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Adams A, Heinert S, Sanchez L, Karasz A, Ramos ME, Sarkar S, Rapkin B, In H. A qualitative analysis of patients' experiences with an emergency department diagnosis of gastrointestinal cancer. Acad Emerg Med 2023; 30:1201-1209. [PMID: 37641573 DOI: 10.1111/acem.14797] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Optimally, cancer is diagnosed through periodic screening or detection of early symptoms in primary care settings. However, an estimated 23%-52% of gastrointestinal (GI) cancers are diagnosed in the emergency department (ED). Cancer diagnosed in the ED has been associated with worse clinical and patient-reported outcomes even after adjustment for cancer stage. We sought to explore patients' accounts of patient and health care system factors related to their diagnosis in the ED and their lived experience of receiving a diagnosis in this setting. METHODS Patients with an ED visit during or within 30 days of their GI cancer diagnosis at an urban academic hospital serving a largely disadvantaged population were recruited. Interviews were coded in NVivo 12 and analyzed using a thematic analysis approach. RESULTS Patient-reported factors associated with their experiences included denial and avoidance of symptoms, mistrust of the health system, and lack of cancer screening knowledge. Health care system factors included misdiagnosis and delayed access to specialty care or tests. Experiences receiving a cancer diagnosis in the ED were overwhelmingly negative. CONCLUSIONS This study highlights the unmet needs in identifying and diagnosing patients who ultimately present to the ED for evaluation and eventual diagnosis of cancer. Our results shed light on several modifiable factors, including the need for increased public awareness of the asymptomatic nature of cancer and the importance of cancer screening. Additionally, health care systems modifications beyond the ED are needed to improve access to timely care when symptoms arise.
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Affiliation(s)
- Alexandra Adams
- Division of Surgical Oncology, Rutgers Cancer Institute, New Brunswick, New Jersey, USA
| | - Sara Heinert
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Lauren Sanchez
- Albert Einstein College of Medicine, New York, New York, USA
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Alison Karasz
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Maria Elena Ramos
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Srawani Sarkar
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Bruce Rapkin
- Albert Einstein College of Medicine, New York, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | - Haejin In
- Division of Surgical Oncology, Rutgers Cancer Institute, New Brunswick, New Jersey, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
- Department of Health, Behavior and Policy, Rutgers University, Piscataway, New Jersey, USA
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2
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Harford S, Darabi H, Heinert S, Weber J, Campbell T, Kotini-Shah P, Markul E, Tataris K, Vanden Hoek T, Del Rios M. Utilizing community level factors to improve prediction of out of hospital cardiac arrest outcome using machine learning. Resuscitation 2022; 178:78-84. [PMID: 35817268 PMCID: PMC9728593 DOI: 10.1016/j.resuscitation.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/04/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To evaluate the impact of community level information on the predictability of out-of-hospital cardiac arrest (OHCA) survival. METHODS We used the Cardiac Arrest Registry to Enhance Survival (CARES) to geocode 9,595 Chicago incidents from 2014 to 2019 into community areas. Community variables including crime, healthcare, and economic factors from public data were merged with CARES. The merged data were used to develop ML models for OHCA survival. Models were evaluated using Area Under the Receiver Operating Characteristic curve (AUROC) and features were analyzed using SHapley Additive exPansion (SHAP) values. RESULTS Baseline results using CARES data achieved an AUROC of 84%. The final model utilizing community variables increased the AUROC to 88%. A SHAP analysis between high and low performing community area clusters showed the high performing cluster is positively impacted by good health related features and good community safety features positively impact the low performing cluster. CONCLUSION Utilizing community variables helps predict neurologic outcomes with better performance than only CARES data. Future studies will use this model to perform simulations to identify interventions to improve OHCA survival.
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Affiliation(s)
- Sam Harford
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Houshang Darabi
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Sara Heinert
- Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Joseph Weber
- Department of Emergency Medicine, John H. Stroger, Jr. Hospital, Chicago, IL, United States
| | - Teri Campbell
- Department of Emergency Medicine, University of Chicago, Chicago, IL, United States
| | - Pavitra Kotini-Shah
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Eddie Markul
- Department of Emergency Medicine, Illinois Masonic Medical Center, Chicago, IL, United States
| | - Katie Tataris
- Department of Emergency Medicine, University of Chicago, Chicago, IL, United States
| | - Terry Vanden Hoek
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Marina Del Rios
- Department of Emergency Medicine, University of Iowa, Iowa City, IA, United States.
