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Bond A. Margin notes from the COVID-19 pandemic for the future of healthcare innovation. Healthc Manage Forum 2023; 36:393-398. [PMID: 37439203 PMCID: PMC10345824 DOI: 10.1177/08404704231185487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
The COVID-19 pandemic has been characterized as a "big-event disruption" that fundamentally challenged the sustainability of existing healthcare business and service models and demanded innovation through "dual transformation" simultaneously to both core operations and the evolution of new strategic directions. The concept of disruptive innovation as applied to healthcare is reviewed and the strategies of distributed healthcare organizations supporting the most medically and socially complex communities during the COVID-19 pandemic are described as demonstrative of the promise of disruptive innovation in healthcare to bring about the necessary shift away from acute and facility-based care to integrated health and social care in the community. The place of new digital health technologies including "big data" analytics, digital platforms, and artificial intelligence/machine learning are identified as being integral to optimizing the scale and scope of impact of distributed community health and social care.
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Affiliation(s)
- Andrew Bond
- Inner City Health Associates, Toronto, Ontario, Canada
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Ahillan T, Emmerson M, Swift B, Golamgouse H, Song K, Roxas A, Mendha SB, Avramović E, Rastogi J, Sultan B. COVID-19 in the homeless population: a scoping review and meta-analysis examining differences in prevalence, presentation, vaccine hesitancy and government response in the first year of the pandemic. BMC Infect Dis 2023; 23:155. [PMID: 36918758 PMCID: PMC10012317 DOI: 10.1186/s12879-023-08037-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023] Open
Abstract
AIMS People experiencing homelessness (PEH) have been identified as being increasingly susceptible to Coronavirus disease (COVID-19), with policies enacted to test, isolate, increase hygiene practices and prioritise vaccines among this population. Here, we conduct a scoping review of the current evidence-base pertaining to the prevalence and presentation of COVID-19 in PEH, COVID-vaccine hesitancy rates and government interventions enacted within the first year of the pandemic for PEH. MATERIALS AND METHODS A systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 prevalence and clinical characteristics in PEH, vaccine uptake for PEH and policies enacted targeting PEH. Study qualities were assessed with The National Heart, Lung and Blood Institute's set of Study Quality. RESULTS Eighty-three studies were included in our final analysis. The overall prevalence of symptomatic COVID-19 infection in PEH is estimated at 35%. The most common symptoms found were cough and shortness of breath, followed by fever. Concerns regarding vaccine hesitancy amongst PEH related to thoroughness of COVID-19 vaccine clinical trials, side effects and mistrust of the government. The main strategies implemented by governments were mass testing, adaption of healthcare service provision, provision of alternative housing, encouraging personal hygiene (hand sanitation and mask wearing), and inter-organisational communication. DISCUSSION In our meta-analysis, 35% of PEH with a COVID-19 infection presented symptomatically; the low prevalence of symptomatic COVID-19 infection suggests widespread testing following outbreaks would be beneficial for this group of individuals. Temporary recuperation units and measures for housing stability in the pandemic, namely provision of alternative housing and stopping evictions, were found to be highly effective. High rates of vaccine hesitancy means that education and encouragement towards vaccination would be beneficial for this vulnerable population, where comorbidities are common. Finally increased focus in research should be placed on the mental health burden of COVID-19 and the pandemic on PEH moving forwards.
