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Beniwal-Patel P, Waclawik G, Browning K, Urmat A, Schell TL, Smith R, Huerta A, Hipp L, Dave S, Shah N, Dillon KE, Reiter-Schreurs K, Russ RK, Mailig MA, Osman F, Farraye FA, Weiss J, Hayney MS, Caldera F. Racial, Ethnic, and Geographic Disparities in Immunization Rates Among Patients With Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2023; 5:otad078. [PMID: 38130948 PMCID: PMC10734681 DOI: 10.1093/crocol/otad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Indexed: 12/23/2023] Open
Abstract
Background and Aims Racial and ethnic disparities exist in the treatment of IBD. These disparities exist in adult vaccine uptake among the general population and may extend to patients with IBD. The primary aim of this study was to determine whether racial, ethnic, or geographic disparities existed in influenza vaccine uptake among patients with IBD. Methods We performed a multicenter, retrospective cohort study evaluating adult vaccine uptake among patients with IBD seen at two tertiary referral centers between September 2019 and February 2020. The primary outcome was to determine if racial/ethnic and geographic disparities existed in influenza vaccine uptake for the two prior seasons. Our secondary outcomes were to determine if disparities existed for pneumococcal, zoster, or hepatitis B vaccines. Results Among the 2453 patients who met the inclusion criteria, most identified as non-Hispanic White (89.9%), were on immunosuppressive therapy (74.5%), and received the influenza vaccine in both seasons (56.0%). Older age (prevalence ratio (PR) 0.98; 95% confidence interval (95%CI) 0.98-0.99; P < .001) and non-Hispanic White patients (PR 0.76, 95%CI 0.59-0.98, P < 0.03) were significantly more likely to be immunized. Black patients (PR 1.37; 95%CI 1.18-1.59; P < .001) and those living in underserved geographic areas (PR 1.35; 95%CI 1.17-1.56; P < 0.001) were less likely to be immunized. Racial/ethnic and geographic disparities were identified for pneumococcal, zoster, and hepatitis B vaccine uptake. Conclusions Racial and ethnic vaccination uptake disparities exist among patients with IBD; patients from medically underserved areas are also vulnerable to these disparities Studies identifying patient, provider, and system-level opportunities to address these disparities are needed.
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Affiliation(s)
- Poonam Beniwal-Patel
- Medical College of Wisconsin, Division of Gastroenterology and Hepatology, Milwaukee, WI, USA
| | - Gabrielle Waclawik
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Keely Browning
- Medical College of Wisconsin, Division of Gastroenterology and Hepatology, Milwaukee, WI, USA
| | - Aijan Urmat
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Trevor L Schell
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Ryan Smith
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Antonio Huerta
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Lauren Hipp
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sonya Dave
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Neemit Shah
- Depatrment of Medicine, Medical College of Wisconsin School of Medicine, Milwaukee, WI, USA
| | - Kayla E Dillon
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Rachel K Russ
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Miguel A Mailig
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Francis A Farraye
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Jennifer Weiss
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Mary S Hayney
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Freddy Caldera
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
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Tarpey RJ. Assessing Primary Care Clinic Operational Strategies via EMR Data Mining. J Ambul Care Manage 2023; 46:251-261. [PMID: 36847647 DOI: 10.1097/jac.0000000000000465] [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: 03/01/2023]
Abstract
Understanding how operational strategies impact critical performance metrics is critical to the clinic's ability to provide a value-based service to patients. This study investigated the utility of electronic medical record (EMR) audit file data in assessing operational strategies. EMR data were used to assess patient appointment lengths and conclude that shorter scheduled patient visit lengths, which resulted from one operational strategy (physician choice of visit lengths), had a negative impact on a second operational strategy (minimizing patient wait times). Patients with 15-minute appointments had a higher total mean wait time and shorter provider care or contact time.
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Affiliation(s)
- Richard J Tarpey
- Department of Management, Middle Tennessee State University, Murfreesboro
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Morris GL. Neighborhood Condition Prevalence Rates Correlate With COVID-19 Mortality in Milwaukee County, Wisconsin. J Patient Cent Res Rev 2023; 10:38-44. [PMID: 36713999 PMCID: PMC9851392 DOI: 10.17294/2330-0698.1967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose We sought to determine if census tract-level (ie, neighborhood) COVID-19 death rates in Milwaukee County correlated with the census tract-level condition prevalence rates (CPRs) for individual COVID-19 mortality risk. Methods This study used Milwaukee County-reported COVID-19 death rates per 100,000 lives for the 296 census tracts within the county to perform a linear regression with individual COVID-19 mortality risk CPR, mean age, racial composition of census tract (by percentage of non-White residents), and poverty (by percentage within census tract), followed by multiple regression with all 7 CPRs as well as the 7 CPRs combined with the additional demographic variables. CPR estimates were accessed from the Centers for Disease Control and Prevention 500 Cities Project. Demographics were accessed from the U.S. Census. The Milwaukee County Medical Examiner's office identified 898 deaths from COVID-19 in Milwaukee County from March 2020 to June 2021. Results Among the variables included, crude death rate demonstrated a statistically significant association with the 7 COVID-19 mortality risk CPRs (as analyzed collectively), census tract mean age, and several of the CPRs individually. The addition of census tract age, race, and poverty in multiple regression did not improve the association of the 7 CPRs with crude death rate. Conclusions Results from this population-level study indicated that census tracts with high COVID-19 mortality correlated with high-risk condition prevalence estimates within those census tracts, illustrating how health data collection and analysis at a census tract level could be helpful when planning pandemic-mitigating public health efforts.
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Affiliation(s)
- George L Morris
- Ascension Columbia St. Mary's Hospital, Milwaukee, WI; Imperial College of London, London, United Kingdom
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Lock LJ, Channa R, Brennan MB, Cao Y, Liu Y. Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening. BMJ Open Diabetes Res Care 2022; 10:10/6/e003174. [PMID: 36517109 PMCID: PMC9756146 DOI: 10.1136/bmjdrc-2022-003174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Rural versus urban disparities have been observed in diabetic eye screening, but whether the level of disadvantage in rural versus urban areas is related to these disparities is unclear. Our goal was to determine the role of level of disadvantage in explaining the effect of health systems on rural and urban disparities in diabetic eye screening. RESEARCH DESIGN AND METHODS This is a retrospective cohort study using an all-payer, state-wide claims database covering over 75% of Wisconsin residents. We included adults with diabetes (18-75 years old) who had claims billed throughout the baseline (2012-2013) and measurement (2013-2014) years. We performed multivariable regressions to assess factors associated with receipt of diabetic eye screening. The primary exposure was the primary care clinic's combined level of rurality and disadvantage. We adjusted for the health system as well as patient-level variables related to demographics and comorbidities. Health system was defined as an associated group of physicians and/or clinics. RESULTS A total of 118 707 adults with diabetes from 698 primary care clinics in 143 health systems met the inclusion criteria. Patients from urban underserved clinics were less likely to receive screening than those from rural underserved clinics before adjusting for health system in the model. After adjusting for health system fixed effects, however, the directionality of the relationship between clinic rurality and screening reversed: patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics. Similar findings were observed for both Medicare and non-Medicare subgroups. CONCLUSIONS The effect of health system on receipt of diabetic eye screening in rural versus urban areas is most pronounced in underserved areas. Health systems, particularly those providing care to urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions to support patients in overcoming barriers from social determinants of health.
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Affiliation(s)
- Loren J Lock
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Meghan B Brennan
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ying Cao
- Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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