scholarly journals Differences in ambulatory care fragmentation by race

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa M. Kern ◽  
Mangala Rajan ◽  
Lisandro D. Colantonio ◽  
Evgeniya Reshetnyak ◽  
Joanna Bryan Ringel ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Racial Differences ◽  
Household Income ◽  
Emergency Department Visits ◽  
Future Research ◽  
First Year ◽  
Fee For Service ◽  
Tobit Regression ◽  
Annual Household Income

Abstract Background More fragmented ambulatory care (i.e., care spread across many providers without a dominant provider) has been associated with more subsequent healthcare utilization (such as more tests, procedures, emergency department visits, and hospitalizations) than less fragmented ambulatory care. It is not known if race and socioeconomic status are associated with fragmented ambulatory care. Methods We conducted a longitudinal analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, using the REGARDS baseline visit plus the first year of follow-up. We included participants ≥65 years old, who had linked fee-for-service Medicare claims, and ≥ 4 ambulatory visits in the first year of follow-up. We used Tobit regression to determine the associations between race, annual household income, and educational attainment at baseline and fragmentation score in the subsequent year (as measured with the reversed Bice-Boxerman Index). Covariates included other demographic characteristics, medical conditions, medication use, health behaviors, and psychosocial variables. Additional analyses categorized visits by the type of provider (primary care vs. specialist). Results The study participants (N = 6799) had an average age of 73.0 years, 53% were female, and 30% were black. Nearly half had low annual household income (<$35,000) and 41% had a high school education or less. Overall, participants had a median of 10 ambulatory visits to 4 providers in the 12 months following their baseline study visit. Participants in the highest quintile of fragmentation scores had a median of 11 visits to 7 providers. Black race was associated with an absolute adjusted 3% lower fragmentation score compared to white race (95% confidence interval (2% lower to 4% lower; p < 0.001). This difference was explained by blacks seeing fewer specialists than whites. Income and education were not independent predictors of fragmentation scores. Conclusions Among Medicare beneficiaries, blacks had less fragmented ambulatory care than whites, due to lower utilization of specialty care. Future research is needed to determine the effect of fragmented care on health outcomes for blacks and whites.

scholarly journals The Role of Patient Navigators in Ambulatory Care: Overview of Systematic Reviews

2021 ◽  
Author(s):  
Hannah Budde ◽  
Gemma Williams ◽  
Juliane Winkelmann ◽  
Laura Pfirter ◽  
Claudia Bettina Maier
Keyword(s):  
Health Services ◽  
Health System ◽  
Ambulatory Care ◽  
Systematic Reviews ◽  
Patient Navigation ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Patient Navigators

Abstract Background: Patient navigators have been introduced across various countries to enable timely access to healthcare services and ensure completion of diagnosis and follow-up of care. There is an increasing amount of evidence on the positive effect of patient navigation for patients. The aim of this study was to analyse the evidence on patient navigation interventions in ambulatory care and to evaluate their effects on individuals and health system outcomes.Methods: An overview of reviews was conducted, based on a prespecified protocol. All patients in ambulatory care or transitional care setting were included in this review as long as it was related to the role of patient navigators. The study analysed all roles of patient navigators covering a wide range of health professionals such as physicians, nurses, pharmacists, social workers as well as lay health workers or community-based workers with no or very limited training. Studies including patient-related measures and health system-related outcomes were eligible for inclusion. A rigorous data collection was performed in multiple data bases. After reaching an inter-rater agreement, title and abstract screening was independently performed. Of an initial 8362 search results a total of 673 articles were eligible for full-text screening. An extraction form was used to analyse the nine included review.Results: Nine systematic reviews were included covering various patient navigation roles in cancer care, disease screening and transitional care. Seven systematic reviews primarily tailored services to ethnic minorities or other disadvantaged groups. Patient navigators performed tasks such as providing education and counselling, translations, home visits, outreach, scheduling of appointments and follow-up. Six reviews identified positive outcomes in expanding access to care, in particular for vulnerable patient groups. Two reviews on patient navigation in transitional care reported improved patient outcomes and hospital readmission rates and mixed evidence on quality of life and emergency department visits.Conclusions: Patient navigators have shown to expand access to screenings and health services for vulnerable patients or population groups who tend to underuse health services.

