1
|
Cronin CE, Singh SR, Burns A, Yeager VA, Puro N, Santos T, Mathew A, Franz B. Ohio Presents Opportunities For Understanding Hospital Alignment With Public Health Agencies On Community Health Assessments. Health Aff (Millwood) 2024; 43:873-882. [PMID: 38830155 DOI: 10.1377/hlthaff.2024.00017] [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: 06/05/2024]
Abstract
Multisector collaboration is critical for improving population health. Improving alignment between nonprofit hospitals and local health departments is one promising approach to achieving health improvement, and a number of states are exploring policies to facilitate such collaboration. Using public documents, we evaluated the alignment between Ohio nonprofit hospitals and local health departments in the community health needs they identify and those they prioritize. The top three needs identified by hospitals and health departments were mental health, substance use, and obesity. Alignment across organizations was high among the top needs, but it varied more among less commonly identified needs. Alignment related to social determinants of health was low, with health departments being more responsive to social determinants than hospitals. Given the different strengths and capacities of hospitals and health departments, this divergence may be in the best interests of the communities they serve. Community benefit policies should consider how to promote collaboration between hospitals and health departments while also encouraging organizations to use their own expertise to meet community needs.
Collapse
Affiliation(s)
| | | | - Ashlyn Burns
- Ashlyn Burns, Indiana University, Indianapolis, Indiana
| | | | - Neeraj Puro
- Neeraj Puro, Florida Atlantic University, Boca Raton, Florida
| | - Tatiane Santos
- Tatiane Santos, Tulane University, New Orleans, Louisiana
| | | | | |
Collapse
|
2
|
Parast L, Tian L, Cai T. Assessing heterogeneity in surrogacy using censored data. Stat Med 2024. [PMID: 38812276 DOI: 10.1002/sim.10122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/22/2024] [Accepted: 05/10/2024] [Indexed: 05/31/2024]
Abstract
Determining whether a surrogate marker can be used to replace a primary outcome in a clinical study is complex. While many statistical methods have been developed to formally evaluate a surrogate marker, they generally do not provide a way to examine heterogeneity in the utility of a surrogate marker. Similar to treatment effect heterogeneity, where the effect of a treatment varies based on a patient characteristic, heterogeneity in surrogacy means that the strength or utility of the surrogate marker varies based on a patient characteristic. The few methods that have been recently developed to examine such heterogeneity cannot accommodate censored data. Studies with a censored outcome are typically the studies that could most benefit from a surrogate because the follow-up time is often long. In this paper, we develop a robust nonparametric approach to assess heterogeneity in the utility of a surrogate marker with respect to a baseline variable in a censored time-to-event outcome setting. In addition, we propose and evaluate a testing procedure to formally test for heterogeneity at a single time point or across multiple time points simultaneously. Finite sample performance of our estimation and testing procedure are examined in a simulation study. We use our proposed method to investigate the complex relationship between change in fasting plasma glucose, diabetes, and sex hormones using data from the diabetes prevention program study.
Collapse
Affiliation(s)
- Layla Parast
- Department of Statistics and Data Sciences, The University of Texas at Austin, Austin, Texas
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - Tianxi Cai
- Department of Biostatistics, Harvard University, Cambridge, Massachusetts
| |
Collapse
|
3
|
Aschbrenner KA, Cruz JL, Kruse GR, Nguyen H, Huebner Torres C, Celli M, Sarcione C, Singh D, Emmons KM. Leveraging an implementation science partnership network to understand how Federally Qualified Health Centers operationalize and address health equity. Transl Behav Med 2024; 14:23-33. [PMID: 37542519 PMCID: PMC10782902 DOI: 10.1093/tbm/ibad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
Health equity-focused implementation research requires using definitions and approaches that are relevant and meaningful to implementation partners. We examined how health equity was operationalized and addressed at Federally Qualified Health Centers (FQHCs). We conducted semi-structured interviews with leadership (n = 19) and staff (n = 12) at 10 FQHCs in an implementation science partnership network for cancer control equity to understand how they operationalized and addressed health equity. We performed rapid qualitative analysis and shared findings with a larger group of 13 community health centers (including the 10 FQHCs) at an Implementation Learning Community (ILC) to identify action areas for research and practice, followed by a second phase of synthesizing qualitative codes into themes and mapping themes onto a framework for advancing health equity in healthcare organizations. Participants defined health equity as central to the mission of FQHCs, and identified barriers (e.g. financing models) and facilitators (e.g. interpreter services) to advancing health equity at FQHCs. These findings resonated with ILC participants who emphasized the challenge of addressing root cause social determinants of inequities using limited available resources in FQHCs and the importance of developing meaningful collaboration with communities for data collection, data interpretation, data use, and data ownership. Themes captured recommendations to advance health equity in daily work at FQHCs, including investments in staffing, training, and resources. Mapping qualitative themes from health equity-centered interviews with FQHC partners onto a framework for advancing health equity in healthcare organizations can provide clear, context-specific direction for actions aimed at improving health and healthcare equity.
