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Howell BA, Hawks LC, Balasuriya L, Chang VW, Wang EA, Winkelman TNA. Health Insurance and Mental Health Treatment Use Among Adults With Criminal Legal Involvement After Medicaid Expansion. Psychiatr Serv 2023; 74:1019-1026. [PMID: 37016823 PMCID: PMC10939137 DOI: 10.1176/appi.ps.20220171] [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] [Indexed: 04/06/2023]
Abstract
OBJECTIVE Individuals with criminal legal involvement have high rates of substance use and other mental disorders. Before implementation of the Affordable Care Act's Medicaid expansion, they also had low health insurance coverage. The objective of this study was to assess the impact of Medicaid expansion on health insurance coverage and use of treatment for substance use or other mental disorders in this population. METHODS The authors used restricted data (2010-2017) from the National Survey on Drug Use and Health (NSDUH). Using a difference-in-differences approach, the authors estimated the impact of Medicaid expansion on health insurance coverage and treatment for substance use or other mental disorders among individuals with recent criminal legal involvement. RESULTS The sample consisted of 9,910 NSDUH respondents who were ages 18-64 years, had a household income ≤138% of the federal poverty level, and reported past-year criminal legal involvement. Medicaid expansion was associated with an 18 percentage-point increase in insurance coverage but no change in receipt of substance use treatment among individuals with substance use disorder. Individuals with any other mental illness had a 16 percentage-point increase in insurance coverage but no change in receipt of mental health treatment. CONCLUSIONS Despite a large increase in health insurance coverage among individuals with criminal legal involvement and substance use or other mental disorders, Medicaid expansion was not associated with a significant change in treatment use for these conditions. Insurance access alone appears to be insufficient to increase treatment for substance use or other mental disorders in this population.
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Affiliation(s)
- Benjamin A Howell
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Laura C Hawks
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Lilanthi Balasuriya
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Virginia W Chang
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Emily A Wang
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Tyler N A Winkelman
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
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Balasuriya L, Briss PA, Twentyman E, Wiltz JL, Richardson LC, Bigman ET, Wright JS, Petersen R, Hannan CJ, Thomas CW, Barfield WD, Kittner DL, Hacker KA. Impacts of the COVID-19 Pandemic on Nationwide Chronic Disease Prevention and Health Promotion Activities. Am J Prev Med 2023; 64:452-458. [PMID: 36347662 PMCID: PMC9574464 DOI: 10.1016/j.amepre.2022.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/08/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lilanthi Balasuriya
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Peter A Briss
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Evelyn Twentyman
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer L Wiltz
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C Richardson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth T Bigman
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet S Wright
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth Petersen
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Casey J Hannan
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Craig W Thomas
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wanda D Barfield
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deirdre L Kittner
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen A Hacker
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Weiss J, Holaday L, Keene D, Akingbesote ND, Balasuriya L, Sharifi M, Latimore D, Genao I. Perspectives of Historically Black College and University Advisors to Premedical Students During the COVID-19 Pandemic: A Qualitative Study. JAMA Netw Open 2022; 5:e2238563. [PMID: 36269351 PMCID: PMC9587479 DOI: 10.1001/jamanetworkopen.2022.38563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Black students remain underrepresented in medicine despite national efforts to increase diversity in the physician workforce. Historically Black College and University (HBCU) students play a vital role in increasing representation in the workforce. Currently, there is a paucity of literature understanding the impact of COVID-19 on premedical students from HBCUs. Understanding the adverse impact of the pandemic on HBCU students is essential to inform strategies that promote holistic medical school admissions and increased diversity, equity, and inclusion in the medical workforce. OBJECTIVE To explore premedical advisors' perspectives on the impact of the COVID-19 pandemic on HBCU premedical students pursuing admission to medical school. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, semistructured interviews of HBCU premedical advisors were performed from March 2020 to March 2021. One-on-one interviews were conducted with 21 advisors with a depth of experience as advisors, varied educational backgrounds, and diverse geographic representation. Data analysis was performed from March 2021 to December 2021. MAIN OUTCOMES AND MEASURES The experiences of HBCU premedical students during the COVID-19 pandemic from the perspective of the premedical advisor. RESULTS Among the 21 participants, 13 (62%) were female, 15 (71%) were Black or African American, 11 (52%) had a doctorate degree, and 7 (33%) had more than 10 years of experience as advisors. Participants described 3 major themes: (1) balancing academic responsibilities with family demands; (2) distraction, disruption, and isolation in the virtual learning environment; and (3) harmful impact of new stressors for HBCU applicants in the medical school admissions process. CONCLUSIONS AND RELEVANCE In this qualitative study of HBCU advisors to premedical students, advisors described how the COVID-19 pandemic adversely affected undergraduate HBCU premedical students; students faced family hardships, challenges with virtual learning, and uncertainty in the medical school admissions process. These findings suggest that medical schools should continue to create direct interventions to address the challenges that HBCU students faced during the height of the pandemic and as longitudinal consequences of the pandemic. Addressing these issues may improve physician workforce representation and promote more equitable patient care for underserved communities disproportionately affected by COVID-19 and other health disparities.
