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Lindly OJ, Wahl TA, Stotts NM, Shui AM. Adaptation of a health literacy screener for computerized, self-administered use by U.S. adults. PEC Innov 2024; 4:100262. [PMID: 38375351 PMCID: PMC10875223 DOI: 10.1016/j.pecinn.2024.100262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/19/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
Objective Health literacy is a critical health determinant, for which few computerized, self-administered assessments exist. This study adapted and tested the reliability of the Newest Vital Sign© (NVS) as a computerized, self-administered health literacy screener. Methods Phase one involved 33 participants to create response options for a computerized, self-administered NVS (C-NVS). Phase two was a randomized crossover trial to test the consistency of C-NVS and original, interviewer-administered NVS (I-NVS) scores in 89 participants. Results Linear mixed-effects regression model results showed a significant carryover effect (p < .001). Crossover trial data from time 1 showed that participants who initially received the C-NVS had significantly higher average scores (M = 5.7, SD = 0.6) than participants who received the I-NVS (M = 4.5, SD = 1.5; t(87) = 5.25, p < .001). Exploratory analysis results showed that when the washout period was longer than 33 days (75th percentile) the carryover effect was not statistically significant (p = .077). Conclusion and innovation Findings suggest learning can occur when health literacy screeners are administered more than once in less than a month's time and computerized, self-administered health literacy screeners may produce ceiling effects. A universal precautions approach to health literacy therefore remains germane.
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Affiliation(s)
| | - Taylor A. Wahl
- Department of Health Sciences, Northern Arizona University, USA
| | - Noa M. Stotts
- Department of Biological Sciences, Northern Arizona University, USA
| | - Amy M. Shui
- Massachusetts General Hospital Biostatistics Center, USA
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2
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Pedersen E, de Jong Carmen CM, Jurca M, Berger DO, Sanz J, Sluka S, Poms M, Baumgartner MR, Regamey N, Kuehni CE, Barben J, Rueegg CS. Cystic fibrosis newborn screening in Switzerland - evaluation and scenarios for improvement after 11 years of follow-up. J Cyst Fibros 2024:S1569-1993(24)00053-5. [PMID: 38658252 DOI: 10.1016/j.jcf.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/15/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Newborn bloodspot screening (NBS) for cystic fibrosis (CF) is important for early diagnosis and treatment. However, screening can lead to false-positive results leading to unnecessary follow-up tests and distress. This study evaluated the 11-year performance of the Swiss CF-NBS programme, estimated optimal cut-offs for immunoreactive trypsinogen (IRT), and examined how simulated algorithms would change performance. METHODS The Swiss CF-NBS is based on an IRT-DNA algorithm with a second IRT (IRT-2) as safety net. We analysed data from 2011 to 2021, covering 959,006 IRT-1 analyses and 282 children with CF. We studied performance based on European Cystic Fibrosis Society (ECFS) standards including sensitivity, specificity, positive predictive value (PPV), false negative rate, and second heel-prick tests; identified optimal IRT cut-offs using receiver operating characteristics (ROC) curves; and calculated performance for simulated algorithms with different cut-offs for IRT-1, IRT-2, and safety net. RESULTS The Swiss CF-NBS showed excellent sensitivity (96 %, 10 false negative cases) but moderate PPV (25 %). Optimal IRT-1 and IRT-2 cut-offs were identified at 2.7 (>99th percentile) and 5.9 (>99.8th percentile) z-scores, respectively. Analysis of simulated algorithms showed that removing the safety net from the current algorithm could increase PPV to 30 % and eliminate >200 second heel-prick tests per year, while keeping sensitivity at 95 %. CONCLUSION The Swiss CF-NBS program performed well over 11 years but did not achieve the ECFS standards for PPV (≥30 %). Modifying or removing the safety net could improve PPV and reduce unnecessary follow-up tests while maintaining the ECFS standards for sensitivity.
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Affiliation(s)
- Esl Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - C M de Jong Carmen
- Division of Paediatric Respiratory Medicine and Allergy, Department of Paediatrics, University Children's Hospital Bern, Bern, Switzerland
| | - M Jurca
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; The University Children's Hospital Basel, Basel, Switzerland
| | - D O Berger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - J Sanz
- Department of Human Genetics, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Shm Sluka
- Newborn Screening Switzerland, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M Poms
- Division of Metabolism and Swiss Newborn Screening, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - M R Baumgartner
- Division of Metabolism and Swiss Newborn Screening, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - N Regamey
- Division of Paediatric Pulmonology, Children's Hospital Lucerne, Lucerne, Switzerland
| | - C E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Division of Paediatric Respiratory Medicine and Allergy, Department of Paediatrics, University Children's Hospital Bern, Bern, Switzerland
| | - J Barben
- Paediatric Pulmonology & CF Centre, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
| | - C S Rueegg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
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Carson SL, Cameron F, Lee D, Zúñiga D, Poole K, Jones A, Herman C, Ramirez M, Harlow S, Johnson J, Agonafer EP, Hong CS, Brown AF. A collaboration team to build social service partnerships within a safety-net health system. BMC Public Health 2024; 24:654. [PMID: 38429651 PMCID: PMC10905940 DOI: 10.1186/s12889-024-18155-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/22/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND To facilitate safety-net healthcare system partnerships with community social service providers, the Los Angeles County Department of Health Services (LAC DHS) created a new collaboration team to spur cross-agency social and medical referral networks and engage communities affected by health disparities as part of a Sect. 1115 Medicaid waiver in Los Angeles County entitled Whole Person Care-Los Angeles (WPC-LA). METHODS This observational research reviews three years of collaboration team implementation (2018-2020) through Medicaid-reportable engagement reports, a collaboration team qualitative survey on challenges, facilitators, and recommendations for community engagement. Member reflections for survey findings were conducted with the collaboration team and LAC DHS WPC-LA leadership. RESULTS Collaboration team Medicaid engagement reports (n = 144) reported > 2,700 events, reaching > 70,000 individuals through cross-agency and community-partnered meetings. The collaboration team survey (n = 9) and member reflection sessions portrayed engagement processes through outreach, service assessments, and facilitation of service partnerships. The collaboration team facilitated community engagement processes through countywide workgroups on justice-system diversion and African American infant and maternal health. Recommendations for future safety net health system engagement processes included assessing health system readiness for community engagement and identifying strategies to build mutually beneficial social service partnerships. CONCLUSIONS A dedicated collaboration team allowed for bi-directional knowledge exchange between county services, populations with lived experience, and social services, identifying service gaps and recommendations. Engagement with communities affected by health disparities resulted in health system policy recommendations and changes.
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Affiliation(s)
- Savanna L Carson
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, 1100 Glendon Ave, Suite 1100, Los Angeles, CA, 90095, USA.
| | - Francesca Cameron
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, 1100 Glendon Ave, Suite 1100, Los Angeles, CA, 90095, USA
| | - Diamond Lee
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Diana Zúñiga
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
- Tres Lunas Consulting, 1509 Stanley Ave. #302, Long Beach, 90804, USA
| | - Kelli Poole
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Adjoa Jones
- Los Angeles County Department of Health Services, 313 N Figueroa St, Los Angeles, CA, 90012, USA
| | - Cristina Herman
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Mayra Ramirez
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Simone Harlow
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Jeannette Johnson
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Etsemaye P Agonafer
- Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Clemens S Hong
- Los Angeles County Department of Health Services, 711 Del Amo Blvd, Torrance, CA, 90502, USA
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, 1100 Glendon Ave, Suite 1100, Los Angeles, CA, 90095, USA
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Valadez MG, Torres M, de Virgilio C, Perez L, La Riva A, Rashidi S, Moazzez A, Archie M. Association of race and ethnicity with initial surgical hemodialysis access type in a safety net system. J Vasc Surg 2024:S0741-5214(24)00396-3. [PMID: 38387815 DOI: 10.1016/j.jvs.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/27/2023] [Revised: 01/10/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES Prior studies have found lower arteriovenous fistula (AVF) creation rates in Black and Hispanic patients. Whether this is due to health care disparities or other differences is unclear. Our objective was to evaluate the racial/ethnic differences in initial surgical access type within a high-volume, safety net system with predominantly Black and Hispanic populations. METHODS A retrospective review of initial hemodialysis (HD) access in consecutive cases between 2014 and 2019 was conducted from all five safety net hospitals in a health care system that primarily treats underserved patients. Patient data collected included race, ethnicity, sex, comorbidities, and initial arteriovenous (AV) access type (AV fistula [AVF] vs AV graft [AVG]). The rates of cephalic vein-based AVF (CAVF; radiocephalic, brachiocephalic) were compared with basilic and brachial vein AVF (BAVF), because the latter are performed as two stages. Bivariate and multivariate logistic regression models were adjusted for demographic and clinical variables to evaluate the relationship between race/ethnicity, surgical access type, and comorbid conditions. RESULTS We included 1334 patients (74% Hispanic, 9% Black, 7% Asian, 2% White, 8% other) who underwent first-time surgical HD access creation. The majority were male (818 [63%]). Medical comorbidities were equal among groups, except for chronic obstructive pulmonary disease and stroke, which were higher in Black patients (P < .005 and P = .005, respectively). Overall, 1303 patients (98%) underwent AVF creation and 31 AVG creation (2%), with no difference between race/ethnicity in AVF vs AVG creation. Of the AVF cohort, 991 (76%) had a CAVF and 312 (24%) had a BAVF. Males were more likely than females to get a CAVF (65% vs 35%; P = .002). CONCLUSIONS Within our safety net health system, where most patients are under-represented minorities, nearly all patients undergoing HD access had an AVF as their initial surgery with no difference in race/ethnicity. AVF type received differed by race, with Black patients twice as likely to undergo BAVF, which required two stages. Further studies are needed to identify the reasons for these differences.
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Affiliation(s)
- Maria G Valadez
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | | | - Christian de Virgilio
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; UCLA David Geffen School of Medicine, Los Angeles, CA; The Lundquist Institute, Torrance, CA
| | | | | | | | - Ashkan Moazzez
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Mark Archie
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; UCLA David Geffen School of Medicine, Los Angeles, CA; The Lundquist Institute, Torrance, CA.
