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Kookal KK, Walji MF, Brandon R, Kivanc F, Mertz E, Kottek A, Mullins J, Liang S, Jenson LE, White JM. Systematically assessing the quality of dental electronic health record data for an investigation into oral health care disparities. J Public Health Dent 2024. [PMID: 38659337 DOI: 10.1111/jphd.12618] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES This work describes the process by which the quality of electronic health care data for a public health study was determined. The objectives were to adapt, develop, and implement data quality assessments (DQAs) based on the National Institutes of Health Pragmatic Trials Collaboratory (NIHPTC) data quality framework within the three domains of completeness, accuracy, and consistency, for an investigation into oral health care disparities of a preventive care program. METHODS Electronic health record data for eligible children in a dental accountable care organization of 30 offices, in Oregon, were extracted iteratively from January 1, 2014, through March 31, 2022. Baseline eligibility criteria included: children ages 0-18 with a baseline examination, Oregon home address, and either Medicaid or commercial dental benefits at least once between 2014 and 2108. Using the NIHPTC framework as a guide, DQAs were conducted throughout data element identification, extraction, staging, profiling, review, and documentation. RESULTS The data set included 91,487 subjects, 11 data tables comprising 75 data variables (columns), with a total of 6,861,525 data elements. Data completeness was 97.2%, the accuracy of EHR data elements in extracts was 100%, and consistency between offices was strong; 29 of 30 offices within 2 standard deviations of the mean (s = 94%). CONCLUSIONS The NIHPTC framework proved to be a useful approach, to identify, document, and characterize the dataset. The concepts of completeness, accuracy, and consistency were adapted by the multidisciplinary research team and the overall quality of the data are demonstrated to be of high quality.
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Affiliation(s)
- Krishna Kumar Kookal
- Technology Services and Informatics, School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Muhammad F Walji
- Department of Clinical and Health Informatics, D. Bradley McWIlliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ryan Brandon
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Ferit Kivanc
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Elizabeth Mertz
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Aubri Kottek
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Joanna Mullins
- Willamette Dental Group and Skourtes Institute, Hillsboro, Oregon, USA
| | - Shuang Liang
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Larry E Jenson
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Joel M White
- Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA
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Rogers SM, Lopez RM, Crossway AK, Moffit DM, Sturtevant J, Hansen A. The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Foundational Knowledge and Disparities-Part I. J Athl Train 2024; 59:338-344. [PMID: 36735644 DOI: 10.4085/1062-6050-0311.22] [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] [Indexed: 02/04/2023]
Abstract
Transgender and gender-diverse (TGD) patients experience discrimination, harassment, marginalization, and minority stress at greater rates than their cisgender counterparts, leading to numerous health and health care disparities that negatively affect well-being and access to quality health care.1 Despite being in an opportune position to improve health equity for TGD patients under their care, many athletic trainers (ATs) report having little to no formal education on TGD patient care, leading to a reduction in self-reported competence. As such, to fill this knowledge gap, the purposes of the first part of this 2-part narrative literature review are to (1) provide readers with foundational information and terminology, (2) explore relevant health and health care disparities, and (3) identify the role of the AT within an interprofessional care team treating TGD patients.
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Affiliation(s)
| | - Rebecca M Lopez
- School of Physical Therapy & Rehabilitation Sciences; Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa
| | | | - Dani M Moffit
- Physical Therapy & Athletic Training Department, Idaho State University, Pocatello
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Fry JM, Antoniades J, Temple JB, Osborne RH, Cheng C, Hwang K, Brijnath B. Health literacy and older adults: Findings from a national population-based survey. Health Promot J Austr 2024; 35:487-503. [PMID: 37452578 DOI: 10.1002/hpja.779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 05/01/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
ISSUE ADDRESSED With an ageing population and growing complexity and fragmentation of health care systems, health literacy is increasingly important in managing health. This study investigated health literacy strengths and challenges reported by older Australians (people aged 65 or over) and identified how socio-demographic and health factors related to their health literacy profiles. METHODS The sample comprised 1578 individuals responding to the Australian Government's 2018 Health Literacy Survey, conducted between January and August. Regression modelling was used to estimate the association between each of nine domains of the Health Literacy Questionnaire (HLQ) and individual socio-demographic and health characteristics. The model allowed for correlation between HLQ scores that was linked to unobserved characteristics of individuals. RESULTS Across the health literacy domains, few individuals received mean scores in the lowest score range. Key individual characteristics associated with higher health literacy were increasing age, English proficiency, higher education levels, better self-assessed health and having certain chronic conditions (cancer, hypertension and arthritis). CONCLUSIONS Our findings suggest that, among those aged 65 or over, being older or living with chronic illnesses were associated with greater confidence in engaging with providers, accessing information and navigating health services compared to individuals aged 65-69 and those older individuals without chronic illness. Lower health literacy was associated with psychological distress and low English proficiency. SO WHAT?: Interventions to improve individual health literacy and organisation health literacy responsiveness to minimise complexity of the Australian health system are required. This may enhance uptake and use of health information and services for the underserviced members of the community.
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Affiliation(s)
- Jane M Fry
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Jo Antoniades
- National Ageing Research Institute (NARI), Melbourne, Victoria, Australia
| | - Jeromey B Temple
- Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Richard H Osborne
- Centre of Global Health and Equity, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Christina Cheng
- Centre of Global Health and Equity, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Kerry Hwang
- National Ageing Research Institute (NARI), Melbourne, Victoria, Australia
| | - Bianca Brijnath
- National Ageing Research Institute (NARI), Melbourne, Victoria, Australia
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Williams KKA, Baidoobonso S, Haggerty J, Lofters A, Adams AM. Anti-Black discrimination in primary health care: a qualitative study exploring internalized racism in a Canadian context. Ethn Health 2024; 29:343-352. [PMID: 38332736 DOI: 10.1080/13557858.2024.2311429] [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] [Received: 09/05/2022] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients' attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care. DESIGN This qualitative study employed purposive maximal variation and snowball sampling to recruit and interview self-identified Black persons aged 18 years and older who: (1) lived in Montréal during the COVID-19 pandemic, (2) could speak English or French, and (3) were registered with the Québec health insurance program. Adopting a phenomenological approach, in-depth interviews took place from October 2021 to July 2022. Following transcription, data were analyzed thematically. RESULTS Thirty-two participants were interviewed spanning an age range from 22 years to 79 years (mean: 42 years). Fifty-nine percent of the sample identified as women, 38% identified as men, and 3% identified as non-binary. Diversity was also reflected in terms of immigration experience, financial situation, and educational attainment. We identified three major themes that describe mechanisms through which internalized racism may manifest in health care to impact experiences: (1) the internalization of anti-Black racism by Black providers and patients, (2) the expression of anti-Black prejudice and discrimination by non-Black racialized minority providers, and (3) an insensitivity towards racial discrimination. CONCLUSION Our study suggests that multiple levels of racism, including internalized racism, must be addressed in efforts to promote health and health care equity among racialized minority groups, and particularly within Black communities.
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Affiliation(s)
| | - Shamara Baidoobonso
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Canada
| | - Aisha Lofters
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Canada
| | - Alayne M Adams
- Department of Family Medicine, McGill University, Montréal, Canada
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He A, Yan MJ, Nijhawan RI. Distribution of various demographic groups within the Medicare population at different Mohs medical practice settings. J Am Acad Dermatol 2024; 90:864-866. [PMID: 38151055 DOI: 10.1016/j.jaad.2023.12.029] [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] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Annie He
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matthew J Yan
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Whitehead RA, Patel EA, Liu JC, Bhayani MK. Racial Disparities in Head and Neck Cancer: It's Not Just About Access. Otolaryngol Head Neck Surg 2024; 170:1032-1044. [PMID: 38258967 DOI: 10.1002/ohn.653] [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: 09/13/2023] [Revised: 12/07/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Medical literature identifies stark racial disparities in head and neck cancer (HNC) in the United States, primarily between non-Hispanic white (NHW) and non-Hispanic black (NHB) populations. The etiology of this disparity is often attributed to inequitable access to health care and socioeconomic status (SES). However, other contributors have been reported. We performed a systematic review to better understand the multifactorial landscape driving racial disparities in HNC. DATA SOURCES A systematic review was conducted in Covidence following Preferred Reporting Items for Systematic Reviews and Meta-analyses Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through November 2022 evaluating racial disparities in HNC identified 2309 publications. REVIEW METHODS Full texts were screened by 2 authors independently, and inconsistencies were resolved by consensus. Three hundred forty publications were ultimately selected and categorized into themes including disparities in access/SES, treatment, lifestyle, and biology. Racial groups examined included NHB and NHW patients but also included Hispanic, Native American, and Asian/Pacific Islander patients to a lesser extent. RESULTS Of the 340 articles, 192 focused on themes of access/SES, including access to high-quality hospitals, insurance coverage, and transportation contributing to disparate HNC outcomes. Additional themes discussed in 148 articles included incongruities in surgical recommendations, tobacco/alcohol use, human papillomavirus-associated malignancies, and race-informed silencing of tumor suppressor genes. CONCLUSION Differential access to care plays a significant role in racial disparities in HNC, disproportionately affecting NHB populations. However, there are other significant themes driving racial disparities. Future studies should focus on providing equitable access to care while also addressing these additional sources of disparities in HNC.
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Affiliation(s)
- Russell A Whitehead
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Evan A Patel
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jeffrey C Liu
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Mihir K Bhayani
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Olchanski N, Zhu Y, Liang L, Cohen JT, Faul JD, Fillit HM, Freund KM, Lin PJ. Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia. J Am Geriatr Soc 2024; 72:1223-1233. [PMID: 38504583 PMCID: PMC11018481 DOI: 10.1111/jgs.18822] [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: 06/26/2023] [Revised: 01/16/2024] [Accepted: 01/28/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Research on racial and ethnic disparities in costs of care during the course of dementia is sparse. We analyzed Medicare expenditures for beneficiaries with dementia to identify when during the course of care costs are the highest and whether they differ by race and ethnicity. METHODS We analyzed data from the 2000-2016 Health and Retirement Study (HRS) linked with corresponding Medicare claims to estimate total Medicare expenditures for four phases: (1) the year before a dementia diagnosis, (2) the first year following a dementia diagnosis, (3) ongoing care for dementia after the first year, and (4) the last year of life. We estimated each patient's phase-specific and disease course Medicare expenditures by using a race-specific survival model and monthly expenditures adjusted for patient characteristics. We investigated healthcare utilization by service type across races/ethnicities and phases of care. RESULTS Adjusted mean total Medicare expenditures for non-Hispanic (NH) Black ($165,730) and Hispanic beneficiaries with dementia ($160,442) exceeded corresponding expenditures for NH Whites ($136,326). In the year preceding and immediately following initial dementia diagnosis, mean Medicare expenditures for NH Blacks ($26,337 and $20,429) exceeded expenditures for Hispanics and NH Whites ($21,399-23,176 and 17,182-18,244). The last year of life was responsible for the greatest cost contribution: $51,294 (NH Blacks), $47,469 (Hispanics), and $39,499 (NH Whites). These differences were driven by greater use of high-cost services (e.g., emergency department, inpatient and intensive care), especially during the last year of life. CONCLUSIONS NH Black and Hispanic beneficiaries with dementia had higher disease course Medicare expenditures than NH Whites. Expenditures were highest for NH Black beneficiaries in every phase of care. Further research should address mechanisms of such disparities and identify methods to improve communication, shared decision-making, and access to appropriate services for all populations.
