding Bias in Critical Clinical Prediction Models. Crit Care Clin 2024; 40:827-857. [PMID: 39218488 DOI: 10.1016/j.ccc.2024.05.011] [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: 09/04/2024]
Abstract
This narrative review focuses on the role of clinical prediction models in supporting informed decision-making in critical care, emphasizing their 2 forms: traditional scores and artificial intelligence (AI)-based models. Acknowledging the potential for both types to embed biases, the authors underscore the importance of critical appraisal to increase our trust in models. The authors outline recommendations and critical care examples to manage risk of bias in AI models. The authors advocate for enhanced interdisciplinary training for clinicians, who are encouraged to explore various resources (books, journals, news Web sites, and social media) and events (Datathons) to deepen their understanding of risk of bias.
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Affiliation(s)
- João Matos
- University of Porto (FEUP), Porto, Portugal; Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal; Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jack Gallifant
- Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Critical Care, Guy's and St Thomas' NHS Trust, London, UK
| | - Anand Chowdhury
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | | | - Marie-Laure Charpignon
- Institute for Data Systems and Society, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Judy Gichoya
- Department of Radiology, Emory University, Atlanta, GA, USA
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Heather King
- Durham VA Health Care System, Health Services Research and Development, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA; Division of General Internal Medicine, Duke University, Duke University School of Medicine, Durham, NC, USA
| | - An-Kwok Ian Wong
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University, Division of Translational Biomedical Informatics, Durham, NC, USA.
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Ares-Blanco S, López-Rodríguez JA, Polentinos-Castro E, Del Cura-González I. Effect of GP visits in the compliance of preventive services: a cross-sectional study in Europe. BMC PRIMARY CARE 2024; 25:165. [PMID: 38750446 PMCID: PMC11094967 DOI: 10.1186/s12875-024-02400-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Performing cardiovascular and cancer screenings in target populations can reduce mortality. Visiting a General Practitioner (GP) once a year is related to an increased likelihood of preventive care. The aim of this study was to analyse the influence of visiting a GP in the last year on the delivery of preventive services based on sex and household income. METHODS Cross-sectional study using data collected from the European Health Interview Survey 2013-2015 of individuals aged 40-74 years from 29 European countries. The variables included: sociodemographic factors (age, sex, and household income (HHI) quintiles [HHI 1: lowest income, HHI 5: more affluent]), lifestyle factors, comorbidities, and preventive care services (cardiometabolic, influenza vaccination, and cancer screening). Descriptive statistics, bivariate analyses and multilevel models (level 1: citizen, level 2: country) were performed. RESULTS 242,212 subjects were included, 53.7% were female. The proportion of subjects who received any cardiometabolic screening (92.4%) was greater than cancer screening (colorectal cancer: 44.1%, gynaecologic cancer: 40.0%) and influenza vaccination. Individuals who visited a GP in the last year were more prone to receive preventive care services (cardiometabolic screening: adjusted OR (aOR): 7.78, 95% CI: 7.43-8.15; colorectal screening aOR: 1.87, 95% CI: 1.80-1.95; mammography aOR: 1.76, 95% CI: 1.69-1.83 and Pap smear test: aOR: 1.89, 95% CI:1.85-1.94). Among those who visited a GP in the last year, the highest ratios of cardiometabolic screening and cancer screening benefited those who were more affluent. Women underwent more blood pressure measurements than men regardless of the HHI. Men were more likely to undergo influenza vaccination than women regardless of the HHI. The highest differences between countries were observed for influenza vaccination, with a median odds ratio (MOR) of 6.36 (under 65 years with comorbidities) and 4.30 (over 65 years with comorbidities), followed by colorectal cancer screening with an MOR of 2.26. CONCLUSIONS Greater adherence to preventive services was linked to individuals who had visited a GP at least once in the past year. Disparities were evident among those with lower household incomes who visited a GP. The most significant variability among countries was observed in influenza vaccination and colorectal cancer screening.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.
- Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain.
| | - Juan A López-Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- General Ricardos Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Elena Polentinos-Castro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Isabel Del Cura-González
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
- Aging Research Center, Karolinksa Instituted, Stockholm, Sweden
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Rasooly A, Pan Y, Tang Z, He J, Shao R, Ellen ME, Manor O, Hu S, Davidovitch N. Quality Measurement in Shanghai From a Global Perspective; A Response to Recent Commentaries. Int J Health Policy Manag 2024; 13:8491. [PMID: 39099497 PMCID: PMC11270598 DOI: 10.34172/ijhpm.2024.8491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- Alon Rasooly
- School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yancen Pan
- Department of Epidemiology, Fielding School of Public Health, University of California – Los Angeles, CA, USA
| | - Zhenqing Tang
- Shanghai Health Development Research Center, Shanghai, China
| | - Jiangjiang He
- Shanghai Health Development Research Center, Shanghai, China
| | - Ruitai Shao
- Department of Chronic Disease & Multimorbidity, School of Population Medicine and Public Health, Chinese Academy of Medicine Science/Peking Union Medical College, Beijing, China
| | - Moriah E. Ellen
- School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
| | - Shanlian Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Nadav Davidovitch
- School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Brewer A, Hughes MC, Patel KN. Impact of Repeated Reimbursement Penalties on Hospital Total Quality Scores. J Patient Saf 2024; 20:198-201. [PMID: 38197907 DOI: 10.1097/pts.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVES The incidence of hospital-acquired conditions (HACs) is a serious public health issue with implications ranging from patient morbidity and mortality to negative financial impacts on patients and health care systems. Despite substantial efforts to address and reduce HACs, research into the effect of quality improvement programs is inconclusive. This study seeks to better understand the relationship between repeated reimbursement penalties and improvement in HAC quality scores. METHODS A quantitative comparative analysis of U.S. health care data was conducted. Data on quality outcomes and hospital characteristics were sourced from the Hospital-Acquired Condition Reduction Program from fiscal years 2018 and 2019 and the Centers for Medicare & Medicaid Services Inpatient Prospective Payment System impact files, respectively. RESULTS In total, 3123 U.S. hospitals were analyzed to compare differences between total HAC scores of hospitals with and without penalties in consecutive years. Hospitals with repeated penalties had significantly greater improvement in scores ( t497.262 = -13.00, P < 0.001), and the impact was greatest in small hospitals (<100 beds). Repeated penalties had a smaller impact on disproportionate share hospitals (Cohen d = 0.73). Among all hospitals, the effect of repeated penalties was large (Cohen d = 0.75). CONCLUSIONS This study suggests that repeated penalties can improve quality scores in U.S. hospitals. However, the effect may be exaggerated for smaller hospitals and those that serve patient populations with a relatively higher socioeconomic status. The reason disproportionate share hospitals did not show as much improvement as nondisproportionate hospitals may be because hospitals serving vulnerable populations often have fewer resources.
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Affiliation(s)
- Alice Brewer
- From the College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois
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Molinaro ML, Shen K, Agarwal G, Inglis G, Vanstone M. Family physicians' moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care. Br J Gen Pract 2024; 74:e41-e48. [PMID: 37957021 PMCID: PMC10664150 DOI: 10.3399/bjgp.2023.0193] [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: 04/18/2023] [Accepted: 08/10/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Family physicians (GPs) working with patients experiencing social inequities have witnessed patients' healthcare needs proliferate. Alongside increased workload demands fostered within current remuneration structures, this has generated concerning reports of family physician attrition and possible experiences of moral distress. AIM To explore stories of moral distress shared by family physicians caring for patients experiencing health needs related to social inequities. DESIGN AND SETTING A critical narrative inquiry, informed by the analytic lens of moral distress, conducted in Ontario, Canada. METHOD Twenty family physicians were recruited through purposive and snowball sampling via word of mouth and email mailing lists relevant to addictions and mental health care. Physicians participated in two narrative interviews and had the opportunity to review the interview transcripts. RESULTS Family physicians' accounts of moral distress were linked to policies governing physician remuneration, scope of practice, and the availability of social welfare programmes. These structural elements left physicians unable to get patients much needed support and resources. CONCLUSION This study provides evidence that physicians experience moral distress when unable to offer crucial resources to improve the health of patients with complex social needs resulting from structural features of the Canadian health and social welfare system. Further research is needed to critically interrogate how health and social welfare systems around the world can be reformed to improve the health of patients and increase family physicians' professional quality of life, potentially improving retention.
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Affiliation(s)
- Monica L Molinaro
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Katrina Shen
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gabrielle Inglis
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Mizumoto J, Harada Y, Terui T, Horo S, Otaka Y, Yokota Y, Komatsu M, Takeda Y. Identifying Unmet Social Needs in a Patient Living in Isolation: A Case Report. Cureus 2024; 16:e52429. [PMID: 38371131 PMCID: PMC10870694 DOI: 10.7759/cureus.52429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/20/2024] Open
Abstract
Loneliness and social isolation are common among older adults. To deliver high-quality care to older patients, healthcare professionals should know the social conditions of their patients. Addressing social determinants of health (SDH) in daily practice is beneficial to both patients and healthcare professionals. We illustrate a patient with congestive heart failure and cognitive decline whose social conditions improved through an SDH assessment. An SDH assessment has some potential advantages, which include facilitating a comprehensive understanding of patients' social conditions, visualizing how patients' social conditions have changed, deepening interprofessional collaboration, and ameliorating unnecessary negative emotions toward patients. This case report conveys two key messages. Firstly, healthcare professionals have the capability to evaluate patients' social backgrounds and enhance their health and social conditions through routine care. Secondly, the utilization of an SDH screening toolkit can support and enhance this initiative.
