Racial Disparities in Senior Healthcare: System‐Level Interventions

ObjectivesTo identify sociodemographic, clinical and behavioural drivers of racial disparities and their association with clinical outcomes among Kaiser Permanente Georgia (KPGA) members with COVID-19.DesignRetrospective cohort of patients with COVID-19 seen from 3 March to 29 October 2020. We described the distribution of underlying comorbidities, quality of care metrics, demographic and social determinants of health (SDOH) indicators across race groups. We also described clinical outcomes in hospitalised patients including length of stay, intensive care unit (ICU) admission, readmission and mortality. We performed multivariable analyses for hospitalisation risk among all patients with COVID-19 and stratifyied by race and sex.SettingKPGA, an integrated healthcare system.Participants5712 patients who all had laboratory-confirmed COVID-19. Of them, 57.8% were female, 58.4% black, 29.5% white, 8.5% Hispanic and 3.6% Asian.ResultsBlack patients had the highest proportions of living in neighborhoods under the federal poverty line (12.4%) and in more deprived locations (neighbourhood deprivation index=0.4). Overall, 14.4% (n=827) of this cohort was hospitalised. Asian patients had the highest rates of ICU admission (53.1%) and mechanical ventilation (21.9%). Among all patients, Hispanics (adjusted 1.60, 95% CI (1.08, 2.37)), blacks (1.43 (1.13, 1.83)), age in years (1.03 (1.02, 1.04)) and living in a zip code with high unemployment (1.08 (1.03, 1.13)) were associated with higher odds of hospitalisation. COVID-19 patients with chronic obstructive pulmonary disease (2.59 (1.67, 4.02)), chronic heart failure (1.79 (1.31, 2.45)), immunocompromised (1.77 (1.16, 2.70)), with glycated haemoglobin >8% (1.68 (1.19, 2.38)), depression (1.60 (1.24, 2.06)), hypertension (1.5 (1.21, 1.87)) and physical inactivity (1.25 (1.03, 1.51)) had higher odds of hospitalisation.ConclusionsBlack and Hispanic KPGA patients were at higher odds of hospitalisation, but not mortality, compared with other race groups. Beyond previously reported sociodemographics and comorbidities, factors such as quality of care, lifestyle behaviours and SDOH indicators should be considered when designing and implementing interventions to reduce COVID-19 racial disparities.

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Racial Disparities in PSA Screening and Referral to Urology in a Large, Integrated Healthcare System: A Retrospective Cohort Study

The Journal of Urology ◽

10.1097/ju.0000000000001763 ◽

2021 ◽

Author(s):

Caroline D. Lu ◽

Oluwaseun Adeyemi ◽

William E. Anderson ◽

Timothy C. Hetherington ◽

David C. Slawson ◽

...

Keyword(s):

Cohort Study ◽

Racial Disparities ◽

Healthcare System ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Integrated Healthcare ◽

Psa Screening ◽

System A

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Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study

BMJ Open ◽

10.1136/bmjopen-2019-033173 ◽

2020 ◽

Vol 10 (1) ◽

pp. e033173

Author(s):

Macarius Donneyong ◽

Charles Reynolds ◽

David Mischoulon ◽

Grace Chang ◽

Heike Luttmann-Gibson ◽

...

Keyword(s):