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Affiliation(s)
- Jasmine Weiss
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Louisa Holaday
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Danya Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Ngozi D. Akingbesote
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut
- Department of Internal Medicine (Endocrinology), Yale University School of Medicine, New Haven, Connecticut
| | - Lilanthi Balasuriya
- Yale National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
| | - Mona Sharifi
- Yale National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Darin Latimore
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Inginia Genao
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
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Goldman ML, Swartz MS, Norquist GS, Horvitz-Lennon M, Balasuriya L, Jorgensen S, Greiner M, Brinkley A, Hayes H, Isom J, Dixon LB, Druss BG. Building Bridges Between Evidence and Policy in Mental Health Services Research: Introducing the Policy Review Article Type. Psychiatr Serv 2022; 73:1165-1168. [PMID: 35378994 DOI: 10.1176/appi.ps.202100428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although it is widely accepted that patients do better when evidence-based health care practices are used, there is less acknowledgment of the positive outcomes associated with evidence-based policy making. To address the need for high-quality evidence to inform mental health policies, Psychiatric Services has recently launched a new article format: the Policy Review. This review type defines a specific policy-relevant issue affecting behavioral health systems, describes current knowledge and limitations, and discusses policy implications. Reviews can focus on mental health policies or examine how other health or social policies affect people with mental illness or substance use disorders. This brief overview of the need for a policy review article type describes differences between evidence-based policy making and practices and looks at research approaches focused on evidence-based policy making, as well as legislative and other efforts to support it. Broad guidelines for potential submissions are also provided.
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Affiliation(s)
- Matthew L Goldman
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Marvin S Swartz
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Grayson S Norquist
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Marcela Horvitz-Lennon
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Lilanthi Balasuriya
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Shea Jorgensen
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Miranda Greiner
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Amy Brinkley
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Heath Hayes
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Jessica Isom
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Lisa B Dixon
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
| | - Benjamin G Druss
- San Francisco Department of Public Health and Department of Psychiatry, University of California, San Francisco, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz); Department of Psychiatry and Behavioral Sciences (Norquist) and Rollins School of Public Health (Druss), Emory University, Atlanta; RAND Corporation, Pittsburgh (Horvitz-Lennon); Yale National Clinical Scholars Program (Balasuriya) and Department of Psychiatry (Isom), Yale University School of Medicine, New Haven, Connecticut; Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Department of Psychiatry, Weill Cornell Medical Center, New York City (Greiner); Indiana Department of Mental Health and Addiction, Indianapolis (Brinkley); Oklahoma Department of Mental Health and Substance Abuse Services, Oklahoma City (Hayes); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Dixon)
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Bartlett VL, Ross JS, Balasuriya L, Rhee TG. Association of Psychiatric Diagnoses and Medicaid Coverage with Length of Stay Among Inpatients Discharged to Skilled Nursing Facilities. J Gen Intern Med 2022; 37:3070-3079. [PMID: 35048298 PMCID: PMC9485316 DOI: 10.1007/s11606-021-07320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Inpatients with psychiatric diagnoses often require higher levels of care in skilled nursing facilities (SNFs) and are more likely to be covered by Medicaid, which reimburses SNFs at significantly lower rates than Medicare and commercial payors. OBJECTIVE To characterize factors affecting length of stay in inpatients discharged to SNFs. DESIGN A retrospective cross-sectional study design using 2016-2018 data from National Inpatient Sample. PARTICIPANTS Inpatients aged ≥ 40 who were discharged to SNFs. EXPOSURES Primary discharge diagnosis (medical, psychiatric, or substance use) and primary payor. MAIN OUTCOMES AND MEASURES Length of stay, categorized non-exclusively as >3 days, >7 days, or > 14 days. RESULTS Among 9,821,155 inpatient discharges to SNFs between 2016 and 2018, 95.7% had medical primary discharge diagnoses, 3.3% psychiatric diagnoses, and 1.0% substance use diagnoses; Medicare was the most common primary payor (83.3%), followed by private insurance (7.9%), Medicaid (6.6%), and others (2.2%). Median length of stay for all patients was 5.0 days (interquartile range [IQR], 3.0-8.0), 5.0 (IQR, 3.0-8.0) for those with medical diagnoses, 8.0 (IQR, 4.0-15.0) for psychiatric diagnoses, and 5.0 (IQR, 3.0-8.0) for substance use diagnoses. After multivariable adjustment, compared to patients with medical diagnoses, patients with psychiatric diagnoses were more likely to have hospital stays > 3, > 7, and > 14 days, respectively (p < 0.001). Compared to Medicare patients, Medicaid patients were more likely to have hospital stays > 3, > 7, and > 14 days, respectively (p < 0.001). Compared to patients with medical diagnoses, those with psychiatric diagnoses were also more likely to have lengths of stay 1 times, 1.5 times, and 2 times greater than the national geometric mean length of stay for that diagnosis-related group (p < 0.001). CONCLUSIONS Patients discharged to SNFs after inpatient hospitalization for psychiatric diagnoses and with Medicaid coverage were more likely to have longer lengths of stay than patients with medical diagnoses and those with Medicare coverage, respectively.