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Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, JPN
| | - Yukinori Harada
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, JPN
| | - Toshihiro Terui
- Department of Neuropsychiatry, Fukushima Medical University, Fukushima, JPN
| | - Saori Horo
- Department of Nursing Care, Kinikyo Tomakomai Clinics, Tomakomai, JPN
| | - Yumi Otaka
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, JPN
| | - Yuya Yokota
- Department of Family Medicine, Family Practice Center of Okayama, Okayama, JPN
| | - Masanari Komatsu
- Department of General Internal Medicine, Kagoshima Seikyo Hospital, Kagoshima, JPN
| | - Yuko Takeda
- Division of Medical Education, Faculty of Medicine, Juntendo University, Tokyo, JPN
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Duhoux A, Rioux-Dubois A, Poitras ME, Lazarovici M, Gabet M, Dufour E. Clinical and Organizational Nursing Innovations in Primary Care: Findings From a Stakeholders' Symposium. J Nurs Adm 2023; 53:654-660. [PMID: 37983604 DOI: 10.1097/nna.0000000000001362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Nursing innovations in primary care, based on interprofessional care models, could be better identified, recognized, and deployed. This article presents the results of a symposium discussing the implementation of nursing innovations in primary care in Quebec, Canada, in partnership with researchers and stakeholders. Built on the appreciative inquiry approach, 9 nursing innovations were described. To support the implementation of such nursing innovations responding to current primary care issues and population needs, 4 recommendations emerged: the need to implement strategies to achieve optimal scope of practice for primary care nurses; the importance to develop funding and organizational models that support primary care nursing innovation; the need to enhance a collaborative and democratic governance open to innovation; and the opportunity to create partnerships with the research community and teaching institutions.
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Affiliation(s)
- Arnaud Duhoux
- Author Affiliations: Associate Professor (Dr Duhoux), Faculty of Nursing, University of Montreal, Montreal; Primary Health Care Nurse Practitioner (PHC-NP) and Professor (Dr Rioux-Dubois), Department of Nursing, University du Québec en Outaouais, Saint-Jérôme; Associate Professor (Dr Poitras), Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke; RN, Faculty of Nursing (Lazarovici), Université de Montréal, Montréal; and Postdoctoral Fellow (Dr Gabet), Department of Family Medicine, Université Laval, Ville de Québec, Quebec, Canada; and Postdoctoral Fellow (Dr Dufour), Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Mullen LG, Oermann MH, Cockroft MC, Sharpe LM, Davison JA. Screening for the social determinants of health: Referring patients to community-based services. J Am Assoc Nurse Pract 2023; 35:835-842. [PMID: 37471525 DOI: 10.1097/jxx.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/13/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Screening patients for the social determinants of health (SDOH) allows clinicians to identify those needs and tailor referral efforts. Due to constraints on clinic time and monetary resources, a simple screening tool incorporated into existing clinic workflow increases its usefulness and impact. LOCAL PROBLEM Our free, nurse-led, mobile health clinic (MHC) needed an enhanced process or tool for screening patients for SDOH. The purpose of this quality-improvement project was to screen adult patients in the MHC for SDOH needs and to increase volunteer staff perceptions of their knowledge and confidence in referring patients to relevant community-based services. METHODS A screening process and tool was developed using guidelines from the Health Leads to identify patients' SDOH needs and related requests for assistance. The tool was introduced to and tested among volunteer staff through pretest/posttest surveys. INTERVENTIONS Patients who visited the clinic were screened for the SDOH within the project period, and volunteer staff were surveyed about their perceptions of the screening tool. RESULTS Sixty-four patients were screened for SDOH needs. Twenty-three percent reported food insecurity, 27% housing insecurity, 14% difficulty obtaining utilities, and 17% difficulty obtaining transportation; 28% requested assistance with their reported SDOH needs. Seventeen percent of patients reported two or more SDOH needs. At posttest, 100% of volunteer staff ( N = 9) indicated satisfaction with the SDOH screening questions, reported feeling knowledgeable about resources to use for patient referrals, and were confident in referring patients to needed resources. CONCLUSION The screening tool aptly guided practice and was evaluated as "easy to use" for clinic patients and volunteer staff.
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Affiliation(s)
- Leigh G Mullen
- Mobile Health Clinic, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marilyn H Oermann
- Mobile Health Clinic, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- School of Nursing, Duke University, Durham, North Carolina
| | - Marianne C Cockroft
- Mobile Health Clinic, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Leslie M Sharpe
- Mobile Health Clinic, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jean A Davison
- Mobile Health Clinic, School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Goodon H, Gawaziuk J, Comaskey B, Afifi TO, Château D, Brownell M, Sareen J, Morgan C, Logsetty S, Spiwak R. Investigating social determinants of child health and their implications in reducing pediatric traumatic injury: A framework and 17-year retrospective case-control study protocol. PLoS One 2023; 18:e0294734. [PMID: 38011128 PMCID: PMC10681167 DOI: 10.1371/journal.pone.0294734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Traumatic physical injuries are the number one cause of hospitalization and death among children in Canada. The majority of these injuries are preventable. The burden from injury can be reduced through prevention programs tailored to at-risk groups, however, existing research does not provide a strong explanation of how social factors influence a child's risk of injury. We propose a theoretical framework to better understand social factors and injury in children and will examine the association between these social factors and physical traumatic injury in children using large population-wide data. METHODS AND ANALYSIS We will examine data from 11,000 children hospitalized for traumatic physical injury and 55,000 matched uninjured children by linking longitudinal administrative and clinical data contained at the Manitoba Centre for Health Policy. We will examine 14 social determinants of child health measures from our theoretical framework, including receipt of income assistance, rural/urban status, socioeconomic status, children in care, child mental disorder, and parental factors (involvement with criminal justice system, education, social housing, immigration status, high residential mobility, mother's age at first birth, maternal Axis I mental disorder, maternal Axis II mental disorder and maternal physical disorder) to identify groups and periods of time when children are at greatest risk for traumatic physical injury. A conditional multivariable logistic regression model will be calculated (including all social determinant measures) to determine odds ratios and adjusted odds ratios (95% confidence interval) for cases (injured) and controls (non-injured). ETHICS AND DISSEMINATION Health Information Privacy Committee (HIPC No. 2017/2018-75) and local ethics approval (H2018-123) were obtained. Once social measures have been identified through statistical modelling, we will determine how they fit into a Haddon matrix to identify appropriate areas for intervention. Knowing these risk factors will guide decision-makers and health policy.
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Affiliation(s)
- Hunter Goodon
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin Gawaziuk
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brenda Comaskey
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O. Afifi
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Château
- ANU College of Health and Medicine, Australian National University, Canberra, Australia
- Data Analysis in Population Health Hub, National Centre for Epidemiology and Population Health, Canberra, Australia
| | - Marni Brownell
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cora Morgan
- Assembly of Manitoba Chiefs, Winnipeg, Manitoba, Canada
| | - Sarvesh Logsetty
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Firefighters Burn Unit, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Rae Spiwak
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Haggerty J, Minotti SC, Bouharaoui F. Development of an individual index of social vulnerability that predicts negative healthcare events: a proposed tool to address healthcare equity in primary care research and practice. Int J Equity Health 2023; 22:157. [PMID: 37596614 PMCID: PMC10436429 DOI: 10.1186/s12939-023-01965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/14/2023] [Indexed: 08/20/2023] Open
Abstract
PURPOSE Socially disadvantaged patients may lack self-efficacy to navigate a complex health system making them vulnerable to healthcare inequity. We aimed to develop an Index of social vulnerability that predicts increased risk of negative healthcare events (e.g. emergency hospitalization), independent of chronic disease burden. The analysis illustrates the conceptual and practical steps leading to the development of a pragmatic Index of social vulnerability to limited healthcare self-efficacy. METHODS Using data from a 3-year cohort of 2507 adult primary care patients in Québec (Canada), we applied two complementary structural equation modelling approaches-Partial Least Squares Path Modelling (PLS-PM) and Multiple indicators and Multiple Causes (MIMIC) modelling-to identify a minimal set of social characteristics that could be summed into an Index related to limited healthcare self-efficacy. We then used logistic regression to determine if the Index predicted: hospital emergency department use; hospital admissions; unmet need for care, and others. We privileged parsimony over explanatory capacity in our analytic decisions to make the Index pragmatic for epidemiologic and clinical use. RESULTS The Individual Social Vulnerability Index is the weighted sum of five indicators: two indicators of social support; educational achievement; financial status; limited language proficiency. The Index predicts increased likelihood of all negative healthcare outcomes except unmet need, with a clear threshold at Index ≥ 2. The effect is independent of chronic disease burden. CONCLUSION When social deficits outweigh social assets by two or more (Index ≥ 2), there is an increased risk of negative healthcare events beyond the risk attributable to poor health. The Index is a pragmatic tool to identify a minority of patients who will require additional support to receive equitable healthcare.
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Affiliation(s)
- Jeannie Haggerty
- McGill University, Department of Family Medicine, Montréal, Québec, H3S 1Z1, Canada.
- St. Mary's Hospital Research Center, Hayes Pavilion - S.4720, 3830 Lacombe Ave., Montréal, Québec, H3T 1M5, Canada.
| | - Simona C Minotti
- St. Mary's Hospital Research Center, Hayes Pavilion - S.4720, 3830 Lacombe Ave., Montréal, Québec, H3T 1M5, Canada
- Institute for Better Health, Trillium Health Partners, 100 Queensway W, Mississauga, ON, L58 1B8, Canada
- Department of Statistics and Quantitative Methods, University of Milano-Bococca, Milano, Italy
| | - Fatima Bouharaoui
- St. Mary's Hospital Research Center, Hayes Pavilion - S.4720, 3830 Lacombe Ave., Montréal, Québec, H3T 1M5, Canada
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Keller MS, Qureshi N, Albertson E, Pevnick J, Brandt N, Bui A, Sarkisian CA. Comparing risk prediction models aimed at predicting hospitalizations for adverse drug events in community dwelling older adults: a protocol paper. RESEARCH SQUARE 2023:rs.3.rs-2429369. [PMID: 36711695 PMCID: PMC9882666 DOI: 10.21203/rs.3.rs-2429369/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background The objective of this paper is to describe the creation, validation, and comparison of two risk prediction modeling approaches for community-dwelling older adults to identify individuals at highest risk for adverse drug event-related hospitalizations. One approach will use traditional statistical methods, the second will use a machine learning approach. Methods We will construct medication, clinical, health care utilization, and other variables known to be associated with adverse drug event-related hospitalizations. To create the cohort, we will include older adults (≥ 65 years of age) empaneled to a primary care physician within the Cedars-Sinai Health System primary care clinics with polypharmacy (≥ 5 medications) or at least 1 medication commonly implicated in ADEs (certain oral hypoglycemics, anti-coagulants, anti-platelets, and insulins). We will use a Fine-Gray Cox proportional hazards model for one risk modeling approach and DataRobot, a data science and analytics platform, to run and compare several widely used supervised machine learning algorithms, including Random Forest, Support Vector Machine, Extreme Gradient Boosting (XGBoost), Decision Tree, Naïve Bayes, and K-Nearest Neighbors. We will use a variety of metrics to compare model performance and to assess the risk of algorithmic bias. Discussion In conclusion, we hope to develop a pragmatic model that can be implemented in the primary care setting to risk stratify older adults to further optimize medication management.