Collapse
Affiliation(s)
- Kelly A Aschbrenner
- Geisel School of Medicine at Dartmouth College, Hanover, USA
- Dartmouth Health System, Lebanon, USA
| | | | | | | | | | - Maria Celli
- Brockton Neighborhood Health Center, Brockton, MA, USA
| | | | | | | |
Collapse
|
4
|
Aschbrenner KA, Oh AY, Tabak RG, Hannon PA, Angier HE, Moore WT, Likumahuwa-Ackman S, Carroll JK, Baumann AA, Beidas RS, Mazzucca-Ragan S, Waters EA, Sadasivam RS, Shelton RC. Integrating a focus on health equity in implementation science: Case examples from the national cancer institute's implementation science in cancer control centers (ISC 3) network. J Clin Transl Sci 2023; 7:e226. [PMID: 38028358 PMCID: PMC10643915 DOI: 10.1017/cts.2023.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background A Health Equity Task Force (HETF) of members from seven Centers funded by the National Cancer Institute's (NCI) Implementation Science in Cancer Control Centers (ISC3) network sought to identify case examples of how Centers were applying a focus on health equity in implementation science to inform future research and capacity-building efforts. Methods HETF members at each ISC3 collected information on how health equity was conceptualized, operationalized, and addressed in initial research and capacity-building efforts across the seven ISC3 Centers funded in 2019-2020. Each Center completed a questionnaire assessing five health equity domains central to implementation science (e.g., community engagement; implementation science theories, models, and frameworks (TMFs); and engaging underrepresented scholars). Data generated illustrative examples from these five domains. Results Centers reported a range of approaches focusing on health equity in implementation research and capacity-building efforts, including (1) engaging diverse community partners/settings in making decisions about research priorities and projects; (2) applying health equity within a single TMF applied across projects or various TMFs used in specific projects; (3) evaluating health equity in operationalizing and measuring health and implementation outcomes; (4) building capacity for health equity-focused implementation science among trainees, early career scholars, and partnering organizations; and (5) leveraging varying levels of institutional resources and efforts to engage, include, and support underrepresented scholars. Conclusions Examples of approaches to integrating health equity across the ISC3 network can inform other investigators and centers' efforts to build capacity and infrastructure to support growth and expansion of health equity-focused implementation science.
Collapse
Affiliation(s)
- Kelly A. Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA
| | - April Y. Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Rachel G. Tabak
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Peggy A. Hannon
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Heather E. Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - W. Todd Moore
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | | | - Ana A. Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Erika A. Waters
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Rajani S. Sadasivam
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
5
|
Bramble K, Blanco MN, Doubleday A, Gassett AJ, Hajat A, Marshall JD, Sheppard L. Exposure Disparities by Income, Race and Ethnicity, and Historic Redlining Grade in the Greater Seattle Area for Ultrafine Particles and Other Air Pollutants. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:77004. [PMID: 37404015 PMCID: PMC10321236 DOI: 10.1289/ehp11662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Growing evidence shows ultrafine particles (UFPs) are detrimental to cardiovascular, cerebrovascular, and respiratory health. Historically, racialized and low-income communities are exposed to higher concentrations of air pollution. OBJECTIVES Our aim was to conduct a descriptive analysis of present-day air pollution exposure disparities in the greater Seattle, Washington, area by income, race, ethnicity, and historical redlining grade. We focused on UFPs (particle number count) and compared with black carbon, nitrogen dioxide, and fine particulate matter (PM 2.5 ) levels. METHODS We obtained race and ethnicity data from the 2010 U.S. Census, median household income data from the 2006-2010 American Community Survey, and Home Owners' Loan Corporation (HOLC) redlining data from the University of Richmond's Mapping Inequality. We predicted pollutant concentrations at block centroids from 2019 mobile monitoring data. The study region encompassed much of urban Seattle, with redlining analyses restricted to a smaller region. To analyze disparities, we calculated population-weighted mean exposures and regression analyses using a generalized estimating equation model to account for spatial correlation. RESULTS Pollutant concentrations and disparities were largest for blocks with median household income of < $ 20,000 , Black residents, HOLC Grade D, and ungraded industrial areas. UFP concentrations were 4% lower than average for non-Hispanic White residents and higher than average for racialized groups (Asian, 3%; Black, 15%; Hispanic, 6%; Native American, 8%; Pacific Islander, 11%). For blocks with median household incomes of < $ 20,000 , UFP concentrations were 40% higher than average, whereas blocks with incomes of > $ 110,000 had UFP concentrations 16% lower than average. UFP concentrations were 28% higher for Grade D and 49% higher for ungraded industrial areas compared with Grade A. Disparities were highest for UFPs and lowest for PM 2.5 exposure levels. DISCUSSION Our study is one of the first to highlight large disparities with UFP exposures compared with multiple pollutants. Higher exposures to multiple air pollutants and their cumulative effects disproportionately impact historically marginalized groups. https://doi.org/10.1289/EHP11662.
Collapse
Affiliation(s)
- Kaya Bramble
- Department of Industrial & Systems Engineering, College of Engineering, University of Washington, Seattle, Washington, USA
| | - Magali N. Blanco
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Annie Doubleday
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Amanda J. Gassett
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Julian D. Marshall
- Department of Civil & Environmental Engineering, College of Engineering, University of Washington, Seattle, Washington, USA
| | - Lianne Sheppard
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, USA
| |
Collapse
|
6
|
Farrell TW, Greer AG, Bennie S, Hageman H, Pfeifle A. Academic Health Centers and the Quintuple Aim of Health Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:563-568. [PMID: 36255204 DOI: 10.1097/acm.0000000000005031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The Quintuple Aim of health care adds health equity to the existing Quadruple Aim of improving the individual experience of care for patients, improving the health of populations, reducing the per capita cost of care, and improving the experience of health care professionals. Health equity has previously been subsumed within the other 4 aims. Elevating health equity to the status of a distinct aim is necessary to address persistent health inequities that disproportionately affect underrepresented and minoritized groups. Academic health centers (AHCs) bear a unique responsibility to advance health equity due to the societal importance of their 4 missions: patient care, education, research, and community collaboration. Interprofessional education and practice provide natural connection points that enable AHCs to prepare both health professions students and practicing health care professionals to address all 5 aims. AHCs are well positioned to assess health outcomes related to health equity, develop a health care workforce that is representative of their communities, develop innovative research questions regarding health equity, and engage and invest in the communities they serve.