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Affiliation(s)
| | - Joseph S Ross
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Lilanthi Balasuriya
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
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Lo E, Balasuriya L, Steiner JL. A Street Psychiatry Rotation for Medical Trainees: Humanizing the Care of People Experiencing Homelessness. Acad Psychiatry 2022; 46:248-253. [PMID: 33928536 PMCID: PMC8083093 DOI: 10.1007/s40596-021-01461-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 04/20/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Emma Lo
- Yale University School of Medicine, New Haven, CT, USA.
| | - Lilanthi Balasuriya
- Yale University School of Medicine, New Haven, CT, USA
- Yale National Clinician Scholars Program, New Haven, CT, USA
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Davis K, Balasuriya L, Dixon LB. Engaging People With Lived Experience in Mental Health Services and Research. Psychiatr Serv 2022; 73:476-477. [PMID: 35360936 DOI: 10.1176/appi.ps.22073001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rafla-Yuan E, Moore S, Carvente-Martinez H, Yang P, Balasuriya L, Jackson K, McMickens C, Robles-Ramamurthy B. Striving for Equity in Community Mental Health: Opportunities and Challenges for Integrating Care for BIPOC Youth. Child Adolesc Psychiatr Clin N Am 2022; 31:295-312. [PMID: 35361366 DOI: 10.1016/j.chc.2021.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 12/12/2022]
Abstract
Supporting the mental health of youth who identify as Black, Indigenous, or Persons of Color (BIPOC) continues to be a challenge for clinicians and policymakers alike. Children and adolescents are a vulnerable population, and for BIPOC youth, these vulnerabilities are magnified by the effects of structural, interpersonal, and internalized racism. Integration of psychiatric care into other medical settings has emerged as an evidence-based method to improve access to psychiatric care, but to bridge the gap experienced by BIPOC youth, care must extend beyond medical settings to other child-focused sectors, including local governments, education, child welfare, juvenile legal systems, and beyond. Intentional policy decisions are needed to incentivize and support these systems, which typically rely on coordination and collaboration between clinicians and other stakeholders. Clinicians must be trauma-informed and strive for structural competency to successfully navigate and advocate for collaborative systems that benefit BIPOC youth.
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Affiliation(s)
- Eric Rafla-Yuan
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, #0851, San Diego, CA 92093, USA.
| | - Shavon Moore
- Department of Psychiatry, UC San Diego Health Psychiatry - La Jolla, 8950 Villa La Jolla Drive, Suite C101, MC 9057, La Jolla, CA 92037, USA
| | | | - Phillip Yang
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7985, San Antonio, TX 78229, USA
| | - Lilanthi Balasuriya
- Yale University School of Medicine, 333 Cedar Street, SHM IE-66, PO Box 208088, New Haven, CT 06510-8088, USA
| | - Kamilah Jackson
- PerformCare, 300 Horizon Drive Suit 306, Trenton, NJ 08691, USA
| | - Courtney McMickens
- North Carolina, Eleanor Health, 610 Pembroke Road, Greensboro, NC 27408-7608, USA
| | - Barbara Robles-Ramamurthy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA
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Balasuriya L, Quinton JK, Canavan ME, Holland ML, Edelman EJ, Druss BG, Ross JS. The Association Between History of Depression and Access to Care Among Medicare Beneficiaries During the COVID-19 Pandemic. J Gen Intern Med 2021; 36:3778-3785. [PMID: 34405350 PMCID: PMC8370448 DOI: 10.1007/s11606-021-06990-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Depression is associated with a higher risk for experiencing barriers to care, unmet social needs, and poorer economic and mental health outcomes. OBJECTIVE To determine the impact of COVID-19 on ability to access care, social and economic needs, and mental health among Medicare beneficiaries with and without depression. DESIGN AND PARTICIPANTS Cross-sectional study using data from the 2020 Medicare Current Beneficiary Survey COVID-19 Summer Supplement Public Use File. MAIN MEASURES Access to medical care, inability to access food, medications, household supplies, pay rent or mortgage, feelings of economic security, and mental health effects since COVID-19, risk-adjusted for sociodemographic and clinical characteristics. KEY RESULTS Participants were 11,080 Medicare beneficiaries (nationally representative of 55,960,783 beneficiaries), 27.0% with and 73.0% without a self-reported history of depression. As compared to those without a history of depression, Medicare beneficiaries with a self-reported history of depression were more likely to report inability to get care because of COVID-19 (aOR = 1.28, 95% CI, 1.09, 1.51; P = 0.003), to get household supplies such as toilet paper (aOR = 1.32, 95% CI, 1.10, 1.58; P = 0.003), and to pay rent or mortgage (aOR = 1.64, 95% CI, 1.07, 2.52; P = 0.02). Medicare beneficiaries with a self-reported history of depression were more likely to report feeling less financially secure (aOR = 1.43, 95% CI, 1.22, 1.68; P < 0.001), more stressed or anxious (aOR = 1.68, 95% CI, 1.49, 1.90; P < 0.001), more lonely or sad (aOR = 1.97, 95% CI, 1.68, 2.31; P < 0.001), and less socially connected (aOR = 1.27, 95% CI, 1.10, 1.47; P = 0.001). CONCLUSION A self-reported history of depression was associated with greater inability to access care, more unmet social needs, and poorer economic and mental health outcomes, suggesting greater risk for adverse health outcomes during COVID-19.