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Affiliation(s)
| | | | | | | | | | - Alex Bui
- David Geffen School of Medicine: University of California Los Angeles David Geffen School of Medicine
| | - Catherine A Sarkisian
- David Geffen School of Medicine: University of California Los Angeles David Geffen School of Medicine
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Whelihan K, Modica C, Bay RC, Lewis JH. Patient and Staff Satisfaction and Experience While Transforming Health Center Systems. Risk Manag Healthc Policy 2022; 15:2115-2124. [PMID: 36386560 PMCID: PMC9664910 DOI: 10.2147/rmhp.s375983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/31/2022] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION Patient satisfaction and experience are important measures of overall quality of care. In 2017, the National Association of Community Health Centers (NACHC) launched an initiative to facilitate changes across organizational systems within Federally Qualified Health Centers (FQHCs) with the goal of improving value-driven care. METHODS NACHC worked with eight health centers, four in Georgia and four in Iowa, along with their state Primary Care Associations, to apply the Value Transformation Framework (VTF). This framework distills evidence-based practices into practical knowledge for goal-driven systems change. It provides actionable steps to help health centers reach value-driven goals of improved health outcomes, improved patient and staff experience, reduced costs, and improved equity (referred to as the Quintuple Aim goals). This paper reports on the patient and staff experience when applying VTF systems changes to improve colorectal cancer screening rates. RESULTS Patient and staff satisfaction and experience remained highly rated even after extensive organizational changes were implemented as part of this project. Implementation of a systems-approach to organizational change, through application of the VTF, did not negatively impact patient or staff experiences. CONCLUSION Patient and staff satisfaction and experience were positive despite the application of the VTF and systems-wide organizational changes. These experience results were alongside improved cancer screening rates, as observed from full project results. Investigators are encouraged that the application of systems change using the VTF may result in the achievement of Quintuple Aim goals without disrupting the experience of patients and staff. Investigators recommend continued exploration of this transformation approach.
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Affiliation(s)
- Kate Whelihan
- Department of Public Health, A.T. Still University of Health Sciences, School of Osteopathic Medicine in Arizona, Mesa, AZ, USA
| | - Cheryl Modica
- Quality Center, National Association of Community Health Centers, Bethesda, MD, USA
| | - R Curtis Bay
- Department of Interdisciplinary Health Sciences, A.T. Still University of Health Sciences, Arizona School of Health Sciences, Mesa, AZ, USA
| | - Joy H Lewis
- Department of Public Health, A.T. Still University of Health Sciences, School of Osteopathic Medicine in Arizona, Mesa, AZ, USA
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Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management. Healthcare (Basel) 2022; 10:healthcare10102006. [PMID: 36292453 PMCID: PMC9602069 DOI: 10.3390/healthcare10102006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Addressing social determinants of health (SDoH) is associated with improved clinical outcomes for patients with chronic diseases in safety-net settings. This qualitative study supplemented by descriptive quantitative analysis investigates the degree of alignment between patient and clinicians’ perceptions of SDoH resources and referrals in clinics within the public healthcare delivery system in San Francisco. We conducted a qualitative analysis of in-depth interviews, patient-led neighborhood tours, and in-person clinic visit observations with 10 patients and 7 primary care clinicians. Using a convergent parallel mixed methodology, we also completed a descriptive quantitative analysis comparing the categories of neighborhood health resources mentioned by patients or community leaders to the resources integrated into the electronic health record. We found that patients held a wealth of knowledge about neighborhood resources relevant to SDoH that were highly localized and specific to their communities. In addition, multiple stakeholders were involved in conducting SDoH screenings and referrals, including clinicians, system navigators such as case workers, and community-based organizations. Yet, the information flow between these stakeholders and patients lacked systematization, and the prioritization of social needs by patients and clinicians was misaligned, as represented by qualitative themes as well as quantitative differences in resource category distribution analysis (p < 0.001). Our results shed light upon opportunities for strengthening social care delivery in safety-net healthcare settings by improving patient engagement, clinic workflow, EHR engagement, and resource dissemination.
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Davis K, Fair ML, Buckingham C, McKinnon H, Theriot Roley L, Sease K. Impacts of a medical-legal partnership on clinical capacity to address social determinants of health. J Epidemiol Community Health 2022; 76:jech-2022-219270. [PMID: 36028307 DOI: 10.1136/jech-2022-219270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/11/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Social determinants of health (SDOHs) impacts on an individual's health outcomes have become more evident, and clinical providers are vital in helping patients address those needs. Providers are experiencing high-stress levels related to patient care, resulting in a diminished capacity to address these SDOHs. This study examines the impact of a medical-legal partnership (MLP) on the clinical capacity to assist providers with addressing SDOH needs and reducing clinician stress. METHODS A 16-question survey was emailed to 532 providers in a local health system. The survey assessed clinicians' perception of their role in addressing SDOH needs, the MLP's impact on their clinical capacity and the MLP's ability to remedy patient SDOH needs. RESULTS Providers who have referred to the MLP indicated higher levels of agreement that SDOH screenings were part of their clinical responsibility and had higher levels of agreement regarding comfort levels for completing SDOH screenings. Geriatric providers reported higher levels of agreement that the MLP reduced clinician stress than paediatric providers. CONCLUSION MLPs have the potential to reduce clinician stress and burnout by standing in the gap to assist providers in addressing their patient's SDOH needs.
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Affiliation(s)
- Kara Davis
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Melissa L Fair
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina, USA
| | - Catie Buckingham
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina, USA
- Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hannah McKinnon
- Institute for the Advancement of Community Health, Furman University, Greenville, South Carolina, USA
| | | | - Kerry Sease
- Children's Hospital, Prisma Health, Greenville, South Carolina, USA
- University of South Carolina School of Medicine, Greenville, South Carolina, USA
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15
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Smoak A, Kim YI, Peral S, Scarinci I. Healthcare Access in Rural Alabama: Patients' Perspective on Access and Utilization. South Med J 2022; 115:414-419. [PMID: 35777746 DOI: 10.14423/smj.0000000000001415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Increasing healthcare access is a Healthy People 2030 priority. This study examined healthcare access from the residents' perspective in the two most rural counties in the United States and compared the findings with data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) in rural and urban counties in Alabama. METHODS We conducted an in-person population-based survey using cluster sampling within census tracts assessing health insurance coverage, having a usual primary care provider, having had a routine healthcare visit within the past year, and barriers to care. RESULTS Among the 395 participants, 81.4% indicated having health insurance coverage, which was slightly lower than the BRFSS data for rural (87.6%) and urban counties in Alabama (87%); 89.6% of respondents indicated having a usual primary care provider compared with 84.3% of rural and 77.2% of urban residents; and 83.2% of participants indicated having had a routine healthcare visit in the last year compared with 77.3% of rural and 77.6% of urban residents. These indicators varied significantly across age, sex, and educational attainment and were consistent with BRFSS findings. CONCLUSIONS Healthcare access, as indicated by health insurance coverage and healthcare utilization, among residents in the two most rural US counties is comparable to access among rural and urban Alabamians. Primary care is a highly used resource in rural areas, and further research should characterize other social/behavioral factors that may explain the poor health outcomes seen in rural areas. In addition, BRFSS data continue to offer a reliable picture of healthcare access in rural areas.
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Affiliation(s)
- Ansley Smoak
- From the School of Medicine, the Division of Preventive Medicine, and the Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham
| | - Young-Il Kim
- From the School of Medicine, the Division of Preventive Medicine, and the Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham
| | - Sylvia Peral
- From the School of Medicine, the Division of Preventive Medicine, and the Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham
| | - Isabel Scarinci
- From the School of Medicine, the Division of Preventive Medicine, and the Department of Obstetrics and Gynecology, University of Alabama-Birmingham, Birmingham
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Mendoza JA, Miller CA, Martin KJ, Resnicow K, Iachan R, Faseru B, McDaniels-Davidson C, Deng Y, Martinez ME, Demark-Wahnefried W, Leader AE, Lazovich D, Jensen JD, Briant KJ, Fuemmeler BF. Examining the Association of Food Insecurity and Being Up-to-Date for Breast and Colorectal Cancer Screenings. Cancer Epidemiol Biomarkers Prev 2022; 31:1017-1025. [PMID: 35247884 PMCID: PMC9135358 DOI: 10.1158/1055-9965.epi-21-1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/05/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Food insecurity (FI) has been associated with poor access to health care. It is unclear whether this association is beyond that predicted by income, education, and health insurance. FI may serve as a target for intervention given the many programs designed to ameliorate FI. We examined the association of FI with being up-to-date to colorectal cancer and breast cancer screening guidelines. METHODS Nine NCI-designated cancer centers surveyed adults in their catchment areas using demographic items and a two-item FI questionnaire. For the colorectal cancer screening sample (n = 4,816), adults ages 50-75 years who reported having a stool test in the past year or a colonoscopy in the past 10 years were considered up-to-date. For the breast cancer screening sample (n = 2,449), female participants ages 50-74 years who reported having a mammogram in the past 2 years were up-to-date. We used logistic regression to examine the association between colorectal cancer or breast cancer screening status and FI, adjusting for race/ethnicity, income, education, health insurance, and other sociodemographic covariates. RESULTS The prevalence of FI was 18.2% and 21.6% among colorectal cancer and breast cancer screening participants, respectively. For screenings, 25.6% of colorectal cancer and 34.1% of breast cancer participants were not up-to-date. In two separate adjusted models, FI was significantly associated with lower odds of being up-to-date with colorectal cancer screening [OR, 0.7; 95% confidence interval (CI), 0.5-0.99)] and breast cancer screening (OR, 0.6; 95% CI, 0.4-0.96). CONCLUSIONS FI was inversely associated with being up-to-date for colorectal cancer and breast cancer screening. IMPACT Future studies should combine FI and cancer screening interventions to improve screening rates.