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Affiliation(s)
- Natalia Olchanski
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Yingying Zhu
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lichen Liang
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jessica D Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Howard M Fillit
- Alzheimer's Drug Discovery Foundation, New York, New York, USA
| | - Karen M Freund
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Brooks Carthon JM, Brom H, Grantham-Murrillo M, Sliwinski K, Mason A, Roeser M, Miles D, Garcia D, Bennett J, Harhay MO, Flores E, Amenyedor K, Clark R. Equity-Centered Postdischarge Support for Medicaid-Insured People: Protocol for a Type 1 Hybrid Effectiveness-Implementation Stepped Wedge Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e54211. [PMID: 38530349 PMCID: PMC11005441 DOI: 10.2196/54211] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Disparities in posthospitalization outcomes for people with chronic medical conditions and insured by Medicaid are well documented, yet interventions that mitigate them are lacking. Prevailing transitional care interventions narrowly target people aged 65 years and older, with specific disease processes, or limitedly focus on individual-level behavioral change such as self-care or symptom management, thus failing to adequately provide a holistic approach to ensure an optimal posthospital care continuum. This study evaluates the implementation of THRIVE-an evidence-based, equity-focused clinical pathway that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home by focusing on the social determinants of health and systemic and structural barriers in health care delivery. THRIVE services include coordinating care, standardizing interdisciplinary communication, and addressing unmet clinical and social needs following hospital discharge. OBJECTIVE The study's objectives are to (1) examine referral patterns, 30-day readmission, and emergency department use for participants who receive THRIVE support services compared to those receiving usual care and (2) evaluate the implementation of the THRIVE clinical pathway, including fidelity, feasibility, appropriateness, and acceptability. METHODS We will perform a sequential randomized rollout of THRIVE to case managers at the study hospital in 3 steps (4 in the first group, 4 in the second, and 5 in the third), and data collection will occur over 18 months. Inclusion criteria for THRIVE participation include (1) being Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) residing in Philadelphia; (3) having experienced a hospitalization at the study hospital for more than 24 hours with a planned discharge to home; (4) agreeing to home care at partner home care settings; and (5) being aged 18 years or older. Qualitative data will include interviews with clinicians involved in THRIVE, and quantitative data on health service use (ie, 30-day readmission, emergency department use, and primary and specialty care) will be derived from the electronic health record. RESULTS This project was funded in January 2023 and approved by the institutional review board on March 10, 2023. Data collection will occur from March 2023 to July 2024. Results are expected to be published in 2025. CONCLUSIONS The THRIVE clinical pathway aims to reduce disparities and improve postdischarge care transitions for Medicaid-insured patients through a system-level intervention that is acceptable for THRIVE participants, clinicians, and their teams in hospitals and home care settings. By using our equity-focused case management services and leveraging the power of the electronic medical record, THRIVE creates efficiencies by identifying high-need patients, improving communication across acute and community-based sectors, and driving evidence-based care coordination. This study will add important findings about how the infusion of equity-focused principles in the design and evaluation of evidence-based interventions contributes to both implementation and effectiveness outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54211. TRIAL REGISTRATION ClinicalTrials.gov NCT05714605; https://clinicaltrials.gov/ct2/show/NCT05714605.
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Affiliation(s)
| | - Heather Brom
- University of Pennsylvania, Philadelphia, PA, United States
| | | | | | - Aleigha Mason
- University of Pennsylvania, Philadelphia, PA, United States
| | - Mindi Roeser
- Pennsylvania Hospital, Philadelphia, PA, United States
| | - Donna Miles
- Pennsylvania Hospital, Philadelphia, PA, United States
| | - Dianne Garcia
- University of Pennsylvania, Philadelphia, PA, United States
| | - Jovan Bennett
- Penn Center for Community Health Workers, Philadelphia, PA, United States
| | | | - Emilia Flores
- University of Pennsylvania Health System, Philadelphia, PA, United States
| | | | - Rebecca Clark
- Pennsylvania Hospital, Philadelphia, PA, United States
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Linggonegoro D, Williams K, Hlobik M, Huang J. Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey. JMIR Dermatol 2024; 7:e51511. [PMID: 38517468 PMCID: PMC10998172 DOI: 10.2196/51511] [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: 08/03/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 03/23/2024] Open
Abstract
Certain sociodemographic factors are associated with low technology access and digital healthy literacy.
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Affiliation(s)
- Danny Linggonegoro
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kathryn Williams
- Biostatistics and Research Design Center, ICCTR, Boston Children's Hospital, Boston, MA, United States
| | - Madeline Hlobik
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
| | - Jennifer Huang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
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Mitre M, Hosein S, Mitri A, Kurtansky NR, Mancebo SE, Fonseca M, Jacobs AK, Rotemberg V, Marchetti MA. Dermatoscopic features and potential pitfalls of artificial intelligence-based analysis of benign acral pigmented lesions in Black patients: A multicenter observational study. J Am Acad Dermatol 2024:S0190-9622(24)00502-4. [PMID: 38513834 DOI: 10.1016/j.jaad.2024.02.058] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/03/2024] [Accepted: 02/18/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Mariela Mitre
- Division of Dermatology, Department of Medicine, Hackensack University Medical Center, Nutley, New Jersey; Hackensack Meridian School of Medicine, Nutley, New Jersey.
| | - Sharif Hosein
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andia Mitri
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Lincoln Medical Center, Bronx, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York
| | | | - Silvia E Mancebo
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Maira Fonseca
- Department of Dermatology, Lincoln Medical Center, Bronx, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Ashley Keyes Jacobs
- Department of Dermatology, Lincoln Medical Center, Bronx, New York; Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Veronica Rotemberg
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Triplett PT, Prince E, Bienvenu OJ, Gerstenblith A, Carroll CP. An Observational Study of Proactive and On-Request Psychiatry Consultation Services: Evidence for Differing Roles and Outcomes. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00038-7. [PMID: 38508493 DOI: 10.1016/j.jaclp.2024.03.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Proactive psychiatric consultation services rapidly identify and assess medical inpatients in need of psychiatric care. In addition to more rapid contact, proactive services may reduce the length of stay and improve staff satisfaction. However, in some settings, it is impractical to integrate a proactive consultation service into every hospital unit; on-request and proactive services are likely to coexist in the future. Prior research has focused on changes in outcomes with the implementation of proactive services. OBJECTIVE AND METHODS This report describes differences between contemporary proactive and on-request services within the same academic medical center, comparing demographic and clinical data collected retrospectively from a 4-year period from the electronic medical record. RESULTS The proactive service saw patients over four times as many initial admissions (7592 vs. 1762), but transitions and handoffs between services were common, with 434 admissions involving both services, comprising nearly 20% of the on-request service's total contacts. The proactive service admissions had a shorter length of stay and a faster time to first psychiatric contact, and the patients seen were more likely to be female, of Black race, and to be publicly insured. There were over three times as many admissions to psychiatry from the proactive service. The on-request service's admissions had a longer length of stay, were much more likely to involve intensive care unit services, surgical services, and transfers among units, and the patients seen were more likely to die in the hospital or to be discharged to subacute rehabilitation. CONCLUSIONS Overall, the results suggest that the two services fulfill complementary roles, with the proactive service's rapid screening and contact providing care to a high volume of patients who might otherwise be unidentified and underserved. Simultaneously, the on-request service's ability to manage patients in response to consult requests over a much larger area of the hospital provided important support and continuity for patients with complex health needs. Institutions revising their consultation services will likely need to consider the best balance of these differing functions to address perceived demand for services.
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Affiliation(s)
- Patrick T Triplett
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Elizabeth Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Avi Gerstenblith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
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Spaulding EM, Fang M, Chen Y, Commodore-Mensah Y, Himmelfarb CR, Martin SS, Coresh J. Satisfaction with Telehealth Care in the United States: Cross-Sectional Survey. Telemed J E Health 2024. [PMID: 38452337 DOI: 10.1089/tmj.2023.0531] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: Telehealth use remains high following the COVID-19 pandemic, but patient satisfaction with telehealth care is unclear. Methods: We used cross-sectional data from the Health Information National Trends Survey (HINTS 6). 2,058 English and Spanish-speaking U.S. adults (≥18 years) with a telehealth visit in the 12 months before March-November 2022 were included in this study. The primary outcomes were telehealth visit modality and satisfaction in the 12 months before HINTS 6. We evaluated sociodemographic predictors of telehealth visit modality and satisfaction via Poisson regression. Analyses were weighted according to HINTS standards. Results: We included 2,058 participants (48.4 ± 16.8 years; 57% women; 66% White), of which 70% had an audio-video and 30% an audio-only telehealth visit. Adults with an audio-video visit were more likely to have health insurance (adjusted prevalence ratio [aPR]: 1.55, 95% confidence interval [CI]: 1.18-2.04) and have an annual household income of ≥$75,000 (aPR: 1.18, 95% CI: 1.00-1.39) and less likely to be ≥65 years (aPR: 0.79, 95% CI: 0.70-0.89), adjusting for sociodemographic characteristics. No further inequities were noted by telehealth modality. Seventy-five percent of participants felt that their telehealth visits were as good as in-person care. No significant differences in telehealth satisfaction were observed across sociodemographic characteristics, telehealth modality, or the participants' primary reason for their most recent telehealth visit in adjusted analysis. Conclusions: Among U.S. adults with a telehealth visit, the majority had an audio-video visit and were satisfied with their care. Telehealth should continue, being offered following COVID-19, as it is uniformly valued by patients.
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Affiliation(s)
- Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Digital Health Innovation Laboratory, Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael Fang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yuling Chen
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Health Equity, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Center for Health Equity, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Seth S Martin
- Digital Health Innovation Laboratory, Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Health Equity, Johns Hopkins University, Baltimore, Maryland, USA
- Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Optimal Aging Institute and Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Antonio AA, Anderson T, Ngo V, Park S, Woolner S, Farooq M, Santos R, Gorelick P. Diversity, Equity, and Inclusion Lessons From Developing Stroke Education Programs for West Michigan Asian Communities. Stroke 2024; 55:757-761. [PMID: 38299388 DOI: 10.1161/strokeaha.123.043092] [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: 03/03/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Asians in the United States, facing health care disparities, have increased stroke risk. Multiple subgroups, with distinct cultures and languages, add complexity to caring for Asian American (AsA) communities. We developed a tailored stroke education program for underserved West Michigan AsA communities. Methodology, lessons learned, and diversity, equity, and inclusion insights are described. METHODS Neurology residents and faculty, in collaboration with trained community-specific navigators, developed culturally resonant stroke education that was tailored to meet the needs of specific self-identified West Michigan AsA communities. Educational and debriefing sessions were delivered over 6 months, following the Plan-Do-Study-Act model, to elucidate diversity, equity, and inclusion insights and improve materials and delivery methods. RESULTS Eighty-six non-English-speaking participants from 5 self-identified AsA communities (Burmese, Buddhist Vietnamese, Catholic Vietnamese, Chinese, and Nepali) attended educational stroke sessions. The average age of attendees was 57.6±13.2 years; most were females (70%). Diversity, equity, and inclusion insights included identification of Asian cultural beliefs about acute stroke treatment (eg, bloodletting), investigator insights (eg, need for kitchen-table programs), systemic barriers (eg, language), and mitigation strategies. CONCLUSIONS Institutions should consider the integration of equity-focused, trainee-influenced quality improvement projects, such as this culturally resonant stroke educational program for AsA, to enhance stroke care in these vulnerable communities.
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Affiliation(s)
- Aileen A Antonio
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Taylor Anderson
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Vincent Ngo
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Sojung Park
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Susan Woolner
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Muhammad Farooq
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Ronel Santos
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
| | - Philip Gorelick
- Hauenstein Neurosciences, Trinity Health Grand Rapids, MI (A.A.A., T.A., V.N., S.P., S.W., M.F., R.S., P.G.)
- Davee Department of Neurology, Northwestern University, Chicago, IL (P.G.)