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Affiliation(s)
- Lilanthi Balasuriya
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA.
| | - Jacob K Quinton
- UCLA National Clinician Scholars Program, UCLA Department of General Internal Medicine, New Haven, CT, USA
| | - Maureen E Canavan
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - E Jennifer Edelman
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | | | - Joseph S Ross
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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Weiss J, Balasuriya L, Cramer LD, Nunez-Smith M, Genao I, Gonzalez-Colaso R, Wong AH, Samuels EA, Latimore D, Boatright D, Sharifi M. Demographic Differences in Medical Students' Perceptions of Respect for Diversity Among Faculty. Acad Med 2021; 96:S218-S219. [PMID: 34705721 DOI: 10.1097/acm.0000000000004284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Jasmine Weiss
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Lilanthi Balasuriya
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Laura D Cramer
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Marcella Nunez-Smith
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Inginia Genao
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Rosana Gonzalez-Colaso
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Ambrose H Wong
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | | | - Darin Latimore
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Dowin Boatright
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
| | - Mona Sharifi
- Author affiliations: J. Weiss, L. Balasuriya, L.D. Cramer, M. Nunez-Smith, I. Genao, R. Gonzalez-Colaso, A.H. Wong, D. Latimore, D. Boatright, M. Sharifi, Yale University School of Medicine
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Lo E, Lifland B, Buelt EC, Balasuriya L, Steiner JL. Implementing the Street Psychiatry Model in New Haven, CT: Community-Based Care for People Experiencing Unsheltered Homelessness. Community Ment Health J 2021; 57:1427-1434. [PMID: 34059983 DOI: 10.1007/s10597-021-00846-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
"Street psychiatry" is an innovative model that serves people experiencing unsheltered homelessness, a vulnerable population with increased rates of mental illness and substance use disorders. Through community-based delivery of mental health and addiction treatment, street psychiatry helps the street-dwelling population overcome barriers to accessing care through traditional routes. Throughout the United States, street psychiatry programs have arisen in multiple cities, often in partnership with street medicine programs. We discuss the philosophy of street psychiatry, document operational highlights involved in the development of a street psychiatry program in New Haven, CT, suggest key ingredients to implementing a street psychiatry program, and explore challenges and future frontiers. Street psychiatry is an effective person-centered model of service delivery with the potential to be applied in a variety of urban settings to serve people experiencing street homelessness.
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Affiliation(s)
- Emma Lo
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, 34 Park St, New Haven, CT, 06519, USA.