Development and Implementation of a Hybrid Online and In-Person Food Sovereignty and Nutrition Education Curriculum for Native American Parents: The FRESH Study

2022 ◽  
pp. 109019812110671
Author(s):  
Alyson Haslam ◽  
Charlotte Love ◽  
Tori Taniguchi ◽  
Mary B. Williams ◽  
Marianna S. Wetherill ◽  
...  
Keyword(s):  
Native American ◽  
Nutrition Education ◽  
Household Income ◽  
Food Sovereignty ◽  
Food Resource ◽  
Future Research ◽  
Full Time ◽  
Education Curriculum ◽  
Annual Household Income ◽  
American Children

The Food Resource Equity and Sustainability for Health (“FRESH”) study is an Indigenous-led intervention to increase vegetable and fruit intake among Native American children. As part of this study, we developed a hybrid (online and in-person) food sovereignty and nutrition education curriculum for the parents of these children. This 16-week curriculum was developed to promote household- and community-level healthy eating and food sovereignty practices to parents of preschool-aged children residing in Osage Nation, Oklahoma. A total of 81 parent/caregivers participated in the curriculum component of the FRESH study, with a median age of 34 years (range: 23–54 years). Most study participants were female (88.9%) and less than half (45.7%) had an annual household income of more than US$50,000. Most were married or had a significant other (76.5%) and worked full-time (65.4%). The median total number of children in the home <18 years of age was three (range: 1–8). Participation among the 94 parents was 56% during the first week and was 12% in the final week. Having some college or technical training (vs. having a college degree) and having an annual household income of US$20,000–US$50,000 (vs. more than US$50,000) were associated with fewer sessions attended ( p = 0.004 and 0.02, respectively) Being married (vs. not) was associated with higher attendance ( p < .0001). Participation in a hybrid food sovereignty and nutrition education curriculum for parents was generally low, but income, education, and marital status were associated with curriculum participation. Our research adds to the literature by describing the development and implementation of this curriculum and recommendations for future research incorporating Indigenous approaches to health.

scholarly journals Ambulatory Care Fragmentation and Incident Stroke

2021 ◽  
Author(s):  
Lisa M. Kern ◽  
Joanna B. Ringel ◽  
Mangala Rajan ◽  
Lisandro D. Colantonio ◽  
Lawrence P. Casalino ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Racial Differences ◽  
Secondary Analysis ◽  
Poor Health ◽  
Fee For Service ◽  
Self Rated Health ◽  
Poisson Models ◽  
Stroke Study ◽  
History Of ◽  
Adjusted Rate

Background More fragmented ambulatory care (ie, care spread across many providers without a dominant provider) has been associated with excess emergency department and inpatient care. We sought to determine whether more fragmented ambulatory care is associated with an increase in the hazard of incident stroke, overall and stratified by health status and by race. Methods and Results We conducted a secondary analysis of data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study (2003–2016), including participants aged ≥65 years who had linked Medicare fee‐for‐service claims and no history of stroke (N=12 510). We measured fragmentation of care with the reversed Bice‐Boxerman index. We used Poisson models to determine the association between fragmentation and adjudicated incident stroke. The average age of participants was 70.5 years; 53% were women, 32% were Black participants, and 16% were participants with fair or poor health. Overall, the adjusted rate of incident stroke was similar for high versus low fragmentation (8.2 versus 8.1 per 1000 person‐years, respectively; P =0.89). Among participants with fair or poor self‐rated health, having high versus low fragmentation was associated with a trend toward a higher adjusted rate of incident strokes (14.8 versus 10.4 per 1000 person‐years, respectively; P =0.067). Among Black participants with fair or poor self‐rated health, having high versus low fragmentation was associated with a higher adjusted rate of strokes (19.3 versus 10.3 per 1000 person‐years, respectively; P =0.02). Conclusions Highly fragmented ambulatory care is independently associated with incident stroke among Black individuals with fair or poor health.