Vitamin D ◽

Healthcare System ◽

Ethnic Disparities ◽

Late Life ◽

System Level ◽

Current Evidence ◽

Depression Treatment ◽

Depression Care ◽

Late Life Depression ◽

Racial Ethnic

IntroductionCurrent evidence indicates that older racial/ethnic minorities encounter disparities in depression care. Because late-life depression is common and confers major adverse health consequences, it is imperative to reduce disparities in depression care. Thus, the primary objectives of this protocol are to: (1) quantify racial/ethnic disparities in depression treatment and (2) identify and quantify the magnitude of these disparities accountable for by a multifactorial combination of patient, provider and healthcare system factors.Methods and analysisData will be derived from the Vitamin D and Omega-3 Trial-Depression Endpoint Prevention (VITAL-DEP) study, a late-life depression prevention ancillary study to the VITAL trial. A total of 25 871 men and women, aged 50+ and 55+ years, respectively, were randomised in a 2×2 factorial randomised trial of heart disease and cancer prevention to receive vitamin D and/or fish oil for 5 years starting from 2011. Most participants were aged 65+ years old at randomisation. Medicare claims data for over 19 000 VITAL/VITAL-DEP participants were linked to conduct our study.The major study outcomes are depression treatment (antidepressant use and/or receipt of psychotherapy services) and adherence to medication treatment (antidepressant adherence and acceptability). The National Academy of Medicine framework for studying racial disparities was leveraged to select patient-level, provider-level and healthcare system-level variables and to address their potential roles in depression care disparities. Blinder-Oaxaca regression decomposition methods will be implemented to quantify and identify correlates of racial/ethnic disparities in depression treatment and adherence.Ethics and disseminationThis study received Institutional Review Board (IRB) approval from the Partners Healthcare (PHS) IRB, protocol# 2010P001881. We plan to disseminate our results through publication of manuscripts patient engagement activities, such as study newsletters regularly sent out to VITAL participants, and presentations at scientific meetings.Trial registration numberNCT01696435.

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Development of an antimicrobial stewardship program in an integrated healthcare system

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxy002 ◽

2018 ◽

Vol 76 (1) ◽

pp. 34-43 ◽

Cited By ~ 1

Author(s):

Michael A Lane ◽

Amanda J Hays ◽

Helen Newland ◽

Jeanne E Zack ◽

Rebecca M Guth ◽

...

Keyword(s):

Healthcare System ◽

Antimicrobial Stewardship ◽

Gap Analysis ◽

System Level ◽

Antimicrobial Use ◽

Antimicrobial Stewardship Program ◽

Integrated Healthcare ◽

Stewardship Program ◽

Regulatory Mandates ◽

The Impact

Abstract Purpose The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. Summary With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4–8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. Conclusion BJC’s ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.

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Abstract B99: Colon cancer treatment: Are there racial disparities in an equal-access healthcare system?

Cancer Prevention Research ◽

10.1158/1940-6207.prev-12-b99 ◽

2012 ◽

Vol 5 (11 Supplement) ◽

pp. B99-B99

Author(s):

Abegail Andaya ◽

Lindsey Enewold ◽

Shelia H. Zahm ◽

Craig D. Shriver ◽

Joan Warren ◽

...

Keyword(s):

Colon Cancer ◽

Cancer Treatment ◽

Racial Disparities ◽

Healthcare System ◽

Equal Access

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Implementation of the Targeted Assessment for Prevention Strategy in a healthcare system to reduce Clostridioides difficile infection rates

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.358 ◽

2020 ◽

Vol 41 (3) ◽

pp. 295-301

Author(s):

Katelyn A. White ◽

Minn M. Soe ◽

Amy Osborn ◽

Christie Walling ◽

Lucy V. Fike ◽

...

Keyword(s):