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Rehman I, Pang E, Harris AC, Chang SD. Bi-parametric prostate MRI with a recall system for contrast enhanced imaging: Improving accessibility while maintaining quality. Eur J Radiol 2023; 169:111186. [PMID: 37989069 DOI: 10.1016/j.ejrad.2023.111186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To review the efficacy of a recall system for bi-parametric non-contrast prostate MRI (bp-MRI). METHODS A bi-parametric protocol was instituted in July 2020 for all patients who had a prostate MRI requested, excluding those after treatment of prostate cancer, patients with hip prosthesis or pacemaker, and those who lived out-of-town. The protocol consisted of tri-planar T2-weighted and diffusion weighted images (DWI) (b = 50, 800 s/mm2 for ADC map; b = 1,500 s/mm2 acquired separately) in accordance with the Prostate Imaging Reporting & Data system (PI-RADS) v2.1 guidelines. After interpretation of bp-MRI exams, patients with equivocal (PI-RADS 3) lesions in peripheral zone (PZ) or any technical limitations were recalled for contrast administration. RESULTS Out of 909 bp-MRI scans performed from July 2020 to April 2021, only 52 (5.7 %) were recalled, of which 46 (88.5 %) attended. Amongst these, 41/52 (78.8 %) were recalled for PZ PI-RADS 3 lesions, while the rest of 11 (21.2 %) cases were recalled for technical reasons. Mean time to subsequent recall scan was 11.6 days. On assessment of post-contrast imaging, 29/46 (63 %) cases were upgraded to PI-RADS 4 while 17/46 (37 %) remained PI-RADS 3. This system avoided contrast-agent use in 857 patients, with contrast cost savings of €64,620 (US$68,560) and 214 hours 15 minutes of scanner time was saved. This allowed 255 additional bp-MRI scans to be performed, reducing the waitlist from 1 year to 2-3 weeks. CONCLUSION A bi-parametric prostate MRI protocol with a robust recall system for contrast administration not only saved time eliminating the marked backlog but was also more cost efficient without compromising the quality of patient care.
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Affiliation(s)
- Iffat Rehman
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada.
| | - Emily Pang
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada
| | - Alison C Harris
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada
| | - Silvia D Chang
- Department of Radiology, Vancouver General Hospital, University of British Columbia, 899 West 12(th) Avenue Vancouver, BC V5Z 1M9, Canada
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Kleipool SC, van Rutte PWJ, Eeftinck Schattenkerk LD, Bonjer HJ, Marsman HA, de Castro SMM, van Veen RN. Evaluation of Postoperative Care Protocol for Roux-en-Y Gastric Bypass Patients with Same-Day Discharge. Obes Surg 2023; 33:2317-2323. [PMID: 37347399 DOI: 10.1007/s11695-023-06697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Same-day discharge (SDD) after bariatric surgery is increasingly being performed and is safe with careful patient selection. However, detecting early complications during the first postoperative days can be challenging. We developed a postoperative care protocol for these patients and aimed to evaluate its effectiveness in detecting complications and monitoring patient recovery. METHODS A single-center retrospective observational study was conducted with patients with who underwent Roux-en-Y Gastric Bypass (RYGB) with successful SDD. The study evaluated the effectiveness of the safety net that included simple remote monitoring with a pulsoximeter and thermometer, a phone consultation on postoperative day (POD) 1, and a physical consultation on POD 2-4. Furthermore, an analysis was performed on various factors including pain scores, painkiller usage, and incidences of nausea and vomiting on POD 1. RESULTS In this study, 373 consecutive patients were included, of whom 19 (5.1%) were readmitted until POD 4. Among these, 12 patients (3.2%) reached out to the hospital themselves, while 7 (1.9%) were readmitted after phone or physical consultations. Ten of the readmitted patients had tachycardia. On POD 1, the mean numeric rating scale was 4 ± 2, and 96.6% of the patients used acetaminophen, 35.5% used naproxen, and 9.7% used oxynorm. Of the patients, 13.9% experienced nausea and 6.7% reported vomiting. CONCLUSION A postoperative care protocol for SDD after RYGB, comprising simple remote monitoring along with a phone consultation on POD 1 and a physical checkup on POD 2-4, was effective in monitoring patient recovery and detecting all early complications.
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Affiliation(s)
| | | | | | - H Jaap Bonjer
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - Ruben N van Veen
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
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Cabeza Rivera FH, Concepcion BP, Levea SLL. Chronic Kidney Disease After Liver Transplantation. Adv Kidney Dis Health 2023; 30:368-377. [PMID: 37657883 DOI: 10.1053/j.akdh.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Chronic kidney disease among liver transplant recipients is common and associated with an increased mortality risk. Several risk factors and causes for the development of chronic kidney disease have been identified. They can be divided into perioperative factors, such as unresolved acute kidney injury; donor-related factors, such as the use of extended criteria liver allografts; and recipient-related factors, such as the use of calcineurin inhibitors and the presence of metabolic syndrome, diabetes, and obesity. There is a bimodal progression, more prominent during the initial post-transplant months, followed by a gradual but progressive decline over the subsequent years. Management strategies to prevent and treat chronic kidney disease in the general population can be reasonably applied to the liver transplant population and include addressing comorbidities such as hypertension and diabetes. Strategies to minimize or withdraw calcineurin inhibitors from the immunosuppressive regimen can slow progression of kidney dysfunction. Patients with advanced chronic kidney disease should be considered for kidney transplantation due to its survival advantage. Allocation policy in the United States confers safety-net allocation priority for liver transplant recipients who develop advanced chronic kidney disease within the first year of liver transplantation.
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Affiliation(s)
- Franco H Cabeza Rivera
- Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL
| | | | - Swee-Ling L Levea
- Division of Nephrology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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Bahlburg H, Tully K, Hoffmann V, Hanske J, von Landenberg N, Roghmann F, Palisaar RJ, Noldus J, Berg S, Brock M. Avoiding Prostate Biopsies in Patients at Low Risk for Prostate Cancer: A Prospective Evaluation of a PSA-Density-Based Safety Net. Urol Int 2023; 107:454-459. [PMID: 37062272 DOI: 10.1159/000529946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/22/2022] [Accepted: 02/22/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES Decision-making to perform prostate biopsy should include individual risk assessment. Patients classified as low risk by the Rotterdam Prostate Cancer Risk Calculator are advised to forego biopsy (PBx). There is concern about missing clinically significant prostate cancer (csPCa). A clear pathway for follow-up is needed. MATERIAL AND METHODS Data for 111 consecutive patients were collected. Patients were encouraged to adhere to a PSA-density-based safety net after PBx was omitted. Cut off values indicating a re-evaluation were PSA density >0.15 ng/mL/ccm in PBx-naïve patients and >0.2 ng/mL/ccm in men with past-PBx. Primary endpoint was whether men had their PSA taken regularly. Secondary endpoint was whether a new multiparametric MRI was performed when PSA-density increased. Tertiary endpoint was whether biopsy was performed when risk stratification revealed an increased risk. RESULTS Median follow-up was 12 months (IQR 9-15 months). The primary endpoint was reached by 97.2% (n = 106). The secondary endpoint was reached by 30% (n = 3). The tertiary endpoint was reached by 50% (n = 2). Histopathologic analyses revealed csPCa in none of these cases. Risk stratification did not change (p = 0.187) with the majority of patients (89.2%, n = 99). CONCLUSION The concern of missing csPCa when omitting PBx in the risk-stratified pathway may be negated. Changes in risk stratification during follow-up should lead to subsequent PBx. We suggest implementing a safety net based on PSA density and digital rectal examination (DRE).
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Affiliation(s)
- Henning Bahlburg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Karl Tully
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Vincent Hoffmann
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Julian Hanske
- Department of Urology, Stiftungsklinikum PROSELIS, Prosper-Hospital Recklinghausen, Recklinghausen, Germany
| | - Nicolas von Landenberg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Florian Roghmann
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Rein-Jüri Palisaar
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Joachim Noldus
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Sebastian Berg
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Marko Brock
- Department of Urology, Stiftungsklinikum PROSELIS, Prosper-Hospital Recklinghausen, Recklinghausen, Germany
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Young MEDT, Perez-Lua F, Sarnoff H, Plancarte V, Goldman-Mellor S, Payán DD. Working around safety net exclusions during the COVID-19 pandemic: A qualitative study of rural Latinx immigrants. Soc Sci Med 2022; 311:115352. [PMID: 36126474 PMCID: PMC9444313 DOI: 10.1016/j.socscimed.2022.115352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/03/2021] [Revised: 06/07/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
Rural Latinx immigrants experienced disproportionately negative health and economic impacts during the COVID-19 pandemic. They contended with the pandemic at the intersection of legal status exclusions from the safety net and long-standing barriers to health care in rural regions. Yet, little is known about how rural Latinx immigrants navigated such exclusions. In this qualitative study, we examined how legal status stratification in rural contexts influenced Latinx immigrant families' access to the safety net. We conducted interviews with first- and second-generation Latinx immigrants (n = 39) and service providers (n = 20) in four rural California communities between July 2020 and April 2021. We examined personal and organizational strategies used to obtain economic, health, and other forms of support. We found that Latinx families navigated a limited safety net with significant exclusions. In response, they enacted short-term strategies and practices - workarounds - that met immediate, short-term needs. Workarounds, however, were enacted through individual efforts, allowing little recourse beyond immediate personal agency. Some took the form of strategic practices within the safety net, such as leveraging resources that did not require legal status verification; in other cases, they took the form of families opting to avoid the safety net altogether.
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Affiliation(s)
- Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA.
| | - Fabiola Perez-Lua
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Hannah Sarnoff
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA
| | | | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Denise Diaz Payán
- Department of Health, Society and Behavior, Program in Public Health, University of California, Irvine, CA, 92697, USA
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Rees-Jones A, D'Attoma J, Piolatto A, Salvadori L. Experience of the COVID-19 pandemic and support for safety-net expansion. J Econ Behav Organ 2022; 200:1090-1104. [PMID: 35822063 PMCID: PMC9263690 DOI: 10.1016/j.jebo.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/31/2022] [Accepted: 07/03/2022] [Indexed: 06/15/2023]
Abstract
Did individuals' experiences with the harms of the COVID-19 pandemic influence their attitudes towards safety-net programs? To assess this question, we combine rich information about county-level impacts and individual-level perceptions of the early pandemic, repeated measurements of attitudes towards safety-net expansion, and pre-pandemic measurements of related political attitudes. Individuals facing higher county-level impact or greater perceived risks are more likely to support long-term expansions to unemployment insurance and government-provided healthcare when surveyed in June 2020. These differences persist across time, with experiences in the early months of the pandemic remaining strongly predictive of attitudes towards safety-net expansion in early 2021.
