Implementation Fidelity of a Complex Behavioral Intervention to Prevent Diabetes Mellitus in Two Safety Net
            Patient‐Centered
            Medical Homes in New York City

Abstract BackgroundIt is critical to assess implementation fidelity for complex interventions to understand the reasons for their success or failure. However, few interventions systematically report implementation evaluation. Therefore, we conducted a concurrent process evaluation of CHORD (Community Health Outreach to Reduce Diabetes), a pragmatic, cluster-randomized, controlled trial to test the impact of a Community Health Workers (CHW) led, health coaching intervention on preventing incident type 2 Diabetes Mellitus (DM). MethodsThe study population included primary care (PC) patients with prediabetes at 2 safety-net hospitals - VA NY Harbor and Bellevue (BH). PC teams were randomized to receive the one-year intervention or usual care. Of the 559 patients in the intervention group to date, 79.4% completed an intake survey, constituting the analytic sample for fidelity assessment. The Conceptual Framework for Implementation Fidelity (CFIF) was applied to measure implementation fidelity and factors moderating fidelity of four core intervention components: patient goal setting, education topic coaching, PC visits, and referrals to address social determinants of health, using descriptive statistics and regression models.ResultsBH contributed 60.0% of the sample and VA contributed 40.0%. Content adherence was high for three components with nearly 80.0% of patients setting >1 goal, having >1 PC visit and receiving coaching on >1 education topic. Only 45.0% patients received >1 referral. After adjusting for patient gender, language, race, ethnicity, and age, the study site moderated adherence to goal setting (77.4% BH vs. 87.7% VA), educational coaching (78.9% BH vs. 88.3% VA), number of successful CHW-patient encounters (6 BH vs 4 VA) and percent of patients receiving all four components (41.1% BH vs. 25.7% VA). ConclusionsThe CFIF enabled analysis of implementation fidelity of a complex, behavioral intervention. The fidelity of CHORD implementation varied across its four components and was moderated by site. Despite implementation in a research setting, interventions may not completely adhere to their core components, which can influence outcomes. Our study emphasizes the importance of examining implementation fidelity of interventions and of assessing moderating factors. Our study also empirically tested the CFIF using quantitative concurrent intervention fidelity evaluation.Trial registration: The trial was registered with ClinicalTrials.gov on 12/30/2016 and the registration number is NCT03006666. The link to trial registration is: https://clinicaltrials.gov/ct2/show/NCT03006666

Download Full-text

Sociodemographic Correlates of Food Insecurity Among New York City Tobacco Users

American Journal of Health Promotion ◽

10.1177/0890117120904002 ◽

2020 ◽

Vol 34 (6) ◽

pp. 664-667

Author(s):

Christina N. Wysota ◽

Scott E. Sherman ◽

Elizabeth Vargas ◽

Erin S. Rogers

Keyword(s):

New York ◽

New York City ◽

Food Insecurity ◽

Low Income ◽

York City ◽

Safety Net ◽

The United States ◽

United States Department ◽

Poverty Level ◽

Sociodemographic Correlates

Purpose: To identify rates and sociodemographic correlates of food insecurity among low-income smokers. Design: Cross-sectional analysis of baseline survey data from a randomized controlled trial (N = 403) testing a smoking cessation intervention for low-income smokers. Setting: Two safety-net hospitals in New York City. Sample: Current smokers with annual household income <200% of the federal poverty level. Measures: Food insecurity was measured using the United States Department of Agriculture 6-item food security module. Participant sociodemographics were assessed by self-reported survey responses. Analysis: We used frequencies to calculate the proportion of smokers experiencing food insecurity and multivariable logistic regression to identify factors associated with being food insecure. Results: Fifty-eight percent of participants were food insecure, with 29% reporting very high food insecurity. Compared to married participants, separated, widowed, or divorced participants were more likely to be food insecure (adjusted odds ratio [AOR] = 2.33, 95% confidence interval [CI]: 1.25-4.33), as were never married participants (AOR = 2.81, 95% CI: 1.54-5.14). Conclusions: Health promotion approaches that target multiple health risks (eg, smoking and food access) may be needed for low-income populations. Interventions which seek to alleviate food insecurity may benefit from targeting socially isolated smokers.