Prevalence and Predictors of Non-Adherence to 6-Mercaptopurine (6MP) in Children with Acute Lymphoblastic Leukemia (ALL) - a Children’s Oncology Group Study.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 897-897
Author(s):  
Smita Bhatia ◽  
Doojduen Villaluna ◽  
Wendy Landier ◽  
Alexandra Schaible ◽  
Lindsey Hageman ◽  
...  
Keyword(s):  
High School ◽  
Household Income ◽  
Lymphoblastic Leukemia ◽  
Systemic Exposure ◽  
Small Sample ◽  
Future Research ◽  
Annual Household Income ◽  
Increased Risk ◽  
The Mean ◽  
The Impact

Abstract Use of contemporary risk-based therapy in children with ALL has resulted in five-year survival rates exceeding 80%. Achievement of durable remissions requires a maintenance phase composed of oral administration of antimetabolites (6-mercaptopurine and methotrexate) for approximately two years. Previous studies have shown that low systemic exposure to oral 6MP adversely affects prognosis, thus emphasizing the critical need for therapeutic levels throughout maintenance. However, significant inter-patient variability in red cell thioguanine nucleotide (6TGN – a major metabolite of 6MP) concentrations exists, and could in part be related to failure to adhere to prescribed therapy. Non-adherence in pediatric ALL patients has been reported – however, small sample sizes and varying methods of assessment make it difficult to understand the magnitude of this problem. The purpose of our study was to describe adherence to oral 6MP in a large multi-ethnic cohort of children with ALL. Patients were eligible to participate if they were diagnosed with ALL at age less than 22 years, belonged to one of four ethnic/racial groups (Asian, African-American, Caucasian, or Hispanic), and had completed at least 24 weeks of maintenance therapy. We have restricted the current report to Caucasians, where we have completed our target accrual. To measure 6MP adherence, we used the Medication Event Management System (MEMS) and supplied each patient with a MEMS TrackCap. This electronic cap allowed the collection of real-time data by recording the date and time(s) when the 6MP bottle was opened over a 6-month period. The MEMS data was downloaded at the end of the 6-month study period. Patients/parents also completed a self-administered sociodemographic questionnaire. Longitudinal analysis was performed using the Generalized Estimating Equations. A total of 173 Caucasian patients provided 26,424 person-days of observation for 6MP adherence. The median age at diagnosis was 5 years (1 to 19), and at study participation was 6 years (range, 2 to 20); median time from diagnosis was 18.8 months, and from start of maintenance, 8.1 months; 67% were males. NCI criteria for high-risk disease were present in 42% of the patients. The median annual household income was between $50K and $75K; 79% of the mothers and 72% of the fathers had received education beyond high school. The median number of household members (including patient) was 4 (range, 2 to 10). Adherence was defined as the ratio of 6MP bottle openings to actual 6MP doses prescribed, calculated as a percentage (“percent adherence”). Prescribed doses for the entire 6-month period were reviewed for each patient, and instances when 6MP was withheld by the prescriber due to toxicity or illness were taken into account for purposes of calculating adherence. The mean percent adherence over the 6-month study period was 85% (range 11% to 100%). The mean monthly percent adherence declined significantly over the 6-month study period (p=0.002). Multivariate analysis identified certain subgroups that were at increased risk of lower percent adherence (Figure): age >8 years at study entry (p=0.01); households that included members other than the mother, father, and patient (<0.001); father’s education ≤ high school or ≥ college degree (p=0.05), and annual household income <$20k or ≥ $100K (p=.045). In this study, 19% of the study participants were <80% adherent at the end of the first study month; this increased to 30% by the end of the 6-month study period. Over 6% of patients were <50% adherent at the end of the first month, and this increased to 11% at month 6 – demonstrating that over 10% of the patients were taking less than 50% of their prescribed doses of 6MP. This study demonstrates that non-adherence to 6MP is prevalent in children undergoing treatment for ALL and increases with time on maintenance. It further delineates certain sociodemographic variables that define those at highest risk for non-adherence. Patients from this study will be followed long-term to understand the impact of non-adherence on outcome. Future research needs to focus on developing targeted, multidisciplinary interventions to reduce non-adherence to therapy. Figure Figure