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Affiliation(s)
- Jason A. Mendoza
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Carrie A. Miller
- Health Behavior and Policy, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | | | - Ken Resnicow
- University of Michigan Rogel Cancer Center and School of Public Health, Ann Arbor, MI
| | | | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS
| | | | | | - Maria Elena Martinez
- Moores Cancer Center and Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | | | - Amy E. Leader
- Sidney Kimmel Cancer Center – Jefferson Health and Thomas Jefferson University
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health and Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Jakob D. Jensen
- Department of Communication and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Bernard F Fuemmeler
- Health Behavior and Policy, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
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McQueen A, Kreuter MW, Herrick CJ, Li L, Brown DS, Haire-Joshu D. Associations among social needs, health and healthcare utilization, and desire for navigation services among US Medicaid beneficiaries with type 2 diabetes. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1035-1044. [PMID: 33704849 PMCID: PMC8433262 DOI: 10.1111/hsc.13296] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/14/2020] [Accepted: 01/07/2021] [Indexed: 05/03/2023]
Abstract
The purpose of this study was to better understand the number and types of social needs experienced by Medicaid beneficiaries with type 2 diabetes, and how their social needs are associated with key health indicators. Also examined were factors that influence patients' interest in navigation services for health and social needs to inform future interventions and service delivery. The study expands upon prior research, much of which has focused on only one social need (e.g., food insecurity) or one health outcome. The hypothesis was that among individuals with type 2 diabetes, those with a greater number of social needs would report more health-related problems and be more interested in receiving social needs navigation services. Participants completed a cross-sectional survey by phone (n = 95) or online (n = 14). Most (85%) reported having at least one social need (M = 2.5, SD = 2.2), most commonly not having enough money for unexpected expenses (68%) or necessities like food, shelter and clothing (31%), medical costs (24%), and utilities (23%). Results supported our comprehensive conceptual model. Having more social needs was associated with greater perceived stress, diabetes distress, problems with sleep and executive and cognitive functioning, less frequent diabetes self-care activities, more days of poor mental health and activity limitations, worse self-reported health and more hospitalisations. Number of social needs also was positively associated with interest in having a social needs navigator. Social needs were not associated with days of poor physical health, BMI, self-reported A1C or smoking status. Social needs were associated with a wide range of indicators of poor health and well-being. Participants with the greatest social need burden were most open to intervention.
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Affiliation(s)
- Amy McQueen
- Department of Internal Medicine, School of Medicine, Washington University in St. Louis, MO
- Brown School of Social Work, Washington University in St. Louis, MO
| | | | - Cynthia J. Herrick
- Department of Internal Medicine, School of Medicine, Washington University in St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, MO
| | - Linda Li
- Brown School of Social Work, Washington University in St. Louis, MO
| | - Derek S. Brown
- Brown School of Social Work, Washington University in St. Louis, MO
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Handerer F, Kinderman P, Shafti M, Tai S. A Scoping Review and Narrative Synthesis Comparing the Constructs of Social Determinants of Health and Social Determinants of Mental Health: Matryoshka or Two Independent Constructs? Front Psychiatry 2022; 13:848556. [PMID: 35492698 PMCID: PMC9046700 DOI: 10.3389/fpsyt.2022.848556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Many health research policies invoke the construct of Social Determinants of Health, and more recently the construct of Social Determinants of Mental Health. While frequently referred to in the literature, it is unclear how these constructs relate to each other. Some commentators conceptualise the Determinants of Mental Health as a subgroup of the Determinants of general Health and others describe the Determinants of Mental Health as an autonomous construct. The current review investigates the relationship between both constructs. Methods Comprehensive literature searches were conducted for both constructs separately within seven electronic databases. A template analysis was conducted to compare the conceptualisations of the Social Determinants of Health and the Social Determinants of Mental Health. Results Of 4250 search results, 50 papers (25 for each construct) fulfilled our inclusion criteria and were incorporated into a narrative synthesis. Discussions of the Social Determinants of both general and Mental Health listed the same determinants. Both constructs were conceptualised on multiple levels and factors. Stress and health behaviour were also described as mediators for both constructs. The constructs differed, however, with respect to two components of their aetiologies and epistemologies. First, the causal mechanisms invoked for the Determinants of general Health followed predominantly direct pathways, in contrast to indirect pathways for the Social Determinants of Mental Health. Second, the Social Determinants of Mental Health were reported to influence mental health mediated through individuals' perceptions and appraisal processes. Appraisal processes were considered of far less relevance in the construct of Social Determinants of Health. Conclusion The constructs of Social Determinants of Health and Social Determinants of Mental Health align in many respects but differ on important aetiological and epistemological grounds. Similar social factors are considered important, but whereas physical health conditions are primarily conceptualised to be driven by objective realities, mental health is explained mainly in terms of perception of these realities. This differentiation between physical and mental health is in line with a modern understanding of mind-body-dualism, the naturalistic dualism after Chalmers. Differentiating the Social Determinants of Mental Health from the Social Determinants of Health might bear relevance for policy making and research.
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Affiliation(s)
- Fritz Handerer
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Peter Kinderman
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Matina Shafti
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sara Tai
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Katz A, Brownell M, Enns JE, Nickel NC. Closing the loop: From system-based data to evidence-influenced policy and practice. Int J Popul Data Sci 2022; 6:1701. [PMID: 35291758 PMCID: PMC8896077 DOI: 10.23889/ijpds.v7i1.1701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
For more than 30 years, the Manitoba Centre for Health Policy has been conducting research and evaluation to provide timely and critical evidence to answer real-world policy questions. Our experienced team of research scientists, analysts and other staff work extensively with policy-makers at the macro, meso and micro levels of government to support evidence-informed policy and program development in an effort to ensure that policy initiatives provide the greatest benefit possible to individuals and society as a whole. Using the widely recognized whole-population Manitoba Population Research Data Repository, which comprises approximately 100 different datasets from multiple sectors, we employ sophisticated and state-of-the-art research methods and data science technologies, and then translate the results into meaningful insights or recommendations for policy-makers. Our long and productive history of working with policy-makers has taught us much about making our research relevant to policy-makers. In this article, we outline some examples of how research evidence has been used to influence policy in Manitoba, and the key lessons we have learned about what makes relationships between researchers and policy-makers work. In essence, policy-makers have supported the growth of the Repository over the last 30 years, because researchers have "closed the loop" by sharing valuable and policy-relevant research results with them. This ability to inform policies, programs and service delivery with scientific evidence continues to benefit individuals, communities and our society as a whole.
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Affiliation(s)
- Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB R3E 3P5, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB R3E 3P5, Canada
| | - Jennifer E. Enns
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB R3E 3P5, Canada
| | - Nathan C. Nickel
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB R3E 3P5, Canada
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20
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Social Vulnerability and Postoperative Complications; We Need More Than ERAS Pathways and Glucose Control to Improve Surgical Outcomes. Ann Surg 2021; 274:892-893. [PMID: 34475323 DOI: 10.1097/sla.0000000000005203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hswen Y, Thorpe Huerta D, Le-Compte C, Hawkins JB, Brownstein JS. A 10-Year Social Media Analysis Exploring Hospital Online Support of Black Lives Matter and the Black Community. JAMA Netw Open 2021; 4:e2126714. [PMID: 34652448 PMCID: PMC8520129 DOI: 10.1001/jamanetworkopen.2021.26714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Tensions around COVID-19 and systemic racism have raised the question: are hospitals advocating for equity for their Black patients? It is imperative for hospitals to be supportive of the Black community and acknowledge themselves as safe spaces, run by clinicians and staff who care about social justice issues that impact the health of the Black community; without the expression of support, Black patients may perceive hospitals as uncaring and unsafe, potentially delaying or avoiding treatment, which can result in serious complications and death for those with COVID-19. OBJECTIVE To explore how hospitals showed public-facing support for the Black community as measured through tweets about social equity or the Black Lives Matter (BLM) movement. DESIGN, SETTING, AND PARTICIPANTS Using a retrospective longitudinal cohort study design, tweets from the top 100 ranked hospitals were collected, starting with the most recent over a 10-year span, from May 3, 2009, to June 26, 2020. The date of the George Floyd killing, May 25, 2020, was investigated as a point of interest. Data were analyzed from June 11 to December 4, 2020. MAIN OUTCOMES AND MEASURES Tweets were manually identified based on 4 categories: BLM, associated with the BLM movement; Black support, expressed support for Black population within the hospital's community; Black health, pertained to health concerns specific to and the creation of health care for the Black community; or social justice, associated with general social justice terms that were too general to label as Black. If a tweet did not contain any hashtags from these categories, it remained unlabeled. RESULTS A total of 281 850 tweets from 90 unique social media accounts were collected. Each handle returned at least 1279 tweets, with 85 handles (94.4%) returning at least 3000 tweets. Tweet publication dates ranged from 2009 to 2020. A total of 274 tweets (0.097%) from 67 handles (74.4%) used a hashtag to support the BLM movement. Among the tweets labeled BLM, the first tweet was published in 2018 and only 4 tweets (1.5%) predated the killing of George Floyd. A similar trend of low signal observed was detected for the other categories (Black support: 244 tweets [0.086%] from 42 handles [46.7%] starting in 2013; Black health: 28 tweets [0.0099%] from 15 handles [16.7%] starting in 2018; social justice: 40 tweets [0.014%] from 21 handles [23.3%] starting in 2015). CONCLUSIONS AND RELEVANCE These findings reflect the low signal of tweets regarding the Black community and social justice in a generalized way across approximately 10 years of tweets for all the hospital handles within the data set. From 2009 to 2020, hospitals rarely engaged in issues pertaining to the Black community and if so, only within the last half of this time period. These later entrances into these discussions indicate that these discussions are relatively recent.