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Heinert S, McCoy J, Ohman Strickland P, Riggs R, Eisenstein R. More Accessible COVID-19 Treatment Through Monoclonal Antibody Infusion in the Emergency Department. West J Emerg Med 2022; 23:618-622. [PMID: 36205670 PMCID: PMC9541995 DOI: 10.5811/westjem.2022.5.55234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/28/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Monoclonal antibody (MAB) infusion is the first treatment to manage coronavirus 2019 (COVID-19) in an outpatient setting. Yet increased risk of severe COVID-19 illness may occur from inequities in social determinants of health including access to quality healthcare. Given the safety-net nature of emergency departments (ED), a model that puts them at the center of MAB infusion may better reach underserved patients than models that require physician referral and distribute MAB at outpatient infusion centers. We examined characteristics of two groups of patients who received MAB infusion in the Robert Wood Johnson University Hospital (RWJUH) ED in New Brunswick, New Jersey: 1) patients who tested positive for COVID-19 in the ED and received ED infusion; and 2) patients who tested positive elsewhere and were referred to the ED for infusion. The process for the latter group was similar to the more common national model of patients testing COVID-19 positive in the community and then being referred to an infusion center for MAB therapy. Methods We performed a cross-sectional retrospective health record review of all adult patients presenting to the ED from November 20, 2020–March 15, 2021 who received MAB infusion at RWJUH ED (N = 486). Patients were identified through the electronic health record system by an administrative query, with manual chart review for any additional characteristics not available through the query. We compared the two groups using chi-squared tests for categorical variables and t-tests for continuous variables. Results We found higher proportions of Black (18% vs 6% P < 0.001, statistically significant), Hispanic (19% vs 11% P = 0.02), Medicaid (12% vs 9% P = 0.01), and uninsured (17% vs 8% P = 0.01) patients who tested positive for COVID-19 in their ED visit and then received MAB therapy during their visit than patients tested elsewhere in the community and referred to the ED for MAB therapy. Conclusion These findings suggest that providing MAB infusion in the ED allows increased access for patients traditionally marginalized from the healthcare system, who may be at risk of longer disease duration and complications from COVID-19.
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Affiliation(s)
- Sara Heinert
- Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey
| | - Jonathan McCoy
- Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey
| | - Pamela Ohman Strickland
- Rutgers School of Public Health, Department of Biostatistics and Epidemiology, Piscataway, New Jersey
| | - Renee Riggs
- Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey
| | - Robert Eisenstein
- Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, New Jersey
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Harford S, Del Rios M, Heinert S, Weber J, Markul E, Tataris K, Campbell T, Vanden Hoek T, Darabi H. A machine learning approach for modeling decisions in the out of hospital cardiac arrest care workflow. BMC Med Inform Decis Mak 2022; 22:21. [PMID: 35078470 PMCID: PMC8787933 DOI: 10.1186/s12911-021-01730-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/08/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A growing body of research has shown that machine learning (ML) can be a useful tool to predict how different variable combinations affect out-of-hospital cardiac arrest (OHCA) survival outcomes. However, there remain significant research gaps on the utilization of ML models for decision-making and their impact on survival outcomes. The purpose of this study was to develop ML models that effectively predict hospital's practice to perform coronary angiography (CA) in adult patients after OHCA and subsequent neurologic outcomes. METHODS We utilized all (N = 2398) patients treated by the Chicago Fire Department Emergency Medical Services included in the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2018 who survived to hospital admission to develop, test, and analyze ML models for decisions after return of spontaneous circulation (ROSC) and patient survival. ML classification models, including the Embedded Fully Convolutional Network (EFCN) model, were compared based on their ability to predict post-ROSC decisions and survival. RESULTS The EFCN classification model achieved the best results across tested ML algorithms. The area under the receiver operating characteristic curve (AUROC) for CA and Survival were 0.908 and 0.896 respectively. Through cohort analyses, our model predicts that 18.3% (CI 16.4-20.2) of patients should receive a CA that did not originally, and 30.1% (CI 28.5-31.7) of these would experience improved survival outcomes. CONCLUSION ML modeling effectively predicted hospital decisions and neurologic outcomes. ML modeling may serve as a quality improvement tool to inform system level OHCA policies and treatment protocols.