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Pampati S, Liddon N, Stuart EA, Waller LA, Mpofu JJ, Lopman B, Adkins SH, Guest JL, Jones J. Disparities in Unmet Health Care Needs Among US Children During the COVID-19 Pandemic. Ann Fam Med 2024; 22:130-139. [PMID: 38527826 DOI: 10.1370/afm.3079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 03/27/2024] Open
Abstract
PURPOSE The COVID-19 pandemic disrupted pediatric health care in the United States, and this disruption layered on existing barriers to health care. We sought to characterize disparities in unmet pediatric health care needs during this period. METHODS We analyzed data from Wave 1 (October through November 2020) and Wave 2 (March through May 2021) of the COVID Experiences Survey, a national longitudinal survey delivered online or via telephone to parents of children aged 5 through 12 years using a probability-based sample representative of the US household population. We examined 3 indicators of unmet pediatric health care needs as outcomes: forgone care and forgone well-child visits during fall 2020 through spring 2021, and no well-child visit in the past year as of spring 2021. Multivariate models examined relationships of child-, parent-, household-, and county-level characteristics with these indicators, adjusting for child's age, sex, and race/ethnicity. RESULTS On the basis of parent report, 16.3% of children aged 5 through 12 years had forgone care, 10.9% had forgone well-child visits, and 30.1% had no well-child visit in the past year. Adjusted analyses identified disparities in indicators of pediatric health care access by characteristics at the level of the child (eg, race/ethnicity, existing health conditions, mode of school instruction), parent (eg, childcare challenges), household (eg, income), and county (eg, urban-rural classification, availability of primary care physicians). Both child and parent experiences of racism were also associated with specific indicators of unmet health care needs. CONCLUSIONS Our findings highlight the need for continued research examining unmet health care needs and for continued efforts to optimize the clinical experience to be culturally inclusive.
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Affiliation(s)
- Sanjana Pampati
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
- Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Nicole Liddon
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
| | - Elizabeth A Stuart
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| | - Lance A Waller
- Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Jonetta J Mpofu
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Benjamin Lopman
- Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Susan Hocevar Adkins
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Jodie L Guest
- Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Jeb Jones
- Emory University, Rollins School of Public Health, Atlanta, Georgia
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Rhudy CN, Perry CL, Hawk GS, Flomenhoft DR, Talbert JC, Barrett TA. Inflammatory Bowel Disease in Appalachian Kentucky: An Investigation of Outcomes and Health Care Utilization. Inflamm Bowel Dis 2024; 30:410-422. [PMID: 37280118 PMCID: PMC10906357 DOI: 10.1093/ibd/izad096] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND Rural residence has been associated with a lower incidence of inflammatory bowel disease (IBD) but higher health care utilization and worse outcomes. Socioeconomic status is intrinsically tied to both IBD incidence and outcomes. Inflammatory bowel disease outcomes have not been investigated in Appalachia: a rural, economically distressed region rife with risk factors for both increased incidence and unfavorable outcomes. METHODS Hospital inpatient discharge and outpatient services databases were utilized to assess outcomes in patients diagnosed with either Crohn's disease (CD) or ulcerative colitis (UC) in Kentucky. Encounters were classified by patient residence in Appalachian or non-Appalachian counties. Data were reported as crude and age-adjusted rates of visits per 100,000 population per year collected in 2016 to 2019. National inpatient discharge data from 2019, stratified by rural and urban classification codes, were utilized to compare Kentucky to national trends. RESULTS Crude and age-adjusted rates of inpatient, emergency department and outpatient encounters were higher in the Appalachian cohort for all 4 years observed. Appalachian inpatient encounters are more frequently associated with a surgical procedure (Appalachian, 676, 24.7% vs non-Appalachian, 1408, 22.2%; P = .0091). In 2019, the Kentucky Appalachian cohort had significantly higher crude and age-adjusted rates of inpatient discharges for all IBD diagnoses compared with national rural and nonrural populations (crude 55.2; 95% CI, 50.9-59.5; age-adjusted 56.7; 95% CI, 52.1-61.3). CONCLUSIONS There is disproportionately higher IBD health care utilization in Appalachian Kentucky compared with all cohorts, including the national rural population. There is a need for aggressive investigation into root causes of these disparate outcomes and identification of barriers to appropriate IBD care.
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Affiliation(s)
- Christian N Rhudy
- University of Kentucky Healthcare, Specialty Pharmacy and Infusion Services, Lexington, Kentucky, USA
| | - Courtney L Perry
- University of Kentucky College of Medicine, Department of Medicine, Division of Digestive Diseases and Nutrition, Lexington, Kentucky, USA
- University of Kentucky Healthcare, Specialty Pharmacy and Infusion Services, Lexington, Kentucky, USA
| | - Gregory S Hawk
- University of Kentucky, Dr. Bing Zhang Department of Statistics, Lexington, Kentucky, USA
| | - Deborah R Flomenhoft
- University of Kentucky College of Medicine, Department of Medicine, Division of Digestive Diseases and Nutrition, Lexington, Kentucky, USA
| | - Jeffery C Talbert
- University of Kentucky College of Medicine, Division of Biomedical Informatics, Lexington, Kentucky, USA
| | - Terrence A Barrett
- University of Kentucky College of Medicine, Department of Medicine, Division of Digestive Diseases and Nutrition, Lexington, Kentucky, USA
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16
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Bonfim S, Massago M, de Carvalho Dutra A, Arruda MHB, Oliveira FS, Thomaz ÉBAF, de Souza EM, Nihei OK, de Andrade L. Hospitalizations for Cardiovascular Diseases Sensitive to Primary Health Care in Paraná State, Brazil: A Bayesian Spatiotemporal Model. Ann Fam Med 2024; 22:140-148. [PMID: 38527827 DOI: 10.1370/afm.3083] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/01/2023] [Accepted: 11/29/2023] [Indexed: 03/27/2024] Open
Abstract
PURPOSE To analyze spatiotemporal trends in hospitalizations for cardiovascular diseases (CVD) sensitive to primary health care (PHC) among individuals aged 50-69 years in Paraná State, Brazil, from 2014 to 2019 and investigate correlations between PHC services and the Social Development Index. METHODS We conducted a cross-sectional ecological study using publicly available secondary data to analyze the municipal incidence of hospitalizations for CVD sensitive to PHC and to estimate the risk of hospitalization for this group of diseases and associated factors using hierarchical Bayesian spatiotemporal modeling with Markov chain Monte Carlo simulation. RESULTS There was a 5% decrease in the average rate of hospitalizations for PHC-sensitive CVD from 2014 to 2019. Regarding standardized hospitalization rate (SHR) according to population size, we found that no large municipality had an SHR >2. Likewise, a minority of these municipalities had SHR values of 1-2 (33%). However, many small and medium-sized municipalities had SHR values >2 (47% and 48%, respectively). A greater Social Development Index value served as a protective factor against hospitalizations, with a relative risk of 0.957 (95% credible interval, 0.929-0.984). CONCLUSIONS The annual risk of hospitalization decreased over time; however, small municipalities had the greatest rates of hospitalization, indicating an increase in health inequity. The inverse association between social development and hospitalizations for CVD sensitive to PHC raises questions about intersectionality in health care.
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Affiliation(s)
- Samile Bonfim
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | - Miyoko Massago
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | | | | | - Fernanda Silva Oliveira
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
| | | | | | - Oscar Kenji Nihei
- Center for Education, Linguistics and Health, Western Paraná State University, Foz do Iguaçu, Paraná, Brazil
| | - Luciano de Andrade
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
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Zagloul MM, Bock JM, Blumin JH, Friedland DR, Adams JA, Tong L, Osinksi KI, Khani M, Luo J. Evaluation of Social Determinants of Health on Dysphagia Care Pathways at a Tertiary Care Facility. Laryngoscope 2024; 134:1139-1146. [PMID: 37681733 DOI: 10.1002/lary.31040] [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: 03/14/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Limited research exists evaluating the impact of social determinants of health in influencing care pathways for patients with dysphagia. A better understanding of whether these determinants correlate to altered care and resource utilization is essential as it relates to patient outcomes. STUDY DESIGN Retrospective chart review. METHODS All adult patients seen at a tertiary midwestern hospital were screened for ICD codes of dysphagia diagnoses from 2009 to 2019. Demographic information was collected from these patients with dysphagia including sex, race, ethnicity, and insurance status. Subgroup analysis was performed to assess referral pattern rates and types of diagnostic interventions ordered (none, videofluoroscopic swallow study, esophagram, and esophagogastroduodenoscopy). RESULTS A total of 31,858 patients with dysphagia were seen at our institution during the study period, with a majority being female (56.36%), Caucasian (79.83%), and publicly insured (63.16%), at a median age of 60.35 years. There were no significant care delivery pattern differences based on geography/zip code analyses. African American patients were significantly more likely to have imaging or interventions performed (odds ratio [OR] 1.463, p = 0.005). Patients with public insurance also had higher rates of diagnostic study utilization (OR 1.53, p = 0.01). Only 3% of all patients with dysphagia were seen by laryngologists. CONCLUSION No significant differences were seen in dysphagia evaluation modalities based on zip code analyses surrounding this tertiary care facility. African American patients and those with public insurance had significantly higher utilization of subsequent testing and intervention for dysphagia care. Further studies are necessary to delineate causes and outcome differences for these measurable differences in dysphagia care pathways. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1139-1146, 2024.
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Affiliation(s)
- Maie M Zagloul
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jonathan M Bock
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Joel H Blumin
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - David R Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jazzmyne A Adams
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Ling Tong
- Department of Health Informatics and Administration, University of Wisconsin - Milwaukee, Milwaukee, Wisconsin, U.S.A
| | - Kristen I Osinksi
- Clinical and Translational Science Institute, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Masoud Khani
- Department of Engineering and Applied Science, University of Wisconsin - Milwaukee, Milwaukee, Wisconsin, U.S.A
| | - Jake Luo
- Department of Health Informatics and Administration, University of Wisconsin - Milwaukee, Milwaukee, Wisconsin, U.S.A
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18
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Casey SD, Stubblefield WB, Luijten D, Klok FA, Westafer LM, Vinson DR, Kabrhel C. Addressing the rising trend of high-risk pulmonary embolism mortality: Clinical and research priorities. Acad Emerg Med 2024; 31:288-292. [PMID: 38129964 DOI: 10.1111/acem.14859] [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: 09/05/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Deaths from high-risk pulmonary embolism (PE) appear to have increased in the US over the last decade. Modifiable risks contributing to this worrisome trend present opportunities for physicians, researchers, and healthcare policymakers to improve care. METHODS We sought to contextualize contemporary, high-risk PE epidemiology and examine clinical trials, quality improvement opportunities, and healthcare policy initiatives directed at reducing mortality. RESULTS We observed significant and modifiable excess mortality due to high-risk PE. We identified several opportunities to improve care including: (1) rapid translation of forthcoming data on reperfusion strategies into clinical practice; (2) improved risk stratification tools; (3) quality improvement initiatives to address presumptive anticoagulation practice gaps; and (3) adoption of health policy initiatives to establish pulmonary embolism response teams and address the social determinants of health. CONCLUSION Addressing knowledge and practice gaps in intermediate and high-risk PE management must be prioritized and informed by forthcoming high-quality data. Implementation efforts are needed to improve acute PE management and resolve treatment disparities.