Collapse
Affiliation(s)
- Timothy W Farrell
- T.W. Farrell is professor of medicine and associate chief for age-friendly care, Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, and physician investigator, VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0003-0070-8757
| | - Annette G Greer
- A.G. Greer is associate professor and vice chair of diversity, equity, and inclusion, Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina; ORCID: https://orcid.org/0000-0002-2868-0306
| | - Scott Bennie
- S. Bennie is dean of academic affairs, Kettering College, Kettering, Ohio; ORCID: https://orcid.org/0000-0001-7601-452X
| | - Heather Hageman
- H. Hageman is director, Center for Interprofessional Practice and Education, Washington University Medical Center, a collaboration between Goldfarb School of Nursing at Barnes-Jewish College, the University of Health Sciences and Pharmacy in St Louis, and Washington University School of Medicine, St Louis, Missouri
| | - Andrea Pfeifle
- A. Pfeifle is professor of family and community medicine and associate vice chancellor for interprofessional practice and education, The Ohio State University and Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
7
|
Myers PL, Chung KC. Role of Health Equity Research and Policy for Diverse Populations Requiring Hand Surgery Care. Hand Clin 2023; 39:17-24. [PMID: 36402522 DOI: 10.1016/j.hcl.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health equity requires allocation of resources to eliminate the systematic disparities in health, imposed on marginalized groups, which adversely impact outcomes. A socioecological approach is implemented to elucidate the role of health equity research and policy for underrepresented minority and socioeconomically disadvantaged populations. Through investigation of the individual, community, institution, and public policy, we investigate problems and propose solutions to ensure fair and just treatment of all patients requiring hand surgery.
Collapse
Affiliation(s)
- Paige L Myers
- Department of Surgery, Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| |
Collapse
|
8
|
Salerno EA, Gao R, Fanning J, Gothe NP, Peterson LL, Anbari AB, Kepper MM, Luo J, James AS, McAuley E, Colditz GA. Designing home-based physical activity programs for rural cancer survivors: A survey of technology access and preferences. Front Oncol 2023; 13:1061641. [PMID: 36761969 PMCID: PMC9907024 DOI: 10.3389/fonc.2023.1061641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Background While technology advances have increased the popularity of remote interventions in underserved and rural cancer communities, less is understood about technology access and preferences for home-based physical activity programs in this cancer survivor population. Purpose To determine access, preferences, and needs, for a home-based physical activity program in rural cancer survivors. Methods A Qualtrics Research Panel was recruited to survey adults with cancer across the United States. Participants self-reported demographics, cancer characteristics, technology access and usage, and preferences for a home-based physical activity program. The Godin Leisure Time Exercise Questionnaire (GLTEQ) assessed current levels of physical activity. Descriptive statistics included means and standard deviations for continuous variables, and frequencies for categorical variables. Independent samples t-tests explored differences between rural and non-rural participants. Results Participants (N=298; mean age=55.2 ± 16.5) had a history of cancer (mean age at diagnosis=46.5), with the most commonly reported cancer type being breast (25.5%), followed by prostate (16.1%). 74.2% resided in rural hometowns. 95% of participants reported accessing the internet daily. On a scale of 0-100, computer/laptop (M=63.4) and mobile phone (M=54.6) were the most preferred delivery modes for a home-based physical activity intervention, and most participants preferred balance/flexibility (72.2%) and aerobic (53.9%) exercises. Desired intervention elements included a frequency of 2-3 times a week (53.5%) for at least 20 minutes (75.7%). While there were notable rural disparities present (e.g., older age at diagnosis, lower levels of education; ps<.001), no differences emerged for technology access or environmental barriers (ps>.08). However, bias due to electronic delivery of the survey should not be discounted. Conclusion These findings provide insights into the preferred physical activity intervention (e.g., computer delivery, balance/flexibility exercises) in rural cancer survivors, while highlighting the need for personalization. Future efforts should consider these preferences when designing and delivering home-based interventions in this population.
Collapse
Affiliation(s)
- Elizabeth A. Salerno
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Rohana Gao
- Academic Program of Medical Education, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Jason Fanning
- Department of Gerontology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Neha P. Gothe
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Lindsay L. Peterson
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Allison B. Anbari
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
| | - Maura M. Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| |
Collapse
|
9
|
Boisvert I, Dunn AG, Lundmark E, Smith-Merry J, Lipworth W, Willink A, Hughes SE, Nealon M, Calvert M. Disruptions to the hearing health sector. Nat Med 2023; 29:19-21. [PMID: 36604541 DOI: 10.1038/s41591-022-02086-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Isabelle Boisvert
- Communication Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. .,Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Erik Lundmark
- Macquarie Business School, Macquarie University, Sydney, New South Wales, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Wendy Lipworth
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
| | - Amber Willink
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) West Midlands, Birmingham, UK.,UK SPINE, University of Birmingham, Birmingham, UK
| | - Michele Nealon
- Collaborator with lived experience of hearing loss. Disability Leadership Institute, Sydney, New South Wales, Australia
| | - Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR), Applied Research Collaboration (ARC) West Midlands, Birmingham, UK.,UK SPINE, University of Birmingham, Birmingham, UK.,DEMAND Hub, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
| |
Collapse
|
10
|
van Leersum CM, Konrad KE, Siebrand E, Malik ZB, den Ouden MEM, Bults M. Engaging older adults with a migration background to explore the usage of digital technologies in coping with dementia. Front Public Health 2023; 11:1125834. [PMID: 37124775 PMCID: PMC10140574 DOI: 10.3389/fpubh.2023.1125834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background Coping with dementia can imply particular challenges for people with a migration background due to diversity in their life course, personal characteristics, and living environment. Some of the services available for people with dementia include digital technologies for care, providing health services, and maintaining or increasing participation, independence, and safety. This study aimed to explore the role of digital technology in coping with dementia in the lives of older adults with a migration background, and the possibilities to engage and collaborate with older adults. Methods This study combined a qualitative interview-based approach with citizen science principles in the design and execution of a project studying the use of Anne4Care. Results and discussion Participants valued that technology should provide health benefits and fit into aspects of their daily lives. Anne4Care was considered helpful in staying independent and connecting to loved ones in their country of birth. The participants needed to learn new competencies to work with the device, and not all had the material prerequisites, such as an internet connection. Still, this learning process was considered purposeful in their life, and the virtual assistant could be integrated into care and daily practices. The involvement of the older adults with dementia as co-researchers made them feel valuable and as equal partners during this research. An important prerequisite for the involvement of older adults with a migration background was existing relations with carers and care organizations. Conclusion Digital care technologies to cope with dementia can become a valuable part of care practices in the lives of older adults with a migration background. Involving older adults in the development of technology, acknowledging their expertise and needs, and working together in short iterations to adapt the technology for their specific needs and situations were experienced as valuable by the researchers, older adults, and care professionals.