Differences in resilience between ‘traditional’ and ‘non-traditional’ university students

2017 ◽  
Vol 18 (1) ◽  
pp. 77-87 ◽  
Author(s):  
Ethel Chung ◽  
Deborah Turnbull ◽  
Anna Chur-Hansen
Keyword(s):  
Academic Success ◽  
Household Income ◽  
Life Experiences ◽  
Well Being ◽  
Traditional Students ◽  
Future Research ◽  
First Year ◽  
First Year Students ◽  
Students First ◽  
Non Traditional Students

Resilience is related to students’ well-being and academic success. While challenges associated with students who are from historically underrepresented backgrounds (i.e. ‘non-traditional students’) have been frequently reported, their resilience has received lesser attention. The primary purpose of this study was to compare levels of resilience between ‘traditional’ and ‘non-traditional’ students. First year students participated in an online mental health survey which included a standardised measure of resilience, demographic questions and an item exploring students’ own perception of being ‘non-traditional’. The results showed that students who considered themselves to be ‘non-traditional’ in life aspects, including age, employment and parenting responsibility, had significantly higher resilience compared to self-identified ‘traditional students’. However, resilience levels of students who deemed themselves to be ‘non-traditional’ in other domains (e.g. household income, cultural background) did not differ significantly from ‘traditional’ students. The findings show that life experiences commonly affiliated with being a mature-aged student, including work and being a carer, may contribute to higher resilience. Implications in relation to practice and future research were discussed.

Abstract MP01: Multiple Social Determinants of Health Disparities Increase the Risk of Diabetes and Mortality in the Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Joanna B Ringel ◽  
April P Carson ◽  
Doyle M Cummings ◽  
Jessica Pena ◽  
Christopher Gamboa ◽  
...  
Keyword(s):  
Relative Risk ◽  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Racial Differences ◽  
Social Determinants ◽  
Multinomial Logistic Regression ◽  
Determinants Of Health ◽  
Incident Diabetes ◽  
Annual Household Income

Introduction: The Healthy People 2020 initiative proposed that social determinants contribute to disparities in health outcomes. While studies have documented the influence of individual social determinants of health (SDOH) on health outcomes, few studies have examined how the aggregation of multiple SDOH within the same person affect health. Hypothesis: We hypothesized that as the number of individual-level and neighborhood-level SDOH increased, the relative risk of incident diabetes and mortality also increased. Methods: This study included 15,310 black and white adults aged > 45 years at baseline (2003-2007) who did not have prevalent diabetes and who completed the 10 year follow-up exam (2014-2016) or died prior to follow-up in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Exposures included 6 SDOH which have been associated with increased health risks: annual household income <$35,000, black race, < high school education, lack of health insurance, residing in a zip code with ≥ 25% poverty, and living in a state with poor public health infrastructure for 10 years prior to 2003. Outcomes were all-cause mortality or incident diabetes, defined as fasting glucose >126 mg/dL, random blood glucose >200 mg/dL, or taking diabetes medication or insulin. Multinomial logistic regression models examined associations of number of SDOH with death and incident diabetes, adjusting for other demographics, health behaviors, and medical conditions. Results: At follow-up, 1,170 (8.7%) had developed diabetes, and 3,790 (26.8%) had died. As the number of SDOH increased, the relative risk of both diabetes and death increased significantly (p for trend <0.001) in both crude and adjusted models (Figure). Conclusions: Counting the aggregate number of SDOH that an individual is exposed to may be a simple way to identify those at greater risk of developing incident diabetes or dying over 10 years. This approach has potential for application in both clinical practice and population health management.

