The Effects of the Palliative Medicine Consultation on the DNR Status of African Americans in a Safety-Net Hospital

Background. John Henryism is defined as a measure of active coping in response to stressful experiences. John Henryism has been linked with health conditions such as diabetes, prostate cancer, and hypertension, but rarely with health behaviors. Aims. We hypothesized that reporting higher scores on the John Henryism Scale may be associated with poorer medication adherence, and trust in providers may mediate this relationship. Method. We tested this hypothesis using data from the TRUST study. The TRUST study included 787 African Americans with hypertension receiving care at a safety-net hospital. Ordinal logistic regression was used to examine the relationship between John Henryism and medication adherence. Results. Within our sample of African Americans with hypertension, lower John Henryism scores was associated with poorer self-reported adherence (low, 20.62; moderate, 19.19; high, 18.12; p < .001). Higher John Henryism scores were associated with lower trust scores (low John Henryism: 40.1; high John Henryism: 37.9; p < .001). In the adjusted model, each 1-point increase in the John Henryism score decreased the odds of being in a better cumulative medication adherence category by a factor of 4% (odds ratio = 0.96, p = .014, 95% confidence interval = 0.93-0.99). Twenty percent of the association between medication adherence and John Henryism was mediated by trust (standard deviation = 0.205, 95% confidence interval = 0.074-0.335). Discussion. This study provides important insights into the complex relationship between psychological responses and health behaviors. It also contributes to the body of literature examining the construct of John Henryism among African Americans with hypertension. Conclusion. The findings of this study support the need for interventions that promote healthful coping strategies and patient–provider trust.

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African Americans with Hepatocellular Carcinoma Have Significantly More Advanced Disease at Presentation: A Safety-Net Hospital Experience

The American Journal of Gastroenterology ◽

10.14309/00000434-201610001-00759 ◽

2016 ◽

Vol 111 ◽

pp. S342

Author(s):

Jonathan Chan ◽

Taft Bhuket ◽

Benny Liu ◽

Robert Wong

Keyword(s):

Hepatocellular Carcinoma ◽

African Americans ◽

Advanced Disease ◽

Safety Net ◽

Hospital Experience ◽

Safety Net Hospital

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Comparison of Diabetes Control Among Haitians, African Americans, and Non-Hispanic Whites in an Urban Safety-Net Hospital

Diabetes Care ◽

10.2337/dc10-1387 ◽

2010 ◽

Vol 34 (1) ◽

pp. 58-60 ◽

Cited By ~ 10

Author(s):

V. G. Vimalananda ◽

J. L. Rosenzweig ◽

H. J. Cabral ◽

M. M. David ◽

K. E. Lasser

Keyword(s):

African Americans ◽

Safety Net ◽

Diabetes Control ◽

Safety Net Hospital ◽

Urban Safety

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Racial and Socioeconomic Disparities in Out-Of-Hospital Cardiac Arrest Outcomes: Artificial Intelligence-Augmented Propensity Score and Geospatial Cohort Analysis of 3,952 Patients

Cardiology Research and Practice ◽

10.1155/2021/3180987 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Dominique J. Monlezun ◽

Alfred T. Samura ◽

Ritesh S. Patel ◽

Tariq E. Thannoun ◽

Prakash Balan

Keyword(s):

Artificial Intelligence ◽

Cardiac Arrest ◽

African Americans ◽

Cohort Analysis ◽

Safety Net ◽

Socioeconomic Disparities ◽

Lower Percentage ◽

Median Income ◽

Safety Net Hospital ◽

Hospital Cardiac Arrest

Introduction. Social disparities in out-of-hospital cardiac arrest (OHCA) outcomes are preventable, costly, and unjust. We sought to perform the first large artificial intelligence- (AI-) guided statistical and geographic information system (GIS) analysis of a multiyear and multisite cohort for OHCA outcomes (incidence and poor neurological disposition). Method. We conducted a retrospective cohort analysis of a prospectively collected multicenter dataset of adult patients who sequentially presented to Houston metro area hospitals from 01/01/07-01/01/16. Then AI-based machine learning (backward propagation neural network) augmented multivariable regression and GIS heat mapping were performed. Results. Of 3,952 OHCA patients across 38 hospitals, African Americans were the most likely to suffer OHCA despite representing a significantly lower percentage of the population (42.6 versus 22.8%; p < 0.001 ). Compared to Caucasians, they were significantly more likely to have poor neurological disposition (OR 2.21, 95%CI 1.25–3.92; p = 0.006 ) and be discharged to a facility instead of home (OR 1.39, 95%CI 1.05–1.85; p = 0.023 ). Compared to the safety net hospital system primarily serving poorer African Americans, the university hospital serving primarily higher income commercially and Medicare insured patients had the lowest odds of death (OR 0.45, p < 0.001 ). Each additional $10,000 above median household income was associated with a decrease in the total number of cardiac arrests per zip code by 2.86 (95%CI -4.26- -1.46; p < 0.001 ); zip codes with a median income above $54,600 versus the federal poverty level had 14.62 fewer arrests ( p < 0.001 ). GIS maps showed convergence of the greater density of poor neurologic outcome cases and greater density of poorer African American residences. Conclusion. This large, longitudinal AI-guided analysis statistically and geographically identifies racial and socioeconomic disparities in OHCA outcomes in a way that may allow targeted medical and public health coordinated efforts to improve clinical, cost, and social equity outcomes.