| | - Brooke Lifland
- Department of Psychiatry, Yale University School of Medicine, 300 George St, New Haven, CT, 06511, USA
| | - Eliza C Buelt
- Massachusetts Mental Health Center, 20 Vining St, Boston, MA, 02115, USA
| | - Lilanthi Balasuriya
- Yale National Clinician Scholars Program, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Jeanne L Steiner
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, 34 Park St, New Haven, CT, 06519, USA
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Balasuriya L, Santilli A, Morone J, Ainooson J, Roy B, Njoku A, Mendiola-Iparraguirre A, O’Connor Duffany K, Macklin B, Higginbottom J, Fernández-Ayala C, Vicente G, Venkatesh A. COVID-19 Vaccine Acceptance and Access Among Black and Latinx Communities. JAMA Netw Open 2021; 4:e2128575. [PMID: 34643719 PMCID: PMC8515205 DOI: 10.1001/jamanetworkopen.2021.28575] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022] Open
Abstract
Importance Black and Latinx communities have faced disproportionate harm from the COVID-19 pandemic. Increasing COVID-19 vaccine acceptance and access has the potential to mitigate mortality and morbidity from COVID-19 for all communities, including those most impacted by the pandemic. Objective To investigate and understand factors associated with facilitating and obstructing COVID-19 vaccine access and acceptance among Black and Latinx communities. Design, Setting, and Participants This community-partnered qualitative study conducted semistructured, in-depth focus groups with Black and Latinx participants from March 17 to March 29, 2021, using a secure video conferencing platform. Participants were recruited through emails from local community-based organizations, federally qualified health centers, social service agencies, the New Haven, Connecticut, Health Department, and in-person distribution of study information from community health workers. A total of 8 focus groups were conducted, including 4 in Spanish and 4 in English, with 72 participants from a diverse range of community roles, including teachers, custodial service workers, and health care employees, in New Haven, Connecticut. Data were analyzed from March 17 to July 30, 2021. Main Outcomes and Measures Interviews were audio-recorded, transcribed, translated, and analyzed using an inductive content analysis approach. Themes and subthemes were identified on the acceptability and accessibility of the COVID-19 vaccine among participants who identified as Black and/or Latinx. Results Among 72 participants, 36 (50%) identified as Black, 28 (39%) as Latinx, and 8 (11%) as Black and Latinx and 56 (78%) identified as women and 16 (22%) identified as men. Participants described 3 major themes that may represent facilitators and barriers to COVID-19 vaccinations: pervasive mistreatment of Black and Latinx communities and associated distrust; informing trust via trusted messengers and messages, choice, social support, and diversity; and addressing structural barriers to vaccination access. Conclusions and Relevance The findings of this qualitative study may impact what health care systems, public health officials, policy makers, health care practitioners, and community leaders can do to facilitate equitable uptake of the COVID-19 vaccine. Community-informed insights are imperative to facilitating COVID-19 vaccine access and acceptance among communities hardest hit by the pandemic. Preventing the further widening of inequities and addressing structural barriers to vaccination access are vital to protecting all communities, especially Black and Latinx individuals who have experienced disproportionate death and loss from COVID-19.
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Affiliation(s)
- Lilanthi Balasuriya
- Yale National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
| | - Alycia Santilli
- Community Alliance for Research and Engagement, New Haven, Connecticut
| | - Jennifer Morone
- Yale National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
- Veterans Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, West Haven, Connecticut
| | | | - Brita Roy
- Yale School of Public Health, New Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Anuli Njoku
- Department of Public Health, College of Health and Human ServiceSouthern Connecticut State University, New Haven
| | | | | | - Bernard Macklin
- Community Alliance for Research and Engagement, New Haven, Connecticut
| | | | | | - Genesis Vicente
- Community Alliance for Research and Engagement, New Haven, Connecticut
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven Connecticut
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Holaday LW, Balasuriya L, Roy B, Ross JS, Oladele CR. Medicare beneficiaries' plans for the COVID-19 vaccine in Fall 2020, and why some planned to decline. J Am Geriatr Soc 2021; 69:2434-2437. [PMID: 33990945 PMCID: PMC8242621 DOI: 10.1111/jgs.17285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Louisa W. Holaday
- National Clinicians Scholars ProgramYale School of MedicineNew HavenConnecticutUSA
| | - Lilanthi Balasuriya
- National Clinicians Scholars ProgramYale School of MedicineNew HavenConnecticutUSA
| | - Brita Roy
- Section of General Medicine, Department of Internal MedicineYale School of Medicine, Yale UniversityNew HavenConnecticutUSA
| | - Joseph S. Ross
- Section of General Medicine, Department of Internal MedicineYale School of Medicine, Yale UniversityNew HavenConnecticutUSA
| | - Carol R. Oladele
- Equity Research and Innovation CenterYale School of Medicine, Yale UniversityNew HavenConnecticutUSA
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14
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Martinez-Strengel A, Balasuriya L, Black A, Berg D, Genao I, Gross CP, Keene D, Latimore D, Sotto-Santiago S, Boatright D. Perspectives of Internal Medicine Residency Program Directors on the Accreditation Council for Graduate Medical Education (ACGME) Diversity Standards. J Gen Intern Med 2021; 36:2539-2546. [PMID: 34145516 PMCID: PMC8390633 DOI: 10.1007/s11606-021-06825-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/29/2020] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To increase diversity and inclusion in graduate medical education, the Accreditation Council for Graduate Medical Education (ACGME) issued a revision to their Common Program Requirements during the 2019-2020 academic year mandating that all residency programs must have policies and practices to achieve appropriate diversity among trainees and faculty. OBJECTIVE To explore the perspectives of internal medicine program directors (PDs) and associate program directors (APDs) on the ACGME diversity standard. DESIGN Qualitative study of internal medicine residency program leadership from academic and community programs across the USA. PARTICIPANTS Current PDs (n = 12) and APDs (n = 8) of accredited US internal medicine residency programs. APPROACH We conducted semi-structured, in-depth qualitative interviews. Data was analyzed using the constant comparative method to extract recurrent themes. KEY RESULTS Three main themes, described by participants, were identified: (1) internal medicine PDs and APDs had limited knowledge of the new Common Program Requirement relating to diversity; (2) program leaders expressed concern that the diversity standard reaches beyond the PDs' scope of influence and lack of institutional commitment to the successful implementation of diversity standards; (3) participants described narrow view of diversity and inclusion efforts focusing on recruitment strategies during the interview season. CONCLUSIONS Our findings of lack of familiarity with the new diversity standards, and limited institutional investment in diversity and inclusion efforts raise a concern about successful implementation across GME programs. Nevertheless, our finding suggests that structured implementation in the form of education, guideposts, and financial allocation can alleviate some of the concerns of program leadership in meeting the new ACGME diversity standard in a meaningful way.