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Affiliation(s)
| | | | - Amedeo Piolatto
- Autonomous University of Barcelona (UAB), Barcelona School of Economics (BSE) and Barcelona Institute of Economics (IEB), Spain
| | - Luca Salvadori
- Autonomous University of Barcelona (UAB), Barcelona School of Economics (BSE), Tax Administration Research Center, TARC (University of Exeter) and Barcelona Institute of Economics (IEB), Spain
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Edwards GC, Wong SL, Russell MC, Winslow ER, Shaffer VO, Pawlik TM. Society for Surgery of the Alimentary Tract Health Care Quality and Outcomes Committee Webinar: Addressing Disparities. J Gastrointest Surg 2022; 26:997-1005. [PMID: 35318595 DOI: 10.1007/s11605-022-05300-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/09/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Gretchen C Edwards
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Maria C Russell
- Department of Surgery, Winship Cancer Institute at Emory University, Atlanta, GA, USA
| | - Emily R Winslow
- Department of Surgery, Medstar Georgetown Medical Center, Washington, DC, USA
| | - Virginia O Shaffer
- Department of Surgery, Winship Cancer Institute at Emory University, Atlanta, GA, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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Petrilli J, Strang L, Von Haunalter E, Costa J, Coughlin E, Mhaskar R. Factors Influencing Healthcare Utilization Among Patients at Three Free Clinics. J Community Health 2022; 47:604-609. [PMID: 35366126 DOI: 10.1007/s10900-022-01083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Despite improvements in healthcare for uninsured persons, health disparities remain. We surveyed patients at three free clinics in an urban Florida community to better understand the factors that influence where they seek healthcare. Survey questions were developed based on factors previously demonstrated to affect healthcare utilization. A focus group validated the instrument. Patients self-administered written surveys over a 6-week period at three free clinics, including a student-run free clinic (SRFC). Results were compiled and analyzed using Chi-square and Fisher-Freeman-Halton Exact tests, Kruskal-Wallis test, Mann-Whitney U test, and Spearman's rho, as appropriate. Odds ratios were calculated for significant findings (p < 0.05). Patients completed 323 surveys. Free clinic visit frequency was positively related to female gender, Hispanic ethnicity, higher income, and poorer health. Black race was related to less frequent visits. Visit frequency differed among the clinic sites. Patients attending a SRFC were more likely to utilize another clinic. Patient satisfaction was not related to visit frequency. Seeking care at other clinics was related to employment. Emergency room utilization was positively related to male gender. Patients listed proximity and ability to receive care not offered at the free clinic as the primary reasons for seeking care at another clinic. In this sample, free clinic utilization was related to demographic and community factors. Free clinics should consider these factors when designing their care delivery. SRFC's should further evaluate how they function in the safety net.
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Affiliation(s)
- J Petrilli
- Department of Family Medicine, University of South Florida Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL, 33612, USA.
| | - L Strang
- University of South Florida Morsani College of Medicine, Tampa, USA
| | - E Von Haunalter
- University of South Florida Morsani College of Medicine, Tampa, USA
| | - J Costa
- Department of Family Medicine, University of South Florida Morsani College of Medicine, 13330 USF Laurel Drive, Tampa, FL, 33612, USA
| | - E Coughlin
- Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, USA
| | - R Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
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Lewis VA, Spivack S, Murray GF, Rodriguez HP. FQHC Designation and Safety Net Patient Revenue Associated with Primary Care Practice Capabilities for Access and Quality. J Gen Intern Med 2021; 36:2922-2928. [PMID: 34346005 PMCID: PMC8481458 DOI: 10.1007/s11606-021-06746-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Concerns exist about the ability of safety net health care organizations to participate in US health care reform. Primary care practices are key to several efforts, but little is known about how capabilities of primary care practices serving a high share of disadvantaged patients compare to other practices. OBJECTIVE To assess capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients. DESIGN We analyzed data from the National Survey of Healthcare Organizations and Systems (response rate 46.8%), conducted 2017-2018. PARTICIPANTS A total of 2190 medical practices with at least three adult primary care physicians. MAIN MEASURES Our key exposures are payer mix and federally qualified health center (FQHC) designation. We classified practices as safety net if they reported a combined total of at least 25% of annual revenue from uninsured or Medicaid patients; we then further classified safety net practices into those that identified as an FQHC and those that did not. KEY RESULTS FQHCs were more likely than other safety net practices and non-safety net practices to offer early or late appointments (79%, 55%, 62%; p=0.001) and weekend appointments (56%, 39%, 42%; p=0.03). FQHCs more often provided medication-assisted treatment for opioid use disorders (43%, 27%, 25%; p=0.004) and behavioral health services (82%, 50%, 36%; p<0.001). FQHCs were more likely to screen patients for social and financial needs. However, FQHCs and other safety net providers had more limited electronic health record (EHR) capabilities (61%, 71%, 80%; p<0.001). CONCLUSION FQHCs were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities.
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Affiliation(s)
- Valerie A Lewis
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, USA.
| | - Steven Spivack
- Center for Outcomes and Evaluation, Yale School of Medicine, New Haven, USA
| | - Genevra F Murray
- Department of General Internal Medicine, Boston Medical Center, Boston, USA
| | - Hector P Rodriguez
- School of Public Health, University of California, Berkeley, Berkley, USA
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Crable EL, Drainoni ML, Jones DK, Walley AY, Milton Hicks J. Predicting longitudinal service use for individuals with substance use disorders: A latent profile analysis. J Subst Abuse Treat 2021; 132:108632. [PMID: 34607732 DOI: 10.1016/j.jsat.2021.108632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/19/2021] [Revised: 08/05/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Substance use disorders (SUD) are chronic conditions that often warrant coordinated medical care throughout a relapsing and remitting course. However, SUD treatment is frequently measured as a binary outcome, where individuals either receive or do not receive care following the immediate treatment seeking event. This study aimed to describe longitudinal treatment seeking behaviors by assessing service use patterns among individuals with diagnosed SUDs in a safety net hospital that offers a "no wrong door" care model. This study also examined whether certain patient subgroups were more likely to transition to service use patterns that support recovery or treatment disengagement over time. METHODS The team conducted a retrospective cohort study using electronic health record data from adult patients diagnosed with SUDs (n = 1157) who regularly accessed services at a safety net hospital over a five-year period. The study used latent class analysis (LCA) and latent profile analysis to empirically identify distinct treatment utilization profiles of individuals with SUDs. We used multinomial logistic regression to evaluate predictors of class membership and transitions over a five-year period. RESULTS The research team identified five distinct service use classes, including patients who disengaged from services (42.4%), or those who predominantly used outpatient substance use services (7.0%), mental health services (13.0%), primary care services (24.7%), or other specialty care services (13.1%). Being female and an older adult were statistically significant predictors for membership in any service use-driven status. Black patients had increased odds for "substance use service" and "primary care" service statuses over time. CONCLUSION LCA and latent transition analysis (LTA) methods are novel approaches for identifying profiles of patients with higher risk for health services disengagement. SUD treatment engagement strategies are needed to reach males, young adults, and individuals with non-opioid SUDs.
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Affiliation(s)
- Erika L Crable
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA; Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; ACTRI UC San Diego Dissemination and Implementation Science Center, La Jolla, CA, USA.
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - David K Jones
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Alexander Y Walley
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Hester T, Thomas R, Cederna J, Peterson AM, Brown J, Johnson TM, Cha KB. Increasing Access to Specialized Dermatology Care: A Retrospective Study Investigating Clinical Operation and Impact of a University-Affiliated Free Clinic. Dermatol Ther (Heidelb) 2020; 11:105-115. [PMID: 33175327 PMCID: PMC7858729 DOI: 10.1007/s13555-020-00462-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Our objective was to study the impact and clinical operation of an integrated model for free specialized dermatology care via collaboration between an academic institution and a nonprofit outpatient clinic through an analysis of patient demographics and care provided. Methods Hope@UMHS is a partnership between the University of Michigan Health System (UMHS) and Hope Clinic (HC) which provides free specialty consultations to uninsured residents of Southeast Michigan. A retrospective chart review was completed for patients referred to the UMHS Dermatology clinic as part of the HOPE@UMHS collaboration from April 2012 through February 2020. Results Of the 294 referred patients, 264 were managed in 30 clinic sessions over 8 years, staffed by 92 unique volunteers. Patients most commonly presented with atopic dermatitis (10.5%), seborrheic dermatitis (7.9%), and actinic keratosis (7.4%). The majority of patients (68.2%) were prescribed at least one new medication. Nine skin cancers, including one melanoma, were diagnosed and treated. There were 102 procedures performed. Eighty-seven percent of patients received conclusive evaluation and treatment at the time of their consultation. Conclusion Our experience illustrates that providing free, comprehensive dermatology care in a university hospital by partnering with a nonprofit clinic is both feasible and beneficial to the greater community.
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Affiliation(s)
- Thomas Hester
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Reinie Thomas
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Timothy M Johnson
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
- Ganger Dermatology, Ann Arbor, MI, USA
| | - Kelly B Cha
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA.
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Bhandarkar AR, Alvi MA, Naessens JM, Bydon M. Do safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome? Clin Neurol Neurosurg 2020; 200:106356. [PMID: 33203594 DOI: 10.1016/j.clineuro.2020.106356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Safety-net hospitals provide care to a substantial share of disadvantaged patient populations. Whether disparities exist between safety-net hospitals and their counterparts in performing emergent neurosurgical procedures has not yet been examined. OBJECTIVE We used the Nationwide Inpatient Sample (NIS), a national all-payer inpatient healthcare database, to determine whether safety-net hospitals provide equitable care after decompressive surgery for acute cauda equina syndrome (CES). METHODS The NIS from 2002 to 2011 was queried for patients with a diagnosis of acute CES who received decompressive surgery. Hospital safety-net burden was designated as low (LBH), medium (MBH), or high (HBH) based on the proportion of inpatient admissions that were billed as Medicaid, self-pay, or charity care. Etiologies of CES were classified as degenerative, neoplastic, trauma, and infectious. Significance was defined at p < 0.01. RESULTS A total of 5607 admissions were included in this analysis. HBHs were more likely than LBHs to treat patients who were Black, Hispanic, on Medicaid, or had a traumatic CES etiology (p < 0.001). After adjusting for patient, hospital, and clinical factors treatment at an HBH was not associated with greater inpatient adverse events (p = 0.611) or LOS (p = 0.082), but was associated with greater inflation-adjusted admission cost (p = 0.001). DISCUSSION Emergent decompressive surgery for CES performed at SNHs is associated with greater inpatient costs, but not greater inpatient adverse events or LOS. Differences in workflows at SNHs may be the drivers of these disparities in cost and warrant further investigation.