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Affiliation(s)
- Yulin Hswen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Bakar Computational Health Sciences Institute, University of California, San Francisco
- Computational Epidemiology Lab, Harvard Medical School, Boston, Massachusetts
- Innovation Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Danyellé Thorpe Huerta
- Computational Epidemiology Lab, Harvard Medical School, Boston, Massachusetts
- Innovation Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Circe Le-Compte
- Department of Social Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jared B. Hawkins
- Computational Epidemiology Lab, Harvard Medical School, Boston, Massachusetts
- Innovation Program, Boston Children’s Hospital, Boston, Massachusetts
| | - John S. Brownstein
- Computational Epidemiology Lab, Harvard Medical School, Boston, Massachusetts
- Innovation Program, Boston Children’s Hospital, Boston, Massachusetts
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22
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Kalabalik-Hoganson J, Ozdener-Poyraz AE, Rizzolo D. Call to Action: Addressing Social Determinants of Health in Pharmacy Practice. Ann Pharmacother 2021; 56:740-745. [PMID: 34541883 DOI: 10.1177/10600280211040895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Social determinants of health (SDOH) are conditions in which individuals are born, live, work, learn, play, and age that affect health, risks, functioning, and outcomes. SDOH are recognized barriers to care, risk factors for certain diseases, and associated with poorer health outcomes. Screening for SDOH in physician practices and hospitals is reportedly low. The accessibility of pharmacists and established relationships with patients make pharmacy settings ideal for identifying and mitigating social needs. An evaluation of the impact of SDOH on health outcomes and opportunities for pharmacists to embed screening into practice is warranted.
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Wang JX, Somani S, Chen JH, Murray S, Sarkar U. Health Equity in Artificial Intelligence and Primary Care Research: Protocol for a Scoping Review. JMIR Res Protoc 2021; 10:e27799. [PMID: 34533458 PMCID: PMC8486995 DOI: 10.2196/27799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/09/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Though artificial intelligence (AI) has the potential to augment the patient-physician relationship in primary care, bias in intelligent health care systems has the potential to differentially impact vulnerable patient populations. OBJECTIVE The purpose of this scoping review is to summarize the extent to which AI systems in primary care examine the inherent bias toward or against vulnerable populations and appraise how these systems have mitigated the impact of such biases during their development. METHODS We will conduct a search update from an existing scoping review to identify studies on AI and primary care in the following databases: Medline-OVID, Embase, CINAHL, Cochrane Library, Web of Science, Scopus, IEEE Xplore, ACM Digital Library, MathSciNet, AAAI, and arXiv. Two screeners will independently review all abstracts, titles, and full-text articles. The team will extract data using a structured data extraction form and synthesize the results in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. RESULTS This review will provide an assessment of the current state of health care equity within AI for primary care. Specifically, we will identify the degree to which vulnerable patients have been included, assess how bias is interpreted and documented, and understand the extent to which harmful biases are addressed. As of October 2020, the scoping review is in the title- and abstract-screening stage. The results are expected to be submitted for publication in fall 2021. CONCLUSIONS AI applications in primary care are becoming an increasingly common tool in health care delivery and in preventative care efforts for underserved populations. This scoping review would potentially show the extent to which studies on AI in primary care employ a health equity lens and take steps to mitigate bias. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/27799.
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Affiliation(s)
- Jonathan Xin Wang
- Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Sulaiman Somani
- Icahn School of Medicine at Mount Sinai, New York City, NY, United States
| | - Jonathan H Chen
- Center for Biomedical Informatics Research, Division of Hospital Medicine, Stanford Department of Medicine, Stanford, CA, United States
| | - Sara Murray
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Urmimala Sarkar
- Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
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Lucas JA, Marino M, Giebultowicz S, Fankhauser K, Suglia SF, Bailey SR, Bazemore A, Heintzman J. Mobility and social deprivation on primary care utilisation among paediatric patients with asthma. Fam Med Community Health 2021; 9:e001085. [PMID: 34244305 PMCID: PMC8278882 DOI: 10.1136/fmch-2021-001085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Asthma care is negatively impacted by neighbourhood social and environmental factors, and moving is associated with undesirable asthma outcomes. However, little is known about how movement into and living in areas of high deprivation relate to primary care use. We examined associations between neighbourhood characteristics, mobility and primary care utilisation of children with asthma to explore the relevance of these social factors in a primary care setting. DESIGN In this cohort study, we conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates. SETTING We used data from community health centres in 15 OCHIN states. PARTICIPANTS The sample included 23 773 children with asthma aged 3-17 across neighbourhoods with different levels of social deprivation from 2012 to 2017. We conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates. RESULTS Clinic visit rates were higher among children living in or moving to areas with higher deprivation than those living in areas with low deprivation (rate ratio (RR) 1.09, 95% CI 1.02 to 1.17; RR 1.05, 95% CI 1.00 to 1.11). Children moving across neighbourhoods with similarly high levels of deprivation had increased RRs of influenza vaccination (RR 1.13, 95% CI 1.03 to 1.23) than those who moved but stayed in neighbourhoods of low deprivation. CONCLUSIONS Movement into and living within areas of high deprivation is associated with more primary care use, and presumably greater opportunity to reduce undesirable asthma outcomes. These results highlight the need to attend to patient movement in primary care visits, and increase neighbourhood-targeted population management to improve equity and care for children with asthma.
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Affiliation(s)
- Jennifer A Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Katie Fankhauser
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrew Bazemore
- American Board of Family Medicine, Lexington, Kentucky, USA
- Center for Professionalism & Value in Health Care, Washington, DC, USA
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA
- OCHIN Inc, Portland, Oregon, USA
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Tsui J, Yang A, Anuforo B, Chou J, Brogden R, Xu B, Cantor JC, Wang S. Health Related Social Needs Among Chinese American Primary Care Patients During the COVID-19 Pandemic: Implications for Cancer Screening and Primary Care. Front Public Health 2021; 9:674035. [PMID: 34123992 PMCID: PMC8192797 DOI: 10.3389/fpubh.2021.674035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients. Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening. Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions. Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.
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Affiliation(s)
- Jennifer Tsui
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Annie Yang
- Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Bianca Anuforo
- Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Jolene Chou
- Rutgers Center for State Health Policy, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, United States
| | - Ruth Brogden
- RWJBarnabas Health Medical Group, Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, United States
| | - Binghong Xu
- RWJBarnabas Health Medical Group, Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, United States
| | - Joel C. Cantor
- Rutgers Center for State Health Policy, Institute for Health, Health Care Policy, and Aging Research, New Brunswick, NJ, United States
- Rutgers Edward J. Bloustein School of Planning and Public Policy, New Brunswick, NJ, United States
| | - Su Wang
- RWJBarnabas Health Medical Group, Center for Asian Health, Saint Barnabas Medical Center, Florham Park, NJ, United States
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Kreuter MW, Thompson T, McQueen A, Garg R. Addressing Social Needs in Health Care Settings: Evidence, Challenges, and Opportunities for Public Health. Annu Rev Public Health 2021; 42:329-344. [PMID: 33326298 PMCID: PMC8240195 DOI: 10.1146/annurev-publhealth-090419-102204] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There has been an explosion of interest in addressing social needs in health care settings. Some efforts, such as screening patients for social needs and connecting them to needed social services, are already in widespread practice. These and other major investments from the health care sector hint at the potential for new multisector collaborations to address social determinants of health and individual social needs. This article discusses the rapidly growing body of research describing the links between social needs and health and the impact of social needs interventions on health improvement, utilization, and costs. We also identify gaps in the knowledge base and implementation challenges to be overcome. We conclude that complementary partnerships among the health care, public health, and social services sectors can build on current momentum to strengthen social safety net policies, modernize social services, and reshape resource allocation to address social determinants of health.
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Affiliation(s)
- Matthew W Kreuter
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Tess Thompson
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Amy McQueen
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63110, USA
| | - Rachel Garg
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
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27
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Sorato MM, Davari M, Kebriaeezadeh A, Sarrafzadegan N, Shibru T, Fatemi B. Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P's (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review. BMC Cardiovasc Disord 2021; 21:123. [PMID: 33663387 PMCID: PMC7971125 DOI: 10.1186/s12872-021-01934-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/23/2021] [Indexed: 01/06/2023] Open
Abstract
AIM Hypertension control in Sub-Saharan Africa (SSA) is the worst (less than one out of ten) when compared to the rest of the world. Therefore, this scoping review was conducted to identify and describe the possible reasons for poor blood pressure (BP) control based on 4Ps' (patient, professional, primary healthcare system, and public health policy) factors. METHODS PRISMA extension for scoping review protocol was used. We systematically searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google scholar. RESULTS Sixty-eight articles were included in this scoping review. The mean prevalence of hypertension, BP control, and patient adherence to prescribed medicines were 20.95%, 11.5%, and 60%, respectively. Only Kenya, Malawi, and Zambia out of ten countries started annual screening of the high-risk population for hypertension. Reasons for nonadherence to prescribed medicines were lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws. Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, maternal and child malnutrition were reasons for the worst BP control. CONCLUSION In conclusion, the rate of BP treatment, control, and medication adherence was low in Eastern SSA. Screening for high-risk populations was inadequate. Therefore, it is crucial to improve government commitment, patient awareness, and access to medicines, design country-specific annual screening programs, and empower clinicians to follow individualized treatment and conduct medication adherence research using more robust tools.