Does Adherence to Mediterranean Diet Mediate the Association Between Food Environment and Obesity Among Non-Hispanic Black and White Older US Adults? A Path Analysis

2020 ◽  
Vol 34 (6) ◽  
pp. 652-658
Author(s):  
Meifang Chen ◽  
Virginia Howard ◽  
Kathy F. Harrington ◽  
Thomas Creger ◽  
Suzanne E. Judd ◽  
...  
Keyword(s):  
United States ◽  
Path Analysis ◽  
Racial Differences ◽  
Mediterranean Diet ◽  
Food Environment ◽  
Household Income ◽  
The United States ◽  
Community Dwelling ◽  
Annual Household Income ◽  
Black And White

Purpose: This study aims to test the hypothesis that in addition to a direct effect of food environment on obesity, food environment is indirectly associated with obesity through consuming Mediterranean diet (MD). Design: Cross-sectional secondary data analysis. Setting: Nationwide community-dwelling residency. Sample: A total of 20 897 non-Hispanic black and white adults aged ≥45 years who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007. Measures: The Modified Retail Food Environment Index (mRFEI; 0-100) was used as food environment indicator. The MD score (0-9) was calculated to indicate the dietary pattern adherence. Body mass index (BMI; kg/m2) was used to estimate obesity. Analysis: Path analysis was used to quantify the pathways between food environment, MD adherence, and obesity. Proper data transformation was made using Box–Cox power transformation to meet certain analysis assumptions. Results: The participants were from 49 states of the United States, with the majority (64.42%) residing in the South. Most of the participants were retired, female, white, married, having less than college graduate education, having annual household income ≤75 000, and having health insurance. The means of mRFEI was 10.92 (standard deviation [SD] = 10.19), MD score was 4.36 (SD = 1.70), and the BMI was 28.96 kg/m2 (SD = 5.90). Access to healthy food outlets (β = .04, P < .0001) and MD adherence (β = .08, P < .0001) had significant and inverse relationships with BMI, respectively. Mediterranean diet adherence mediated the relationship between food environment and obesity among a subpopulation who had an annual household income of <$75 000 (β = −.02, P = .0391). Conclusion: Population-tailored interventions/policies to modify food environment and promote MD consumption are needed in order to combat the obesity crisis in the United States.

scholarly journals “My Uni Experience Wasn’t Completely Ruined”: The Impacts of COVID-19 on the First-Year Experience

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
Loraine McKay ◽  
Steven O'Bryan ◽  
Ella R Kahu
Keyword(s):  
Teacher Education Program ◽  
First Trimester ◽  
First Year Experience ◽  
Photo Elicitation ◽  
Future Research ◽  
First Year ◽  
Cumulative Stress ◽  
New Students ◽  
Quantitative Results

The first year at university is always challenging, but particularly in 2020 when COVID-19 triggered lockdowns and a rapid shift to online learning. This mixed methods study tracked the wellbeing and engagement of 60 new students in an undergraduate teacher education program at an Australian university throughout the first trimester of 2020. Follow-up focus groups with 14 students used interview and photo elicitation to explore how COVID-19 influenced wellbeing and engagement. Quantitative results demonstrate both student wellbeing and student engagement dipped strongly at the start of lockdown but recovered towards the end of the trimester. Focus group findings illustrate the diversity of experience in terms of student access to time and space to study, their ability to sustain relationships online, and the cumulative stress of COVID-19. The findings lead to recommendations for supporting this cohort and for future research.