Collapse
Affiliation(s)
- Catharina M. van Leersum
- Science, Technology, and Policy Studies, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands
- *Correspondence: Catharina M. van Leersum,
| | - Kornelia E. Konrad
- Science, Technology, and Policy Studies, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands
| | - Egbert Siebrand
- Ethics and Technology Research Group, Saxion University of Applied Science, Deventer, Netherlands
| | - Zohrah B. Malik
- Technology, Health and Care Research Group, Saxion University of Applied Science, Enschede, Netherlands
| | - Marjolein E. M. den Ouden
- Technology, Health and Care Research Group, Saxion University of Applied Science, Enschede, Netherlands
| | - Marloes Bults
- Technology, Health and Care Research Group, Saxion University of Applied Science, Enschede, Netherlands
| |
Collapse
|
11
|
Keene Woods N, Ali U, Medina M, Reyes J, Chesser AK. Health Literacy, Health Outcomes and Equity: A Trend Analysis Based on a Population Survey. J Prim Care Community Health 2023; 14:21501319231156132. [PMID: 36852725 PMCID: PMC10071098 DOI: 10.1177/21501319231156132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Health literacy continues to be an issue among minority groups. Population surveys are one strategy used to help better understand health disparities. The Behavioral Risk Factor Surveillance System (BRFSS) in Kansas added health literacy questions to the survey in 2012. This study examined population health literacy levels and health trends from 2012 to 2018. The health status variables included health care coverage status, general health rating, presence of chronic conditions, and length of time since the last check-up. The percentage of individuals reporting low health literacy decreased from 67% in 2012 to 51% in 2018. The percentage of participants with income levels less than $15 000 was 9% in 2012 and 7% in 2018. Health literacy was lowest among the age group 18 to 24-year-olds, those who identified as multiracial, separated, not graduated from high school, out of work for more than 1 year, income less than $10 000, with other living arrangements, and living in a suburban county of metropolitan statistical area. Additionally, many health conditions improved, and those reporting health insurance increased slightly. The study demonstrates how health literacy continues to be an issue, and how education and primary prevention are necessary to improve limited health literacy and health outcomes. Findings from both state-level and national BRFSS population surveys can help educate the public health and clinical health services workforce to provide better care and address health disparities for highrisk populations.
Collapse
Affiliation(s)
| | - Umama Ali
- Wichita State University, Wichita, KS, USA
| | | | | | | |
Collapse
|
12
|
Ferguson T, Olds T, Curtis R, Blake H, Crozier AJ, Dankiw K, Dumuid D, Kasai D, O'Connor E, Virgara R, Maher C. Effectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analyses. Lancet Digit Health 2022; 4:e615-e626. [PMID: 35868813 DOI: 10.1016/s2589-7500(22)00111-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/22/2022] [Accepted: 05/27/2022] [Indexed: 05/27/2023]
Abstract
Wearable activity trackers offer an appealing, low-cost tool to address physical inactivity. This systematic review of systematic reviews and meta-analyses (umbrella review) aimed to examine the effectiveness of activity trackers for improving physical activity and related physiological and psychosocial outcomes in clinical and non-clinical populations. Seven databases (Embase, MEDLINE, Ovid Emcare, Scopus, SPORTDiscus, the Cochrane Library, and Web of Science) were searched from database inception to April 8, 2021. Systematic reviews of primary studies using activity trackers as interventions and reporting physical activity, physiological, or psychosocial outcomes were eligible for inclusion. In total, 39 systematic reviews and meta-analyses were identified, reporting results from 163 992 participants spanning all age groups, from both healthy and clinical populations. Taken together, the meta-analyses suggested activity trackers improved physical activity (standardised mean difference [SMD] 0·3-0·6), body composition (SMD 0·7-2·0), and fitness (SMD 0·3), equating to approximately 1800 extra steps per day, 40 min per day more walking, and reductions of approximately 1 kg in bodyweight. Effects for other physiological (blood pressure, cholesterol, and glycosylated haemoglobin) and psychosocial (quality of life and pain) outcomes were typically small and often non-significant. Activity trackers appear to be effective at increasing physical activity in a variety of age groups and clinical and non-clinical populations. The benefit is clinically important and is sustained over time. Based on the studies evaluated, there is sufficient evidence to recommend the use of activity trackers.