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Affiliation(s)
- Mende Mensa Sorato
- Department of Pharmacy, Arba Minch University College of Medicine and Health Sciences, P.O. Box 21, Arba Minch, Ethiopia
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tamiru Shibru
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Behzad Fatemi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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28
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Wilson EC, Pammett R, McKenzie F, Bourque H. Engagement of nurse practitioners in primary health care in northern British Columbia: a mixed-methods study. CMAJ Open 2021; 9:E288-E294. [PMID: 33785476 PMCID: PMC8096393 DOI: 10.9778/cmajo.20200075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nurse practitioners (NPs) have been regulated primary care providers in British Columbia since 2005; however, many practices and contributions of NPs, especially those in northern or rural regions, remain unarticulated in primary health care. The objective of this study was to evaluate NP practices in the context of providing primary health care in northern BC. METHODS This was a qualitative-dominant mixed-methods study. We recruited NP participants working in northern BC; recruitment and data collection occurred between April and June 2018. Participants completed the validated 28-item Primary Health Care Engagement (PHCE) Scale to assess their perceptions of their workplace with 8 attributes of primary health care (quality improvement, community participation, patient-centred care, accessibility, intersectoral team, interdisciplinary collaboration, continuity and population orientation). We also interviewed NPs about their everyday practice. Transcribed data from the interviews were analyzed interpretively. RESULTS In total, 13 of 30 (43%) eligible NPs participated in the survey and interview. The PHCE Scale results showed that all NPs perceived their workplaces to be highly engaged in patient-centred care, but none reported their workplaces as accessible. Interview data were organized into 5 headings which described how NPs see patients who are medically and socially complex, address inequities in access, practice collaboratively, address local service gaps and improve patient abilities to access care. INTERPRETATION In interprofessional primary health care teams, NPs are key members and attend to both direct patient care and broader social conditions affecting health. Nurse practitioners can help accelerate advancements to deliver responsive community-based primary health care.
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Affiliation(s)
- Erin C Wilson
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
| | - Robert Pammett
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
| | - Farah McKenzie
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
| | - Helen Bourque
- School of Nursing (Wilson), University of Northern British Columbia; Northern Health (Wilson, Pammett, Bourque), Prince George, BC; Faculty of Pharmaceutical Sciences (Pammett), University of British Columbia, Vancouver, BC; BC Cancer Centre for the North (McKenzie), Prince George, BC
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29
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Hand BN, Coury DL, White S, Darragh AR, Moffatt-Bruce S, Harris L, Longo A, Garvin JH. Specialized primary care medical home: A positive impact on continuity of care among autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:258-265. [PMID: 32907353 PMCID: PMC7854931 DOI: 10.1177/1362361320953967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
LAY ABSTRACT There is a nationally recognized need for innovative healthcare delivery models to improve care continuity for autistic adults as they age out of pediatric and into adult healthcare systems. One possible model of care delivery is called the "medical home". The medical home is not a residential home, but a system where a patient's healthcare is coordinated through a primary care physician to ensure necessary care is received when and where the patient needs it. We compared the continuity of care among autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the CAST, to matched national samples of autistic adults with private insurance or Medicare. Continuity of primary care among CAST patients was significantly better than that of matched national samples of autistic adult Medicare beneficiaries and similar to that of privately insured autistic adults. Our findings suggest that medical homes, like CAST, are a promising solution to improve healthcare delivery for the growing population of autistic adults.
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Affiliation(s)
| | | | - Susan White
- The Ohio State University Wexner Medical Center
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Giordani JMDA, Amaral Júnior OLD, Hugo FN, Hilgert JB. Factors associated with service user embracement by Primary Health Care teams in Brazil, 2012: a cross-sectional study. ACTA ACUST UNITED AC 2020; 29:e2019468. [PMID: 33146321 DOI: 10.1590/s1679-49742020000500017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate prevalence and factors associated with service user embracement by Primary Health Care teams in Brazil. METHODS This is a cross-sectional study that included teams that took part in the 2012 National Program for Primary Health Care Access and Quality Improvement (PMAQ-AB) (Cycle I). The outcome used was 'user embracement by the health team'. The independent variables were macro-region, municipal profile, Gini index and Family Health Strategy population coverage, team meetings, study of spontaneous demand, consideration of user opinions and existence of continuing education. Multilevel Poisson regression analysis was performed. RESULTS The sample consisted of 13,751 teams. User embracement prevalence was 78.3% (95%CI 77.6;79.1). In the hierarchical analysis, the highest prevalence of user embracement was found among Southern region teams (PR=1.37 - 95%CI 1.27;1.48) taking the Northeast region as a reference. CONCLUSION There is an uneven distribution of Primary Care teams practicing user embracement in Brazil, possibly associated with regional inequalities.
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Affiliation(s)
| | | | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Porto Alegre, RS, Brasil
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31
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Padalko A, Cristall N, Gawaziuk JP, Logsetty S. Social Complexity and Risk for Pediatric Burn Injury: A Systematic Review. J Burn Care Res 2020; 40:478-499. [PMID: 30918946 DOI: 10.1093/jbcr/irz059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Social complexity in health outcomes has been attributed to greater risk of injury, adverse health consequences, and early death in a variety of populations. To determine what social complexity factors associated with burn injury in children, a systematic review of the literature was performed. Two different databases (PubMed and SCOPUS) were searched for articles related to environmental and social determinants of burn injury. Selected literature examined social complexity factors to establish the strength of evidence in relation to incidence of burn injury in children. The extent of factors and the most common social complexities were reviewed. The 641 manuscripts found in PubMed and 327 from SCOPUS were initially reviewed for duplication and English language. Subsequently, manuscripts were selected for relevance based on titles followed by abstracts. Forty-seven manuscripts were reviewed in their entirety. The literature supports a relationship between an increased incidence of pediatric burns in lower income families, children with behavioral disorders, fewer years of parental education and children residing in a rural setting. The majority of reports came from Europe followed by Australia, and scattered information from other countries. Social complexity factors in the environment of the child are associated with an increased risk of burn injury in children. The literature supports the influence of lower income, lower parental education, behavioral disorders and living rurally with an increased incidence of injury. By identifying children at increased risk, it is possible to develop targeted burn prevention and education programs to mitigate burn injury.
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Affiliation(s)
- Adam Padalko
- BSc Med Research Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nora Cristall
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Canada
| | | | - Sarvesh Logsetty
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Canada.,Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Cole MB, Nguyen KH. Unmet social needs among low-income adults in the United States: Associations with health care access and quality. Health Serv Res 2020; 55 Suppl 2:873-882. [PMID: 32880945 PMCID: PMC7518813 DOI: 10.1111/1475-6773.13555] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To describe social needs among low-income adults and estimate the relationship between level of unmet social needs and key indicators of health care access and quality. DATA SOURCE National survey data from 12 states from the 2017 Behavioral Risk Factor Surveillance System, which added a "Social Determinants of Health" Module in 2017. STUDY DESIGN We examined differences in eight measures of health care access and quality (eg, check-up in last 12 months, inability to see doctor due to cost, receipt of eye examination for diabetics) for low-income adults with 0, 1, 2-3, and 4+ unmet social needs based on 7 social needs measures. We used adjusted logistic regression models to estimate the association between level of unmet need and each outcome. PRINCIPAL FINDINGS Most common unmet social needs included not having enough money for balanced meals (33 percent) or food (32 percent). After adjusting for observable characteristics, higher levels of unmet social need were associated with poorer access and quality. Compared to those with no reported unmet needs, having 4+ unmet needs was significantly associated with reduced probability of having a yearly check-up (65 percent vs 78 percent, adjusted difference = -7.1 percentage points (PP)), receiving a flu vaccine (33 percent vs 42 percent, adjusted difference = -5.4 PP), having a personal doctor (74 percent vs 80 percent, adjusted difference = -3.1 PP), and having a foot (63 percent vs 80 percent, adjusted difference = -12.8 PP) or eye examination (61 percent vs 73 percent, adjusted difference = -12.6 PP) for diabetic patients, and increased probability of being unable to see a doctor due to cost (44 percent vs 9 percent, adjusted difference = 27.9 PP) and having diabetes affect the eyes (22 percent vs 19 percent, adjusted difference = 8.0 PP) at α = 0.05. CONCLUSIONS Higher levels of unmet social needs were associated with poorer access to and quality of care among low-income adults. Addressing social needs both inside and outside of health care settings may help mitigate these negative effects. Additional research on if and how to effectively do so is critical.
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Affiliation(s)
- Megan B. Cole
- Boston University School of Public HealthBostonMassachusetts
| | - Kevin H. Nguyen
- Brown University School of Public HealthProvidenceRhode Island
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33
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Helpman L, Pond GR, Elit L, Anderson LN, Seow H. Disparities in surgical management of endometrial cancers in a public healthcare system: A question of equity. Gynecol Oncol 2020; 159:387-393. [PMID: 32928520 DOI: 10.1016/j.ygyno.2020.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Timely surgery has been shown to impact outcome in endometrial cancer patients. Social determinants of health (SDH) are associated with adverse cancer outcomes. We sought to evaluate the association of SDH with surgical treatment indicators in endometrial cancer patients in a public healthcare system. METHODS Endometrial cancer patients in Ontario, Canada, diagnosed between 2009 and 2017 were identified, and clinical, social and demographic variables were extracted from administrative databases. Validated community marginalization scores that include material deprivation, residential instability and ethnic concentration were used for stratification. Surgical treatment features were compared across marginalization quintiles using chi-square, Fischer exact or Wilcoxon rank sum tests as appropriate. Predictors of timely surgical treatment were evaluated with logistic regression. RESULTS 20228 patients were identified of whom 14,423 had primary hysterectomy for a preoperative diagnosis of endometrial cancer. Fewer patients in marginalized communities received surgery (89% vs. 93%, p < 0.001). Surgical delay was longer among marginalized patients and 78% had surgery within 12 weeks compared to 84% of those least marginalized (p < 0.0001). Other quality indicators of surgical treatment were not negatively associated with marginalization. On multivariable analysis adjusted for patient and disease factors, marginalization was independently associated with increased odds of delayed surgery (OR = 0.94/quintile, CI 0.91-0.97, p < 0.001). CONCLUSIONS Social marginalization is associated with decreased likelihood of having surgery and with delayed surgery among endometrial cancer patients in Ontario. This may be mediated by delayed presentation and real or perceived barriers to access. Reducing surgical wait times among marginalized cancer patients is an important deliverable in public healthcare.