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Affiliation(s)
- Scott D Casey
- Kaiser Permanente Division of Research, Oakland, California, USA
- The Kaiser Permanente CREST Network, Oakland, California, USA
- Department of Emergency Medicine, Kaiser Permanente Vallejo Medical Center, Vallejo, California, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dieuwke Luijten
- Department of Medicine-Thrombosis and Hemostasis, Leiden University Medicine Center, Leiden, Netherlands
| | - Frederikus A Klok
- Department of Medicine-Thrombosis and Hemostasis, Leiden University Medicine Center, Leiden, Netherlands
| | - Lauren M Westafer
- Department of Emergency Medicine, UMASS Chan Medical School-Baystate, Springfield, Massachusetts, USA
- Department of Healthcare Delivery and Population Science, UMASS Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - David R Vinson
- Kaiser Permanente Division of Research, Oakland, California, USA
- The Kaiser Permanente CREST Network, Oakland, California, USA
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California, USA
| | - Christopher Kabrhel
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Chen M, Bacong AM, Feng C, Kikuta NT, Datir RR, Chen S, Srinivasan M, Camargo CA, Palaniappan L, Arroyo AC. Asthma heterogeneity among Asian American children: The California Health Interview Survey. Ann Allergy Asthma Immunol 2024; 132:368-373.e2. [PMID: 37949352 PMCID: PMC10922489 DOI: 10.1016/j.anai.2023.10.030] [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: 08/02/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden among AsA ethnic groups. The relation between obesity and asthma in AsA ethnic groups also remains unclear. OBJECTIVE To evaluate asthma prevalence and the relation of obesity to asthma risk among children in 7 AsA ethnic groups. METHODS We analyzed data from the California Health Interview Survey from 2011 to 2020. AsA ethnicities were self-reported. Body mass index z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on body mass index-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months was calculated. We performed multivariable logistic regressions adjusting for age and sex. RESULTS Of 34,146 survey respondents, 12.2% non-Hispanic White and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Non-Hispanic White children and AsA children had a similar lifetime asthma prevalence (adjusted odds ratio [aOR], 1.05; 95% CI, 0.71-1.55; P = .81), but prevalence was lower in Korean American children (aOR, 0.37; 95% CI, 0.19-0.73; P = .004) and higher in Filipino American children (aOR, 1.97; 95% CI, 1.22-3.17; P = .006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status. CONCLUSION Childhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence in Korean American children and highest prevalence in Filipino American. Further characterization of asthma burden among AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.
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Affiliation(s)
- Meng Chen
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Center for Asian Health Research and Education, Stanford, California.
| | - Adrian Matias Bacong
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Charles Feng
- Division of Allergy/Immunology, Palo Alto Medical Foundation, Mountain View, California
| | | | - Rohan Rahul Datir
- Stanford Center for Asian Health Research and Education, Stanford, California
| | - Shihua Chen
- Stanford Center for Asian Health Research and Education, Stanford, California
| | - Malathi Srinivasan
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Carlos A Camargo
- Department of Emergency Medicine and Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Latha Palaniappan
- Stanford Center for Asian Health Research and Education, Stanford, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Epidemiology and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Anna Chen Arroyo
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Center for Asian Health Research and Education, Stanford, California
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Faraj KS, Kaufman SR, Oerline M, Herrel LA, Maganty A, Caram MEV, Shahinian VB, Hollenbeck BK. The 340B Program and oral specialty drugs for advanced prostate cancer. Cancer 2024. [PMID: 38395607 DOI: 10.1002/cncr.35262] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Expensive oral specialty drugs for advanced prostate cancer can be associated with treatment disparities. The 340B program allows hospitals to purchase medications at discounts, generating savings that can improve care of the socioeconomically disadvantaged. This study assessed the effect of hospital 340B participation on advanced prostate cancer. METHODS The authors performed a retrospective cohort study of Medicare beneficiaries with advanced prostate cancer from 2012 to 2019. The primary outcome was use of an oral specialty drug. Secondary outcomes included monthly out-of-pocket costs and treatment adherence. We evaluated the effects of 1) hospital 340B participation, 2) a regional measure vulnerability, the social vulnerability index (SVI), and 3) the interaction between hospital 340B participation and SVI on outcomes. RESULTS There were 2237 and 1100 men who received care at 340B and non-340B hospitals. There was no difference in specialty drug use between 340B and non-340B hospitals, whereas specialty drug use decreased with increased SVI (odds ratio, 0.95, p = .038). However, the interaction between hospital 340B participation and SVI on specialty drug use was not significant. Neither 340B participation, SVI, or their interaction were associated with out-of-pocket costs. Although hospital 340B participation and SVI were not associated with treatment adherence, their interaction was significant (p = .020). This demonstrated that 340B was associated with better adherence among socially vulnerable men. CONCLUSIONS The 340B program was not associated with specialty drug use in men with advanced prostate cancer. However, among those who were started on therapy, 340B was associated with increased treatment adherence in more socially vulnerable men.
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Affiliation(s)
- Kassem S Faraj
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Samuel R Kaufman
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Avinash Maganty
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan E V Caram
- VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Vahakn B Shahinian
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Dowlatshahi S, Koh J, Vyas A, Mack WJ, Turner BJ. Disparities in Care for Low-Income Patients with Cirrhosis: Implementing an Innovative Outpatient Clinic for Refractory Ascites in a Safety Net Hospital. J Gen Intern Med 2024:10.1007/s11606-024-08675-0. [PMID: 38378980 DOI: 10.1007/s11606-024-08675-0] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Disparities in life-saving interventions for low-income patients with cirrhosis necessitate innovative models of care. AIM To implement a novel generalist-led FLuid ASPiration (FLASP) clinic to reduce emergency department (ED) care for refractory ascites. SETTING A large safety net hospital in Los Angeles. PARTICIPANTS MediCal patients with paracentesis in the ED from 6/1/2020 to 1/31/2021 or in FLASP clinic or the ED from 3/1/2021 to 4/30/2022. PROGRAM DESCRIPTION According to RE-AIM, adoption obtained administrative endorsement and oriented ED staff. Reach engaged ED staff and eligible patients with timely access to FLASP. Implementation trained FLASP clinicians in safer, guideline-based paracentesis, facilitated timely access, and offered patient education and support. PROGRAM EVALUATION After FLASP clinic opened, significantly fewer ED visits were made by patients discharged after paracentesis [rate ratio (RR) of 0.33 (95% CI 0.28, 0.40, p < 0.0001)] but not if subsequently hospitalized (RR = 0.88, 95% CI 0.70, 1.11). Among 2685 paracenteses in 225 FLASP patients, complications were infrequent: 39 (1.5%) spontaneous bacterial peritonitis, 265 (9.9%) acute kidney injury, and 2 (< 0.001%) hypotension. FLASP patients rated satisfaction highly on a Likert-type question. DISCUSSION Patients with refractory ascites in large safety net hospitals may benefit from an outpatient procedure clinic instead of ED care.
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Affiliation(s)
- Shadi Dowlatshahi
- Department of Hospital Medicine, Los Angeles General Medical Center, Los Angeles, CA, USA
- Department of Medicine, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - Jennifer Koh
- Department of Medicine, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - Annasha Vyas
- Department of Medicine, Keck Medical Center of University of Southern California, Los Angeles, CA, USA
| | - Wendy J Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, USC, Los Angeles, CA, USA
| | - Barbara J Turner
- Department of Medicine, Keck Medical Center of University of Southern California, Los Angeles, CA, USA.
- Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine of USC, Clinical Sciences Center, Los Angeles, CA, USA.
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22
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Patel EA, Shah SV, Poulson TA, Jagasia AA. An Integrative Model of ENT Healthcare for the Homeless Population. Laryngoscope 2024. [PMID: 38362639 DOI: 10.1002/lary.31332] [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: 07/18/2023] [Revised: 11/29/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Our aim was to determine the need for otolaryngology care within the homeless population, identify barriers to access that the homeless population may face, and develop a model system which would address these needs with respect to the barriers. METHODS A retrospective chart review of 812 patients seen between 1/25/16-3/21/2020 was performed. Charts were obtained from homeless patients seen at free general clinics held shelters in Chicago, IL (781 charts) and in Champaign, IL (31 charts). Records reporting at least one otolaryngology disease in a patient experiencing homelessness were included in this study. Patients were considered homeless if they resided at the shelter at the time of their appointment. To determine common barriers to care, a simple yes/no questionnaire was administered to residents at west-side Chicago homeless shelters. Questions addressed barriers to health care access that had been mentioned by patients seen at free clinics. RESULTS Chart review findings demonstrated that 14.3% (n = 142) of all homeless patients seen at free in-shelter clinics were seen for ENT-related disorders. Survey results revealed that 76.3% (n = 71) of respondents believed that telemedicine services would be useful in shelters. 74.2% (n = 69) stated they were unable to afford prescribed medications. 93.5% (n = 87) stated that better access to transportation would increase their likelihood of seeking care. CONCLUSIONS In our attempt to bridge this inequity, we have launched a hybrid in-person/virtual care program to improve access to otolaryngology care for the homeless community. LEVEL OF EVIDENCE N/A Laryngoscope, 2024.
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Affiliation(s)
- Evan A Patel
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Swapnil V Shah
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Creighton University School of Medicine, Omaha, Nebraska, U.S.A
| | - Trevor A Poulson
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Ashok A Jagasia
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Felzer JR, Montgomery A, LeMahieu AM, Finney Rutten LJ, Juhn YJ, Wi CI, Jacobson RM, Kennedy CC. Disparities in Influenza, Pneumococcal, COVID-19 Vaccine Coverage in High-Risk Adults 19 to 64 Years of Age in Southeastern Minnesota, 2010-2021. Chest 2024:S0012-3692(24)00145-4. [PMID: 38342164 DOI: 10.1016/j.chest.2024.01.049] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/17/2023] [Accepted: 01/24/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Despite effective vaccines against influenza, pneumococcus, and COVID-19, uptake has been suboptimal. RESEARCH QUESTION Although disparities in vaccination by race and ethnicity have been observed, what is the role of other sociodemographic in US vaccine uptake? STUDY DESIGN AND METHODS We conducted a population-based study using the Rochester Epidemiology Project (REP), a comprehensive medical records linkage system, to assess effects of sociodemographic factors including race, ethnicity, individual-level socioeconomic status (SES) via the housing-based socioeconomic status index, education, population density (urban or nonurban), and marital status with uptake of influenza, pneumococcal, and COVID-19 vaccination in high-risk adults. Adults at high risk of invasive pneumococcal disease residing in four counties in southeastern Minnesota who were 19 to 64 years of age were identified. Vaccination data were obtained from the Minnesota Immunization Information Connection and REP from January 1, 2010, through December 31, 2021. RESULTS We identified 45,755 residents. Most were White (82%), non-Hispanic (94%), married (56%), and living in an urban setting (81%), with three-quarters obtaining at least some college education (74%). Although 45.1% were up-to-date on pneumococcal vaccines, 60.1% had completed the primary COVID-19 series. For influenza and COVID-19, higher SES, living in an urban setting, older age, and higher education positively correlated with vaccination. Magnitude of differences in race, education, and SES widened with booster vaccines. INTERPRETATION This high-risk population is undervaccinated against preventable respiratory diseases, especially influenza and pneumococcus. Although national data reported improvement of disparities in COVID-19 vaccination uptake observed early in the pandemic, our data demonstrated gaps related to race, education level, SES, and age that widened with booster vaccines. Communities with high social vulnerabilities often show increased risk of severe disease outcomes, yet demonstrate lower uptake of preventive services. This highlights the need to understand better vaccine compliance and access in rural, lower SES, less-educated, Black, Hispanic, and younger populations, each of which were associated independently with decreased vaccination.
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Affiliation(s)
- Jamie R Felzer
- Division of Pulmonary & Critical Care, Mayo Clinic, Rochester, MN
| | | | - Allison M LeMahieu
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Lila J Finney Rutten
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Young J Juhn
- Divisions of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Chung-Il Wi
- Divisions of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Robert M Jacobson
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Divisions of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine
| | - Cassie C Kennedy
- Division of Pulmonary & Critical Care, Mayo Clinic, Rochester, MN; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN.