Racial Differences in the Formation of Postsecondary Educational Expectations: A Structural Model

2010 ◽  
Vol 112 (3) ◽  
pp. 811-842 ◽  
Author(s):  
Samuel D. Museus ◽  
Shaun R. Harper ◽  
Andrew H. Nichols
Keyword(s):  
High School ◽  
Educational Attainment ◽  
Racial Differences ◽  
Structural Model ◽  
Educational Expectations ◽  
Equation Modeling ◽  
Future Research ◽  
Racial Groups ◽  
Interpersonal Factors

Background Educational attainment is associated with a plethora of positive economic and social implications for individuals, institutions, and the broader society. One factor that has been identified as an important predictor of students’ educational attainment is their educational expectations. Thus, understanding how educational expectations are shaped is important to comprehending how success can be fostered among students from diverse racial backgrounds. Purpose of the Study This quantitative study is aimed at understanding the process by which students from various racial backgrounds cultivate and reformulate their educational expectations during the high school years. Three research questions were explored in this study: (1) How do various academic and interpersonal factors directly affect students’ educational expectations? (2) How do academic and interpersonal factors indirectly affect students’ educational expectations via their self-perceptions? and (3) How do those effects vary across different racial groups? Populations and Participants The National Education Longitudinal Study (NELS) survey was first administered to students in the spring of eighth grade, and the first two follow-up surveys were administered in the spring of those students’ 10th- and 12th-grade years. Students who participated in the NELS surveys from the base year to the second follow-up (88:92) were included in the omnibus analysis, resulting in an overall sample size of 12,144. That sample was divided into Asian (n = 764), Black (n = 1,041), Latina/o (n =1,444), Native American (n= 399), and White (n = 7,626) subsamples, and a parallel analysis was conducted to allow for the comparison of effects across various racial subpop-ulations. Research Design Using a pretest-posttest design and structural equation modeling techniques, we created a structural model and examined how academic and interpersonal factors directly and indirectly, via self-efficacy and locus of control, influence students’ educational expectations. Particular attention is given to how those effects vary across racial subpopulations. Conclusions and Recommendations Relationships between the results of this inquiry and earlier studies are complex, with some of our findings confirming and some contradicting those of other researchers. The results of this analysis indicate that the process by which students formulate and reformulate their educational expectations during the high school years varies across racial groups. Recommendations for future research involve considering racial, gender, socioeconomic, and other differences in examining students’ educational expectations and outcomes. We also recommend that future research focus on understanding the reasons why such racial differences exist.

A Pilot Study of Mobile Telephone Message Interventions with Suicide Attempters in China

Crisis ◽  
2010 ◽  
Vol 31 (2) ◽  
pp. 109-112 ◽  
Author(s):  
Hui Chen ◽  
Brian L. Mishara ◽  
Xiao Xian Liu
Keyword(s):  
Pilot Study ◽  
Effective Means ◽  
Text Message ◽  
Text Messages ◽  
Mobile Telephone ◽  
Future Research ◽  
Quick Method ◽  
Suicide Attempters ◽  
To Receive

Background: In China, where follow-up with hospitalized attempters is generally lacking, there is a great need for inexpensive and effective means of maintaining contact and decreasing recidivism. Aims: Our objective was to test whether mobile telephone message contacts after discharge would be feasible and acceptable to suicide attempters in China. Methods: Fifteen participants were recruited from suicide attempters seen in the Emergency Department in Wuhan, China, to participate in a pilot study to receive mobile telephone messages after discharge. All participants have access to a mobile telephone, and there is no charge for the user to receive text messages. Results: Most participants (12) considered the text message contacts an acceptable and useful form of help and would like to continue to receive them for a longer period of time. Conclusions: This suggests that, as a low-cost and quick method of intervention in areas where more intensive follow-up is not practical or available, telephone messages contacts are accessible, feasible, and acceptable to suicide attempters. We hope that this will inspire future research on regular and long-term message interventions to prevent recidivism in suicide attempters.

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