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Tu1457 - African Americans and Africans with Chronic Hepatitis B Virus Infection are at Highest Risk of Poor Retention to Care: A Safety-Net Hospital Experience

Gastroenterology ◽

10.1016/s0016-5085(18)34035-6 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-1223

Author(s):

Elaine Tang ◽

Ann Robinson ◽

Benny Liu ◽

Taft Bhuket ◽

Robert J. Wong

Keyword(s):

Chronic Hepatitis ◽

Hepatitis B Virus ◽

African Americans ◽

Virus Infection ◽

Hepatitis B ◽

Safety Net ◽

Hepatitis B Virus Infection ◽

Chronic Hepatitis B Virus ◽

Safety Net Hospital ◽

B Virus

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The Lived Experience of Discharged and Readmitted African Americans with Chronic Obstructive Pulmonary Disease to a Safety-Net Hospital

10.22371/07.2019.036 ◽

2019 ◽

Author(s):

Kiiyonna Jones

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

African Americans ◽

Lived Experience ◽

Pulmonary Disease ◽

Safety Net ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Safety Net Hospital

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Racial disparities and survival with non-small lung cancer (NSCLC) at an urban safety net hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e19102 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e19102-e19102

Author(s):

David J. Ernst

Keyword(s):

Lung Cancer ◽

African Americans ◽

Median Survival ◽

Demographic Data ◽

Hospital Setting ◽

Safety Net ◽

Disease Stage ◽

Primary Therapy ◽

Safety Net Hospital ◽

Urban Safety

e19102 Background: Disparities in cancer outcomes have been documented for many tumor types. This study aims to investigate the influence of race on clinical presentation, treatment and outcome of non-small cell lung cancer at a safety net hospital. Methods: A retrospective review of all patients with NSCLC diagnosed at an urban safety net hospital was done. Demographic data, diagnostic approach, primary therapy, and survival were analyzed. Results: There were 359 patients with NSCLC who met study inclusion criteria. There were 179 Caucasian, 177 African American, and 3 Asian patients. Nearly half of all patients had metastatic disease at the time of diagnosis (Stage I 15%, Stage II 5%, Stage III 28%, and Stage IV 49%). Treatment varied by disease stage, but not by race, 35.2% Caucasians and 39.5% African Americans were treated with radiation, 42.5% Caucasians and 44.6% African Americans were treated with chemotherapy, and 26.3% Caucasians and 20.9% African Americans were treated with surgery. Median survival was very short and again, did not vary by race: for Caucasians diagnosed with any stage of NSCLC was 6.439 months, whereas in African Americans it was 7.852 months. Conclusions: In a safety net hospital setting, there were no disparities in treatment based on race and median survival in this study was uniformly poor. Significant comorbidity was likely and will be investigated further.

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Delays and gaps in progressing through the hepatitis C virus cascade of care: An underserved safety-net hospital experience

Journal of Translational Internal Medicine ◽

10.2478/jtim-2020-0039 ◽

2020 ◽

Vol 8 (4) ◽

pp. 261-267

Author(s):

Chantal Gomes ◽

Dina Ginzberg ◽

Robert J. Wong

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

African Americans ◽

Median Time ◽

Linkage To Care ◽

Safety Net ◽

Hcv Treatment ◽

Safety Net Hospital ◽

Cascade Of Care ◽

Chronic Hcv

AbstractBackground and ObjectiveWhile highly effective hepatitis C virus (HCV) therapies exist, gaps in the cascade of care remain. Disparities in the HCV cascade are prominent among underserved safety-net populations. We aim to evaluate the HCV cascade among an urban safety-net cohort of HCV patients.MethodsWe retrospectively evaluated adults with chronic HCV to determine rates of linkage to care (LTC), retention to care, and receiving HCV treatment from 2002 to 2018. Comparisons between groups utilized Chi-square testing; comparisons of median time to LTC and HCV treatment were evaluated with Student’s t-test and analysis of variance.ResultsAmong 600 chronic HCV patients (60.7% male, 20.7% non-Hispanic white, 49.2% African American, 92.5% treatment naïve, 26.8% cirrhosis), successful LTC within one year of HCV diagnosis was 57.7%, among which, 91.6% were successfully retained into care. In those with successful LTC, 72.6% received HCV treatment, 91.8% completed treatment, and 89% achieved SVR12. Women with HCV experienced longer delays from LTC to HCV treatment (331 vs. 206 days in men, P < 0.05), as did African Americans (280 vs. 165 days in non-Hispanic whites, P < 0.05). Compared to the non-Hispanic whites, HCV treatment was lower in African Americans (70.4% vs. 74.4%, P < 0.05).ConclusionWomen with HCV experienced significant delays along the HCV cascade, with median time of over 2 years from diagnosis to treatment. African Americans also experienced significant delays along the HCV cascade of care. However, sex and race/ethnicity were not found to be significant predictors of overall LTC or treatment.

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