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24
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Hill RC, Axler E, Curtis KL, Katsiaunis A, Lipner SR. Representation for all: Educational handouts inclusive of patient skin color in a nail specialty clinic. J Am Acad Dermatol 2024; 90:e57. [PMID: 37844689 DOI: 10.1016/j.jaad.2023.10.013] [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] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023]
Affiliation(s)
| | - Eden Axler
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | | | | | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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25
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Zheng M, Wandell GM, Maxin AJ, Gomez-Castillo LA, Giliberto JP, Bhatt NK. Sociodemographic Disparities in Tracheostomy Timing and Outcomes. Laryngoscope 2024; 134:582-587. [PMID: 37584408 DOI: 10.1002/lary.30872] [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: 03/01/2023] [Revised: 05/30/2023] [Accepted: 06/25/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE Tracheostomies are commonly performed in critically ill patients requiring prolonged mechanical ventilation. Although early tracheostomy has been associated with improved outcomes, the reasons for delayed tracheostomy are complex. We examined the impact of sociodemographic factors on tracheostomy timing and outcomes. METHODS Medical records were retrospectively reviewed of ventilator-dependent adult patients who underwent tracheostomy from 2021 to 2022. Tracheostomy timing was defined as routine (<21 days) versus late (21 days or more). Sociodemographic variables were compared between cohorts using univariate and multivariate models. Secondary outcomes included hospital length of stay (LOS), decannulation, tracheostomy-related complications, and inhospital mortality. RESULTS One hundred forty-two patients underwent tracheostomy after initial intubation: 74.7% routine (n = 106) and 25.4% late (n = 36). In a multivariate model adjusted for age, race, surgical service, tracheostomy technique, and time between consultation and surgery, non-English speaking patients and women were more likely to receive a late tracheostomy compared with English speaking patients and men, respectively (odds ratio [OR] 3.18, 95% confidence interval [CI] 1.03, 9.81, p < 0.05), (OR 3.15, 95% CI 1.18, 8.41, p < 0.05). Late tracheostomy was associated with longer median hospital LOS (62 vs. 52 days, p < 0.05). Tracheostomy timing did not significantly impact mortality, decannulation or tracheostomy-related complications. CONCLUSION Despite an association between earlier tracheostomy and shorter LOS, non-English speaking patients and female patients are more likely to receive a late tracheostomy. Standardized protocols for tracheostomy timing may address bias in the referral and execution of tracheostomy and reduce unnecessary hospital days. LEVEL OF EVIDENCE 4 Laryngoscope, 134:582-587, 2024.
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Affiliation(s)
- Melissa Zheng
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Grace M Wandell
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Anthony J Maxin
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
- School of Medicine, Creighton University, Omaha, Nebraska, U.S.A
| | - Luis A Gomez-Castillo
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - John P Giliberto
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
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26
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Cater M, Kuruvilla R, Lee J, Alibeji N, Wilaisakditipakorn TJ, Clark M. Resident Experiences in Pathways to Health for Cleveland Refugees: A Pilot Study. Clin Pediatr (Phila) 2024; 63:195-200. [PMID: 37151088 DOI: 10.1177/00099228231171231] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Refugee families often report discomfort with navigating the United States health care system, while medical trainees feel unprepared to meet the needs of refugee families. Pediatric residents partnered with a local refugee resettlement organization to create and deliver a user-friendly health care navigation curriculum to newly arrived refugee families. Pediatric residents completed pre-intervention and post-intervention surveys to assess their comfort and interest in working with refugee populations. Residents reported high interest in working with refugees despite little direct experience working with this population. There was a significant increase in residents' reported understanding of refugee health as a result of this intervention. Future research is needed to assess the efficacy of such curricula for both refugee families and pediatric residents.
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Affiliation(s)
- Mackenzie Cater
- University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Rebecca Kuruvilla
- University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Jenny Lee
- University of Michigan, Ann Arbor, MI, USA
| | - Naba Alibeji
- University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | | | - Marie Clark
- University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
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Breathett K, Manning KD. Catalyzing Restructure of a Broken Health Care System. Circ Cardiovasc Qual Outcomes 2024; 17:e010009. [PMID: 38377225 PMCID: PMC10949780 DOI: 10.1161/circoutcomes.123.010009] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Khadijah Breathett
- Division of Cardiovascular Medicine, Department of Medicine, Indiana University, Indianapolis (K.B.)
| | - Kimberly D Manning
- Division of General Medicine, Department of Medicine, Emory University, Atlanta, GA (K.D.M.)
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Pappalardo AA, Codispoti CD, Mahdavinia M. Health care access in allergy and immunology: Problems and potential solutions. J Allergy Clin Immunol 2024; 153:401-403. [PMID: 37926120 DOI: 10.1016/j.jaci.2023.10.020] [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] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Andrea A Pappalardo
- Department of Internal Medicine, University of Illinois Chicago, Chicago, Ill; Department of Pediatrics, University of Illinois Chicago, Chicago, Ill
| | - Christopher D Codispoti
- Department of Internal Medicine, Rush University Medical Center, Chicago, Ill; Department of Pediatrics, Rush University Medical Center, Chicago, Ill.
| | - Mahboobeh Mahdavinia
- Department of Internal Medicine, Rush University Medical Center, Chicago, Ill; Department of Pediatrics, Rush University Medical Center, Chicago, Ill
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29
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Natour AK, Shepard A, Nypaver T, Weaver M, Peshkepija A, Kafri O, Kabbani L. Socioeconomic status is not associated with unfavorable outcomes in patients with acute limb ischemia. Vascular 2024; 32:118-125. [PMID: 36117451 DOI: 10.1177/17085381221124994] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Whether socioeconomic status (SES) is associated with health outcomes in patients with acute limb ischemia (ALI) is largely unknown. We aimed to determine whether SES is associated with worse presentations and outcomes for patients with ALI. METHODS We performed a retrospective medical record review of patients who presented with ALI between April 2016 and October 2020 at a single tertiary care center. SES was quantified using individual variables (median household income, level of education, and employment) and a composite endpoint, the neighborhood deprivation index (NDI). The NDI is a standardized and reproducible index that uses census tract data (higher number indicates lower SES status). The NDI summarizes 8 domains of socioeconomic deprivation. ALI severity was categorized using the Rutherford classification. The association between SES and the severity of ALI at presentation and between SES and other health outcomes were analyzed using bivariate analysis of variance, independent t test, and multivariate logistic regression. RESULTS During the study period, 278 patients were treated for ALI, of whom 211 had complete SES data available. The mean age was 64 years, 55% were men, and 57% were White. The Rutherford classification of disease severity was grade 1, 2a, 2b, and 3 for 6%, 54%, 32%, and 8% of patients, respectively. Patients with a low SES status per the NDI were more likely to have a history of peripheral arterial disease and chronic kidney disease at presentation. The ALI etiology (thrombotic vs embolic) was not associated with SES. No significant differences were seen between SES and the severity of ALI at presentation (p = 0.96) or the treatment modality (p = 0.80). No associations between SES and 30-day or 1-year mortality were observed (mean NDI, 0.15 vs 0.26, p = 0.58, and 0.20 vs 0.26, p = 0.71, respectively) or between SES and 30-day or 1-year limb loss (mean NDI, 0.06 vs 0.30, p = 0.18, and 0.1 vs 0.32, p = 0.17, respectively). Lower SES (higher NDI) was associated with increased 30-day readmission (mean NDI, 0.49 vs 0.15, p = 0.021). However, this association was not significant on multivariate analysis (odds ratio 1.4, 95% CI 0.9-2.1, p = 0.06). CONCLUSIONS SES was not associated with the severity of ALI at patient presentation. Although SES was associated with the presence of peripheral arterial disease and chronic kidney disease at presentation, SES was not a predictor of short-term or 1-year limb loss and mortality. Overall, ALI presentation and treatment outcomes were independent of SES.
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Affiliation(s)
| | | | - Timothy Nypaver
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Mitchell Weaver
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Andi Peshkepija
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Omar Kafri
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Loay Kabbani
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, MI, USA
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30
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Ishmael L, Apter A, Busse PJ, Calderon-Candelario R, Carroll JK, Casale T, Celedón JC, Cohen R, Coyne-Beasley T, Cui J, Ericson B, Hernandez P, Kaelber DC, Maher N, Merriman C, Mosnaim G, Nazario S, Phipatanakul W, Pinto-Plata V, Riley I, Shenoy K, Wisnivesky J, Yawn B, Israel E, Cardet JC. Asthma morbidity measures across Black ethnic subgroups. J Allergy Clin Immunol 2024; 153:408-417. [PMID: 38000696 PMCID: PMC10922293 DOI: 10.1016/j.jaci.2023.10.028] [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: 06/21/2023] [Revised: 10/04/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Black adults are disproportionately affected by asthma and are often considered a homogeneous group in research studies despite cultural and ancestral differences. OBJECTIVE We sought to determine if asthma morbidity differs across adults in Black ethnic subgroups. METHODS Adults with moderate-severe asthma were recruited across the continental United States and Puerto Rico for the PREPARE (PeRson EmPowered Asthma RElief) trial. Using self-identifications, we categorized multiethnic Black (ME/B) participants (n = 226) as Black Latinx participants (n = 146) or Caribbean, continental African, or other Black participants (n = 80). African American (AA/B) participants (n = 518) were categorized as Black participants who identified their ethnicity as being American. Baseline characteristics and retrospective asthma morbidity measures (self-reported exacerbations requiring systemic corticosteroids [SCs], emergency department/urgent care [ED/UC] visits, hospitalizations) were compared across subgroups using multivariable regression. RESULTS Compared with AA/B participants, ME/B participants were more likely to be younger, residing in the US Northeast, and Spanish speaking and to have lower body mass index, health literacy, and <1 comorbidity, but higher blood eosinophil counts. In a multivariable analysis, ME/B participants were significantly more likely to have ED/UC visits (incidence rate ratio [IRR] = 1.34, 95% CI = 1.04-1.72) and SC use (IRR = 1.27, 95% CI = 1.00-1.62) for asthma than AA/B participants. Of the ME/B subgroups, Puerto Rican Black Latinx participants (n = 120) were significantly more likely to have ED/UC visits (IRR = 1.64, 95% CI = 1.22-2.21) and SC use for asthma (IRR = 1.43, 95% CI = 1.06-1.92) than AA/B participants. There were no significant differences in hospitalizations for asthma among subgroups. CONCLUSIONS ME/B adults, specifically Puerto Rican Black Latinx adults, have higher risk of ED/UC visits and SC use for asthma than other Black subgroups.
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Affiliation(s)
- Leah Ishmael
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Andrea Apter
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Paula J Busse
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Jennifer K Carroll
- American Academy of Family Physicians National Research Network, Leawood, Kan; Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colo
| | - Thomas Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh, Pittsburgh, Pa
| | - Rubin Cohen
- Division of Pulmonary Critical Care and Sleep Medicine, Syracuse VA Medical Center, SUNY Upstate Medical University, Syracuse, NY
| | - Tamera Coyne-Beasley
- Department of Adolescent Medicine, University of North Carolina, Chapel Hill, NC
| | - Jing Cui
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Mass
| | - Brianna Ericson
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Paulina Hernandez
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David C Kaelber
- Center for Clinical Informatics Research and Education, MetroHealth System, Cleveland, Ohio; Departments of Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Nancy Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Conner Merriman
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Giselle Mosnaim
- Division of Allergy, Asthma, and Immunology, Northshore University Health System, Evanston, Ill
| | - Sylvette Nazario
- Allergy and Immunology Section, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Wanda Phipatanakul
- Departments of Allergy and Immunology and Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Victor Pinto-Plata
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, Burlington, Mass
| | - Isaretta Riley
- Division of Pulmonary and Critical Care Medicine, Duke University School of Medicine, Durham, NC
| | - Kartik Shenoy
- Temple Lung Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
| | - Juan Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Barbara Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, Minn
| | - Elliot Israel
- Divisions of Pulmonary and Critical Care Medicine and Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla.