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Affiliation(s)
- Samuel Harford
- grid.185648.60000 0001 2175 0319Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, IL USA
| | - Marina Del Rios
- Department of Emergency Medicine, University of Iowa - Carver College of Medicine, Iowa City, IA, USA.
| | - Sara Heinert
- grid.430387.b0000 0004 1936 8796Department of Emergency Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | - Joseph Weber
- grid.413120.50000 0004 0459 2250Department of Emergency Medicine, John H. Stroger, Jr. Hospital, Chicago, IL USA
| | - Eddie Markul
- grid.413330.60000 0004 0435 6194Illinois Masonic Medical Center, Chicago, IL USA
| | - Katie Tataris
- grid.170205.10000 0004 1936 7822Department of Emergency Medicine, University of Chicago, Chicago, IL USA
| | - Teri Campbell
- grid.185648.60000 0001 2175 0319Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL USA
| | - Terry Vanden Hoek
- grid.185648.60000 0001 2175 0319Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL USA
| | - Houshang Darabi
- grid.185648.60000 0001 2175 0319Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, IL USA
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Esposito A, Patti L, Laumbach S, Polvino D, Butler L, Heinert S. 92 The Impact of the COVID-19 Pandemic on Medical Student Residency Specialty Selection. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.07.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prendergast H, Del Rios M, Durazo‐Arvizu R, Escobar‐Schulz S, Heinert S, Jackson M, Gimbar RP, Daviglus M, Lara B, Khosla S. Effect of an emergency department education and empowerment intervention on uncontrolled hypertension in a predominately minority population: The AHEAD2 randomized clinical pilot trial. J Am Coll Emerg Physicians Open 2021; 2:e12386. [PMID: 33718921 PMCID: PMC7926004 DOI: 10.1002/emp2.12386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/08/2021] [Accepted: 01/22/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine whether an emergency department (ED) education and empowerment intervention coupled with early risk assessment can help improve blood pressure (BP) in a high-risk population. METHODS A hypertension emergency department intervention aimed at decreasing disparities (AHEAD2) is a 3-arm, single-site randomized pilot trial for feasibility in an urban academic ED. A total of 150 predominantly ethnic minorities with no primary care provider and severely elevated blood pressure (BP) (≥160/100 mm Hg) were enrolled over 10 months. Participants were randomized into 1 of 3 study arms: (1) enhanced usual care (EUC), (2) ED-initiated screening, brief intervention, and referral for treatment (ED-SBIRT), or (3) ED- SBIRT plus a 48-72 hours post-acute care hypertension transition clinic (ED-SBIRT+PACHT-c). Primary outcomes were change in systolic and diastolic BP (SBP and DBP) from baseline to 9 months. Secondary outcomes were BP control (BP <140/90 mm Hg), changes in hypertension knowledge, medication adherence, and limited bedside echocardiogram (LBE) findings. RESULTS SBP reduction from baseline to month 9 was -26.8 (95% confidence interval [CI]: -32.8, -20.7) mm Hg for ED-SBIRT, -23.4 (95% CI: -29.5, -17.3) mm Hg for ED-SBIRT+PACHT-c, and -18.9 (95% CI: -24.9, -12.9) mm Hg for EUC. DBP decreased by -12.5 (95% CI: -16.1, -9.0) mm Hg for ED-SBIRT, -11.3 (95% CI: -14.8, -7.7) mm Hg for ED-SBIRT+PACHT-c, and -8.4 (95% CI: -11.9, -4.9) mm Hg for EUC. A multicomponent intervention compared with EUC resulted in SBP decrease of -7.9 mm Hg (95% CI: -16.4, 0.6). At 9 months, hypertension was controlled for 29.3% (95% CI: 20.3, 38.3) of intervention and 23.5% (95% CI: 11.9, 35.2) of EUC participants. All groups saw improvements in hypertension knowledge, medication adherence, and LBEs, with greater improvements in intervention groups. CONCLUSIONS The study findings suggest that a multicomponent intervention comprising of ED education and empowerment coupled with early risk assessment may help improve BP in a high-risk population.