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Affiliation(s)
- Archis R Bhandarkar
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | | | - James M Naessens
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
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Dhanani NH, Olavarria OA, Millas S, Askenasy EP, Ko TC, Liang MK, Holihan JL. Is robotic surgery feasible at a safety net hospital? Surg Endosc 2021; 35:4452-8. [PMID: 32880747 DOI: 10.1007/s00464-020-07948-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Robotic surgery offers potential advantages of improved ability to complete procedures using a minimally invasive approach, recovery, and clinical outcomes. It has been previously established that safety net hospitals are outliers for surgical complications. As such, the adoption of new technology may not achieve the same outcomes as other institutions. We hypothesized that, compared to laparoscopic and open surgeries, robotic surgeries have fewer post-operative Clavien-Dindo complications at our safety net hospital. METHODS All robotic surgeries performed from 2017 to 2019 at a single, safety net hospital were reviewed. Cases were matched 1:3 to laparoscopic controls. Surgeries commonly performed open were additionally matched 1:3 to open counterparts. The primary outcome was Clavien-Dindo complications at 90 days post-operatively. Secondary outcomes included inadvertent enterotomy, conversion to open, operative duration, wound class, surgical site infection (SSI), surgical site occurrence (SSO), length of stay (LOS), reoperation, readmission, and recurrence. RESULTS A total of 160 robotic surgeries were included and matched to 480 laparoscopic surgeries and 108 open surgeries. Open surgeries were associated with greater risk of Clavien-Dindo complication (OR = 2.7, p = 0.040, 95% confidence interval 1.0-6.9) than either robotic or laparoscopic surgeries. Robotic cases had increased operative duration when compared to laparoscopic (p < 0.001) but not open cases (p = 0.093). No difference was seen in enterotomy, conversion to open, SSI, SSO, LOS, reoperation, readmission, or recurrence between robotic and laparoscopic, and robotic and open cases. CONCLUSION Robotic surgery is safe and feasible at a safety net hospital. Robotic and laparoscopic surgeries were associated with fewer Clavien-Dindo complications than open surgery, but no differences were seen between robotic and laparoscopic cases. Robotic surgery, compared to both laparoscopic and open surgery, had longer operative durations. Further studies are needed to assess the value of robotic as opposed to laparoscopic surgery in a safety net setting.
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Lebrun-Harris LA, Mendel Van Alstyne JA, Sripipatana A. Influenza vaccination among U.S. pediatric patients receiving care from federally funded health centers. Vaccine 2020; 38:6120-6126. [PMID: 32713680 PMCID: PMC7378489 DOI: 10.1016/j.vaccine.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION During the 2018-2019 influenza season, vaccination coverage among U.S. children was 62.6%. The purpose of this study was to estimate the prevalence of influenza vaccinations among pediatric patients seen in U.S. health centers, and to explore potential disparities in vaccination coverage among subpopulations. Funded by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services, these health centers provide primary and preventive care to underserved and vulnerable individuals and families in order to reduce health disparities based on economic, geographic, or cultural barriers. METHODS Cross-sectional data, analyzed in 2019, came from the most recent waves of the Health Center Patient Survey (2009, 2014). The sample consisted of children ages 2-17 years receiving care from HRSA-funded health centers. The outcome of interest was self- or parent-reported receipt of influenza vaccine in the past year. Multivariable logistic regression was used to estimate the adjusted prevalence rate ratios for the association between demographic characteristics (age, sex, race/ethnicity, poverty level, urban/rural residence, geographic region), health-related variables (receipt of well-child check-up, asthma diagnosis), and influenza vaccination. RESULTS Influenza vaccination coverage among pediatric health center patients increased from 46.6% in 2009 to 67.8% in 2014. In the adjusted model for 2014, there were few statistically significant differences in vaccination coverage among subpopulation groups, however American Indian/Alaska Native children had 31% increased vaccination coverage compared with non-Hispanic White children (aPRR: 1.31, 95% CI: 1.02-1.60) and children living in the South had 26% decreased vaccination coverage compared with those living in the Northeast (aPRR: 0.74, 95% CI: 0.54-0.93). CONCLUSIONS Influenza vaccination coverage among pediatric health center patients in 2014 exceeded the national average (as of 2018-2019), and few differences were found among at-risk subpopulations. HRSA-funded health centers are well-positioned to further increase the vaccination rate among children living in underserved communities.
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Affiliation(s)
- Lydie A Lebrun-Harris
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Office of Epidemiology and Research, Rockville MD, United States.
| | - Judith A Mendel Van Alstyne
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville MD, United States
| | - Alek Sripipatana
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville MD, United States
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Rosero EB, Modrall JG, Joshi GP. Failure to rescue after major abdominal surgery: The role of hospital safety net burden. Am J Surg 2020; 220:1023-30. [PMID: 32199603 DOI: 10.1016/j.amjsurg.2020.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/19/2020] [Accepted: 03/08/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND We aimed to examine whether safety-net burden is a significant predictor of failure-to-rescue (FTR) after major abdominal surgery controlling for patient and hospital characteristics, including surgical volume. METHODS Data were extracted from the 2007-2011 Nationwide Inpatient Sample. FTR was defined as mortality among patients experiencing major postoperative complications. Differences in rates of complications, mortality, and FTR across quartiles of safety-net burden were assessed with univariate analyses. Multilevel regression models were constructed to estimate the association between FTR and safety-net burden. RESULTS Among 238,645 patients, the incidence of perioperative complications, in-hospital mortality, and FTR were 33.7%, 4.4%, and 11.8%, respectively. All the outcomes significantly increased across the quartiles of safety-net burden. In the multilevel regression analyses, safety-net burden was a significant predictor of FTR after adjustment for patient and hospital characteristics, including hospital volume. CONCLUSION Increasing hospital safety-net burden is associated with higher odds of FTR for major abdominal surgery.
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Turner JS, Courtney RD, Sarmiento E, Ellender TJ. Frequency of safety net errors in the emergency department: Effect of patient handoffs. Am J Emerg Med 2020; 42:188-191. [PMID: 32151369 DOI: 10.1016/j.ajem.2020.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/10/2019] [Revised: 02/12/2020] [Accepted: 02/16/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine physician awareness of abnormal vital signs and key clinical interventions (oxygen provision, intravenous access) in the emergency department, and to measure the effect of patient handoffs on this awareness. METHODS This was a prospective observational study at two large, urban, academic emergency departments. Emergency department physicians were asked the following about each of the physician's patients: 1) the number of IV lines, 2) whether the patient was on supplemental oxygen, and 3) whether the patient had any abnormal vital signs. Physicians were blind to the nature of the study prior to enrollment. Error rates between physician responses and actual patient status were calculated, and logistic regression, adjusted for physician clustering, was used to calculate association of errors with multiple situational factors, including handoff status. RESULTS We analyzed 463 patient encounters from 74 physicians. Physicians missed abnormal vital signs in 19.4% of encounters. They made errors in oxygen status and number of IV lines in 16.6% and 35.8% of encounters, respectively. Physicians were significantly more likely to make all types of errors on patients who had undergone handoff as opposed to their primary patients. CONCLUSION Emergency physicians make frequent errors regarding awareness of their patients' vital signs, oxygen and vascular status and patient handoffs are associated with an increased frequency of such errors.
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Affiliation(s)
- Joseph S Turner
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN 46202, United States of America.
| | - Rachel D Courtney
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN 46202, United States of America
| | - Elisa Sarmiento
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN 46202, United States of America.
| | - Timothy J Ellender
- Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskenazi Avenue, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN 46202, United States of America.
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Crable EL, Biancarelli D, Walkey AJ, Drainoni ML. Barriers and facilitators to implementing priority inpatient initiatives in the safety net setting. Implement Sci Commun 2020; 1:35. [PMID: 32885192 PMCID: PMC7427845 DOI: 10.1186/s43058-020-00024-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/28/2020] [Indexed: 02/03/2023] Open
Abstract
Background Safety net hospitals, which serve vulnerable and underserved populations and often operate on smaller budgets than non-safety net hospitals, may experience unique implementation challenges. We sought to describe common barriers and facilitators that affect the implementation of improvement initiatives in a safety net hospital, and identify potentially transferable lessons to enhance implementation efforts in similar settings. Methods We interviewed leaders within five inpatient departments and asked them to identify the priority inpatient improvement initiative from the last year. We then conducted individual, semi-structured interviews with 25 stakeholders across the five settings. Interviewees included individuals serving in implementation oversight, champion, and frontline implementer roles. The Consolidated Framework for Implementation Research informed the discussion guide and a priori codes for directed content analysis. Results Despite pursuing diverse initiatives in different clinical departments, safety net hospital improvement stakeholders described common barriers and facilitators related to inner and outer setting dynamics, characteristics of individuals involved, and implementation processes. Implementation barriers included (1) limited staffing resources, (2) organizational recognition without financial investment, and (3) the use of implementation strategies that did not adequately address patients’ biopsychosocial complexities. Facilitators included (1) implementation approaches that combined passive and active communication styles, (2) knowledge of patient needs and competitive pressure to perform well against non-SNHs, (3) stakeholders’ personal commitment to reduce health inequities, and (4) the use of multidisciplinary task forces to drive implementation activities. Conclusion Inner and outer setting dynamics, individual’s characteristics, and process factors served as implementation barriers and facilitators within the safety net. Future work should seek to leverage findings from this study toward efforts to enact positive change within safety net hospitals.