Collapse
Affiliation(s)
- Ty Ferguson
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Timothy Olds
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Rachel Curtis
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Henry Blake
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Alyson J Crozier
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Kylie Dankiw
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Daiki Kasai
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Edward O'Connor
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Rosa Virgara
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition, and Activity, University of South Australia, Adelaide, SA, Australia.
| |
Collapse
|
13
|
Engler D, Hanson CL, Desteghe L, Boriani G, Diederichsen SZ, Freedman B, Palà E, Potpara TS, Witt H, Heidbuchel H, Neubeck L, Schnabel RB. Feasible approaches and implementation challenges to atrial fibrillation screening: a qualitative study of stakeholder views in 11 European countries. BMJ Open 2022; 12:e059156. [PMID: 35728895 PMCID: PMC9214372 DOI: 10.1136/bmjopen-2021-059156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Atrial fibrillation (AF) screening may increase early detection and reduce complications of AF. European, Australian and World Heart Federation guidelines recommend opportunistic screening, despite a current lack of clear evidence supporting a net benefit for systematic screening. Where screening is implemented, the most appropriate approaches are unknown. We explored the views of European stakeholders about opportunities and challenges of implementing four AF screening scenarios. DESIGN Telephone-based semi-structured interviews with results reported using Consolidated criteria for Reporting Qualitative research guidelines. Data were thematically analysed using the framework approach. SETTING AF screening stakeholders in 11 European countries. PARTICIPANTS Healthcare professionals and regulators (n=24) potentially involved in AF screening implementation. INTERVENTION Four AF screening scenarios: single time point opportunistic, opportunistic prolonged, systematic single time point/prolonged and patient-led screening. PRIMARY OUTCOME MEASURES Stakeholder views about the challenges and feasibility of implementing the screening scenarios in the respective national/regional healthcare system. RESULTS Three themes developed. (1) Current screening approaches: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity. (2) Feasibility of screening: single time point opportunistic screening in primary care using single-lead ECG devices was considered the most feasible. Software algorithms may aid identification of suitable patients and telehealth services have potential to support diagnosis. (3) Implementation requirements: sufficient evidence of benefit is required. National screening processes are required due to different payment mechanisms and health service regulations. Concerns about data security, and inclusivity for those without primary care access or personal devices must be addressed. CONCLUSIONS There is an overall awareness of AF screening. Opportunistic screening appears the most feasible across Europe. Challenges are health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit and a tailored approach adapted to national realities.
Collapse
Affiliation(s)
- Daniel Engler
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Coral L Hanson
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Lien Desteghe
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Søren Zöga Diederichsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ben Freedman
- Heart Research Institute, The University of Sydney, Sydney, New South Wales, Australia
- University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
- Deptartment of Cardiology, Concord Hospital, Concord, Sydney, Australia
| | - Elena Palà
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Autonomous University of Barcelona, Barcelona, Spain
| | - Tatjana S Potpara
- Deptartment for Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Beograd, Serbia
| | | | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Research Group Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Renate B Schnabel
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| |
Collapse
|
14
|
Chirumamilla S, Gulati M. Patient Education and Engagement through Social Media. Curr Cardiol Rev 2021; 17:137-143. [PMID: 31752656 PMCID: PMC8226210 DOI: 10.2174/1573403x15666191120115107] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/26/2019] [Accepted: 10/08/2019] [Indexed: 12/20/2022] Open
Abstract
This review addresses the demographics of social media users and their relative health literacy. Means of overcoming health inequities via social media and the role of social media in patient education and engagement are explored. This review discusses forms of appropriate patient engagement, including the pitfalls of social media use.
Collapse
Affiliation(s)
- Sravya Chirumamilla
- Huntsville Heart Center, 930 Franklin St SE, Huntsville, AL 35801, United States
| | - Martha Gulati
- Division of Cardiology, University of Arizona- Phoenix, 475 N. 5th Street, Phoenix, AZ 85004, United States
| |
Collapse
|
15
|
Griffin AC, Xing Z, Mikles SP, Bailey S, Khairat S, Arguello J, Wang Y, Chung AE. Information needs and perceptions of chatbots for hypertension medication self-management: a mixed methods study. JAMIA Open 2021; 4:ooab021. [PMID: 33898936 PMCID: PMC8054030 DOI: 10.1093/jamiaopen/ooab021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Chatbots have potential to deliver interactive self-management interventions but have rarely been studied in the context of hypertension or medication adherence. The objective of this study was to better understand patient information needs and perceptions of chatbots to support hypertension medication self-management. Materials and Methods Mixed methods were used to assess self-management needs and preferences for using chatbots. We purposively sampled adults with hypertension who were prescribed at least one medication. Participants completed questionnaires on sociodemographics, health literacy, self-efficacy, and technology use. Semi-structured interviews were conducted, audio-recorded, and transcribed verbatim. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using applied thematic analysis. Results Thematic saturation was met after interviewing 15 participants. Analysis revealed curiosity toward chatbots, and most perceived them as humanlike. The majority were interested in using a chatbot to help manage medications, refills, communicate with care teams, and for accountability toward self-care tasks. Despite general enthusiasm, there were concerns with chatbots providing too much information, making demands for lifestyle changes, invading privacy, and usability issues with deployment on smartphones. Those with overall positive perceptions toward chatbots were younger and taking fewer medications. Discussion Chatbot-related informational needs were consistent with existing self-management research, and many felt chatbots would be valuable if customizable and compatible with patient portals, pharmacies, or health apps. Conclusion Although most were not familiar with chatbots, patients were interested in interacting with them, but this varied. This research informs future design and functionalities of conversational interfaces to support hypertension self-management.