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Affiliation(s)
- Heather Prendergast
- Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Marina Del Rios
- Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | | | | | - Sara Heinert
- Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Maya Jackson
- Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | | | - Martha Daviglus
- Institute for Minority Health ResearchUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Brenda Lara
- Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Shaveta Khosla
- Department of Emergency MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
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7
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Heinert S, Escobar-Schulz S, Jackson M, Del Rios M, Kim S, Kahkejian J, Prendergast H. Barriers and Facilitators to Hypertension Control Following Participation in a Church-Based Hypertension Intervention Study. Am J Health Promot 2019; 34:52-58. [PMID: 31409096 DOI: 10.1177/0890117119868384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Hypertension is the primary risk factor for development of cardiovascular complications. Community-initiated interventions have proven effective in reducing cardiovascular disease risk among individuals who might otherwise face barriers to care. The purposes of this study were to gain feedback on a church-based hypertension intervention study and assess barriers and facilitators to hypertension control after participation in the study. DESIGN Qualitative study of 4 focus groups. SETTING Focus groups took place at 4 churches in primarily minority neighborhoods of Chicago, Illinois, in summer 2017. PARTICIPANTS Thirty-one community members participated in the focus groups. METHOD The Community Targeting of Uncontrolled Hypertension (CTOUCH) study was a church-based screening, brief intervention, and referral for treatment program for hypertension. Following the study completion, participants were invited to join a focus group to provide feedback on the study and discuss barriers and facilitators to hypertension control. The authors used the Framework Method to analyze the data. RESULTS Community Targeting of Uncontrolled Hypertension was well received by participants, particularly the awareness of their individual blood pressure and subsequent education on risk modification. The most common facilitators for hypertension control were social support, knowing how to control hypertension, and community resources. The most common barriers to hypertension control were lack of hypertension knowledge, negative primary care experiences, and lack of disease awareness. CONCLUSION Knowledge of barriers and facilitators can inform areas of success and opportunities for improvement in community-based hypertension programs including future renditions in CTOUCH.
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Affiliation(s)
- Sara Heinert
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sandra Escobar-Schulz
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Maya Jackson
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Marina Del Rios
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sarah Kim
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Jennica Kahkejian
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Heather Prendergast
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Heinert S, Kowalski S, Quasim N, Suarez N, Hoek TV. Empowering Chicago's Youths as the Next Generation of Health Advocates. Am J Public Health 2019; 109:1025-1027. [PMID: 31095408 DOI: 10.2105/ajph.2019.305055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The CHAMPIONS NETWork summer program trains high school students to become health advocates in underserved Chicago, Illinois, communities. It provides a more innovative approach to traditional pipeline programs through the added responsibility of active health promotion. To determine whether student empowerment changed during the program, participants completed pre- and postassessments on health knowledge and self-efficacy. We found significant increases in student empowerment after the program compared with before, especially regarding the students' abilities and experiences.