Healthcare System ◽

Negative Binomial ◽

Interrupted Time Series ◽

Strategy Implementation ◽

System Level ◽

National Goal ◽

Clostridioides Difficile ◽

National Priority ◽

Before And After ◽

Prevention Interventions

AbstractBackground:Prevention of Clostridioides difficile infection (CDI) is a national priority and may be facilitated by deployment of the Targeted Assessment for Prevention (TAP) Strategy, a quality improvement framework providing a focused approach to infection prevention. This article describes the process and outcomes of TAP Strategy implementation for CDI prevention in a healthcare system.Methods:Hospital A was identified based on CDI surveillance data indicating an excess burden of infections above the national goal; hospitals B and C participated as part of systemwide deployment. TAP facility assessments were administered to staff to identify infection control gaps and inform CDI prevention interventions. Retrospective analysis was performed using negative-binomial, interrupted time series (ITS) regression to assess overall effect of targeted CDI prevention efforts. Analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after implementation of the TAP facility assessments.Results:The systemwide monthly CDI rate significantly decreased at the intervention (β2, −44%; P = .017), and the postintervention CDI rate trend showed a sustained decrease (β1 + β3; −12% per month; P = .008). At an individual hospital level, the CDI rate trend significantly decreased in the postintervention period at hospital A only (β1 + β3, −26% per month; P = .003).Conclusions:This project demonstrates TAP Strategy implementation in a healthcare system, yielding significant decrease in the laboratory-identified C. difficile rate trend in the postintervention period at the system level and in hospital A. This project highlights the potential benefit of directing prevention efforts to facilities with the highest burden of excess infections to more efficiently reduce CDI rates.

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Eliminating Racial Disparities: Esophageal Cancer Treatment and Outcomes in a Va Healthcare System

Gastroenterology ◽

10.1016/s0016-5085(17)33011-1 ◽

2017 ◽

Vol 152 (5) ◽

pp. S880-S881 ◽

Cited By ~ 1

Author(s):

Yakira N. David ◽

Shivakumar Vignesh ◽

Manuel Martinez ◽

Samy Mcfarlane ◽

Anil Kabrawala

Keyword(s):

Esophageal Cancer ◽

Cancer Treatment ◽

Racial Disparities ◽

Healthcare System

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534: Racial disparities in growth restriction in a single payer healthcare system

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2013.10.567 ◽

2014 ◽

Vol 210 (1) ◽

pp. S262-S263

Author(s):

April McGill ◽

Ava Marie Conlin ◽

Carter Sevick ◽

Anna Bukowinski ◽

Jordan Levine ◽

...

Keyword(s):

Racial Disparities ◽

Healthcare System ◽

Growth Restriction ◽

Single Payer

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Racial disparities in pedestrian-related injury hospitalizations in the United States

10.21203/rs.3.rs-15658/v1 ◽

2020 ◽

Author(s):

Cara Hamann ◽

Corinne Peek-Asa ◽

Brandon Butcher

Keyword(s):

United States ◽

Length Of Stay ◽

Racial Disparities ◽

Hospital Admissions ◽

The United States ◽

System Level ◽

United States Census ◽

Pedestrian Injury ◽

Race Ethnicity ◽

Pedestrian Injuries

Abstract Background. Racial/ethnic disparity has been documented in a wide variety of health outcomes, and environmental components are contributors. For example, food deserts have been tied to obesity rates. Pedestrian injuries are strongly tied to environmental factors, yet no studies have examined racial disparity in pedestrian injury rates. We examine a nationally-representative sample of pedestrian-related hospitalizations in the United States to identify differences in incidence, severity, and cost by race/ethnicity.Methods. Patients with ICD diagnosis E-codes for pedestrian injuries were drawn from the United States Nationwide Inpatient Sample (2009-2016). Rates were calculated using the United States Census. Descriptive statistics and generalized linear regression were used to examine characteristics (age, sex, severity of illness, mortality rates, hospital admissions, length of stay, total costs) associated with hospitalizations for pedestrian injuries.Results. Hospitalization rates were The burden of injury was higher among Black, Hispanic, and Multiracial/Other groups in terms of admission rates, costs per capita, proportion of children injured, and length of stay compared to Whites and Asian or Pacific Islander race/ethnicities. Extreme and major loss of function proportions were also highest among Black and Multiracial/Other groups.Discussion. Results from this study show racial disparities in pedestrian injury hospitalizations and outcomes, particularly among Black, Hispanic, and Multiracial/Other race/ethnicity groups and support population and system-level approaches to prevention. Access to transportation is an indicator for health disparity, and these results indicate that access to safe transportation also shows inequity by race/ethnicity.

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