Collapse
Affiliation(s)
- Ashley C Griffin
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Zhaopeng Xing
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Sean P Mikles
- Lineberger Comprehensive Cancer Outcomes Program, UNC, Chapel Hill, North Carolina, USA
| | - Stacy Bailey
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Saif Khairat
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,School of Nursing, UNC, Chapel Hill, North Carolina, USA
| | - Jaime Arguello
- School of Information & Library Science, UNC, Chapel Hill, North Carolina, USA
| | - Yue Wang
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,School of Information & Library Science, UNC, Chapel Hill, North Carolina, USA
| | - Arlene E Chung
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Outcomes Program, UNC, Chapel Hill, North Carolina, USA.,Division of General Medicine & Clinical Epidemiology, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA.,Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA.,Program on Health and Clinical Informatics, UNC School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
16
|
Ebinger JE, Driver M, Ji H, Claggett B, Wu M, Luong E, Sun N, Botting P, Kim EH, Hoang A, Nguyen TT, Diaz J, Park E, Davis T, Hussain S, Cheng S, Figueiredo JC. Temporal variations in the severity of COVID-19 illness by race and ethnicity. BMJ Nutr Prev Health 2021; 4:166-173. [PMID: 34308124 PMCID: PMC7985979 DOI: 10.1136/bmjnph-2021-000253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Early reports highlighted racial/ethnic disparities in the severity of COVID-19 seen across the USA; the extent to which these disparities have persisted over time remains unclear. Our research objective was to understand temporal trends in racial/ethnic variation in severity of COVID-19 illness presenting over time. Methods We conducted a retrospective cohort analysis using longitudinal data from Cedars-Sinai Medical Center, a high-volume health system in Southern California. We studied patients admitted to the hospital with COVID-19 illness from 4 March 2020 through 5 December 2020. Our primary outcome was COVID-19 severity of illness among hospitalised patients, assessed by racial/ethnic group status. We defined overall illness severity as an ordinal outcome: hospitalisation but no intensive care unit (ICU) admission; admission to the ICU but no intubation; and intubation or death. Results A total of 1584 patients with COVID-19 with available demographic and clinical data were included. Hispanic/Latinx compared with non-Hispanic white patients had higher odds of experiencing more severe illness among hospitalised patients (OR 2.28, 95% CI 1.62 to 3.22) and this disparity persisted over time. During the initial 2 months of the pandemic, non-Hispanic blacks were more likely to suffer severe illness than non-Hispanic whites (OR 2.02, 95% CI 1.07 to 3.78); this disparity improved by May, only to return later in the pandemic. Conclusion In our patient sample, the severity of observed COVID-19 illness declined steadily over time, but these clinical improvements were not seen evenly across racial/ethnic groups; greater illness severity continues to be experienced among Hispanic/Latinx patients.
Collapse
Affiliation(s)
- Joseph E Ebinger
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew Driver
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hongwei Ji
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Department of Cardiology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Min Wu
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Eric Luong
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nancy Sun
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Patrick Botting
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Elizabeth H Kim
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amy Hoang
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Trevor Trung Nguyen
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jacqueline Diaz
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Eunice Park
- Advanced Data Analytics, Enterprise Information Systems, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tod Davis
- Advanced Data Analytics, Enterprise Information Systems, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shehnaz Hussain
- Department of Public Health Sciences and Comprehensive Cancer Center, University of California, Davis, Davis, California, USA
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jane C Figueiredo
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Cedars-Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
17
|
Abstract
Although the current COVID-19 crisis is felt globally, at the local level, COVID-19 has disproportionately affected poor, highly segregated African American communities in Chicago. To understand the emerging pattern of racial inequality in the effects of COVID-19, we examined the relative burden of social vulnerability and health risk factors. We found significant spatial clusters of social vulnerability and risk factors, both of which are significantly associated with the increased COVID-19-related death rate. We also found that a higher percentage of African Americans was associated with increased levels of social vulnerability and risk factors. In addition, the proportion of African American residents has an independent effect on the COVID-19 death rate. We argue that existing inequity is often highlighted in emergency conditions. The disproportionate effects of COVID-19 in African American communities are a reflection of racial inequality and social exclusion that existed before the COVID-19 crisis.
Collapse
Affiliation(s)
- Sage J Kim
- School of Public Health, University of Illinois, Chicago, IL, USA
| | - Wendy Bostwick
- College of Nursing, University of Illinois, Chicago, IL, USA
| |
Collapse
|
18
|
Schlosser A, Harris S. Care during COVID-19: Drug use, harm reduction, and intimacy during a global pandemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102896. [PMID: 32768156 PMCID: PMC7392208 DOI: 10.1016/j.drugpo.2020.102896] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Allison Schlosser
- University of Nebraska, Omaha, 222 University Drive E Arts & Sciences Hall 383 Omaha, Nebraska 68182, United States
| | - Shana Harris
- University of Central Florida, 4000 Central Florida Boulevard, Howard Phillips Hall Room 309, Orlando, FL 32816, United States.
| |
Collapse
|
19
|
Abstract
Although the current COVID-19 crisis is felt globally, at the local level, COVID-19 has disproportionately affected poor, highly segregated African American communities in Chicago. To understand the emerging pattern of racial inequality in the effects of COVID-19, we examined the relative burden of social vulnerability and health risk factors. We found significant spatial clusters of social vulnerability and risk factors, both of which are significantly associated with the increased COVID-19-related death rate. We also found that a higher percentage of African Americans was associated with increased levels of social vulnerability and risk factors. In addition, the proportion of African American residents has an independent effect on the COVID-19 death rate. We argue that existing inequity is often highlighted in emergency conditions. The disproportionate effects of COVID-19 in African American communities are a reflection of racial inequality and social exclusion that existed before the COVID-19 crisis.