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Genderson D, Gotschall JW, Fitzsimmons R, Wiebe DJ, Shin DB, Takeshita J. Population sociodemographic and geographic factors associated with dermatologist distribution in the United States. J Am Acad Dermatol 2024; 90:440-443. [PMID: 37866455 DOI: 10.1016/j.jaad.2023.10.027] [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] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 10/24/2023]
Affiliation(s)
| | - Jeromy W Gotschall
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas J Wiebe
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Mora Hurtado AC, Endo JO. Lack of skin of color reporting in disease severity rating tools used for inflammatory skin conditions: A scoping review. J Am Acad Dermatol 2024; 90:432-434. [PMID: 37839737 DOI: 10.1016/j.jaad.2023.09.083] [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] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Affiliation(s)
| | - Justin O Endo
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Division of Dermatology, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
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Gallagher KA, Mills JL, Armstrong DG, Conte MS, Kirsner RS, Minc SD, Plutzky J, Southerland KW, Tomic-Canic M. Current Status and Principles for the Treatment and Prevention of Diabetic Foot Ulcers in the Cardiovascular Patient Population: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e232-e253. [PMID: 38095068 DOI: 10.1161/cir.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Despite the known higher risk of cardiovascular disease in individuals with type 2 diabetes, the pathophysiology and optimal management of diabetic foot ulcers (DFUs), a leading complication associated with diabetes, is complex and continues to evolve. Complications of type 2 diabetes, such as DFUs, are a major cause of morbidity and mortality and the leading cause of major lower extremity amputation in the United States. There has recently been a strong focus on the prevention and early treatment of DFUs, leading to the development of multidisciplinary diabetic wound and amputation prevention clinics across the country. Mounting evidence has shown that, despite these efforts, amputations associated with DFUs continue to increase. Furthermore, due to increasing patient complexity of management secondary to comorbid conditions, such as cardiovascular disease, the management of peripheral artery disease associated with DFUs has become increasingly difficult, and care delivery is often episodic and fragmented. Although structured, process-specific approaches exist at individual institutions for the management of DFUs in the cardiovascular patient population, there is insufficient awareness of these principles in the general medicine communities. Furthermore, there is growing interest in better understanding the mechanistic underpinnings of DFUs to better define personalized medicine to improve outcomes. The goals of this scientific statement are to provide salient background information on the complex pathogenesis and current management of DFUs in cardiovascular patients, to guide therapeutic and preventive strategies and future research directions, and to inform public policy makers on health disparities and other barriers to improving and advancing care in this expanding patient population.
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Givens RC. Racial disparities across multiple stages of the deceased organ donation process. Am J Transplant 2024:S1600-6135(24)00068-6. [PMID: 38211654 DOI: 10.1016/j.ajt.2023.12.024] [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: 09/25/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
Pervasive structural violence causes higher organ failure rates among Black Americans and an excess of Black potential deceased organ donors. Underuse of Black donors would exacerbate organ shortages that disproportionately harm Black transplant candidates. This study investigates racial differences in transit between distinct donation steps among 132 968 potential donors across 557 hospitals and 6 organ procurement organizations (OPOs) from 2015 through 2021. Multilevel multistate modeling with patient covariates and OPO random effects shows adjusted likelihoods (95% confidence interval) of non-Black versus Black patients transitioning from OPO referral to approach of 1.39 (1.35, 1.44), approach to authorization: 1.64 (1.56, 1.72), authorization to procurement: 1.10 (1.04, 1.16), and procurement to transplant: 1.00 (0.95, 1.06). Overall organ utilization rates for Black, Latino, White, and other OPO referrals were 5.89%, 8.18%, 6.79%, and 5.24%, respectively. Adjusting for patient covariates and hospital and OPO random effects, multilevel logistic models estimated that compared with Black patients, Latino, White, and other patients had odds ratios of organ utilization of 1.81 (1.61, 2.03), 3.19 (2.91, 3.50), and 1.24 (1.05, 1.47), respectively. Nationwide in 2022, donor conversion disparities likely lost more than 1700 donors-two-thirds of whom would have been Black. Achieving racial equity for transplant candidates will require reducing racial disparities in organ donation.
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Affiliation(s)
- Raymond C Givens
- Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, Georgia, 30322, USA.
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Nadgauda AS, Butts S. Barriers to fertility preservation access in transgender and gender diverse adolescents: a narrative review. Ther Adv Reprod Health 2024; 18:26334941231222120. [PMID: 38292918 PMCID: PMC10826369 DOI: 10.1177/26334941231222120] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/24/2023] [Indexed: 02/01/2024] Open
Abstract
Fertility preservation (FP) involves the cryopreservation of gametes, embryos, and/or gonadal tissue oocytes, for future use in family building. FP as part of a comprehensive approach to care of transgender and gender diverse (TGD) individuals is an understudied topic. Current evidence indicates that gender affirming therapies may increase the risk for infertility. As a result, TGD individuals, including adolescents, should receive counseling regarding FP prior to beginning gender affirming treatment. Many barriers exist to TGD adolescents receiving FP counseling and undergoing FP if desired. The objective of this narrative review is to summarize the literature regarding the desire for FP in TGD adolescents, the barriers to TGD adolescents in accessing of FP, and to discuss potential interventions for alleviation of such barriers. A literature search using the following Medical Subject Headings search terms: 'transgender persons' and 'fertility preservation' and 'adolescents' was conducted via searching PubMed. Additional articles were located via reference review. Included articles consist of qualitative and quantitative research and society guidelines. Articles from inception to 1st July 2023 were included. The results of the literature search have been summarized into the format of a narrative review. Key barriers to FP for TGD adolescents include inconsistencies in form and timing of counseling, potential worsening of gender dysphoria with FP treatment, high cost of treatment, limited research on FP outcomes, and legal barriers. Intersectionality between gender identity and other forms of minority status can compound these barriers to FP and healthcare in general. Barriers to TGD adolescents accessing FP are significant. Increased research is needed upon methods to mitigate these barriers. Solutions include increasing uniformity and timing of FP counseling by varying health care providers, advocacy efforts to mitigate legal and financial barriers, increased research efforts in FP outcomes, and increased cultural competency in clinics offering FP care to TGD adolescents.
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Affiliation(s)
- Ashni S. Nadgauda
- Department of Obstetrics and Gynecology, Reading Hospital – Tower Health, 420 South 5th Avenue, Reading, PA 19611, USA
| | - Samantha Butts
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Penn State – Main Campus, Hershey, PA, USA
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Sullivan-Detheridge JH, Reifsnider E, Mengsteab M, Merie K, Staller J, Allen AM. Cross Cultural Empathetic Behavior in Health Care Providers: A Review of 3 Countries. J Prim Care Community Health 2024; 15:21501319241226765. [PMID: 38254300 PMCID: PMC10807346 DOI: 10.1177/21501319241226765] [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: 07/09/2023] [Revised: 11/24/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024] Open
Abstract
This paper examines empathetic behavior in the United States, a strongly individualistic country, as contrasted with Hungary and Ethiopia, which are moderately individualistic and strongly collectivistic respectively. It suggests that empathy may have a wider than originally perceived application in diverse settings to combat factors of ethnic bias and discrimination that adversely impact health. Models that distinctly focus on the development of healthcare provider empathic care are needed to enable the needs of resource scarce regions of the world to be met, including pockets of the U.S. More investigation is warranted on how empathic behavior can positively impact health outcomes and disparities.
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Nourmahnad A, Raslan S, Ezeh UC, Rossborough J, Ma R, Anis MM. Association of Sociodemographic Factors on the Presentation and Management of Unilateral Vocal Fold Immobility. Laryngoscope 2024; 134:297-304. [PMID: 37515514 DOI: 10.1002/lary.30917] [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: 03/04/2023] [Revised: 06/12/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To determine the association of social determinants of health (SDOH) on the presentation and management of unilateral vocal fold immobility (UVFI). METHODS Retrospective chart review of 207 adult UVFI patients evaluated at a tertiary-care hospital between 2018 and 2019 was performed. Sociodemographic factors including gender, median household income, preferred language, and insurance type were recorded. Confounding clinical factors including etiology of UVFI, Voice Handicap Index-10 (VHI-10) score, laryngoscopic findings, and intervention history were extracted from medical records. Multivariable logistic regression was performed using sociodemographic and clinical factors. RESULTS Patient demographics and socioeconomic status were not associated with time to presentation. Patients presenting with glottic insufficiency and UVFI due to malignancy or recurrent laryngeal nerve (RLN) sacrifice had a shorter time to presentation. Higher household income was associated with greater number of interventions (p = 0.02), but neither income nor insurance type affected intervention type or timing. Female patients were less likely to undergo injection medialization laryngoplasty (odds ratio [OR] 0.25, p = 0.005). Older patients were more likely to undergo injection (OR 1.04, p = 0.027). Patients with large glottic gaps (OR 21.2, p = 0.014) and higher VHI-10 scores (OR 1.06, p = 0.047) were more likely to undergo surgery. CONCLUSION Higher household income was associated with greater number of interventions and longer duration of care at a private tertiary-care hospital. RLN sacrifice, known malignancy, and glottic insufficiency significantly reduced the time to presentation. Type of intervention received was a complex interplay of both demographic and clinical factors. Large prospective studies should examine the role of SDOH in the presentation and management of UVFI. LEVEL OF EVIDENCE 4 Laryngoscope, 134:297-304, 2024.
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Affiliation(s)
- Anahita Nourmahnad
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Hospital, Miami, Florida, U.S.A
| | - Shahm Raslan
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, U.S.A
| | - Uche C Ezeh
- University of Miami School of Medicine, Miami, Florida, U.S.A
| | | | - Ruixuan Ma
- Division of Biostatistics, Department of Public Health Science, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Mursalin M Anis
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Hospital, Miami, Florida, U.S.A
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Sadauskas L, Commodore-Mensah Y, Wu C, Taylor CO, Epstein JA, Stackhouse BK, Hasselfeld BW, Hughes HK. Individual- and Neighborhood-Level Disparities in Audio-Only Telemedicine Utilization Across a Large Academic Health System. Telemed J E Health 2024; 30:47-56. [PMID: 37389845 DOI: 10.1089/tmj.2023.0050] [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] [Indexed: 07/01/2023] Open
Abstract
Introduction: The objective of this study was to understand whether use of audio-only telemedicine visits differed by individual- and neighborhood-level patient characteristics during the COVID-19 pandemic. Methods: We conducted a retrospective cross-sectional study of telemedicine encounter data from a large academic health system. The primary outcome was rate of audio-only versus video visits. The exposures of interest were individual- (age, race, insurance, preferred language) and neighborhood-level (Social Deprivation Index [SDI]) patient characteristics. Results: Our study included 1,054,465 patient encounters from January 1, 2020 to December 31, 2021, of which 18.33% were completed via audio-only. Encounters among adults 75 years or older, Black patients, Spanish-speakers, and those with public insurance were more frequently conducted by audio-only (p < 0.001). Overall, populations showed decreasing rates of audio-only visits over time. We also observed an increase in the rate of audio-only encounters as SDI scores increased. Discussion: We found that audio-only disparities exist in telemedicine utilization by individual and zip code level characteristics. Though these disparities have improved over time as seen by our temporal analysis, marginalized and minority groups still showed the lowest rates of video utilization. In conclusion, access to audio-only care is a critical component to ensure that telemedicine is accessible to all populations. State and federal policy should support continued reimbursement of audio-only care to ensure equitable access to care while the implications of different care modalities are further studied.