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Affiliation(s)
- Angela Martinez-Strengel
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA. .,Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.
| | | | - Aba Black
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David Berg
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Inginia Genao
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Cary P Gross
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Danya Keene
- Yale School of Public Health, New Haven, CT, USA
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sylk Sotto-Santiago
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Alliance for Academic Internal Medicine, Alexandria, VA, USA
| | - Dowin Boatright
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA. .,Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.
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Jackson DS, Jorgensen S, Balasuriya L. Improving Access to Care for Patients With Opioid Use Disorder Requires a Health Equity Lens. Psychiatr Serv 2021; 72:865. [PMID: 34333999 DOI: 10.1176/appi.ps.72802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Danielle S Jackson
- Department of Psychiatry, Yale University, New Haven, Connecticut (Jackson); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya)
| | - Shea Jorgensen
- Department of Psychiatry, Yale University, New Haven, Connecticut (Jackson); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya)
| | - Lilanthi Balasuriya
- Department of Psychiatry, Yale University, New Haven, Connecticut (Jackson); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya)
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Weiss J, Balasuriya L, Cramer LD, Nunez-Smith M, Genao I, Gonzalez-Colaso R, Wong AH, Samuels EA, Latimore D, Boatright D, Sharifi M. Medical Students' Demographic Characteristics and Their Perceptions of Faculty Role Modeling of Respect for Diversity. JAMA Netw Open 2021; 4:e2112795. [PMID: 34086032 PMCID: PMC8178710 DOI: 10.1001/jamanetworkopen.2021.12795] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Faculty role modeling is critical to medical students' professional development to provide culturally adept, patient-centered care. However, little is known about students' perceptions of faculty role modeling of respect for diversity. OBJECTIVE To examine whether variation exists in medical students' perceptions of faculty role modeling of respect for diversity by student demographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from the Association of American Medical Colleges' 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020. MAIN OUTCOMES AND MEASURES Students' perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables. RESULTS Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08). CONCLUSIONS AND RELEVANCE In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.
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Affiliation(s)
- Jasmine Weiss
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Lilanthi Balasuriya
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Laura D. Cramer
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Inginia Genao
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mona Sharifi
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Balasuriya L, Dixon LB. Homelessness and Mental Health: Part 1. Psychiatr Serv 2021; 72:485-486. [PMID: 33789464 DOI: 10.1176/appi.ps.72402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Balasuriya L, Jorgensen S, Swartz MS. Prevention in the Era of COVID-19 and the Role of Behavioral Health Care Teams. Psychiatr Serv 2021; 72:369. [PMID: 33789462 DOI: 10.1176/appi.ps.72401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lilanthi Balasuriya
- National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz). Send correspondence to Dr. Balasuriya
| | - Shea Jorgensen
- National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz). Send correspondence to Dr. Balasuriya
| | - Marvin S Swartz
- National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya); Department of Psychiatry, University of Iowa Hospitals and Clinics, Iowa City (Jorgensen); Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz). Send correspondence to Dr. Balasuriya
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Balasuriya L, Berkowitz SA, Seligman HK. Federal Nutrition Programs after the Pandemic: Learning from P-EBT and SNAP to Create the Next Generation of Food Safety Net Programs. Inquiry 2021; 58:469580211005190. [PMID: 33769116 PMCID: PMC8743939 DOI: 10.1177/00469580211005190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It is thought that childhood food insecurity rates increased to 18 million impacted children in 2020. In response, innovative policy solutions from the Supplemental Nutrition Assistance Program (SNAP) and the Pandemic Electronic Benefit Transfer (P-EBT) were swiftly implemented. These innovations must serve as catalysts to create the next generation of food safety net programs. These include the removal of administrative barriers to enrollment, the use of streamlined procedures to access food, the expansion of P-EBT to daycare and childcare centers, and the uncoupling of receipt of benefits from physical presence in schools. Critical gaps also remain. SNAP benefit amounts are often too low, leaving many families ineligible. More realistic benefit amounts are needed, such as those used in the USDA’s Moderate Cost Food Plan. Eligibility cut-offs exclude many food insecure families. Better alignment of SNAP eligibility with income levels that substantially increase food insecurity risk are critical. Lastly, creating slower phase-out periods for benefits as incomes rise is essential. Additionally, food insecurity continues to disproportionately impact racial and ethnic minority populations and low-income households. These deeply rooted inequalities in access to nutrition play an important role in driving health disparities, including obesity, hypertension, diabetes, and other chronic comorbidities and must be further examined. Changes to SNAP and the P-EBT program illustrate how innovative, broad-scale policy solutions can expeditiously support the nutritional needs of families with children. While pandemic-inspired innovation offers critical lessons for designing the next generation of nutrition assistance, there remain gaps that can perpetuate disparities in access to food and health. As a community of medical providers, we must advocate for broader, more inclusive policies to support those facing food insecurity. The future depends on it.