Collapse
Affiliation(s)
- Sage J Kim
- School of Public Health, University of Illinois, Chicago, IL, USA
| | - Wendy Bostwick
- College of Nursing, University of Illinois, Chicago, IL, USA
| |
Collapse
|
20
|
Kim SJ, Ramirez-Valles J, Watson K, Allen-Mears P, Matthews A, Martinez E, Odoms-Young A, Daviglus M, Winn RA. Fostering health equity research: Development and implementation of the Center for Health Equity Research (CHER) Chicago. J Clin Transl Sci 2020; 4:53-60. [PMID: 32257411 PMCID: PMC7103474 DOI: 10.1017/cts.2019.415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The purpose of this article is to describe the process of developing and implementing a transdisciplinary community-based research center, the Center for Health Equity Research (CHER) Chicago, to offer a model for designing and implementing research centers that aim to address structural causes of health inequality. METHODS Scholars from diverse backgrounds and disciplines formed a multidisciplinary team for the Center and adopted the structural violence framework as the organizing conceptual model. All Center activities were based on community partnership. The Center activities were organized within three cores: administrative, investigator development, and community engagement and dissemination cores. The key activities during the first year were to develop a pilot grant program for early-stage investigators (ESIs) and to establish community partnership mechanisms. RESULTS CHER provided more than 60 consultations for ESIs, which resulted in 31 pilot applications over the three application cycles. Over 200 academic and community partners attended the community symposium and discussed community priority. Some challenges encountered were to improve communication among investigators, to clarify roles and responsibilities of the three cores, and to build consensus on the definition and operationalization of the concept of structural violence. CONCLUSION There is an increasing need for local hubs to facilitate transdisciplinary collaboration and community engagement to effectively address health inequity. Building consensus around a shared vision among partners is a difficult and yet important step toward achieving equity.
Collapse
Affiliation(s)
- Sage J. Kim
- University of Illinois at Chicago, School of Public Health, Division of Health Policy and Administration, Chicago, IL, USA
| | | | - Karriem Watson
- University of Illinois at Chicago, School of Public Health, Division of Community Health Sciences, University of Illinois Cancer Center, Chicago, IL, USA
| | - Paula Allen-Mears
- University of Illinois at Chicago, College of Medicine, Chicago, IL, USA
| | - Alicia Matthews
- University of Illinois at Chicago, College of Nursing, Chicago, IL, USA
| | | | - Angela Odoms-Young
- University of Illinois at Chicago, College of Applied Health Sciences, Chicago, IL, USA
| | - Martha Daviglus
- University of Illinois at Chicago, College of Medicine, Chicago, IL, USA
| | - Robert A. Winn
- University of Illinois at Chicago, College of Medicine, Chicago, IL, USA
| |
Collapse
|
21
|
Quaglio G, Figueras J, Mantoan D, Dawood A, Karapiperis T, Costongs C, Bernal-Delgado E. An overview of future EU health systems. An insight into governance, primary care, data collection and citizens' participation. J Public Health (Oxf) 2019; 40:891-898. [PMID: 29590431 DOI: 10.1093/pubmed/fdy054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background Health systems in the European Union (EU) are being questioned over their effectiveness and sustainability. In pursuing both goals, they have to conciliate coexisting, not always aligned, realities. Methods This paper originated from a workshop entitled 'Health systems for the future' held at the European Parliament. Experts and decision makers were asked to discuss measures that may increase the effectiveness and sustainability of health systems, namely: (i) increasing citizens' participation; (ii) the importance of primary care in providing integrated services; (iii) improving the governance and (iv) fostering better data collection and information channels to support the decision making process. Results In the parliamentary debate, was discussed the concept that, in the near future, health systems' effectiveness and sustainability will very much depend on effective access to integrated services where primary care is pivotal, a clearer shift from care-oriented systems to health promotion and prevention, a profound commitment to good governance, particularly to stakeholders participation, and a systematic reuse of data meant to build health data-driven learning systems. Conclusions Many health issues, such as future health systems in the EU, are potentially transformative and hence an intense political issue. It is policy-making leadership that will mostly determine how well EU health systems are prepared to face future challenges.
Collapse
Affiliation(s)
- Gianluca Quaglio
- Scientific Foresight Unit (Science and Technology Options Assessment [STOA]), Directorate-General for Parliamentary Research Service (EPRS), European Parliament, Rue Wiertz 60, Brussels, Belgium.,Directorate-General for Health and Social Services, Veneto Region, Venice, Italy
| | - Josep Figueras
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Domenico Mantoan
- Directorate-General for Health and Social Services, Veneto Region, Venice, Italy
| | - Amr Dawood
- Scientific Foresight Unit (Science and Technology Options Assessment [STOA]), Directorate-General for Parliamentary Research Service (EPRS), European Parliament, Rue Wiertz 60, Brussels, Belgium
| | - Theodoros Karapiperis
- Scientific Foresight Unit (Science and Technology Options Assessment [STOA]), Directorate-General for Parliamentary Research Service (EPRS), European Parliament, Rue Wiertz 60, Brussels, Belgium
| | | | - Enrique Bernal-Delgado
- Institute for Health Sciences in Aragon (IACS), Zaragoza, Spain.,European Collaboration in Health Care Optimization - ECHO Project, Spain.,BRIDGEHealth Project, Brussels, Belgium
| |
Collapse
|
22
|
Dorn SD. Gastroenterologists Without Borders: Using Virtual Care to Reach Beyond the Clinic Walls. Gastroenterology 2019; 157:272-274. [PMID: 30981788 DOI: 10.1053/j.gastro.2019.03.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Spencer D Dorn
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| |
Collapse
|
23
|
Mitchell UA, Chebli PG, Ruggiero L, Muramatsu N. The Digital Divide in Health-Related Technology Use: The Significance of Race/Ethnicity. THE GERONTOLOGIST 2019; 59:6-14. [PMID: 30452660 DOI: 10.1093/geront/gny138] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Indexed: 01/31/2023] Open
Abstract
Background and Objectives Technology can enhance the health and quality of life of diverse populations and may play an important role in reducing health disparities. Although a "digital divide" between the young and the old has been noted, it is unclear whether the use of technology for managing health differs by race/ethnicity among older adults. This study uses nationally representative data from community-dwelling older Americans to characterize racial/ethnic differences in health-related technology use. Design and Methods Data came from 1,336 white, black, and Hispanic adults aged 54 and older who completed the 2014 technology module of the Health and Retirement Study. Racial/ethnic differences in overall health-related technology use were assessed using Poisson regression. Then, F-tests were used to assess differences in the use of phone calls, text messages, E-mails, social media, health management sites, health-related mobile applications, web searches, and brain games for health purposes. Results Compared to whites, older blacks and Hispanics were less likely to use technology for health-related purposes after accounting for demographic characteristics, education, and health conditions. They were also less likely to make or receive phone calls, use health management sites, search the web for health information, and use brain games for their health. Discussion and Implications Older racial and ethnic minorities are less likely than whites to use certain technologies when managing their health. These findings highlight the importance of understanding the patterns of health-related technology use across racially and ethnically diverse populations to appropriately tailor interventions aimed at improving minority health and eliminating health disparities.
