Advancing health equity by addressing social determinants of health: Using health data to improve educational outcomes

Health Information Exchange Implications for School Nursing: An Integrative Review

School nurses coordinate care for school-age children with various chronic diseases but rarely are included in access to electronic health records or health information exchanges. This integrative review aimed to obtain evidence-based information on health information exchange (HIE) and health information exchange organizations (HIOs) in the United States and the implications for school nurses. The review found no instances in the published literature of school nurses' access to an HIE through a regional or non-vendor-based HIO. Information from the review was mapped to the four National Association of School Nursing School Nurse Practice FrameworkTM principles to provide knowledge on the importance of incorporating HIE in school-based healthcare. These results highlight a gap in identifying the school nurse as an essential use case for regional or national HIOs in care coordination for school-age children. School nurses can learn about HIE, advocate for their access to HIOs, and acknowledge their importance in the care coordination team.

Agenda setting for health equity assessment through the lenses of social determinants of health using machine learning approach: a framework and preliminary pilot study

INTRODUCTION

The integration of Artificial Intelligence (AI) and Machine Learning (ML) is transforming public health by enhancing the assessment and mitigation of health inequities. As the use of AI tools, especially ML techniques, rises, they play a pivotal role in informing policies that promote a more equitable society. This study aims to develop a framework utilizing ML to analyze health system data and set agendas for health equity interventions, focusing on social determinants of health (SDH).

METHOD

This study utilized the CRISP-ML(Q) model to introduce a platform for health equity assessment, facilitating its design and implementation in health systems. Initially, a conceptual model was developed through a comprehensive literature review and document analysis. A pilot implementation was conducted to test the feasibility and effectiveness of using ML algorithms in assessing health equity. Life expectancy was chosen as the health outcome for this pilot; data from 2000 to 2020 with 140 features was cleaned, transformed, and prepared for modeling. Multiple ML models were developed and evaluated using SPSS Modeler software version 18.0.

RESULTS

ML algorithms effectively identified key SDH influencing life expectancy. Among algorithms, the Linear Discriminant algorithm as classification model was selected as the best model due to its high accuracy in both testing and training phases, its strong performance in identifying key features, and its good generalizability to new data. Additionally, CHAID in numeric models was the best for predicting the actual value of life expectancy based on various features. These models highlighted the importance of features like current health expenditure, domestic general government health expenditure, and GDP in predicting life expectancy.

CONCLUSION

The findings underscore the significance of employing innovative methods like CRISP-ML(Q) and ML algorithms to enhance health equity. Integrating this platform into health systems can help countries better prioritize and address health inequities. The pilot implementation demonstrated these methods' practical applicability and effectiveness, aiding policymakers in making informed decisions to improve health equity.

Examination of Social Determinants of Health, District Health Needs, School Nurse Caseload, and Academic Outcomes in Washington State

The purpose of this study was to examine associations between caseload, social determinants, health needs, students meeting grade-level English and Math standards, and attendance. Data from the Washington State Open Data Portal and Report Card were combined with District Health Assessment data from 264 school districts. Analyses of variance and linear stepwise regression analyses were conducted. Key findings indicate significant differences in English and Math outcomes by caseloads, with higher caseload districts have lower percentages of students meeting English and Math standards, but not attendance. Caseload is a significant predictor of students meeting English and Math standards, after controlling for social determinants and district health needs. Findings point to the complexity of school nursing work and builds a foundation to guide future nursing research. Large prospective studies that allow for comprehensive measurement of structure, process and outcomes variables are needed to advance school nursing research.

Addressing Social Determinants of Health in Family Medicine Practices

Primary care practices are under pressure to address patients' social determinants of health (SDOH). However, the extent to which these practices have this ability remains unknown. The objective of this study was to examine the association between physician, practice, and community characteristics and the ability of family medicine practices to address patients' SDOH. This cross-sectional study used data from the American Board of Family Medicine Continuing Certification Questionnaire from 2017 to 2019, with a 100% response rate. Respondents rated their practice's ability to address SDOH, which was dichotomized as high or low. Sequential multivariate logistic regression determined the association of the reported ability to address SDOH with physician, practice, and community characteristics. Among 19,300 respondents, 55.6% reported a high ability to address patients' SDOH. Across models controlling for different groups of variables, characteristics persistently positively associated with ability to address SDOH included employment at a federally qualified health center (Odds Ratios [OR] = 2.111-3.012), federally funded clinic (OR = 1.999-2.897), managed care organization (OR = 2.038-2.303), and working collaboratively with a social worker (OR = 2.000-2.523) or care coordinator (OR = 1.482-1.681). Characteristics persistently negatively associated with the ability to address SDOH were practicing at an independently owned (OR = 0.726-0.812) or small practice (OR = 0.512-0.863). While results varied across models, these findings are important for developing evidence-based policies and recommendations for resource sharing and allocation in clinics and communities. Ensuring availability and access to allied health professionals and community resources may be key components in Family Medicine clinics addressing SDOH.