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Affiliation(s)
- Limor Helpman
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Gregory R Pond
- Escarpment Cancer Research Institute, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Lorraine Elit
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada; Escarpment Cancer Research Institute, McMaster University, Hamilton, ON, Canada; Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Kreuter MW, Garg R, Li L, McNulty L, Thompson T, McQueen A, Luke AA. How Do Social Needs Cluster Among Low-Income Individuals? Popul Health Manag 2020; 24:322-332. [PMID: 32877298 DOI: 10.1089/pop.2020.0107] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Social needs screening in health care settings reveals that many low-income individuals have multiple unmet social needs at the same time. Having multiple simultaneous social needs greatly increases the odds of experiencing adverse health outcomes. To better understand how and which social needs cluster in these cases, the authors examined data from 14,749 low-income adults who completed a social needs assessment in one of 4 separate studies conducted between 2008 and 2019 in the United States. Participants were Medicaid beneficiaries, helpline callers, and daily smokers. Findings were strikingly consistent across the 4 studies. Participants with ≥2 social needs (n = 5621; 38% of total) experienced more stress, depressive symptoms, sleep problems, and chronic diseases and were more likely to rate their health as fair or poor. Social needs reflecting financial strain were highly correlated, such as needing help paying utility bills and needing money for necessities such as food, shelter, and clothing (r = .49 to .71 across studies). Participants experienced 351 distinct combinations of ≥2 social needs. The 10 most common combinations accounted for more than half of all participants with ≥2 needs. Clusters of social needs varied by subgroups. Women with children were more likely than others to need more space in their home and help paying utility bills; low-income men were more likely to be physically threatened and need a place to stay; older, sicker adults were more likely to need money for necessities and unexpected expenses, as well as transportation. Findings are discussed in the context of creating smarter, more efficient social needs interventions.
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Affiliation(s)
- Matthew W Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Linda Li
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Laura McNulty
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.,Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alina A Luke
- Cardiovascular Division, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Bryant A, Walsh-Felz A, Jacklitz J, Lindberg S. The Impact of a Community Resource Navigator Program on Patient Trust. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2020; 119:190-193. [PMID: 33091287 PMCID: PMC9125772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Addressing patients' nonmedical needs has become a focal point in primary care research and practice. Programs such as the Center for Patient Partnerships' Community Resource Navigator Program address social determinants of health by connecting participants to community-based resources in an effort to ameliorate unmet social needs. METHODS Twenty-six interviews were conducted with program participants to assess improvements in social needs and trust with the health care system as a result of the program. RESULTS Program participants reported increased trust in their provider or health system, improved health, and confidence in self-advocacy. DISCUSSION Findings suggest that in addition to providing crucial support to address participants' unmet social needs, navigation programs have the added benefit of enhancing their relationship with the clinic and health system.
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Affiliation(s)
- Alex Bryant
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
| | - Aria Walsh-Felz
- University of Wisconsin Population Health Institute, Madison, Wisconsin
| | | | - Sara Lindberg
- University of Wisconsin Population Health Institute, Madison, Wisconsin
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Febbraro M, Conlon M, Caswell J, Laferriere N. Access to cancer care in northwestern Ontario-a population-based study using administrative data. ACTA ACUST UNITED AC 2020; 27:e271-e275. [PMID: 32669933 DOI: 10.3747/co.27.5717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Despite universal access to health care in Canada, there are disparities relating to social determinants of health that contribute to discrepancies between rural and urban areas in cancer incidence and outcomes. Given that Canada has one of the highest-quality national population-based cancer registry systems in the world and that little information is available about cancer statistics specific to northwestern Ontario, the purpose of the present study was to estimate the percentage of cancer patients without documentation of a specialist consultation (medical or radiation oncology consultation) and to determine factors that affect access to specialist consultation in northwestern Ontario. Methods This population-based retrospective study used administrative data obtained through the Ontario Cancer Data Linkage Project. For each index case, a timeline was constructed of all Ontario Health Insurance Plan billing codes and associated service dates, starting with the primary cancer diagnosis and ending with death. Specific factors affecting access to specialist consultation were assessed. Results Within the 6-year study period (2010-2016), 2583 index cases were identified. Most (n = 2007, 78%) received a specialist consultation. Factors associated with not receiving a specialist consultation included older age [p < 0.0001; odds ratio (or): 0.29; 95% confidence interval (ci): 0.19 to 0.44] and rural residence (p < 0.0001; or: 0.48; 95% ci: 0.48 to 0.72). Factors associated with receiving a specialist consultation included a longer timeline (p < 0.0001; or: 1.32; 95% ci: 1.19 to 1.46), a diagnosis of breast cancer (p < 0.0001; or: 2.51; 95% ci: 1.43 to 4.42), and a diagnosis of lung cancer (p < 0.0001; or: 1.77; 95% ci: 1.38 to 2.26). Conclusions This study is the first to look at care access in northwestern Ontario. The complexity and multidisciplinary nature of cancer care makes the provision of appropriate care a challenge; a one-size-fits-all disease prevention and treatment strategy might not be appropriate.
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Affiliation(s)
- M Febbraro
- Northern Ontario School of Medicine, McMaster University, Thunder Bay, ON
| | - M Conlon
- Institute for Clinical Evaluative Sciences North, and Epidemiology, Outcomes and Evaluation Research, Health Sciences North Research Institute, Northeast Cancer Centre, Sudbury, ON
| | - J Caswell
- Institute for Clinical Evaluative Sciences North, and Epidemiology, Outcomes and Evaluation Research, Health Sciences North Research Institute, Northeast Cancer Centre, Sudbury, ON
| | - N Laferriere
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON
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Padalko A, Gawaziuk J, Chateau D, Sareen J, Logsetty S. Social Determinants Associated with Pediatric Burn Injury: A Population-Based, Case-Control Study. J Burn Care Res 2020; 41:743-750. [PMID: 32352522 DOI: 10.1093/jbcr/iraa045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Social determinants of health (SDoH) influence risk of injury. We conducted a population-based, case-control study to identify which social determinants influence burn injury in children. Children (≤16 years of age) admitted to a Canadian regional burn center between January 1, 1999 and March 30, 2017 were matched based on age, sex, and geographic location 1:5 with an uninjured control cohort from the general population. Population-level administrative data describing the SDoH at the Manitoba Center for Health Policy (MCHP) were compared between the cohorts. Specific SDoH were chosen based on a published systematic review conducted by the research team. In the final multivariable model, children from a low-income household odds ratio (OR) (95% confidence interval) 1.97 (1.46, 2.65), in care 1.57 (1.11, 2.21), from a family that received income assistance 1.71 (1.33, 2.19) and born to a teen mother 1.43 (1.13, 1.81) were significantly associated with an increased risk of pediatric burn injury. This study identified SDoH that are associated with an increased risk of burn injury. This case-control study supports the finding that children from a low-income household, children in care, from a family that received income assistance, and children born to a teen mother are at an elevated risk of burn injury. Identifying children at increased potential risk allows targeting of burn risk reduction and home safety programs.
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Affiliation(s)
- Adam Padalko
- BSc Med Research Program, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Justin Gawaziuk
- Manitoba Firefighters' Burn Unit, Health Sciences Centre, Winnipeg, Canada; From the
| | - Dan Chateau
- Manitoba Centre for Health Policy, Winnipeg, Canada.,Department of Community Health Sciences, Winnipeg, Canada
| | - Jitender Sareen
- Department of Community Health Sciences, Winnipeg, Canada.,Department of Psychiatry, Winnipeg, Canada
| | - Sarvesh Logsetty
- Department of Psychiatry, Winnipeg, Canada.,Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Helpman L, Pond GR, Elit L, Anderson LN, Seow H. Endometrial cancer presentation is associated with social determinants of health in a public healthcare system: A population-based cohort study. Gynecol Oncol 2020; 158:130-136. [DOI: 10.1016/j.ygyno.2020.04.693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/15/2020] [Indexed: 12/30/2022]
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Social Risks Among Primary Care Patients in a Large Urban Health System. Am J Prev Med 2020; 58:514-525. [PMID: 32199514 PMCID: PMC7362999 DOI: 10.1016/j.amepre.2019.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Health systems are increasingly interested in addressing the social determinants of health via social risk screening. The objective of this study is to understand the variability in the number and types of social risks overall and in population subgroups among primary care patients routinely screened in a large urban health system. METHODS Between April and December 2018, a total of 24,633 primary care patients completed a 10-item screener across 19 ambulatory sites within a health system in the Bronx, NY. The prevalence of any social risk and specific social risks was estimated overall and for population subgroups. Wald tests were used to determine statistically significant differences by subgroup. Data were analyzed in winter/spring 2019. RESULTS Twenty percent of patients presented with at least 1 social risk. The most frequently reported risks included housing quality (6.5%) and food insecurity (6.1%). Middle-aged (30-59 years) respondents (24.7%, 95% CI=23.6%, 25.7%) compared with those aged 18-29 years (17.7%, 95% CI=16.4%, 19.2%, p<0.001), and Medicaid patients (24.8%, 95% CI=24.0%, 25.5%) compared with commercially insured patients (11.8%, 95% CI=11.1%, 12.5%, p<0.001), were more likely to report social risks. The strongest predictor of housing quality risk was residing in public housing (15.1%, 95% CI=13.8%, 16.6%) compared with those not in public housing (5.6%, 95% CI=5.3%, 5.9%, p<0.001). Housing quality was the most frequently reported risk for children (aged <18 years) and older adults (aged ≥70 years), whereas, for middle-aged respondents (30-69 years), it was food insecurity. CONCLUSIONS There are important differences in the prevalence of overall and individual social risks by subgroup. These findings should be considered to inform clinical care and social risk screening and interventions.