Collapse
Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Perla G Chebli
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Laurie Ruggiero
- Behavioral Health and Nutrition Department, College of Health Sciences, University of Delaware, Newark
| | - Naoko Muramatsu
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| |
Collapse
|
24
|
Anthony DL, Campos-Castillo C, Lim PS. Who Isn’t Using Patient Portals And Why? Evidence And Implications From A National Sample Of US Adults. Health Aff (Millwood) 2018; 37:1948-1954. [DOI: 10.1377/hlthaff.2018.05117] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Denise L. Anthony
- Denise L. Anthony is a professor of health management and policy and of sociology in the Department of Health Management and Policy, University of Michigan School of Public Health, in Ann Arbor
| | - Celeste Campos-Castillo
- Celeste Campos-Castillo is an assistant professor in the Department of Sociology, University of Wisconsin–Milwaukee
| | - Paulina S. Lim
- Paulina S. Lim is a graduate student in the Department of Psychology, University of Wisconsin–Milwaukee
| |
Collapse
|
25
|
Rawl SM, Dickinson S, Lee JL, Roberts JL, Teal E, Baker LB, Kianersi S, Haggstrom DA. Racial and Socioeconomic Disparities in Cancer-Related Knowledge, Beliefs, and Behaviors in Indiana. Cancer Epidemiol Biomarkers Prev 2018; 28:462-470. [PMID: 30487135 DOI: 10.1158/1055-9965.epi-18-0795] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/05/2018] [Accepted: 11/08/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This statewide survey examined differences in cancer-related knowledge, beliefs, and behaviors between racial and socioeconomic groups in select counties in Indiana. METHODS A stratified random sample of 7,979 people aged 18-75 who lived in one of 34 Indiana counties with higher cancer mortality rates than the state average, and were seen at least once in the past year in a statewide health system were mailed surveys. RESULTS Completed surveys were returned by 970 participants, yielding a 12% response rate. Black respondents were less likely to perceive they were at risk for cancer and less worried about getting cancer. Individuals most likely to perceive that they were unlikely to get cancer were more often black, with low incomes (less than $20,000) or high incomes ($50,000 or more), or less than a high school degree. Black women were greater than six times more likely to be adherent to cervical cancer screening. Higher income was associated with receiving a sigmoidoscopy in the last 5 years and a lung scan in the past year. Those with the highest incomes were more likely to engage in physical activity. Both income and education were inversely related to smoking. CONCLUSIONS Socioeconomic and racial disparities were observed in health behaviors and receipt of cancer screening. Black individuals had less worry about cancer. IMPACT Understanding populations for whom cancer disparities exist and geographic areas where the cancer burden is disproportionately high is essential to decision-making about research priorities and the use of public health resources.
Collapse
Affiliation(s)
- Susan M Rawl
- Indiana University School of Nursing, Indianapolis, Indiana. .,Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana
| | | | - Joy L Lee
- Indiana University School of Medicine, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana
| | - Jamie L Roberts
- Indiana University Center for Survey Research, Bloomington, Indiana
| | | | | | - Sina Kianersi
- Indiana University School of Public Health, Bloomington, Indiana
| | - David A Haggstrom
- Indianapolis VA HSR&D Center for Health Information & Communication, Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana
| |
Collapse
|
26
|
Mattiucci MJ. Engaging Youth in a New Kind of Advocacy. Pediatrics 2018; 142:peds.2018-2755. [PMID: 30355588 DOI: 10.1542/peds.2018-2755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Michael J Mattiucci
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
27
|
Tuot DS, Liddy C, Vimalananda VG, Pecina J, Murphy EJ, Keely E, Simon SR, North F, Orlander JD, Chen AH. Evaluating diverse electronic consultation programs with a common framework. BMC Health Serv Res 2018; 18:814. [PMID: 30355346 PMCID: PMC6201558 DOI: 10.1186/s12913-018-3626-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/15/2018] [Indexed: 11/17/2022] Open
Abstract
Background Electronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion. Methods Using a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems’ end-users. Results Organizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies. Conclusion A core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3626-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Delphine S Tuot
- Center for Innovation in Access and Quality at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, 94110, USA. .,Deparment of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Medical Center, Bedford, MA, USA.,Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jennifer Pecina
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J Murphy
- Center for Innovation in Access and Quality at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, 94110, USA.,Deparment of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,The Ottawa Hospital, Ottawa, ON, Canada
| | - Steven R Simon
- Harvard Medical School, Boston, USA.,VA Boston Healthcare System, Boston, USA
| | - Frederick North
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jay D Orlander
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,VA Boston Healthcare System, Boston, USA
| | - Alice Hm Chen
- Center for Innovation in Access and Quality at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, 94110, USA.,Deparment of Medicine, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|