Exploring Wellness Through Concept Analysis

Modern wellness is a concept that has been discussed in the literature since the 1960's. To better understand wellness complexities in a school setting, a concept analysis was conducted using a modified version of Walker and Avant's method incorporating the nursing paradigm in the implications. A literature review was conducted and except for background information, the publication dates were limited to 2017-2022. Key search terms included "wellness," "school wellness," "wellness concept." Additional literature reviews were conducted based on data related to the definitions, attributes, antecedents, and consequences of wellness that were collected from the reviewed studies. Defining attributes of wellness included healthy habits, conscientiousness, and optimum state of health. The antecedents, consequences, and empirical referents of wellness were identified with examples from the literature and case exemplars. Wellness is a dynamic process that has unique implications for school health and school nurses. This concept analysis lays the foundation for future research incorporating nursing domains.

Exploring Trends in Social Vulnerability for Pharmacy Students at a Large Public University

OBJECTIVE

This study aimed to describe trends in social vulnerability (SV) among pharmacy students at a large public college of pharmacy, and to describe differences in SV by race and ethnicity using the Centers for Disease Control and Prevention Social Vulnerability Index (SVI).

METHODS

The SVI was determined for each student admitted between Fall 2017 and Fall 2022 using the submitted permanent address for each student in a deidentified fashion. International students and students not from the 50 US states were excluded from the analysis.

RESULTS

During the study period, 1427 pharmacy students met the study inclusion criteria and were included in the final analysis. Students from historically minoritized populations accounted for 53.4% (n = 763/1427) of students. The median SVI score for all students was 0.4091 (interquartile range [IQR]: 0.2091-0.6395), which is consistent with low/moderate SV risk. When considering SVI by race, students from historically minoritized populations had a higher median SVI (0.4807 [IQR: 0.2791-0.7071] vs 0.3562 [IQR: 0.1561-0.5523]), and were more likely to come from moderate/high SV regions compared with White students (odds ratio 2.00 [95% confidence interval: 1.609-2.486]).

CONCLUSION

Among pharmacy students at a large public university, a substantial proportion of students had moderate/high SV risk, particularly those from historically minoritized backgrounds. Colleges and schools of pharmacy need to consider the unique needs of students from high SV backgrounds and provide intentional equity-based mitigation strategies to maximize the potential for student success for all.

Application of the Toxic Stress Schema: An Exemplar for School Nurses

For many children of color, the cumulative impact of pre-existing stressors, disparities, and pandemic-related losses has contributed to a toxic level of stress. Toxic stress can disrupt healthy brain development making children vulnerable to physical and mental health problems. School nurses are the primary health professionals who interact with children daily during the academic year, which positions them to identify risk factors within the social determinants of health that contribute to the development of toxic stress. The Toxic Stress Schema (TSS) provides a framework for assessment and care planning related to social determinants of health and potential sources of stress and/or buffering support for the physical and mental well-being of children. A case study approach is used to demonstrate the application of the TSS to school nursing and provide the basis for conceptualizing a plan of care and identifying resources to support the child's physical and mental health.

A Clinical Preventive Strategy Based on a Digital Tool to Improve Access to Endocrine Disruptors Exposure Prevention: The MEDPREVED Study

Introduction: The digitalized PREVED (PREgnancy, PreVention, Endocrine Disruptor) questionnaire was used in the clinical practices of health professionals (HP) who adhered to the MEDPREVED strategy. The objectives were to assess the strategy and to determine if it could improve access to endocrine disruptor (ED) exposure prevention. Methods: After having filled in the digital questionnaire in HP waiting rooms, patients were invited to talk about ED exposure during the consultation. HPs were previously trained in ED and had received a prevention kit for their patients. After the seven-month implementation phase, the evaluation phase consisted of five mixed assessments: interviews with: (i) patients who were young children's parents; (ii) patients in the general population; (iii) paediatricians; (iv) midwives; and a quantitative study on GPs. Assessment concerned feasibility, accessibility, and usefulness of the strategy; we then used the Levesque model to evaluate how it could improve access to ED exposure prevention. Results: The study included 69 participants. The strategy appeared feasible for the filling-out step due to digital and environment access. However, it depended on patient and HP profiles. The strategy seemed useful insofar as it facilitated reflexive investment, an intention to healthy behaviour and, rather rarely, talk about ED exposure. The beginning of this discussion depended on time, prioritizing of the topic and HP profile. The strategy has confirmed the Levesque model's limiting factors and levers to access ED prevention. Conclusions: The MEDPREVED strategy is feasible, accessible, and useful in clinical prevention practice. Further study is needed to measure the impact on knowledge, risk perception and behavior of beneficiaries of the MEDPREVED strategy in the medium and long term.