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Affiliation(s)
- Sara Heinert
- Sara Heinert, Selina Kowalski, Nasseef Quasim, Natalia Suarez, and Terry Vanden Hoek are with the Department of Emergency Medicine, University of Illinois at Chicago
| | - Selina Kowalski
- Sara Heinert, Selina Kowalski, Nasseef Quasim, Natalia Suarez, and Terry Vanden Hoek are with the Department of Emergency Medicine, University of Illinois at Chicago
| | - Nasseef Quasim
- Sara Heinert, Selina Kowalski, Nasseef Quasim, Natalia Suarez, and Terry Vanden Hoek are with the Department of Emergency Medicine, University of Illinois at Chicago
| | - Natalia Suarez
- Sara Heinert, Selina Kowalski, Nasseef Quasim, Natalia Suarez, and Terry Vanden Hoek are with the Department of Emergency Medicine, University of Illinois at Chicago
| | - Terry Vanden Hoek
- Sara Heinert, Selina Kowalski, Nasseef Quasim, Natalia Suarez, and Terry Vanden Hoek are with the Department of Emergency Medicine, University of Illinois at Chicago
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9
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Heinert S, Del Rios M, Arya A, Amirsoltani R, Quasim N, Gehm L, Suarez N, Vanden Hoek T. The CHAMPIONS NETWork: Training Chicago High School Students as Health Advocates to Improve Health Equity. Health Promot Pract 2018; 20:57-66. [PMID: 29400084 DOI: 10.1177/1524839918757755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Chicago, major disparities exist across ethnic groups, income levels, and education levels for common chronic conditions and access to care. Concurrently, many of Chicago's youth are unemployed, and the number of minorities pursuing health professions is low. In an effort to eliminate this health equity gap, the University of Illinois at Chicago convened a community-university-hospital partnership to implement the CHAMPIONS NETWork (Community Health And eMPowerment through Integration Of Neighborhood-specific Strategies using a Novel Education & Technology-leveraged Workforce). This innovative workforce training program is a "High School to Career Training Academy" to empower underserved youth to improve population health in their communities, expose them to careers in the health sciences, and provide resources for them to become community and school advocates for healthy lifestyles. This program differs from other traditional pipeline programs because it gives its students a paid experience, extends beyond the summer, and broadens the focus to population health with patient contact. The CHAMPIONS NETWork creates a new type of health workforce that is both sustainable and replicable throughout the United States.
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Affiliation(s)
- Sara Heinert
- 1 University of Illinois at Chicago, Chicago, IL, USA
| | | | - Arjun Arya
- 1 University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Lisa Gehm
- 1 University of Illinois at Chicago, Chicago, IL, USA
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Prendergast HM, Del Rios M, Petzel-Gimbar R, Garside D, Heinert S, Escobar-Schulz S, Kotini-Shah P, Brown M, Chen J, Colla J, Fitzgibbon M, Durazo-Arvizu RA, Daviglus M. A hypertension emergency department intervention aimed at decreasing disparities: Design of a randomized clinical trial. Contemp Clin Trials 2017; 64:1-7. [PMID: 29128648 DOI: 10.1016/j.cct.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/02/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
Effective interventions to identify and treat uncontrolled hypertension (HTN), particularly in underrepresented populations that use the emergency department (ED) for primary care, are critically needed. Uncontrolled HTN contributes significantly to cardiovascular morbidity and mortality and is more frequently encountered among patients presenting to the ED as compared to the primary care setting. EDs serve as the point of entry into the health care system for high-risk patient populations, including minority and low-income patients. Previous studies have demonstrated that the prevalence of uncontrolled/undiagnosed HTN in patients presenting to the ED is alarmingly high. Thus ED engagement and early risk assessment/stratification is a feasible innovation to help close health disparity gaps in HTN. A Hypertension Emergency Department Intervention Aimed at Decreasing Disparities (AHEAD2) trial, funded by the National Heart, Lung, and Blood Institute (NHLBI) is a three-arm single site randomized clinical pilot trial of adults presenting to the ED with Stage 2 hypertension (blood pressure [BP]>160/100) comparing (1) an ED-initiated Screening, Brief Intervention, and Referral for Treatment (SBIRT) focused on HTN, (2) the same ED-initiated SBIRT coupled with a Post-Acute Care Hypertension Transition Consultation by ED Clinical Pharmacists, and (3) usual care. The primary outcome is mean BP differences between study arms. Secondary outcomes are proportion of participants with BP control (BP<140/90mmHg), and improvements in HTN knowledge and medication adherence scores between study arms. The objective of this report is to describe the development of the AHEAD2 trial, including the methods, research infrastructure, and other features of the randomized clinical trial design.
