Digital disparities: designing telemedicine systems with a health equity aim

2021 ◽  
pp. emermed-2020-210896
Author(s):  
Margaret Samuels-Kalow ◽  
Todd Jaffe ◽  
Kori Zachrison
Keyword(s):  
Primary Care ◽  
Health Disparities ◽  
Health Equity ◽  
Digital Literacy ◽  
Older Patients ◽  
Care Setting ◽  
Clinical Care ◽  
Acute Care Setting ◽  
Clinical Environments ◽  
Improve Health

The use of telemedicine has grown immensely during the COVID-19 pandemic. Telemedicine provides a means to deliver clinical care while limiting patient and provider exposure to the COVID-19. As such, telemedicine is finding applications in a variety of clinical environments including primary care and the acute care setting and the array of patient populations who use telemedicine continues to grow. Yet as telehealth becomes ubiquitous, it is critical to consider its potential to exacerbate disparities in care. Challenges accessing technology and digital literacy, for example, disproportionately impact older patients and those living in poverty. When implemented with the consideration of health disparities, telemedicine provides an opportunity to address these inequities. This manuscript explores potential mechanisms by which telemedicine may play a role in exacerbating or ameliorating disparities in care. We further describe a framework and suggested strategies with which to implement telemedicine systems to improve health equity.

scholarly journals Progress towards using community context with clinical data in primary care

2018 ◽  
Vol 7 (1) ◽  
pp. e000028 ◽  
Author(s):  
Heather Angier ◽  
Elizabeth A Jacobs ◽  
Nathalie Huguet ◽  
Sonja Likumahuwa-Ackman ◽  
Stephanie Robert ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Equity ◽  
Clinical Care ◽  
Community Context ◽  
Community Level ◽  
Patient Health ◽  
The Usa ◽  
The Impact ◽  
Combined Data ◽  
Improve Health

Community-level factors have significant impacts on health. There is renewed enthusiasm for integrating these data with electronic health record (EHR) data for use in primary care to improve health equity in the USA. Thus, it is valuable to reflect on what has been published to date. Specifically, we comment on: (1) recommendations about combining community-level factors in EHRs for use in primary care; (2) examples of how these data have been combined and used; and (3) the impact of using combined data on healthcare, patient health and health equity. We found publications discussing the potential of combined data to inform clinical care, target interventions, track population health and spark community partnerships with the goal of reducing health disparities and improving health equity. Although there is great enthusiasm and potential for using these data to inform primary care, there is little evidence of improved healthcare, patient health or health equity.

scholarly journals Practice-Based Research Networks: Strategic Opportunities to Advance Implementation Research for Health Equity

2019 ◽  
Vol 29 (Suppl 1) ◽  
pp. 113-118 ◽  
Author(s):  
John M. Westfall ◽  
Rebecca Roper ◽  
Anne Gaglioti ◽  
Donald E. Nease, Jr.
Keyword(s):  
Primary Care ◽  
Health Disparities ◽  
Community Health ◽  
Health Equity ◽  
Implementation Research ◽  
Clinical Care ◽  
Research Networks ◽  
Practice Based Research ◽  
Care Practices ◽  
Primary Care Practices

While the vast majority of people re­ceive their medical care in community primary and specialty care clinics, most clinical research is performed in academic tertiary care hospitals and hospital clin­ics. Practice-based research networks are most commonly collections of primary care practices that work together to ask and answer health questions for their patients and communities and are an integral part of the translational pathway from discovery to practice to community health. Community primary care practices are at the front line of health equity issues; equity in clinical care, equity in community health, equity in social determinants of health, and equity in health outcomes. Practice-based research networks can gather and combine data from dozens of communities, hundreds of prac­tices and thousands of patients to address health equity and disparities across the full spectrum of community and public health to clinical and primary care. This article will briefly outline the history of PBRNs, types of PBRNs, locations, topics, and patient outcomes over the past 25 years. Current PBRN efforts to address health disparities and improve health equity will be described. New PBRN opportunities to address health disparities and approaches to advance implementation research for health equity in the practice and community will be described. Readers will be challenged to consider ways to engage practice-based research networks in their health equity ef­forts.Ethn Dis. 2019;29(Suppl 1):113-118; doi:10.18865/ed.29.S1.113.

scholarly journals Practice-Based Research Networks: Strategic Opportunities to Advance Implementation Research for Health Equity

2019 ◽  
Vol 29 (Suppl 1) ◽  
pp. 113-118
Author(s):  
John M. Westfall ◽  
Rebecca Roper ◽  
Anne Gaglioti ◽  
Donald E. Nease, Jr.
Keyword(s):  
Primary Care ◽  
Health Disparities ◽  
Community Health ◽  
Health Equity ◽  
Implementation Research ◽  
Clinical Care ◽  
Research Networks ◽  
Practice Based Research ◽  
Care Practices ◽  
Primary Care Practices

While the vast majority of people re­ceive their medical care in community primary and specialty care clinics, most clinical research is performed in academic tertiary care hospitals and hospital clin­ics. Practice-based research networks are most commonly collections of primary care practices that work together to ask and answer health questions for their patients and communities and are an integral part of the translational pathway from discovery to practice to community health. Community primary care practices are at the front line of health equity issues; equity in clinical care, equity in community health, equity in social determinants of health, and equity in health outcomes. Practice-based research networks can gather and combine data from dozens of communities, hundreds of prac­tices and thousands of patients to address health equity and disparities across the full spectrum of community and public health to clinical and primary care. This article will briefly outline the history of PBRNs, types of PBRNs, locations, topics, and patient outcomes over the past 25 years. Current PBRN efforts to address health disparities and improve health equity will be described. New PBRN opportunities to address health disparities and approaches to advance implementation research for health equity in the practice and community will be described. Readers will be challenged to consider ways to engage practice-based research networks in their health equity ef­forts.Ethn Dis. 2019;29(Suppl 1):113-118; doi:10.18865/ed.29.S1.113.