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Affiliation(s)
| | | | - Bethan Swift
- Wellcome Centre for Human Genetics, Oxford, UK.,Nuffield Department of Women's and Reproductive Health, Oxford, UK
| | | | | | | | | | | | | | - Binta Sultan
- Institute of Global Health, University College London, London, UK
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3
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Del Buono BC, Salhi BA, Kimmel AE, Santen SA, Jarrell KL, White MH, Brown CK, Moll JL. Prioritizing homelessness in emergency medicine education: A concept paper. AEM EDUCATION AND TRAINING 2022; 6:S85-S92. [PMID: 35774356 PMCID: PMC9222893 DOI: 10.1002/aet2.10753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/03/2022] [Accepted: 03/25/2022] [Indexed: 06/15/2023]
Abstract
Patients experiencing homelessness visit the emergency department (ED) often and have worse clinical outcomes. Caring for this patient population is complex, challenging, and resource-intensive. Emergency medicine (EM) education is lacking in formal curricula on the topic of homelessness, despite benefits for resident morale and patient care. Our goals were to identify a gap in EM education and training of the intersection of housing and health and propose educational topics and teaching methods to be included in residency curricula. Methodology was based on the development of a didactic session at the 2021 SAEM Annual Meeting. A needs assessment was performed through a review of medical education literature, a national survey of EM residency curricula, the individual curricula utilized by respective team members, and perspective from the team's own individual experiences with teaching about homelessness. Topics presented were chosen through discussion between the authors and determined to be common and relevant and cover a broad spectrum of content. The four presented topics included the intersection of COVID-19 and housing, the impact of LGBTQIA+ status on homelessness, housing status related to health system utilization and health outcomes, and housing inequity as a means of perpetuating structural racism. Suggestions for education of these topics included case-based learning, journal clubs, simulation, collaboration with social work, quality improvement projects, and engagement with community leaders. The ED is uniquely positioned to encounter the impacts of homelessness on health. Emergency physicians should be prepared to effectively care for these patients with complex social needs. Structured learning on this topic would benefit EM resident growth and lead to better patient care through improved screening, recognition of risk factors, and use of social resources.
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Affiliation(s)
- Benedict C. Del Buono
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Bisan A. Salhi
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Alexis E. Kimmel
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Sally A. Santen
- Virginia Commonwealth University School of MedicineProfessor, Emergency Medicine and Medical EducationUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kelli L. Jarrell
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Melissa H. White
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christopher K. Brown
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Joel L. Moll
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
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Corey J, Lyons J, O’Carroll A, Stafford R, Ivers JH. A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063219. [PMID: 35328907 PMCID: PMC8954292 DOI: 10.3390/ijerph19063219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.
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Affiliation(s)
- Julia Corey
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | - James Lyons
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | | | - Richie Stafford
- HSE Community Healthcare Organisation Dublin North City & County, D09C8P5 Dublin, Ireland;
| | - Jo-Hanna Ivers
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
- Correspondence:
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Barocas JA, Jacobson KR, Hamer DH. Addressing the COVID-19 Pandemic Among Persons Experiencing Homelessness: Steps to Protect a Vulnerable Population. J Gen Intern Med 2021; 36:1416-1417. [PMID: 33532960 PMCID: PMC7852479 DOI: 10.1007/s11606-020-06434-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/09/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, MA, USA.
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Karen R Jacobson
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Davidson H Hamer
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Komaromy M, Harris M, Koenig RM, Tomanovich M, Ruiz-Mercado G, Barocas JA. Caring for COVID's Most Vulnerable Victims: a Safety-Net Hospital Responds. J Gen Intern Med 2021; 36:1006-1010. [PMID: 33469746 PMCID: PMC7815181 DOI: 10.1007/s11606-020-06499-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/17/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Miriam Komaromy
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA.
- Section of General Internal Medicine, Department of Medicine, Boston University, Boston, MA, USA.