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Affiliation(s)
- Lilija Sadauskas
- Office of Telemedicine, Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Colin Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Casey Overby Taylor
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeremy A Epstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian K Stackhouse
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian W Hasselfeld
- Office of Telemedicine, Johns Hopkins Health System, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Helen K Hughes
- Office of Telemedicine, Johns Hopkins Health System, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lion KC, Arthur KC, Frías García M, Hsu C, Sotelo Guerra LJ, Chisholm H, Griego E, Ebel BE, Penfold RB, Rafton S, Zhou C, Mangione-Smith R. Pilot Evaluation of the Family Bridge Program: A Communication- and Culture-Focused Inpatient Patient Navigation Program. Acad Pediatr 2024; 24:33-42. [PMID: 37354947 DOI: 10.1016/j.acap.2023.06.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/17/2023] [Accepted: 06/18/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Children with low income and minority race and ethnicity have worse hospital outcomes due partly to systemic and interpersonal racism causing communication and system barriers. We tested the feasibility and acceptability of a novel inpatient communication-focused navigation program. METHODS Multilingual design workshops with parents, providers, and staff created the Family Bridge Program. Delivered by a trained navigator, it included 1) hospital orientation; 2) social needs screening and response; 3) communication preference assessment; 4) communication coaching; 5) emotional support; and 6) a post-discharge phone call. We enrolled families of hospitalized children with public or no insurance, minority race or ethnicity, and preferred language of English, Spanish, or Somali in a single-arm trial. We surveyed parents at enrollment and 2 to 4 weeks post-discharge, and providers 2 to 3 days post-discharge. Survey measures were analyzed with paired t tests. RESULTS Of 60 families enrolled, 57 (95%) completed the follow-up survey. Most parents were born outside the United States (60%) with a high school degree or less (60%). Also, 63% preferred English, 33% Spanish, and 3% Somali. The program was feasible: families received an average of 5.3 of 6 components; all received >2. Most caregivers (92%) and providers (81% [30/37]) were "very satisfied." Parent-reported system navigation improved from enrollment to follow-up (+8.2 [95% confidence interval 2.9, 13.6], P = .003; scale 0-100). Spanish-speaking parents reported decreased skills-related barriers (-18.4 [95% confidence interval -1.8, -34.9], P = .03; scale 0-100). CONCLUSIONS The Family Bridge Program was feasible, acceptable, and may have potential for overcoming barriers for hospitalized children at risk for disparities.
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Affiliation(s)
- K Casey Lion
- Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics (K Casey Lion, E Griego, BE Ebel, C Zhou, and R Mangione-Smith), University of Washington School of Medicine, Seattle, Wash.
| | - Kimberly C Arthur
- Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Mariana Frías García
- Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute (C Hsu and RB Penfold), Seattle, Wash
| | - Laura J Sotelo Guerra
- Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Hillary Chisholm
- Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash
| | - Elena Griego
- Department of Pediatrics (K Casey Lion, E Griego, BE Ebel, C Zhou, and R Mangione-Smith), University of Washington School of Medicine, Seattle, Wash
| | - Beth E Ebel
- Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics (K Casey Lion, E Griego, BE Ebel, C Zhou, and R Mangione-Smith), University of Washington School of Medicine, Seattle, Wash
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute (C Hsu and RB Penfold), Seattle, Wash
| | - Sarah Rafton
- Center for Diversity and Health Equity, Seattle Children's Hospital (S Rafton), Seattle, Wash
| | - Chuan Zhou
- Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics (K Casey Lion, E Griego, BE Ebel, C Zhou, and R Mangione-Smith), University of Washington School of Medicine, Seattle, Wash
| | - Rita Mangione-Smith
- Center for Child Health, Behavior and Development (K Casey Lion, KC Arthur, MF García, LJ Sotelo Guerra, H Chisholm, BE Ebel, C Zhou, and R Mangione-Smith), Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics (K Casey Lion, E Griego, BE Ebel, C Zhou, and R Mangione-Smith), University of Washington School of Medicine, Seattle, Wash
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Eliason EL, Agostino J, Vivier P. Infant Health Care Disruptions by Race and Ethnicity, Income, and Insurance During the COVID-19 Pandemic. Acad Pediatr 2024; 24:105-110. [PMID: 37487800 DOI: 10.1016/j.acap.2023.07.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Research has found disruptions in pediatric care during the COVID-19 pandemic, likely exacerbating existing disparities, which has not been explored among infants. This study evaluated how infant health care was disrupted during the COVID-19 pandemic overall and by race and ethnicity, income, and insurance type. METHODS This cross-sectional study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. Unadjusted, weighted proportions of outcomes were calculated overall and by race and ethnicity, income, and insurance. We estimated multivariable odds ratios for the association between infant care disruptions and race and ethnicity, income, and insurance. RESULTS Overall, among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. In adjusted analyses, we found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments were significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries. CONCLUSIONS Study findings suggest that the COVID-19 pandemic particularly affected infant health care for non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid, with important implications for addressing infant health inequities and improving health outcomes in the United States.
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Affiliation(s)
- Erica L Eliason
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI.
| | - Jasmine Agostino
- Department of Health Services, Policy & Practice (EL Eliason and J Agostino), Brown University School of Public Health, Providence, RI
| | - Patrick Vivier
- Department of Public Health and Community Medicine (P Vivier), Tufts University School of Medicine, Boston, Mass
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Wang AW, Patel EA, Patel N, Poulson TA, Jagasia AA. Otolaryngology Care Disparities in American Indian Populations. OTO Open 2024; 8:e124. [PMID: 38495073 PMCID: PMC10941493 DOI: 10.1002/oto2.124] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Our objectives were to quantify geographical disparities in otolaryngology care access with respect to American Indian (AI) populations and to identify gaps in care. Although increased incidence and mortality rates of ear, nose, and throat (ENT) conditions in AI populations are well documented, few studies address factors contributing to these differential outcomes. We conducted a cross-sectional study of US states with AI areas that either met the population threshold for the American Community Survey annual estimate or annual supplemental estimate. A 2-tailed t test was used to compare the geographic distribution of ENT providers practicing within AI areas against non-AI areas, showing a statistically significant difference (P < .001) in the concentration of providers (0.409 vs 2.233 providers per 100,000 patients). To our knowledge, this is the first study to explore geographic barriers contributing to AI disparities within otolaryngology.
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Affiliation(s)
- Alan W. Wang
- Chicago Medical SchoolRosalind Franklin UniversityNorth ChicagoIllinoisUSA
| | - Evan A. Patel
- Department of Otolaryngology–Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Nina Patel
- Department of Otolaryngology–Head and Neck SurgeryLoyola University Stritch School of MedicineMaywoodIllinoisUSA
| | - Trevor A. Poulson
- Department of Otolaryngology–Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Ashok A. Jagasia
- Department of Otolaryngology–Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
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Ruiz J. Closing the Gap: How a Community Effort Can Improve Rural Maternity Care. Ann Fam Med 2024; 22:68. [PMID: 38253500 DOI: 10.1370/afm.3056] [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: 04/20/2023] [Revised: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
- Jesus Ruiz
- University of North Carolina at Chapel Hill School of Medicine, Department of Family Medicine, Chapel Hill, North Carolina
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Rising KL, Kemp M, Leader AE, Chang AM, Monick AJ, Guth A, Esteves Camacho T, Laynor G, Worster B. A Prioritized Patient-Centered Research Agenda to Reduce Disparities in Telehealth Uptake: Results from a National Consensus Conference. Telemed Rep 2023; 4:387-395. [PMID: 38169980 PMCID: PMC10758542 DOI: 10.1089/tmr.2023.0051] [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] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 01/05/2024]
Abstract
Introduction We hosted a national consensus conference with a diverse group of stakeholders to develop a patient-centered research agenda focused on reducing disparities in telehealth use. Methods Attendees were purposively invited to participate in a 2-day virtual conference. The group developed a prioritized research agenda focused on reducing disparities in telehealth uptake, with discussion informed by findings from a scoping review. All work was conducted in partnership with a Steering Committee of national experts in telehealth and patient-centered care (n = 5) and a community-based Telehealth Advisory Board with experience with telehealth use and barriers (n = 8). Results Sixty individuals participated in the conference and discussion resulted in a final list of 20 questions. Fifty-two attendees voted on the final prioritization of these questions. Results were aggregated for all voters (n = 52) and patient-only voters (n = 8). The top question identified by both groups focused on patient and family perspectives on important barriers to telehealth use. The entire group voting identified telehealth's impact on patient outcomes as the next most important questions, while the patient-only group identified trust-related considerations and cultural factors impacting telehealth use as next priorities. Conclusions This project involved extensive patient and stakeholder engagement. While voting varied between patients only and the entire group of conference attendees, top identified priorities included patient and family perspectives on important barriers to telehealth, trust and cultural barriers and facilitators to telehealth, and assessment of telehealth's impact on patient outcomes. This research agenda can inform design of future research focused on addressing disparities in telehealth use.
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Affiliation(s)
- Kristin L. Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mackenzie Kemp
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy E. Leader
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew J. Monick
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amanda Guth
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tracy Esteves Camacho
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory Laynor
- Health Sciences Library, NYU Grossman School of Medicine, New York, New York, USA
| | - Brooke Worster
- Department of Medical Oncology, Jefferson Health, Philadelphia, Pennsylvania, USA
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Martei YM, Obasohan M, Mokokwe L, Ralefala T, Mosepele M, Gross R, Barg FK. Stigma and Social Determinants of Health Associated With Fidelity to Guideline-Concordant Therapy in Patients With Breast Cancer Living With and Without HIV in Botswana. Oncologist 2023; 28:e1230-e1238. [PMID: 37405697 PMCID: PMC10712728 DOI: 10.1093/oncolo/oyad183] [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: 11/07/2022] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Patients with breast cancer in sub-Saharan Africa (SSA) experience a disproportionate burden of mortality. Fidelity to treatment guidelines, defined as receiving optimal dose and frequency of prescribed treatments, improves survival. We sought to identify patient factors associated with treatment fidelity and how this may differ for people with HIV (PWH) and breast cancer. METHODS We conducted a qualitative study of women who initiated outpatient treatment for stages I-III breast cancer in Botswana, with deviance sampling of high- and low-fidelity patients. One-on-one interviews were conducted using semi-structured guides informed by the Theory of Planned Behavior. The sample size was determined by thematic saturation. Transcribed interviews were double coded with an integrated analytic approach. RESULTS We enrolled 15 high- and 15 low-fidelity participants from August 25, 2020 to December 15, 2020, including 10 PWH (4 high, 6 low fidelity). Ninety-three percent had stage III disease. Barriers to treatment fidelity included stigma, social determinants of health (SDOH), and health system barriers. Acceptance and de-stigmatization, peer and other social support, increased knowledge and self-efficacy were identified as facilitators. The COVID-19 pandemic amplified existing socioeconomic stressors. Unique barriers and facilitators identified by PWH included intersectional stigma, and HIV and cancer care integration, respectively. CONCLUSION We identified multilevel modifiable patient and health system factors associated with fidelity. The facilitators provide opportunities for leveraging existing strengths within the Botswana context to design implementation strategies to increase treatment fidelity to guideline-concordant breast cancer therapy. However, PWH experienced unique barriers, suggesting that interventions to address fidelity may need to be tailored to specific comorbidities.
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Affiliation(s)
- Yehoda M Martei
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA
| | - Modesty Obasohan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lebogang Mokokwe
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | | | - Robert Gross
- Department of Medicine (Infectious Diseases), University of Pennsylvania, Philadelphia, PA, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
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Waterhouse JV, Welch CA, Battisti NML, Sweeting MJ, Paley L, Lambert PC, Deanfield J, de Belder M, Peake MD, Adlam D, Ring A. Geographical Variation in Underlying Social Deprivation, Cardiovascular and Other Comorbidities in Patients with Potentially Curable Cancers in England: Results from a National Registry Dataset Analysis. Clin Oncol (R Coll Radiol) 2023; 35:e708-e719. [PMID: 37741712 DOI: 10.1016/j.clon.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023]
Abstract
AIMS To describe the prevalence of cardiovascular disease (CVD), multiple comorbidities and social deprivation in patients with a potentially curable cancer in 20 English Cancer Alliances. MATERIALS AND METHODS This National Registry Dataset Analysis used national cancer registry data and CVD databases to describe rates of CVD, comorbidities and social deprivation in patients diagnosed with a potentially curable malignancy (stage I-III breast cancer, stage I-III colon cancer, stage I-III rectal cancer, stage I-III prostate cancer, stage I-IIIA non-small cell lung cancer, stage I-IV diffuse large B-cell lymphoma, stage I-IV Hodgkin lymphoma) between 2013 and 2018. Outcome measures included observation of CVD prevalence, other comorbidities (evaluated by the Charlson Comorbidity Index) and deprivation (using the Index of Multiple Deprivation) according to tumour site and allocation to Cancer Alliance. Patients were allocated to CVD prevalence tertiles (minimum: <33.3rd percentile; middle: 33.3rd to 66.6th percentile; maximum: >66.6th percentile). RESULTS In total, 634 240 patients with a potentially curable malignancy were eligible. The total CVD prevalence for all cancer sites varied between 13.4% (CVD n = 2058; 95% confidence interval 12.8, 13.9) and 19.6% (CVD n = 7818; 95% confidence interval 19.2, 20.0) between Cancer Alliances. CVD prevalence showed regional variation both for male (16-26%) and female patients (8-16%) towards higher CVD prevalence in northern Cancer Alliances. Similar variation was observed for social deprivation, with the proportion of cancer patients being identified as most deprived varying between 3.3% and 32.2%, depending on Cancer Alliance. The variation between Cancer Alliance for total comorbidities was much smaller. CONCLUSION Social deprivation, CVD and other comorbidities in patients with a potentially curable malignancy in England show significant regional variations, which may partly contribute to differences observed in treatments and outcomes.