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Affiliation(s)
| | - Marina Del Rios
- Department of Emergency Medicine, University of Illinois, Chicago, IL, USA.
| | - Renee Petzel-Gimbar
- Department of Emergency Medicine, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Daniel Garside
- Institute for Minority Health Research, University of Illinois, Chicago, IL, USA
| | - Sara Heinert
- Department of Emergency Medicine, University of Illinois, Chicago, IL, USA
| | | | | | - Michael Brown
- Department of Kinesiology and Nutrition, University of Illinois, Chicago, IL, USA
| | - Jinsong Chen
- Institute for Minority Health Research, University of Illinois, Chicago, IL, USA
| | - Joseph Colla
- Department of Emergency Medicine, University of Illinois, Chicago, IL, USA
| | - Marian Fitzgibbon
- Institute for Health Policy Research, University of Illinois, Chicago, IL, USA
| | | | - Martha Daviglus
- Institute for Minority Health Research, University of Illinois, Chicago, IL, USA
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11
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Lin J, Baghikar S, Mauntel-Medici C, Heinert S, Patel D. Patient and System Factors Related to Missed Opportunities for Screening in an Electronic Medical Record-driven, Opt-out HIV Screening Program in the Emergency Department. Acad Emerg Med 2017; 24:1358-1368. [PMID: 28833779 DOI: 10.1111/acem.13277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/09/2017] [Accepted: 08/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Emergency departments (EDs) have implemented HIV screening using a variety of strategies. This study investigates how specific patient and health system factors in the ED impact who is and is not screened in a combined targeted and nontargeted, electronic medical record (EMR)-driven, opt-out, HIV screening program. METHODS This was a retrospective, cross-sectional study of ED visits where patients were determined eligible for HIV screening by an EMR algorithm between November 18, 2014, and July 15, 2015. The HIV screening workflow included three sequential events, all of which were required to get screened for HIV at the ED visit. The events were having a blood draw, being informed of the HIV screening policy by an ED nurse at the point of blood draw, and the patient consenting to the HIV test. Each event represented a dichotomous outcome and its association with six patient factors (age, sex, race/ethnicity, marital status, preferred language, and Emergency Severity Index [ESI]) and two health system factors (ED crowding and program phase) was investigated using multivariable modeling. RESULTS A total of 15,918 ED visits were analyzed. Blood was drawn in 8,388 of 15,918 visits (53%). Of 8,388 visits where blood was drawn, there were 5,947 (71%) visits where ED nurses documented informing patients of the HIV screening policy. Of those visits, patient consent to the HIV test was documented at 3,815 (64%) visits. Patients between 13 and 19 years of age were significantly less likely to have blood drawn, to be informed of the screening policy, and to consent to the HIV test compared to other age groups. Both ED crowding and a patient's ESI were associated with decreased odds of having a blood draw and being informed of HIV screening by an ED nurse, but showed no association with patients consenting to the HIV test. CONCLUSION Many patients, particularly adolescents and young adults, are missed in ED HIV screening programs that require blood draw and depend on providers to obtain consent for testing. To ensure that these patients are reached, future ED screening programs should strive to develop innovative workflows that allow for blood draws for HIV screening only and streamline the processes of obtaining informed consent and ordering tests for all eligible patients.
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Affiliation(s)
- Janet Lin
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
| | - Sara Baghikar
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
| | - Cammeo Mauntel-Medici
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
| | - Sara Heinert
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
| | - Daven Patel
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
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Heinert S, Carter J, Mauntel-Medici C, Lin J. Assessment of Nurse Perspectives on an Emergency Department-Based Routine Opt-Out HIV Screening Program. J Assoc Nurses AIDS Care 2016; 28:316-326. [PMID: 28087204 DOI: 10.1016/j.jana.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/07/2016] [Indexed: 11/15/2022]
Abstract
Routine opt-out HIV screening is recommended for everyone between 13 and 64 years of age. An urban, academic emergency department implemented a nurse-driven routine opt-out HIV screening program. The aim of our study was to assess program uptake and opportunities to improve the program from the perspectives of emergency nurses. Emergency nurses completed a brief prediscussion questionnaire and then participated in a focus group or semi-structured one-on-one interview to elicit feedback on the routine opt-out HIV screening program. All 16 participants felt adequately prepared for the screening program. Several themes emerged from the discussions, including challenges of specific patient characteristics and overall nurse and patient support for the program. One thread across themes was the importance of good language and communication skills in such programs. While there are opportunities to improve nurse-driven routine opt-out HIV testing programs in emergency settings, this program was found to be accepted by emergency nurses.