| | - Miriam Harris
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University, Boston, MA, USA
- Clinical Addiction Research and Education (CARE) Unit, Boston University, Boston, MA, USA
| | | | - Mary Tomanovich
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Glorimar Ruiz-Mercado
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University, Boston, MA, USA
| | - Joshua A Barocas
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Section of Infectious Diseases, Department of Medicine, Boston University, Boston, MA, USA
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Affiliation(s)
- Joshua A Barocas
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Esther K Choo
- Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland
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Fuchs JD, Carter HC, Evans J, Graham-Squire D, Imbert E, Bloome J, Fann C, Skotnes T, Sears J, Pfeifer-Rosenblum R, Moughamian A, Eveland J, Reed A, Borne D, Lee M, Rosenthal M, Jain V, Bobba N, Kushel M, Kanzaria HK. Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness. JAMA Netw Open 2021; 4:e210490. [PMID: 33651111 PMCID: PMC7926291 DOI: 10.1001/jamanetworkopen.2021.0490] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/11/2021] [Indexed: 01/17/2023] Open
Abstract
Importance Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting. Objective To assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity. Design, Setting, and Participants This retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness. Exposure A physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder. Main Outcomes and Measures Characteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay. Results Overall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P < .001) and quarantine status (adjusted odds ratio, 2.6; 95% CI, 1.5-4.6; P = .001). In total, 346 of 549 patients (63%) were transferred from the county hospital; of 113 ineligible referrals, 48 patients (42%) had behavioral health needs exceeding I/Q hotel capabilities. Thirteen of the 346 patients transferred from the county hospital (4%) were readmitted for worsening COVID-19. Overall, direct transfers to I/Q hotels from emergency and outpatient departments were associated with averting many hospital admissions. There was a nonsignificant decrease in the mean hospital length of stay for inpatients with confirmed or suspected COVID-19 from 5.5 to 2.7 days from March to May 2020 (P = .11). Conclusions and Relevance To support persons experiencing homelessness during the COVID-19 pandemic, San Francisco rapidly and safely scaled a hotel-based model of I/Q that was associated with reduced strain on inpatient capacity. Strategies to improve guest retention and address behavioral health needs not met in hotel settings are intervention priorities.
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Affiliation(s)
- Jonathan D. Fuchs
- San Francisco Department of Public Health, San Francisco, California
- Department of Medicine, University of California, San Francisco
| | | | - Jennifer Evans
- Department of Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
| | - Dave Graham-Squire
- Department of Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
| | - Elizabeth Imbert
- Department of Medicine, University of California, San Francisco
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco
| | - Jessica Bloome
- Department of Medicine, University of California, San Francisco
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco
| | - Charles Fann
- San Francisco Department of Public Health, San Francisco, California
| | - Tobi Skotnes
- San Francisco Department of Public Health, San Francisco, California
| | - Jonathan Sears
- San Francisco Department of Public Health, San Francisco, California
| | | | - Alice Moughamian
- San Francisco Department of Public Health, San Francisco, California
| | - Joanna Eveland
- San Francisco Department of Public Health, San Francisco, California
| | - Amber Reed
- San Francisco Department of Public Health, San Francisco, California
| | - Deborah Borne
- San Francisco Department of Public Health, San Francisco, California
| | - Michele Lee
- San Francisco Department of Public Health, San Francisco, California
| | - Molly Rosenthal
- Department of Medicine, University of California, San Francisco
| | - Vivek Jain
- Department of Medicine, University of California, San Francisco
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco
| | - Naveena Bobba
- San Francisco Department of Public Health, San Francisco, California
| | - Margot Kushel
- Department of Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
| | - Hemal K. Kanzaria
- Benioff Homelessness and Housing Initiative, University of California, San Francisco
- Department of Emergency Medicine, University of California, San Francisco
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Kimmel SD, Bazzi AR, Barocas JA. Integrating harm reduction and clinical care: Lessons from Covid-19 respite and recuperation facilities. J Subst Abuse Treat 2020; 118:108103. [PMID: 32972644 PMCID: PMC7419278 DOI: 10.1016/j.jsat.2020.108103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/24/2020] [Accepted: 08/07/2020] [Indexed: 02/04/2023]
Abstract
In response to the novel coronavirus 2019 (Covid-19) pandemic, many people experiencing homelessness and substance use disorders entered respite and recuperation facilities for care and to isolate and prevent subsequent SARS-CoV-2 transmission. However, because drug use was officially prohibited in these facilities, we observed people who use substances leaving isolation temporarily or prematurely. The initial Covid-19 surge magnified the need for harm reduction access for those who use substances to ensure their safety and well-being and that of their local communities. In this commentary, we argue that expanding harm reduction access is crucial for subsequent waves of SARS-CoV-2 infection and also for patients who use substances and are hospitalized for other reasons.
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Affiliation(s)
- Simeon D Kimmel
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, United States of America; Section of Infectious Diseases, Department of Medicine, Boston Medical Center, United States of America; Boston University School of Medicine, United States of America.
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, United States of America
| | - Joshua A Barocas
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, United States of America; Boston University School of Medicine, United States of America
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