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Affiliation(s)
- J V Waterhouse
- Breast Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, SM2 5PT, London, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, London, United Kingdom
| | - C A Welch
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, LE1 7RH, Leicester, United Kingdom; National Disease Registration Service, NHS England, 10 South Colonnade, Canary Wharf, E14 4PU, London, United Kingdom
| | - N M L Battisti
- Breast Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, SM2 5PT, London, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, London, United Kingdom
| | - M J Sweeting
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, LE1 7RH, Leicester, United Kingdom; Statistical Innovation, Oncology Biometrics, Oncology R&D, AstraZeneca, Cambridge, United Kingdom
| | - L Paley
- National Disease Registration Service, NHS England, 10 South Colonnade, Canary Wharf, E14 4PU, London, United Kingdom
| | - P C Lambert
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, University Road, LE1 7RH, Leicester, United Kingdom; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - J Deanfield
- Institute of Cardiovascular Sciences, University College London, 62 Huntley St London, WC1E 6DD, United Kingdom
| | - M de Belder
- National Institute for Cardiovascular Outcomes Research, NHS Arden & Greater East Midlands Commissioning Support Unit, 2nd floor 1 St Martin's le Grand London, EC1A 4AS, United Kingdom
| | - M D Peake
- Department of Health Sciences, University of Leicester, University Rd, Leicester, LE1 7RH, United Kingdom; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - D Adlam
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, United Kingdom.
| | - A Ring
- Breast Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, SM2 5PT, London, United Kingdom; Breast Cancer Research Division, The Institute of Cancer Research, London, United Kingdom
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Peek ME, Gottlieb LM, Doubeni CA, Viswanathan M, Cartier Y, Aceves B, Fichtenberg C, Cené CW. Advancing health equity through social care interventions. Health Serv Res 2023; 58 Suppl 3:318-326. [PMID: 38015863 PMCID: PMC10684037 DOI: 10.1111/1475-6773.14244] [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] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To use evidence on addressing racism in social care intervention research to create a framework for advancing health equity for all populations with marginalized social identities (e.g., race, gender, and sexual orientation). Such groups have disproportionate social needs (e.g., food insecurity) and negative social determinants of health (SDOH; e.g., poverty). We recommend how the Agency for Healthcare Research and Quality (AHRQ) could advance health equity for marginalized populations through social care research and care delivery. DATA SOURCES AND STUDY SETTING This commentary is informed by a literature review of social care interventions that were affiliated with healthcare systems; input from health equity researchers, policymakers, and community leaders attending the AHRQ Health Equity Summit; and consensus of the authors. PRINCIPAL FINDINGS We recommend that AHRQ: (1) create an ecosystem that values research on SDOH and the effectiveness and implementation of social care interventions in the healthcare sector; (2) work with other federal agencies to (a) develop position statements with actionable recommendations about racism and other systems that perpetuate marginalization based on social identity and (b) develop aligned, complementary approaches to research and care delivery that address social marginalization; (3) advance both inclusive care delivery and inclusive research teams; (4) advance understanding of racism as a social determinant of health and effective strategies to mitigate its adverse impact on health; (5) advance the creation and scaling of effective strategies for addressing SDOH in healthcare systems, particularly in co-creation with community partners; and (6) require social care intervention researchers to use methods that advance our understanding of social health equity. CONCLUSIONS AHRQ, as a federal agency, could help advance health equity using a range of strategies, including using the agency's levers to ensure AHRQ stakeholders examine and address the unique experiences of socially marginalized populations in SDOH and social care intervention research.
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Affiliation(s)
- Monica E. Peek
- Section of General Internal Medicine, Chicago Center for Diabetes Translation Research, MacLean Center for Clinical Medical Ethics, Center for the Study of Race, Politics and CultureThe University of ChicagoChicagoIllinoisUSA
| | - Laura M. Gottlieb
- Social Interventions Research and Evaluation Network (SIREN), Center for Health and CommunityUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Chyke A. Doubeni
- The Ohio State University Wexner Medical Center, Family and Community MedicineThe Ohio State University College of MedicineColumbusOhioUSA
| | | | - Yuri Cartier
- Social Interventions Research and Evaluation Network (SIREN), Center for Health and CommunityUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Benjamin Aceves
- School of Public HealthSan Diego State UniversitySan DiegoCaliforniaUSA
| | - Caroline Fichtenberg
- Department of Family and Community Medicine, Social Interventions Research and Evaluation Network (SIREN), Center for Health and Community ResearcherUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Crystal W. Cené
- Section of General Internal MedicineUniversity of CaliforniaSan DiegoCaliforniaUSA
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Dingillo G, Alvarado CE, Rice JD, Sinopoli J, Badrinathan A, Linden PA, Towe CW. Affordable Care Act Medicaid Expansion is Associated With Increased Utilization of Minimally Invasive Lung Resection for Early Stage Lung Cancer. Am Surg 2023; 89:5147-5155. [PMID: 36341749 DOI: 10.1177/00031348221138081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
OBJECTIVE Minimally invasive lung resection (MILR) is underutilized in the United States. Under the Affordable Care Act (ACA), 39 states adopted Medicaid expansion, while 12 did not. Although Medicaid expansion has been associated with improved access to cancer care, its effect on utilization of MILR is unclear. We hypothesize that MILR would increase in Medicaid expansion states. METHODS The National Cancer Database was queried for adult patients from 2010 to 2018 with cT1/2N0M0 non-small cell lung cancer who received surgical resection by wedge, segmentectomy, or lobectomy. Patients were grouped by whether they received care in a state without Medicaid expansion vs expansion in January 2014. The outcome of interest was MILR (defined as video-assisted or robotic-assisted thoracoscopy) relative to open. Multivariable difference in differences (DID) cross-sectional analysis was used to estimate the average treatment effect (ATE) of Medicaid expansion. RESULTS There were 41,439 patients who met inclusion criteria: 20,446 (49.3%) in expansion states and 20,993 (50.7%) in non-expansion states. Multivariable DID analysis showed that Medicaid expansion was associated with an increase in Medicaid insurance type with an ATE of 7.4% (95% CI 7.1-7.7%, P = .002). Medicaid expansion was also associated with increased MILR utilization in unadjusted analysis (10,278/20,446 (50.3%) vs 9,953/20,993 (47.4%), p < .001) and in multivariable DID analysis (ATE 0.6%, 95% CI 0.3-0.8%, P = .008). CONCLUSIONS Although Medicaid expansion was associated with increased utilization of MILR for early stage lung cancer, the treatment effect was modest. This suggests that barriers in access to MILR are larger than simply access to care.
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Affiliation(s)
- Gianna Dingillo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christine E Alvarado
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jonathan D Rice
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jillian Sinopoli
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Avanti Badrinathan
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Narayan AK, Miles RC, Milton A, Salazar G, Spalluto LB, Babagbemi K, Stowell JT, Flores EJ, Dako F, Weissman IA. Fostering Patient-Centered Equitable Care in Radiology: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:711-719. [PMID: 37255040 DOI: 10.2214/ajr.23.29261] [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] [Indexed: 06/01/2023]
Abstract
Patient-centered care (PCC) and equity are two of the six core domains of quality health care, according to the Institute of Medicine. Exceptional imaging care requires radiology practices to provide patient-centered (i.e., respectful and responsive to individual patient preferences, needs, and values) and equitable (i.e., does not vary in quality on the basis of gender, ethnicity, geographic location, or socioeconomic status) care. Specific barriers that prevent the delivery of patient-centered equitable care include information gaps, breaches of trust, organizational medical culture, and financial incentives. Information gaps limit practitioners in understanding the lived experience of patients. Breaches of trust prevent patients from seeking needed medical care. Organizational medical cultures may not be centered around patient experiences. Financial incentives can impede practitioners' ability to spend the time and resources required to meet patient goals and needs. Intentional approaches that integrate core principles in both PCC and health equity are required to deliver high-quality patient-centered imaging care for diverse patient populations. The purpose of this AJR Expert Panel Narrative Review is to review the origins of the PCC movement in radiology, characterize connections between the PCC and health equity movements, and describe concrete examples of ways to foster patient-centered equitable care in radiology.
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Affiliation(s)
- Anand K Narayan
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | | | - Arissa Milton
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, F6/178C, Madison, WI 53792-3252
| | - Gloria Salazar
- Department of Radiology, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Lucy B Spalluto
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
- Department of Radiology, Vanderbilt-Ingram Cancer Center, Nashville, TN
- Department of Radiology, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, TN
| | - Kemi Babagbemi
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | | | - Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Farouk Dako
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ian A Weissman
- Department of Radiology, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
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Hobbs AJ, Mitchell TV, Bray KK, Sutton JD. Dental hygiene student perceptions of a school-based sealant program: A qualitative review. J Dent Educ 2023; 87:1645-1653. [PMID: 37752848 DOI: 10.1002/jdd.13378] [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: 12/16/2022] [Revised: 06/28/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE/OBJECTIVES The purpose of this 2021 study was to explore experiences acquired from a school-based sealant program (SBSP), to improve understanding of the relationship between SBSP and dental hygiene (DH) student outcomes, and to inform institutions of the value of educational experiences aiming to reduce disparities in access to dental care. METHODS University of Missouri Kansas City School of Dentistry Senior DH students complete a community engaged course which includes participation in community projects and clinical activities targeting Kansas City's urban and surrounding rural environments. The SBSP is a component of this course. This investigation utilized a qualitative methodology to examine SBSP experiences through the experience of the primary investigator, on-site dentist, and DH students involved in the program. RESULTS Data analysis resulted in consensus of five synthesized conceptual models and twenty-three emergent themes. The conceptual models include: competence, roles and responsibilities, social justice, value added, and lessons learned. CONCLUSION Based on triangulated results, SBSPs improve access to care for children, save dental costs, and provide essential experiences for DH students.
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Affiliation(s)
- Ashley J Hobbs
- Division of Dental Hygiene, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Tanya V Mitchell
- Division of Dental Hygiene, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Kimberly K Bray
- Division of Dental Hygiene, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Julie D Sutton
- Division of Dental Hygiene, School of Dentistry, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Goldin Evans M, Gee RE, Phillippi S, Sothern M, Theall KP, Wightkin J. Multilevel Barriers to Long-Acting Reversible Contraceptive Uptake: A Narrative Review. Health Promot Pract 2023:15248399231211531. [PMID: 37978809 DOI: 10.1177/15248399231211531] [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] [Indexed: 11/19/2023]
Abstract
Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice.
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Affiliation(s)
- Melissa Goldin Evans
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, LA, USA
| | | | - Stephen Phillippi
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Melinda Sothern
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Katherine P Theall
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, LA, USA
| | - Joan Wightkin
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
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