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Affiliation(s)
- Erika L Crable
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2030, Boston, 02118 MA USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA USA
| | - Dea Biancarelli
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2030, Boston, 02118 MA USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA USA
| | - Allan J Walkey
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2030, Boston, 02118 MA USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA USA.,The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Mari-Lynn Drainoni
- Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown 2030, Boston, 02118 MA USA.,Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA USA.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA USA
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Dixit N, Burke N, Rodriguez G, Sarkar U, Cicerelli B, DeVore JD, Nápoles AM. Knowledge and self-efficacy for caring for breast and colon cancer survivors among safety net primary care providers. Support Care Cancer 2020; 28:4923-4931. [PMID: 32016600 DOI: 10.1007/s00520-019-05277-z] [Citation(s) in RCA: 4] [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: 07/14/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary care providers (PCPs) are critical to the provision of comprehensive care for cancer survivors, yet there is very little data on the practices and quality of survivorship care occurring in safety net primary care settings. This study aimed to assess the knowledge and attitudes of PCPs and preferences for care models for breast and colon cancer survivors in a safety net health network. METHODS A modified National Cancer Institute Survey of Physician Attitudes Regarding the Care of Cancer Survivors was sent electronically to 220 PCPs in 12 primary care clinics in the San Francisco Health Network affiliated with Zuckerberg San Francisco General Hospital and Trauma Center. RESULTS The response rate was 50% (110/220). About half of PCPs strongly/somewhat agreed (vs. strongly/somewhat disagreed) that PCPs have the knowledge needed to provide follow-up care related to breast (50%) and colon cancer (54%). Most providers (93%) correctly reported recommended frequency of mammography, however, frequency of blood tests and other imaging surveillance were not as well recognized for breast or colon cancer. Recognition of long-term side effects of chemotherapy drugs ranged from 12% for oxaliplatin to 44% for doxorubicin. Only 33% of providers reported receiving any survivorship training. The most preferred model for survivorship care was shared care model (40%). CONCLUSIONS Safety net PCPs prefer a shared care model for care of cancer survivors but are limited by lack of training, poor communication, and poor delineation of roles. Patient-centered survivorship care can be improved through effective oncologist-PCP-patient partnerships and coordination.
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Affiliation(s)
- Niharika Dixit
- University of California San Francisco/Zuckerberg San Francisco General Hospital and Trauma Center, 995 Potrero Avenue, Ward 84, San Francisco, CA, 94110, USA.
| | - Nancy Burke
- University of California, Merced, 5200 N Lake Rd, Merced, CA, 95343, USA
| | - Gladys Rodriguez
- University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, USA
| | - Urmimala Sarkar
- Center for Vulnerable Populations, University of California San Francisco/Zuckerberg San Francisco General Hospital and Trauma Center Division of General Internal Medicine, 1001 Potrero Avenue, Ward 13, San Francisco, CA, 94110, USA
| | - Barbara Cicerelli
- Zuckerberg San Francisco General Hospital and Trauma Center, 995 Potrero Avenue, Ward 84, San Francisco, CA, 94110, USA
| | | | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA
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Bronchetti ET, Christensen G, Hoynes HW. Local food prices, SNAP purchasing power, and child health. J Health Econ 2019; 68:102231. [PMID: 31634764 DOI: 10.1016/j.jhealeco.2019.102231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/14/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
The Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) is one of the most important elements of the social safety net. Unlike most other safety net programs, SNAP varies little across states and over time, which creates challenges for quasi-experimental evaluation. Notably, SNAP benefits are fixed across 48 states; but local food prices vary, leading to geographic variation in the real value - or purchasing power - of SNAP benefits. In this study, we provide the first estimates that leverage variation in SNAP purchasing power across markets to examine effects of SNAP on child health. We link panel data on regional food prices to National Health Interview Survey data and use a fixed effects framework to estimate the relationship between local purchasing power of SNAP and children's health and health care utilization. We find that lower SNAP purchasing power leads to lower utilization of preventive health care and more days of school missed due to illness. We estimate no effect on parent-reported health status.
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Affiliation(s)
| | | | - Hilary W Hoynes
- Department of Economics and Public Policy, UC Berkeley, United States.
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Cedars B, Lisker S, Borno HT, Kamal P, Breyer B, Sarkar U. An electronic registry to improve adherence to active surveillance monitoring among men with prostate cancer at a safety-net hospital: protocol for a pilot study. Pilot Feasibility Stud 2019; 5:101. [PMID: 31428442 PMCID: PMC6694525 DOI: 10.1186/s40814-019-0482-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 07/29/2019] [Indexed: 12/02/2022] Open
Abstract
Background The evidence-based practice of active surveillance to monitor men with favorable-risk prostate cancer in lieu of initial definitive treatment is becoming more common. However, there are barriers to effective implementation, particularly in low-resource settings. Our goal is to assess the efficacy and feasibility of a health information technology registry for men on active surveillance at a safety-net hospital to ensure patients receive guideline-recommended care. Methods We developed an electronic registry for urology clinic staff to monitor men on active surveillance. The health information technology tool was developed using the Systems Engineering Initiative for Patient Safety model and iteratively tailored to the needs of the clinic by engaging providers in a co-design process. We will enroll all men at Zuckerberg San Francisco General Hospital and Trauma Center who choose active surveillance as a treatment strategy. The primary outcomes to be assessed during this non-randomized, pragmatic evaluation are number of days delayed beyond recommended date of follow-up testing, the proportion of men who are lost to follow-up, the cancer stage at active treatment, and the feasibility and acceptability of the clinic-wide intervention with clinic staff. Secondary outcomes include appointment adherence within 30 days of the scheduled date. Discussion Use of a customized electronic approach for monitoring men on active surveillance could improve patient outcomes. It may help reduce the number of men lost to follow-up and improve adherence to timely follow-up testing. Evaluating the adoption and efficacy of a customized registry in a safety-net setting may also demonstrate feasibility for implementation in diverse clinical contexts. Trial registration ClinicalTrials.gov identifier NCT03553732, An Electronic Registry to Improve Adherence to Active Surveillance Monitoring at a Safety-net Hospital. Registered 11 June 2018.
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Affiliation(s)
- Benjamin Cedars
- 1Department of Urology, School of Medicine, University of California San Diego, 200 West Arbor Drive, San Diego, CA 92103 USA
| | - Sarah Lisker
- 2Center for Vulnerable Populations, University of California San Francisco, 2789 25th Street, San Francisco, CA 94110 USA.,3Department of Medicine, School of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Hala T Borno
- 3Department of Medicine, School of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Puneet Kamal
- 4Department of Urology, School of Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110 USA
| | - Benjamin Breyer
- 4Department of Urology, School of Medicine, University of California San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110 USA.,5Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 550 16th Street, San Francisco, CA 94158 USA
| | - Urmimala Sarkar
- 2Center for Vulnerable Populations, University of California San Francisco, 2789 25th Street, San Francisco, CA 94110 USA.,3Department of Medicine, School of Medicine, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA
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Roberts TJ, Matthews JL, Brown PK, Lysikowski JR, Rabaglia JR. Enhanced Recovery Pathway Improves Colorectal Surgery Outcomes in Private and Safety-Net Settings. J Surg Res 2019; 245:354-359. [PMID: 31425875 DOI: 10.1016/j.jss.2019.07.067] [Citation(s) in RCA: 3] [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: 04/13/2019] [Revised: 06/17/2019] [Accepted: 07/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Enhanced recovery pathways (ERPs) can decrease length of stay (LOS) and improve colorectal surgery outcomes in private health care; however, their efficacy in the public realm, comprised largely of underserved and uninsured patients, remains uncertain. MATERIALS AND METHODS An ERP without social interventions was implemented at a private hospital (PH) and a safety-net hospital (SNH) within a large academic medical center in 2014. Process and outcome metrics from 100 patients in the 18 mo before ERP implementation at each institution were retrospectively compared with a similar group after ERP implementation. Primary outcomes were LOS, 30-d readmission, and reoperation. RESULTS Post-ERP groups were older than pre-ERP (P = 0.047, 0.034), with no difference in sex or body mass index. Rate of open versus minimally invasive was similar at the SNH (P = 0.067), whereas more post-ERP patients at PH underwent open surgery (P = 0.002). Ninety six percentage of PH patients were funded through private insurance or Medicare, verses 6% at the SNH. LOS at PH decreased from 8.1 to 5.9 d (P = 0.028) and at SNH from 7.0 to 5.1 d (P = 0.004). There was no change in 30-d all-cause readmission (PH P = 0.634; SNH P = 1) or reoperation (PH P = 0.610; SNH P = 0.066). CONCLUSIONS ERP reduced LOS in both private and safety-net settings without addressing social determinants of health. Readmission and reoperation rates were unchanged. As health care moves toward a bundled payment model, ERP can help optimize outcomes and control costs in the public arena.
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Vander Schaaf EB, Quinonez RB, Cornett AC, Randolph GD, Boggess K, Flower KB. A Pilot Quality Improvement Collaborative to Improve Safety Net Dental Access for Pregnant Women and Young Children. Matern Child Health J 2018; 22:255-63. [PMID: 29168163 DOI: 10.1007/s10995-017-2397-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives To determine acceptability and feasibility of a quality improvement (QI) collaborative in safety net dental practices, and evaluate its effects on financial stability, access, efficiency, and care for pregnant women and young children. Methods Five safety net dental practices participated in a 15-month learning collaborative utilizing business assessments, QI training, early childhood oral health training, and prenatal oral health training. Practices collected monthly data on: net revenue, no-show rates, total encounters, and number of encounters for young children and pregnant women. We analyzed quantitative data using paired t-tests before and after the collaborative and collected supplemental qualitative feedback from clinic staff through focus groups and directed email. Results All mean measures improved, including: higher monthly revenue ($28,380-$33,102, p = 0.37), decreased no-show rate (17.7-14.3%, p = 0.11), higher monthly dental health encounters (283-328, p = 0.08), and higher monthly encounters for young children (8.8-10.5, p = 0.65), and pregnant women (2.8-9.7, p = 0.29). Results varied by practice, with some demonstrating largest increases in encounters for young children and others pregnant women. Focus group participants reported that the collaborative improved access for pregnant women and young children, and that QI methods were often new and difficult. Conclusion for practice Participation by safety net dental practices in a QI collaborative is feasible and acceptable. Individual sites saw greater improvements in different outcomes areas, based on their own structures and needs. Future efforts should focus on specific needs of each dental practice and should offer additional QI training.
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Cooke AC, Knight KR, Miaskowski C. Patients' and clinicians' perspectives of co-use of cannabis and opioids for chronic non-cancer pain management in primary care. Int J Drug Policy 2018; 63:23-28. [PMID: 30472467 DOI: 10.1016/j.drugpo.2018.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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: 05/16/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prevalence of opioid-associated morbidity and mortality underscores the need for research on non-opioid treatments for chronic non-cancer pain (CNCP). Pain is the most common medical condition for which patients request medical cannabis. Limited research indicates that patients are interested in cannabis as a potential addition to or replacement for opioid medication. This analysis reports on CNCP patient and clinician perceptions about the co-use of cannabis and opioids for CNCP management. METHODS We interviewed 23 clinicians and 46 CNCP patients, using semi-structured interview guides, from six safety-net clinics across the San Francisco Bay Area, and 5 key stakeholders involved in CNCP management. We used a modified grounded theory approach to code and analyze transcripts. RESULTS CNCP patients described potential benefits of co-use of cannabis and opioids for pain management and concerns about dosing and addictive potential. Patients reported seeking cannabis when unable to obtain prescription opioids. Clinicians stated that their patients reported cannabis being helpful in managing pain symptoms. Clinicians expressed concerns about the potential exacerbation of mental health issues resulting from cannabis use. CONCLUSION Clinicians are hampered by a lack of clinically relevant information about cannabis use, efficacy and side-effects. Currently no guidelines exist for clinicians to address opioid and cannabis co-use, or to discuss the risk and benefits of cannabis for CNCP management, including side effects. Cannabis and opioid co-use was commonly reported by patients in our sample, yet rarely addressed during clinical CNCP care. Further research is needed on the risks and benefits of cannabis and opioid co-use.