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Balasuriya L, Gregory A, Hernandez A, Ibe I, Jordan A. The Creation of the Minority Housestaff Organization: a Liberated Space for Underrepresented Minority Physicians to Thrive in Medicine. Acad Psychiatry 2021; 45:73-77. [PMID: 32691374 DOI: 10.1007/s40596-020-01285-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 07/05/2020] [Indexed: 06/11/2023]
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Balasuriya L, Isom J, Cyrus K, Ali H, Sloan A, Arnaout B, Steinfeld M, DeSouza F, Jordan A, Encandela J, Rohrbaugh R. The Time Is Now: Teaching Psychiatry Residents to Understand and Respond to Oppression through the Development of the Human Experience Track. Acad Psychiatry 2021; 45:78-83. [PMID: 33512693 DOI: 10.1007/s40596-021-01399-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Affiliation(s)
| | | | - Kali Cyrus
- Johns Hopkins Medicine, Baltimore, MD, USA
| | - Hana Ali
- Yale School of Medicine, New Haven, CT, USA
| | | | - Bachaar Arnaout
- Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Flavia DeSouza
- Yale School of Medicine, New Haven, CT, USA
- Howard University, Washington, DC, USA
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Affiliation(s)
- Jessica Isom
- Codman Square Health Center, Boston Medical Center, Dorchester, Massachusetts (Isom); Yale National Clinician Scholars Program, New Haven, Connecticut (Balasuriya)
| | - Lilanthi Balasuriya
- Codman Square Health Center, Boston Medical Center, Dorchester, Massachusetts (Isom); Yale National Clinician Scholars Program, New Haven, Connecticut (Balasuriya)
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Affiliation(s)
- Matthew L Goldman
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman); Yale National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya); Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz)
| | - Lilanthi Balasuriya
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman); Yale National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya); Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz)
| | - Marvin S Swartz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman); Yale National Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut (Balasuriya); Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (Swartz)
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Williams JC, Balasuriya L, Alexander-Bloch A, Qayyum Z. Comparing the Effectiveness of a Guide Booklet to Simulation-Based Training for Management of Acute Agitation. Psychiatr Q 2019; 90:861-869. [PMID: 31463735 DOI: 10.1007/s11126-019-09670-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Simulation-based training may be an effective teaching modality for psychiatry residents; however, simulation-based training is an unstudied and underutilized aspect of psychiatry resident training. The objective of this study was to compare the teaching effectiveness of a simulation-based training to reading a resident on-call psychiatry guide booklet in improving the self-confidence and knowledge of residents that is necessary for managing acutely agitated patients. Pre-intervention self-confidence and knowledge were measured for all residents using a Likert scale questionnaire and a clinical vignette questionnaire, respectively. Residents (n = 23) were randomly assigned to either the simulation group (n = 12) or the guide booklet group (n = 11). Residents in the simulation group completed the simulation-based training, and residents in the guide booklet group were instructed to read the corresponding pages of the booklet regarding management of acute agitation. The comparative teaching effectiveness of the guide booklet and simulation-based training was measured with a post-intervention self-confidence questionnaire and a clinical vignette questionnaire. The study spanned approximately one academic year (July 2016- Sept 2017). Residents who participated in the simulation-based training showed significantly greater improvement in self-confidence (simulation median improvement = 1.458 vs. guide median improvement = 0.033, p = 0.002) and knowledge (simulation median improvement = 0.135 vs. guide median improvement = 0.021, p = 0.0124). Simulation-based training was more effective at improving residents' self-confidence and knowledge compared to the on-call psychiatry booklet for the management of acutely agitated patients. Though simulation is being used in other specialties, it is a very underutilized tool in the field of psychiatry. This finding underscores the potential for simulation-based training in residency programs to improve resident learning.