Download Full-text

Morbidity and mortality of infective endocarditis in a hospital system in New York City serving a diverse urban population

Journal of Investigative Medicine ◽

10.1136/jim-2015-000040 ◽

2016 ◽

Vol 64 (6) ◽

pp. 1118-1123 ◽

Cited By ~ 9

Author(s):

Hassan Alkhawam ◽

Robert Sogomonian ◽

Feras Zaiem ◽

Neil Vyas ◽

Mohammed El-Hunjul ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

New York ◽

New York City ◽

Infective Endocarditis ◽

York City ◽

Heart Valves ◽

Morbidity And Mortality ◽

Unknown Etiology ◽

Control Group

Infective endocarditis (IE) is a severe illness associated with significant morbidity and mortality. The primary purpose of this study was to evaluate morbidity and mortality of IE in a hospital serving the most diverse area in New York City. An analysis of 209 patients admitted to the hospital from 2000 to 2012 who were found to have IE based on modified Duke criteria. Among the 209 patients with IE, 188 (88.8%) had native heart valves and 21 (11.2%) had prosthetic valves. Of the patients with native heart valves, 3.7% had coronary artery bypass graft, 4.3% were active drug users, 6.3% had permanent pacemakers, 12.2% had a history of IE, 25.7% were diabetic, 17% had end-stage renal disease (ESRD), 9% had congestive heart failure, 8% had abnormal heart valves, and 13.8% had an unknown etiology. Mortality rates of the patients with prosthetic heart valves were 27.7% compared to 8.11% in patients with native heart valves (OR 3, p<0.0001). Since we identified diabetes mellitus and ESRD to be significant risk factors in our population, we isolated and compared characteristics of patients with and without IE. IE among patients with diabetes mellitus was 23% compared with 13.8% in the control group (p=0.016). Cases of IE in patients with ESRD were 15.3%, compared with 4% in the control group (p<0.0001). We identified an overall mortality rate of 20.1% in patients with IE, a readmission rate within 30 days of discharge of 21.5%, and an average age of 59 years. Among 209 patients, 107 were males and 102 females. The most common organisms identified were Staphylococcus aureus (43.7%), viridans streptococci (17%) followed by Enterococcus (14.7%). Despite appropriate treatment, high rates of morbidity and mortality remained, with a higher impact in patients greater than 50 years of age. Such discoveries raise the importance of controlling and monitoring risk factors for IE.

Download Full-text

Working but Poor in New York City

10.36650/nexus9.1-2_101-112_shih ◽

2011 ◽

Vol 9 (1-2) ◽

pp. 101-112

Author(s):

Howard Shih

Keyword(s):

New York ◽

New York City ◽

Asian Americans ◽

Asian American ◽

Low Income ◽

York City ◽

Safety Net ◽

Low Income Families ◽

American Children ◽

American Poverty

This policy brief summarizes the methodology and key findings of the Asian American Federation’s report, Working but Poor: Asian Americans in New York City. The report marked the first time Asian American poverty in New York City was examined in detail using the new American Community Survey (ACS) Public Use Microdata Sample. The report also uses two definitions to examine struggling Asian Americans, the official poverty thresholds traditionally used and a concept of low-income families defined as families living below twice the federal poverty thresholds. After a summary on the methodology of the report, the brief will cover the findings and recommendations through three issue areas: improving job opportunities for working-age Asian Americans, building skills to help Asian American children broaden their future opportunities, and helping seniors in need of access to the social safety net. The brief concludes with an overview of Asian American poverty from a national perspective and discussion of future areas of study.

Download Full-text