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Purakal J, Hughes-Strange G, Heinert S, Prendergast H, Colla J, Del Rios Rivera M. Elevated Blood Pressure in the Emergency Department: How Well Do Emergency Physicians Treat, Inform and Refer Their Hypertensive Patients Based on Chief Complaint? J Am Soc Hypertens 2016; 10 Suppl 1:e9. [PMID: 27677149 DOI: 10.1016/j.jash.2016.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- J Purakal
- Emergency Medicine, University of Illinois at Chicago, Chicago, IL
| | - G Hughes-Strange
- Emergency Medicine, University of Illinois at Chicago, Chicago, IL
| | - S Heinert
- Emergency Medicine, University of Illinois at Chicago, Chicago, IL
| | - H Prendergast
- Emergency Medicine, University of Illinois at Chicago, Chicago, IL
| | - J Colla
- Emergency Medicine, University of Illinois at Chicago, Chicago, IL
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Hughes G, Velez J, Heinert S, Brown S, Purakal J, Del Rios M. 367 Treatment and Referral of Markedly Elevated Blood Pressure in an Urban Emergency Department: How Well Do Emergency Physicians Adhere to American College of Emergency Physicians Clinical Guidelines? Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Jee SH, Couderc JP, Swanson D, Gallegos A, Hilliard C, Blumkin A, Cunningham K, Heinert S. A pilot randomized trial teaching mindfulness-based stress reduction to traumatized youth in foster care. Complement Ther Clin Pract 2015; 21:201-9. [DOI: 10.1016/j.ctcp.2015.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/28/2022]
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16
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Del Rios M, Aldeen A, Campbell T, Demertsidis E, Heinert S, Sinchi J, Hoek TV. Save-a-life at the ballpark: 10-min spectator training achieves proficiency in cardiac arrest response. Resuscitation 2015; 87:21-5. [DOI: 10.1016/j.resuscitation.2014.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 10/19/2014] [Accepted: 10/28/2014] [Indexed: 11/27/2022]
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17
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Chae SR, Biskup T, Heinert S, Lin J. Building community trust through quality assurance of malaria diagnosis
and management at a rural clinic in Uganda. Ann Glob Health 2014. [DOI: 10.1016/j.aogh.2014.08.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Iadarola S, Hetherington S, Clinton C, Dean M, Reisinger E, Huynh L, Locke J, Conn K, Heinert S, Kataoka S, Harwood R, Smith T, Mandell DS, Kasari C. Services for children with autism spectrum disorder in three, large urban school districts: Perspectives of parents and educators. Autism 2014; 19:694-703. [PMID: 25192859 DOI: 10.1177/1362361314548078] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study used qualitative methods to evaluate the perceptions of parents, educators, and school administrators in three large, urban school districts (Los Angeles, Philadelphia, and Rochester) regarding services for children with autism spectrum disorder within the context of limited district resources. Facilitators followed a standard discussion guide that contained open-ended questions regarding participants' views on strengths and limitations of existing services and contextual factors that would facilitate or inhibit the process of introducing new interventions. Three primary themes were identified: (1) tension between participant groups (teachers and paraprofessionals, staff and administration, teachers and parents, special education and general education teachers), (2) necessity of autism spectrum disorder-specific and behavioral training for school personnel, and (3) desire for a school culture of accepting difference. These themes highlight the importance of developing trainings that are feasible to deliver on a large scale, that focus on practical interventions, and that enhance communication and relationships of school personnel with one another and with families.
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Affiliation(s)
| | | | | | | | | | - Linh Huynh
- University of California, Los Angeles, USA
| | - Jill Locke
- University of Pennsylvania, Pennsylvania, USA
| | - Kelly Conn
- University of Rochester Medical Center, New York, USA
| | - Sara Heinert
- University of Rochester Medical Center, New York, USA
| | | | - Robin Harwood
- Health Resources & Services Administration, Maternal and Child Health Bureau, Maryland, USA
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