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Affiliation(s)
- Alexis C Cooke
- Department of Psychiatry, University of California, San Francisco CA, United States.
| | - Kelly R Knight
- Department of Anthropology, History and Social Medicine, University of California, San Francisco CA, United States
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco CA, United States
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Bradley CJ, Neumark D, Walker LS. The effect of primary care visits on other health care utilization: A randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia. J Health Econ 2018; 62:121-133. [PMID: 30366229 DOI: 10.1016/j.jhealeco.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
We conducted a randomized controlled trial, enrolling low-income uninsured adults in Virginia (United States), to determine whether cash incentives are effective at encouraging a primary care provider (PCP) visit, and at lowering utilization and costs. Subjects were randomized to four groups: untreated controls, and one of three incentive arms with incentives of $0, $25, or $50 for visiting a PCP within six months of group assignment. We used the exogenous variation generated by the experiment to obtain causal evidence on the effects of a PCP visit. We observed modest reductions in non-urgent emergency department visits and increased outpatient visits, but no reductions in overall costs. These findings in utilization are consistent with the expectation that PCPs offer an alternative to the emergency department for non-emergent conditions. Total costs did not decline because any savings from avoiding the emergency department were offset by increased outpatient utilization.
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Affiliation(s)
- Cathy J Bradley
- Department of Health Systems, Management and Policy, University of Colorado Cancer Center, University of Colorado, Aurora, CO, United States.
| | - David Neumark
- Department of Economics and Economic Self-Sufficiency Policy Research Institute, University of California at Irvine, CA, United States; National Bureau of Economic Research, United States; IZA, Germany.
| | - Lauryn Saxe Walker
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States.
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Campbell B, Lopez A, Liu B, Bhuket T, Wong RJ. A Pilot Program Integrating Hepatitis B Virus (HBV) Screening into an Outpatient Endoscopy Unit Improves HBV Screening Among an Ethnically Diverse Safety-Net Hospital. Dig Dis Sci 2018; 63:242-7. [PMID: 29209920 DOI: 10.1007/s10620-017-4870-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/24/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Safety-net hospitals are enriched in ethnic minorities and provide opportunities for high-impact hepatitis B virus (HBV) screening. AIM We aim to evaluate the impact of a pilot program integrating HBV screening into outpatient endoscopy among urban safety-net populations. METHODS From July 2015 to May 2017, consecutive adults undergoing outpatient endoscopy were prospectively assessed for HBV screening eligibility using US Preventative Services Task Force guidelines. Rates of prior HBV screening were assessed, and those eligible but not screened were offered HBV testing. Multivariate logistic regression models evaluated predictors of test acceptance among eligible patients. RESULTS Among 1557 patients (47.1% male, 69.4% foreign born), 65.1% were eligible for HBV screening, among which 24.5% received prior screening. In our pilot screening program in the endoscopy unit, 91.4% (n = 855) of eligible patients accepted HBV testing. However, only 55.3% (n = 415) of those that accepted actually completed HBV testing. While there was a trend toward higher rates of test acceptance among African-Americans compared to non-Hispanic whites (OR 3.31, 95% CI 0.96-11.38, p = 0.06), no other sex-specific or race/ethnicity-specific disparities in HBV test acceptance were observed. Among those who completed HBV testing, we identified 10 new patients with chronic HBV (2.4% prevalence). Only 24.5% of eligible patients received prior HBV screening among our cohort. CONCLUSIONS Our pilot program integrating HBV screening into outpatient endoscopy successfully tested an additional 415 patients, improving overall HBV screening from 24.5 to 75.6%. Integrating HBV testing into non-traditional settings has potential to bridge the gap in HBV screening among safety-net systems.
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Napoles TM, Burke NJ, Shim JK, Davis E, Moskowitz D, Yen IH. Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings. J Urban Health 2017; 94:803-13. [PMID: 28597203 DOI: 10.1007/s11524-017-0159-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We sought to examine the literature using the Patient Activation Measure (PAM) or the Patient Enablement Instrument (PEI) with high-need, high-cost (HNHC) patients receiving care in urban safety net settings. Urban safety net care management programs serve low-income, racially/ethnically diverse patients living with multiple chronic conditions. Although many care management programs track patient progress with the PAM or the PEI, it is not clear whether the PAM or the PEI is an effective and appropriate tool for HNHC patients receiving care in urban safety net settings in the United States. We searched PubMed, EMBASE, Web of Science, and PsycINFO for articles published between 2004 and 2015 that used the PAM and between 1998 and 2015 that used the PEI. The search was limited to English-language articles conducted in the United States and published in peer-reviewed journals. To assess the utility of the PAM and the PEI in urban safety net care settings, we defined a HNHC patient sample as racially/ethnically diverse, low socioeconomic status (SES), and multimorbid. One hundred fourteen articles used the PAM. All articles using the PEI were conducted outside the U.S. and therefore were excluded. Nine PAM studies (8%) included participants similar to those receiving care in urban safety net settings, three of which were longitudinal. Two of the three longitudinal studies reported positive changes following interventions. Our results indicate that research on patient activation is not commonly conducted on racially and ethnically diverse, low SES, and multimorbid patients; therefore, there are few opportunities to assess the appropriateness of the PAM in such populations. Investigators expressed concerns with the potential unreliability and inappropriate nature of the PAM on multimorbid, older, and low-literacy patients. Thus, the PAM may not be able to accurately assess patient progress among HNHC patients receiving care in urban safety net settings. Assessing progress in the urban safety net care setting requires measures that account for the social and structural challenges and competing demands of HNHC patients.
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Basu S, Carney MA, Kenworthy NJ. Ten years after the financial crisis: The long reach of austerity and its global impacts on health. Soc Sci Med 2017; 187:203-207. [PMID: 28666546 DOI: 10.1016/j.socscimed.2017.06.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Sanjay Basu
- Medicine, Stanford University, United States.
| | | | - Nora J Kenworthy
- School of Nursing and Health Studies, University of Washington, United States.
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32
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Jackson MI, Mayne P. Child access to the nutritional safety net during and after the Great Recession: The case of WIC. Soc Sci Med 2016; 170:197-207. [PMID: 27821303 DOI: 10.1016/j.socscimed.2016.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 11/21/2022]
Abstract
Because children disproportionately live in poverty, they are especially vulnerable during economic crises, making the social safety net a key buffer against the effects of economic disadvantage on their development. The Great Recession of 2007-2009 had strong and lasting effects on American children and families, including striking negative effects on their health environments. Understanding access to the health safety net during this time of increased economic need, as well as the extent to which all children-regardless of age, income or race/ethnicity-share in the increased use of transfer programs, is therefore important in identifying the availability and accessibility of government assistance for those in need. Focusing on the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program because of its strong effects on child development, we use longitudinal data from the Survey of Income and Program Participation (SIPP) to examine change and stability in children's WIC enrollment before, during and after the recession. Specifically, we examine: 1) whether children's WIC enrollment increased alongside changing family income, and 2) the extent to which changes in participation were shared by all subpopulations, regardless of age, income, and race/ethnicity. Analyses reveal that WIC participation among eligible children increased leading up to, during, and after the Great Recession, suggesting that the program was responsive to increasing economic need. Examining the distribution of WIC enrollment across demographic groups largely reveals a pattern of stable inequality in access and "take up." Children born to poorer and less-educated mothers were more likely to be enrolled prior to the recession, and these differences remain mostly constant during and after the recession. Eligible Hispanic children had consistently higher enrollment, particularly among those in families with foreign-born mothers. The findings suggest that not all eligible children equally enroll in WIC, but that these differences have not been drastically exacerbated by macroeconomic instability.
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Gunter KE, Nocon RS, Gao Y, Casalino LP, Chin MH. Medical Home Characteristics and Quality of Diabetes Care in Safety Net Clinics. J Community Health 2017; 42:303-11. [PMID: 27659297 DOI: 10.1007/s10900-016-0256-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We examined associations between patient-centered medical home (PCMH) characteristics and quality of diabetes care in 15 safety net clinics in five states. Surveys among clinic directors assessed PCMH characteristics using the Safety Net Medical Home Scale. Chart audits among 864 patients assessed diabetes process and outcome measures. We modeled the odds of the patient receiving performance measures as a function of total PCMH score and of PCMH subscales and covariates. PCMH characteristics had mixed, inconsistent associations with the quality of diabetes care. The PCMH model may require refinement in design and implementation to improve diabetes care among vulnerable populations.
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Jones E, Zur J, Elam L. Off to the Right Start: Well-Child Visit Attendance Among Health Center Users. J Pediatr Health Care 2016; 30:435-43. [PMID: 26671315 DOI: 10.1016/j.pedhc.2015.10.008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/15/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION This study examines correlates of past-year well-child visit attendance, reasons for choosing to receive care at a health center, and patient experience among pediatric federally qualified health center users. METHOD This observational study used cross-sectional 2009 Health Center Patient Survey data. Descriptive statistics, bivariate analysis, and multivariable models were utilized. RESULTS This study found that 83.0% of children who visited a health center in the past year had a well-child visit in the past year and 88.5% had a usual source of care, with no disparities based on race/ethnicity or insurance status. A usual source of care, especially a health center, enhanced well-child visit attendance. The top reasons for seeking care at a health center include convenience (31.6%), quality (24.5%), accessibility (17.7%), and co-located nonmedical services (11.5%). DISCUSSION Well-child visit attendance is high but there is room for improvement, particularly among patients who lack a usual source of care.