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Affiliation(s)
- J Corey Williams
- The Children's Hospital of Philadelphia, Department of Child & Adolescent Psychiatry and Behavioral Sciences, Philadelphia, PA, USA.
| | | | | | - Zheala Qayyum
- School of Medicine, Harvard University, Boston, MA, USA
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Osseo-Asare A, Balasuriya L, Huot SJ, Keene D, Berg D, Nunez-Smith M, Genao I, Latimore D, Boatright D. Minority Resident Physicians' Views on the Role of Race/Ethnicity in Their Training Experiences in the Workplace. JAMA Netw Open 2018; 1:e182723. [PMID: 30646179 PMCID: PMC6324489 DOI: 10.1001/jamanetworkopen.2018.2723] [Citation(s) in RCA: 288] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Black, Hispanic, and Native American physicians remain underrepresented in medicine despite national efforts to increase diversity in the health care workforce. Understanding the unique workplace experiences of minority physicians is essential to inform strategies to create a diverse and inclusive workforce. While prior research has explored the influence of race/ethnicity on the experiences of minority faculty and medical students, there is a paucity of literature investigating how race/ethnicity affects the training experiences of resident physicians in graduate medical education. OBJECTIVE To characterize how black, Hispanic, and Native American resident physicians experience race/ethnicity in the workplace. DESIGN, SETTING, AND PARTICIPANTS Semistructured, in-depth qualitative interviews of black, Hispanic, and Native American residents were performed in this qualitative study. Interviews took place at the 2017 Annual Medical Education Conference (April 12-17, 2017, in Atlanta, Georgia), sponsored by the Student National Medical Association. Interviews were conducted with 27 residents from 21 residency programs representing a diverse range of medical specialties and geographic locations. MAIN OUTCOMES AND MEASURES The workplace experiences of black, Hispanic, and Native American resident physicians in graduate medical education. RESULTS Among 27 participants, races/ethnicities were 19 (70%) black, 3 (11%) Hispanic, 1 (4%) Native American, and 4 (15%) mixed race/ethnicity; 15 (56%) were female. Participants described the following 3 major themes in their training experiences in the workplace: a daily barrage of microaggressions and bias, minority residents tasked as race/ethnicity ambassadors, and challenges negotiating professional and personal identity while seen as "other." CONCLUSIONS AND RELEVANCE Graduate medical education is an emotionally and physically demanding period for all physicians. Black, Hispanic, and Native American residents experience additional burdens secondary to race/ethnicity. Addressing these unique challenges related to race/ethnicity is crucial to creating a diverse and inclusive work environment.
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Affiliation(s)
- Aba Osseo-Asare
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Stephen J. Huot
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Danya Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - David Berg
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Inginia Genao
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Balasuriya L, Vyles D, Bakerman P, Holton V, Vaidya V, Garcia-Filion P, Westdorp J, Sanchez C, Kurz R. Computerized Dose Range Checking Using Hard and Soft Stop Alerts Reduces Prescribing Errors in a Pediatric Intensive Care Unit. J Patient Saf 2018; 13:144-148. [PMID: 25370855 DOI: 10.1097/pts.0000000000000132] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE An enhanced dose range checking (DRC) system was developed to evaluate prescription error rates in the pediatric intensive care unit and the pediatric cardiovascular intensive care unit. METHODS An enhanced DRC system incorporating "soft" and "hard" alerts was designed and implemented. Practitioner responses to alerts for patients admitted to the pediatric intensive care unit and the pediatric cardiovascular intensive care unit were retrospectively reviewed. RESULTS Alert rates increased from 0.3% to 3.4% after "go-live" (P < 0.001). Before go-live, all alerts were soft alerts. In the period after go-live, 68% of alerts were soft alerts and 32% were hard alerts. Before go-live, providers reduced doses only 1 time for every 10 dose alerts. After implementation of the enhanced computerized physician order entry system, the practitioners responded to soft alerts by reducing doses to more appropriate levels in 24.7% of orders (70/283), compared with 10% (3/30) before go-live (P = 0.0701). The practitioners deleted orders in 9.5% of cases (27/283) after implementation of the enhanced DRC system, as compared with no cancelled orders before go-live (P = 0.0774). Medication orders that triggered a soft alert were submitted unmodified in 65.7% (186/283) as compared with 90% (27/30) of orders before go-live (P = 0.0067). After go-live, 28.7% of hard alerts resulted in a reduced dose, 64% resulted in a cancelled order, and 7.4% were submitted as written. CONCLUSIONS Before go-live, alerts were often clinically irrelevant. After go-live, there was a statistically significant decrease in orders that were submitted unmodified and an increase in the number of orders that were reduced or cancelled.
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Affiliation(s)
- Lilanthi Balasuriya
- From *The University of Arizona College of Medicine-Phoenix; and †Department of Pediatric Critical Care, Phoenix Children's Hospital, Phoenix, Arizona
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