Rehabilitation in Neurocritical Care

2018 ◽  
pp. 286-296
Author(s):  
Michael E. Reznik ◽  
Amy K. Wagner
Keyword(s):  
Sleep Disturbances ◽  
Care Setting ◽  
Clinical Care ◽  
Management Strategies ◽  
Acquired Brain Injury ◽  
Medical Complications ◽  
Acute Care Setting ◽  
Rehabilitation Team ◽  
Bowel And Bladder Dysfunction ◽  
Language Pathology

Rehabilitation is a process that should begin in the neurointensive care unit. Once a rough prognosis has been made within the context of goals of care discussions, and a decision has been made to proceed with measures geared toward recovery, the focus of clinical care should begin to shift toward the transition to rehabilitation in order to maximize functional gains. In the acute care setting, this necessitates the collaboration of a multidisciplinary team, including physical medicine and rehabilitation, physical and occupational therapy, speech and language pathology, neuropsychology, social work, and nursing. Among the most challenging issues facing intensivists and the rehabilitation team in the critical care setting is the management of the various rehabilitation-related medical complications associated with acquired brain injury, including decreased level of arousal, agitation, sleep disturbances, depression, dysautonomia, bowel and bladder dysfunction, and spasticity. This chapter highlights current management strategies for dealing with these issues.

Using a Nursing Minimum Data Set with older patients with dementia in an acute care setting

2004 ◽  
Vol 47 (3) ◽  
pp. 329-339 ◽  
Author(s):  
Myonghwa Park ◽  
Connie Delaney ◽  
Meridean Maas ◽  
David Reed
Keyword(s):  
Acute Care ◽  
Older Patients ◽  
Care Setting ◽  
Minimum Data Set ◽  
Acute Care Setting ◽  
Data Set ◽  
Minimum Data

scholarly journals Recommendations for improving national clinical datasets for health equity research

2020 ◽  
Vol 27 (11) ◽  
pp. 1802-1807
Author(s):  
Rebecca G Block ◽  
Jon Puro ◽  
Erika Cottrell ◽  
Mitchell R Lunn ◽  
M J Dunne ◽  
...  
Keyword(s):  
Health Disparities ◽  
Health Equity ◽  
Collaborative Research ◽  
Healthcare Disparities ◽  
Data Science ◽  
Patient Centered ◽  
Equity Research ◽  
Health Equity Research ◽  
Research And Policy ◽  
Improve Health

Abstract Health and healthcare disparities continue despite clinical, research, and policy efforts. Large clinical datasets may not contain data relevant to healthcare disparities and leveraging these for research may be crucial to improve health equity. The Health Disparities Collaborative Research Group was commissioned by the Patient-Centered Outcomes Research Institute to examine the data science needs for quality and complete data and provide recommendations for improving data science around health disparities. The group convened content experts, researchers, clinicians, and patients to produce these recommendations and suggestions for implementation. Our desire was to produce recommendations to improve the usability of healthcare datasets for health equity research. The recommendations are summarized in 3 primary domains: patient voice, accurate variables, and data linkage. The implementation of these recommendations in national datasets has the potential to accelerate health disparities research and promote efforts to reduce health inequities.

Addressing the Health Care Delivery Needs in the Acute Care Setting by Developing a Postmaster’s Acute Care Certification Program

2016 ◽  
Vol 9 (1) ◽  
pp. 124-127
Author(s):  
Helen Miley ◽  
Courtney Reinisch
Keyword(s):  
Primary Care ◽  
New Jersey ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Care Setting ◽  
Care Delivery ◽  
The State ◽  
Inpatient Setting ◽  
Acute Care Setting ◽  
Term Care

The state of New Jersey certifies nurse practitioners and clinical nurse specialists from all specialties as advanced practice nurses (APNs). There are more than 4,000 certified APNs in the state in 17 specialty areas. APNs in the state have the privilege of practicing in various settings such as ambulatory, inpatient, and long-term care. The state does not limit the setting where an APN chooses to practice. A trend is emerging in the state to address the concern of primary care–educated APNs to prepare them for the delivery of care in the acute care setting. Some institutions within the state of New Jersey are requiring their primary care educated and certified adult primary care APNs working in an inpatient setting to obtain an acute care certification. Recognizing the needs of these adult primary care APNs, Dr. Helen Miley developed a postmaster’s certificate program which has been approved by Rutgers School of Nursing faculty. Although the first cohort has not yet been admitted to the program, it will be implemented in the near future. Because it is important to address the educational needs of adult primary care APNs, this article describes the needs assessment and development plan used for this program.

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