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Ko NY, Battaglia TA, Gupta-Lawrence R, Schiller J, Gunn C, Festa K, Nelson K, Flacks J, Morton SJ, Rosen JE. Burden of socio-legal concerns among vulnerable patients seeking cancer care services at an urban safety-net hospital: a cross-sectional survey. BMC Health Serv Res 2016; 16:196. [PMID: 27296566 PMCID: PMC4906581 DOI: 10.1186/s12913-016-1443-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/03/2016] [Indexed: 12/23/2022] Open
Abstract
Background Social and economic conditions that affect one’s ability to satisfy life’s most basic needs such as lack of affordable housing, restricted access to education and employment, or inadequate income are increasingly well-documented barriers to optimal health. The burden of these challenges among vulnerable patients accessing cancer care services is unknown. Methods We conducted a cross-sectional survey of patients presenting for ambulatory cancer care services (screening and treatment) at an urban safety-net hospital to assess socio-legal concerns (social problems related to meeting life’s basic needs supported by public policy or programming and potentially remedied through legal advocacy/action). Results Among 104 respondents, 80 (77 %) reported concerns with one or more socio-legal needs in the past month, with a mean of 5.75 concerns per participant. The most common socio-legal concerns related to income supports, housing, and employment/education. Conclusion Our findings support the need for innovations in cancer care delivery to address socio-legal concerns of a vulnerable patient population. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1443-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Naomi Yu Ko
- Section of Hematology Oncology, Women's Health Unit, Boston Medical Center, 801 Massachusetts Ave, First Floor, Boston, MA, 02118, USA.
| | - Tracy A Battaglia
- Women's Health Unit, Boston Medical Center, 801 Massachusetts Ave, First Floor, Boston, MA, 02118, USA
| | - Rebecca Gupta-Lawrence
- Women's Health Unit, Boston Medical Center, 801 Massachusetts Ave, First Floor, Boston, MA, 02118, USA
| | - Jessica Schiller
- Women's Health Unit, Boston Medical Center, 801 Massachusetts Ave, First Floor, Boston, MA, 02118, USA
| | - Christine Gunn
- Women's Health Unit, Boston Medical Center, 801 Massachusetts Ave, First Floor, Boston, MA, 02118, USA
| | - Kate Festa
- Women's Health Unit, Boston Medical Center, 801 Massachusetts Ave, First Floor, Boston, MA, 02118, USA
| | - Kerrie Nelson
- Department of Biostatistics, Boston University, 801 Massachusetts Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - JoHanna Flacks
- Medical-Legal Partnership I Boston, c/o Nutter McClennen & Fish LLP 155 Seaport Blvd, Boston, MA, 02210, USA
| | - Samantha J Morton
- Medical-Legal Partnership I Boston, c/o Nutter McClennen & Fish LLP 155 Seaport Blvd, Boston, MA, 02210, USA
| | - Jennifer E Rosen
- Department of Surgery, MedStar Washington Hospital Center, 110 Irving Street NW Suite G247C, Washington DC, 20010, USA
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Aysola J, Groves D, Hicks LS. Health Center Professional Programs and Primary Care Workforce. J Fam Med Community Health 2015; 2:1063. [PMID: 27891532 PMCID: PMC5120588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Current policy promotes health center professional training and pipeline programs as solutions to bolster primary care workforce in shortage areas, despite the paucity of evidence. METHODS We analyzed data from US health centers we surveyed from March to June 2010, merged with federal health center data, to estimate associations between health center training and pipeline programs and provider recruitment and retention. RESULTS Of the 976 surveyed, 391 health centers responded. Health centers with career ladder programs compared to those without had higher adjusted rates of no/minimal difficulty in recruitment of primary care providers. (17.6% vs. 10.6%; p=.01) and close to double the adjusted rates of reporting no/minimal difficulty in retention of primary care providers (39.4% vs. 21.2%; p=.0001). DISCUSSION There remains a need for further evaluation of health professional programs in order to expand models, such as career ladder programs, that demonstrate effectiveness in improving the primary care workforce in shortage areas.
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Affiliation(s)
- Jaya Aysola
- Division of General Internal Medicine, University of Pennsylvania, USA
- Department of Health Care Policy, Harvard Medical School, USA
- Division of General Medicine, Brigham and Women’s Hospital, USA
| | - DaShawn Groves
- Department of Health Care, National Association of Community Health Centers, USA
| | - LeRoi S Hicks
- Department of Health Care Policy, Harvard Medical School, USA
- Division of Hospital Medicine, University of Massachusetts Memorial Medical Center, USA
- Department of Medicine, Christiana Care Health Care System, USA
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Ramondetta LM, Meyer LA, Schmeler KM, Daheri ME, Gallegos J, Scheurer M, Montealegre JR, Milbourne A, Anderson ML, Sun CC. Avoidable tragedies: Disparities in healthcare access among medically underserved women diagnosed with cervical cancer. Gynecol Oncol 2015; 139:500-5. [PMID: 26498912 PMCID: PMC7418500 DOI: 10.1016/j.ygyno.2015.10.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 07/20/2015] [Revised: 10/19/2015] [Accepted: 10/20/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose was to identify barriers including logistical and health belief correlates of late stage presentation of cervical cancer (CxCa) among medically underserved women presenting to a safety net health care system. METHODS Women presenting with newly diagnosed CxCa were asked to complete a detailed health belief survey that included questions about barriers to care and their knowledge of CxCa. All information was collected prior to initiating cancer treatment. Comparisons were made among women diagnosed at early stages of disease amendable to surgical treatment (≤IB1) and those diagnosed at a stage requiring local-regional or systemic/palliative treatment (≥IB2). RESULTS Among the 138 women, 21.7% were diagnosed with ≤lB1 disease, while 78.3% were diagnosed with ≥IB2 disease. Late-stage diagnosis was associated with a greater number of emergency room (ER) visits (p<.001) and blood transfusions (p<.001) prior to diagnosis. Compared to 88% with ≤lB1 disease, only 53% of patients with ≥IB2 disease had a car (p=.003). Women with ≥IB2 disease were more likely to be without a primary care provider (75.0% vs. 42.3%, p=.001). CONCLUSION Access to transportation and lack of a regular primary care provider or a medical home are associated with late-stage of CxCa at diagnosis. Many medically underserved women continue to use the ER as their primary source of health care, and as a result their CxCa is diagnosed in advanced stages, with higher medical costs and lower chances of cure. The lack of Medicaid expansion in Texas may result in a worsening of this situation.
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Affiliation(s)
- Lois M Ramondetta
- Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States.
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States
| | - Maria E Daheri
- Cervical Cancer Case Management, Harris Health System, Houston, TX 77054, United States
| | - Jessica Gallegos
- Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States
| | - Michael Scheurer
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States
| | - Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, United States
| | - Andrea Milbourne
- Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States
| | - Matthew L Anderson
- Departments of Obstetrics & Gynecology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, United States
| | - Charlotte C Sun
- Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, TX 77030, United States; Lyndon Baines Hospital, Division Gynecologic Oncology, Harris Health System, Houston, TX 77026, United States
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Ell K, Katon W, Lee PJ, Guterman J, Wu S. Demographic, clinical and psychosocial factors identify a high-risk group for depression screening among predominantly Hispanic patients with Type 2 diabetes in safety net care. Gen Hosp Psychiatry 2015; 37:414-9. [PMID: 26059979 DOI: 10.1016/j.genhosppsych.2015.05.010] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/15/2015] [Accepted: 05/22/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Identify biopsychosocial factors associated with depression for patients with Type 2 diabetes. METHOD A quasi-experimental clinical trial of 1293 patients was predominantly Hispanic (91%) female (62%), mean age 53 and average diabetes duration 10 years; 373 (29%) patients were depressed and assessed by Patient Health Questionnaire-9. Demographic, baseline clinical and psychosocial variables were compared between depressed and nondepressed patients. RESULTS Bivariate analyses found depression significantly associated (p<0.05) with female gender, diabetes emotional burden and regimen distress, BMI ≥ 30, lack of an A1C test, diabetes duration, poor self-care, number of diabetes symptoms and complications, functional and physical characteristics (pain, self-rated health condition, Short-Form Health Survey SF-physical, disability score and comorbid illnesses), as well as higher number of ICD-9 diagnoses and emergency room use. A multivariable regression model with stepwise selection identified six key risk factors: greater disability, diabetes symptoms and regimen distress, female gender, less diabetes self-care and lack of A1C. In addition, after controlling for identified six factors, the number of psychosocial stressors significantly associated with increased risk of depression (adjusted odds ratio=1.37, 95% confidence intervals: 1.18-1.58, p<.0001). CONCLUSION Knowing biopsychosocial factors could help primary care physicians and endocrinologists identify a high-risk group of patients needing depression screening.
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Affiliation(s)
- Kathleen Ell
- School of Social Work, University of Southern California.
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California.
| | - Jeffrey Guterman
- David Geffen School of Medicine at UCLA and the Los Angeles County Department of Health Services.
| | - Shinyi Wu
- School of Social Work, University of Southern California; Edward R. Roybal Institute on Aging, University of Southern California; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California.
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Tuot DS, Grubbs V. Chronic kidney disease care in the US safety net. Adv Chronic Kidney Dis 2015; 22:66-73. [PMID: 25573515 DOI: 10.1053/j.ackd.2014.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 11/11/2022]
Abstract
The US Health Care System provides a patchwork of services, known as the safety net, for the uninsured, underinsured, and indigent populations who would otherwise have little access to health care services. Individuals who rely on safety-net facilities are from racial/ethnic minority groups, have low socioeconomic status, and often have low health literacy and/or limited English proficiency. They shoulder a disproportionate burden of CKD in the United States and experience excess CKD-associated morbidity and mortality. Suboptimal delivery of CKD care may be contributing and is an area of active translational research. Several initiatives that show promise in improving safety-net CKD care delivery include those that enhance diagnostic and management skills of primary care providers, rely on comprehensive care management programs led by nonphysicians, and leverage technology to enhance patient access to virtual nephrology expertise. Uncovering better ways to translate scientific evidence into practice for vulnerable patients with CKD is a formidable challenge that will require national surveillance of CKD quality measures across diverse ambulatory health systems, including safety nets. Only then will the nephrology community be to identify and share best practices to enhance health and mitigate disparities of care among patients with CKD.