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Oldfield BJ, Casey M, DeCew A, Morales SI, Olson DP. Screening for Social Determinants of Health Among Children: Patients' Preferences for Receiving Information to Meet Social Needs and a Comparison of Screening Instruments. Popul Health Manag 2020; 24:141-148. [PMID: 32096695 DOI: 10.1089/pop.2019.0211] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To characterize optimal strategies for screening for social determinants of health (SDOH) among children, the authors performed a cross-sectional study of parents and adolescents ages ≥13 years in a community health center. Participants were queried about how they prefer to receive information about social needs resources and 2 screening instruments were compared: Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education (WE CARE) and Accountable Health Communities (AHC). In July 2019, 154 parents and 21 adolescents were surveyed. Surveys were administered via tablet and required 5.6 minutes (standard deviation [SD] 3.9 minutes) for parents and 3.9 minutes (SD 1.4 minutes) for adolescents to complete. Parents identified technology (text message, email) and informational printouts as preferred mechanisms for information receipt (58% and 32% of participants, respectively); adolescents preferred text message (57%) and printouts (19%). Few (<10% overall) preferred in-person consultation with a care coordinator. Adolescent/parent pairs (n = 19 pairs) agreed, on average across SDOH, 82% of the time for WE CARE and 85% for AHC. AHC elicited more positive screens than WE CARE for housing insecurity (12% of parents versus 7%) and food insecurity (47% versus 16%) but fewer positive screens than WE CARE for difficulties paying for utilities (27% versus 39%). Routine screening for SDOH in children requires 2-3 minutes per screening instrument. Screening can target parents of young children and either adolescents themselves or their parents. Families prefer to receive information about meeting social needs via technologically-based methods as opposed to in-person consultation with enabling services providers.
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Affiliation(s)
- Benjamin J Oldfield
- Fair Haven Community Health Care, New Haven, Connecticut, USA.,National Clinician Scholars Program, and Yale School of Medicine, New Haven, Connecticut, USA.,Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | - Meghan Casey
- Fair Haven Community Health Care, New Haven, Connecticut, USA.,Yale School of Nursing, Orange, Connecticut, USA.,Yale School of Public Health, New Haven, Connecticut, USA
| | - Amanda DeCew
- Fair Haven Community Health Care, New Haven, Connecticut, USA
| | - Sofia I Morales
- Fair Haven Community Health Care, New Haven, Connecticut, USA
| | - Douglas P Olson
- Fair Haven Community Health Care, New Haven, Connecticut, USA
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Affiliation(s)
- Karina W Davidson
- Northwell Health, Long Island, New York
- Donald and Barbara Zucker School of Medicine at Hofstra University, Long Island, New York
| | - Thomas McGinn
- Northwell Health, Long Island, New York
- Donald and Barbara Zucker School of Medicine at Hofstra University, Long Island, New York
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Murakami Y, Kanazu S, Petigara T, Oba MS, Nishiwaki Y, Watanabe A. Factors associated with PPSV23 coverage among older adults in Japan: a nationwide community-based survey. BMJ Open 2019; 9:e030197. [PMID: 31315877 PMCID: PMC6661882 DOI: 10.1136/bmjopen-2019-030197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The 23-valent pneumococcal polysaccharide vaccine (PPSV23) was included in Japan's national immunisation programme for older adults in 2014. While vaccination coverage has increased following the implementation of the national immunisation programme, little is known about the factors that have influenced changes in PPSV23 uptake in Japan. This study aimed to investigate the effects of municipality-level activities implemented to improve vaccine uptake during the fiscal year 2015 (April 2015-March 2016). DESIGN Community-based national survey. A postal and web-based nationwide survey was sent to all municipalities in Japan in June 2016 (n=1741). The survey included questions regarding PPSV23 coverage, out-of-pocket costs by individuals for vaccination and community-level activities implemented to improve and promote PPSV23 uptake. Municipality-level and prefecture-level variables (eg, unemployment rates, average per capita income) retrieved from published sources were also incorporated to explore the impact of social determinants on vaccine uptake. SETTING Japan. PARTICIPANTS Municipal vaccination officers. PRIMARY AND SECONDARY OUTCOME MEASURES The primary study outcome was PPSV23 coverage among adults aged 65 years in Japanese municipalities. RESULTS A total of 1010 municipalities (58.0%) responded to the survey. The median PPSV23 coverage among responding municipalities was 41.8%. Vaccine coverage increased by 18.7% (16.7%-20.7%)%) in municipalities that sent a direct mail notification to the target population of adults compared with municipalities that did not send any notification. Vaccine coverage decreased by 3.02% (2.4%-3.6%)%) for every 1000 JPY increase in out-of-pocket costs. Municipality-level unemployment rates and average per capita income were negatively associated with PPSV23 coverage. CONCLUSIONS This nationwide survey provides insight into factors that may influence PPSV23 coverage in Japanese municipalities. Reduced out-of-pocket costs and direct mail notifications to the target population were associated with higher PPSV23 coverage in Japanese municipalities.
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Affiliation(s)
| | | | | | - Mari Saito Oba
- Department of Medical Statistics, Toho University, Ota-ku, Tokyo, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Medicine, Toho University, Ota-ku, Tokyo, Japan
| | - Akira Watanabe
- Research Division for Development of Anti-Infective Agents, Tohoku Bunka Gakuen University, Miyagi, Japan
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Hatef E, Predmore Z, Lasser EC, Kharrazi H, Nelson K, Curtis I, Fihn S, Weiner JP. Integrating social and behavioral determinants of health into patient care and population health at Veterans Health Administration: a conceptual framework and an assessment of available individual and population level data sources and evidence-based measurements. AIMS Public Health 2019; 6:209-224. [PMID: 31637271 PMCID: PMC6779595 DOI: 10.3934/publichealth.2019.3.209] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/24/2019] [Indexed: 12/28/2022] Open
Abstract
The premise of this project was that social and behavioral determinants of health (SBDH) affect the use of healthcare services and outcomes for patients in an integrated healthcare system such as the Veterans Health Administration (VHA), and thus individual patient level socio-behavioral factors in addition to the neighborhood characteristics and geographically linked factors could add information beyond medical factors mostly considered in clinical decision making, patient care, and population health. To help VHA better address SBDH risk factors for the veterans it cares for within its primary care clinics, we proposed a conceptual and analytic framework, a set of evidence-based measures, and their data source. The framework and recommended SBDH metrics can provide a road map for other primary care-centric healthcare organizations wishing to use health analytic tools to better understand how SBDH affect health outcomes.
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Affiliation(s)
- Elham Hatef
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zachary Predmore
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elyse C. Lasser
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karin Nelson
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Idamay Curtis
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Stephan Fihn
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan P. Weiner
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Fostering Quality Improvement Capacity in a Network of Primary Care Practices Affiliated With a Pediatric Accountable Care Organization. Pediatr Qual Saf 2019; 4:e175. [PMID: 31579874 PMCID: PMC6594781 DOI: 10.1097/pq9.0000000000000175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/12/2019] [Indexed: 12/13/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: Quality improvement (QI) methodologies are not widely implemented in primary care practices. As an accountable care organization serving pediatric Medicaid recipients in Ohio, Partners For Kids (PFK) sought to build QI capacity in affiliated primary care practices to improve organizational performance on key quality measures. Methods: A team of QI specialists developed a comprehensive training program focused on pediatric QI initiatives. From 2014 to 2017, community-based, primary care practices affiliated with PFK were recruited to participate in QI. The primary outcome, assessed yearly, was the proportion of eligible PFK patients accessing care at a practice with ≥1 active QI project. The proportion of QI projects that demonstrated moderate improvement, defined as the implementation of ≥1 intervention and observed improvement in process measures, within 12 months of initiation was also calculated for 2017. Results: Over the study period, the PFK QI team supported 72 projects in 33 primary care practices throughout central and southeast Ohio. In 2017, 26 practices were engaged in ≥1 active QI project, reaching 26% of all eligible PFK patients. Of the 21 projects active as of January 2017, 11 (52%) showed moderate improvement within 12 months. Conclusions: The PFK QI team successfully supported QI capacity building in primary care practices throughout Ohio using a systematic approach to recruitment, training, and QI resource support. New, multilevel interventions are needed to promote the uptake of preventive services among patients.
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Haire-Joshu D, Hill-Briggs F. The Next Generation of Diabetes Translation: A Path to Health Equity. Annu Rev Public Health 2019; 40:391-410. [PMID: 30601723 DOI: 10.1146/annurev-publhealth-040218-044158] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Disparities in diabetes burden exist in large part because of the social determinants of health (SDOH). Translation research and practice addressing health equity in diabetes have generally focused on changing individual behavior or providing supportive approaches to compensate for, rather than directly target, SDOH. The purpose of this article is to propose a pathway for addressing SDOH as root causes of diabetes disparities and as an essential target for the next generation of interventions needed to achieve health equity in diabetes prevention and treatment. This review describes ( a) the current burden of diabetes disparities, ( b) the influence of SDOH on diabetes disparities, ( c) gaps in and implications of current translation research, and ( d) approaches to achieving health equity in the next generation of diabetes translation.
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Affiliation(s)
- Debra Haire-Joshu
- Public Health and Medicine, Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
| | - Felicia Hill-Briggs
- Departments of Medicine; Health, Behavior and Society; and Acute and Chronic Care; and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;
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