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Laiteerapong N, Kirby J, Gao Y, Yu TC, Sharma R, Nocon R, Lee SM, Chin MH, Nathan AG, Ngo-Metzger Q, Huang ES. Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care. Health Serv Res 2014; 49:1498-518. [PMID: 24779670 DOI: 10.1111/1475-6773.12178] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 11/26/2022] Open
Abstract
OBJECTIVE To compare utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. DATA SOURCES A nationally representative sample of adults from the Medical Expenditure Panel Survey (2004-2008). STUDY DESIGN HC patients were defined as those with ≥50 percent of outpatient visits at HCs in the first panel year. Outcomes included utilization and preventive care receipt from the second panel year. We used negative binomial and logistic regression models with propensity score adjustment for confounding differences between HC and non-HC patients. PRINCIPAL FINDINGS Compared to non-HC patients, HC patients had fewer office visits (adjusted incidence rate ratio [aIRR], 0.63) and hospitalizations (aIRR, 0.43) (both p < .001). HC patients were more likely to receive breast cancer screening than non-HC patients (adjusted odds ratio [aOR] 2.78, p < .01). In subgroup analyses, uninsured HC patients had fewer outpatient and emergency room visits and were more likely to receive dietary advice and breast cancer screening compared to non-HC patients. CONCLUSIONS Health centers add value to the health care system by providing socially and medically disadvantaged patients with care that results in lower utilization and maintained or improved preventive care.
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Affiliation(s)
- Neda Laiteerapong
- University of Chicago, 5841 S. Maryland Ave., MC 2007, Chicago, IL, 60637
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Ko M, Derose KP, Needleman J, Ponce NA. Whose social capital matters? The case of U.S. urban public hospital closures and conversions to private ownership. Soc Sci Med 2014; 114:188-96. [PMID: 24919649 DOI: 10.1016/j.socscimed.2014.03.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 03/06/2014] [Accepted: 03/24/2014] [Indexed: 11/28/2022]
Abstract
Prior literature on social capital and health has predominantly focused on health outcomes and individual access to healthcare services. It is not known to what degree, if any, community social capital influences the performance or behaviors of public hospitals, a key source of healthcare for disadvantaged communities in the United States. In this study we developed measures of community bridging social capital - horizontal social networks between heterogeneous groups of similar social position - and linking social capital - vertical networks across the status hierarchy - relevant to public hospitals. We examined associations between social capital, and U.S. urban public hospital closures and conversions to private ownership from 1987 to 2007. We found that higher voting participation was associated with a greater hazard of public hospital closure over time (p < 0.01), whereas the number of business, professional and political organizations per 10,000 residents was associated a greater hazard of conversion (p < 0.05). Additional measures of bridging and linking social capital were not associated with either outcome. Taken together, our findings suggest that, at least historically, horizontal forms of social capital among more privileged groups (e.g., business, professional, and political associations) bear influence on public hospital outcomes. Specific efforts to increase engagement of disadvantaged groups and connect them with decision-makers may be needed to fully realize the potential of linking social capital to influence local healthcare policy promoting social protection.
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Affiliation(s)
- Michelle Ko
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Box 951772, Los Angeles, CA 90095-1772, USA.
| | | | - Jack Needleman
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Box 951772, Los Angeles, CA 90095-1772, USA.
| | - Ninez A Ponce
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Box 951772, Los Angeles, CA 90095-1772, USA.
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Fayanju OM, Jeffe DB, Elmore L, Ksiazek DN, Margenthaler JA. Breast cancer patients' experiences within and outside the safety net. J Surg Res 2014; 190:126-33. [PMID: 24768022 DOI: 10.1016/j.jss.2014.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/03/2014] [Accepted: 03/12/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Following reforms to the breast-cancer referral process for our city's health Safety Net (SN), we compared the experiences from first abnormality to definitive diagnosis of breast-cancer patients referred to Siteman Cancer Center from SN and non-SN (NSN) providers. MATERIALS AND METHODS SN-referred patients with any stage (0-IV) and NSN-referred patients with late-stage (IIB-IV) breast cancer were prospectively identified after diagnosis during cancer center consultations conducted between September 2008 and June 2010. Interviews were taped and transcribed verbatim; transcripts were independently coded by two raters using inductive methods to identify themes. RESULTS Of 82 eligible patients, 57 completed interviews (33/47 SN [70%] and 24/35 NSN [69%]). Eighteen SN-referred patients (52%) had late-stage disease at diagnosis, as did all NSN patients (by design). A higher proportion of late-stage SN patients (67%) than either early-stage SN (47%) or NSN (33%) patients reported feelings of fear and avoidance that deterred them from pursuing care for concerning breast findings. A higher proportion of SN late-stage patients than NSN patient reported behaviors concerning for poor health knowledge or behavior (33% versus 8%), but reported receipt of timely, consistent communication from health care providers once they received care (50% versus 17%). Half of late-stage SN patients reported improper clinical or administrative conduct by health care workers that delayed referral and/or diagnosis. CONCLUSIONS Although SN patients reported receipt of compassionate care once connected with health services, they presented with higher-than-expected rates of late-stage disease. Psychological barriers, life stressors, and provider or clinic delays affected access to and navigation of the health care system and represent opportunities for intervention.
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Moore SL, Fischer HH, Steele AW, Joshua Durfee M, Ginosar D, Rice-Peterson C, Berschling JD, Davidson AJ. A mobile health infrastructure to support underserved patients with chronic disease. Healthc (Amst) 2014; 2:63-8. [PMID: 26250090 DOI: 10.1016/j.hjdsi.2013.12.016] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic diseases are the global leading cause of death, but the US health system is poorly designed to support patients with chronic disease. Underserved patients report high rates of cell phone use and interest in using mobile technology for health care. A mobile health infrastructure may help transform health care delivery for underserved patients with chronic disease. PROBLEM This study assessed the feasibility of integrating mobile health infrastructure with clinical information systems and the electronic medical record (EMR) to support patients with chronic disease through automated, bidirectional text messaging. GOALS Three priority areas of chronic disease management were targeted. Existing self-management support was expanded, and new support for laboratory test scheduling and medication management was created. STRATEGY Adult patients (n=135) with diabetes selected preferred content and scheduling for self-management message prompts. Outreach messages were sent to patients overdue for laboratory tests and medications. Manual review of pharmacy and laboratory outreach data was conducted for quality assurance. Focus groups were held to solicit patient perspectives. RESULTS Patients sent over 6500 response messages with response rates of 53.7% (blood sugar), 48.8% (step counts), and 31.9% (blood pressure). Laboratory data integration was achieved, but pharmacy data gaps required ongoing manual review. Focus group participants reported improved self-management and information awareness. IMPLICATIONS HIT was used to address dependency on visit-bound disease management in a novel, low-cost way. Use of a mobile health infrastructure was feasible. Text messaging solutions may mitigate barriers to access and enhance support for patients with chronic disease.
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Affiliation(s)
- Susan L Moore
- Denver Health and Hospital Authority, Denver, CO, USA
| | - Henry H Fischer
- Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado Denver School of Medicine, USA.
| | - Andrew W Steele
- Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado Denver School of Medicine, USA
| | | | - David Ginosar
- Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado Denver School of Medicine, USA
| | | | | | - Arthur J Davidson
- Denver Health and Hospital Authority, Denver, CO, USA; University of Colorado Denver School of Medicine, USA
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Wu S, Ell K, Gross-Schulman SG, Sklaroff LM, Katon WJ, Nezu AM, Lee PJ, Vidyanti I, Chou CP, Guterman JJ. Technology-facilitated depression care management among predominantly Latino diabetes patients within a public safety net care system: comparative effectiveness trial design. Contemp Clin Trials 2013; 37:342-54. [PMID: 24215775 DOI: 10.1016/j.cct.2013.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/29/2013] [Accepted: 11/01/2013] [Indexed: 01/15/2023]
Abstract
Health disparities in minority populations are well recognized. Hispanics and Latinos constitute the largest ethnic minority group in the United States; a significant proportion receives their care via a safety net. The prevalence of diabetes mellitus and comorbid depression is high among this group, but the uptake of evidence-based collaborative depression care management has been suboptimal. The study design and baseline characteristics of the enrolled sample in the Diabetes-Depression Care-management Adoption Trial (DCAT) establishes a quasi-experimental comparative effectiveness research clinical trial aimed at accelerating the adoption of collaborative depression care in safety net clinics. The study was conducted in collaboration with the Los Angeles County Department of Health Services at eight county-operated clinics. DCAT has enrolled 1406 low-income, predominantly Hispanic/Latino patients with diabetes to test a translational model of depression care management. This three-group study compares usual care with a collaborative care team support model and a technology-facilitated depression care model that provides automated telephonic depression screening and monitoring tailored to patient conditions and preferences. Call results are integrated into a diabetes disease management registry that delivers provider notifications, generates tasks, and issues critical alerts. All subjects receive comprehensive assessments at baseline, 6, 12, and 18 months by independent English-Spanish bilingual interviewers. Study outcomes include depression outcomes, treatment adherence, satisfaction, acceptance of assessment and monitoring technology, social and economic stress reduction, diabetes self-care management, health care utilization, and care management model cost and cost-effectiveness comparisons. DCAT's goal is to optimize depression screening, treatment, follow-up, outcomes, and cost savings to reduce health disparities.
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Affiliation(s)
- Shinyi Wu
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States; RAND Corporation, United States.
| | - Kathleen Ell
- School of Social Work, University of Southern California, United States.
| | | | | | - Wayne J Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington, United States.
| | - Art M Nezu
- Drexel University College of Arts and Sciences, United States.
| | - Pey-Jiuan Lee
- School of Social Work, University of Southern California, United States.
| | - Irene Vidyanti
- Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States.
| | - Chih-Ping Chou
- Keck School of Medicine, Department of Preventive Medicine, University of Southern California, United States.
| | - Jeffrey J Guterman
- Los Angeles County Department of Health Services, United States; David Geffen School of Medicine at UCLA, United States.
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Abstract
Although the importance of social supports for single mothers in times of crisis is widely recognized, little is known about the stability of such "private safety nets" over time, as children age and maternal and household characteristics change. This study uses multilevel models and 4 waves of data from the Fragile Families and Child Wellbeing Study to describe trajectories of social support perceptions for 3,065 unmarried mothers. Results suggest that, following a birth, most unmarried mothers perceive the availability of support, but these support perceptions disintegrated somewhat in subsequent years. Mothers who appeared to have the greatest need for support-those without stable employment or a stable partner-experienced more rapid deterioration of their perceived safety nets than more advantaged mothers. Future research should examine network composition and conditions for support provision among the most vulnerable single mothers and consider how safety net stability influences maternal and child health and well-being.
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Affiliation(s)
- Melissa Radey
- Florida State University College of Social Work Tallahassee, FL 32306
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