Promises and Challenges of Medical Patient Healthcare Portals in Underserved Communities

2022 ◽  
pp. 505-537
Author(s):  
Diane C. Lee ◽  
David Gefen
Keyword(s):  
Health Literacy ◽  
Catchment Area ◽  
Medical Center ◽  
Medical Patient ◽  
Large Degree ◽  
Safety Net ◽  
Typical Case ◽  
It Adoption ◽  
Underserved Communities ◽  
Poor Health Literacy

As a safety-net medical center that serves many underserved communities, Einstein Medical Center Philadelphia (EMCP) faces many challenges in providing healthcare to its communities. To improve those services, EMCP has released a new IT healthcare portal (app). This chapter describes some of the promises and challenges EMCP is currently facing in their attempts to convince communities in its catchment area to adopt that healthcare portal. The challenges are discussed in the contexts of poor social determinants of health (SDOH), unique social factors, as well as the importance of managing community trust in EMCP within the broader contexts of underserved communities of which the new portal is only part of the story. This is not a typical case of IT adoption. The challenges at hand are not only technical but to a large degree social, dealing in part with issues of cultural diversity, perceived lack of respect, and poor health literacy.

Promises and Challenges of Medical Patient Healthcare Portals in Underserved Communities

2020 ◽  
pp. 219-251
Author(s):  
Diane C. Lee ◽  
David Gefen
Keyword(s):  
Health Literacy ◽  
Catchment Area ◽  
Medical Center ◽  
Medical Patient ◽  
Large Degree ◽  
Safety Net ◽  
Typical Case ◽  
It Adoption ◽  
Underserved Communities ◽  
Poor Health Literacy

As a safety-net medical center that serves many underserved communities, Einstein Medical Center Philadelphia (EMCP) faces many challenges in providing healthcare to its communities. To improve those services, EMCP has released a new IT healthcare portal (app). This chapter describes some of the promises and challenges EMCP is currently facing in their attempts to convince communities in its catchment area to adopt that healthcare portal. The challenges are discussed in the contexts of poor social determinants of health (SDOH), unique social factors, as well as the importance of managing community trust in EMCP within the broader contexts of underserved communities of which the new portal is only part of the story. This is not a typical case of IT adoption. The challenges at hand are not only technical but to a large degree social, dealing in part with issues of cultural diversity, perceived lack of respect, and poor health literacy.

scholarly journals Minority status and readmissions: a moderated mediation model of caregivers’ health literacy

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 917-917
Author(s):  
Nosaiba Rayan-Gharra ◽  
Nurit Gur-Yaish ◽  
Ksenya Shulyaev
Keyword(s):  
Health Literacy ◽  
Native Speakers ◽  
Medical Center ◽  
Informal Caregivers ◽  
Moderated Mediation ◽  
Minority Status ◽  
Mediation Model ◽  
Clinical Encounters ◽  
Moderated Mediation Model ◽  
Time Of Admission

Abstract Family caregivers help patients to understand informa¬tion during clinical encounters. Less is known about factors that may affect family caregiver’s Ensuring and Explaining Medical Care (EEMC) during hospitalization and its impact on improved health outcomes. This study examined whether EEMC during hospitalization mediated the association between minority status of patients and 30-day-readmissions, and whether levels of Health Literacy (HL) of caregivers moderated this mediated association. A prospective cohort study of 517 internal medicine patients, Hebrew (general population, coded as 0) and Russian, or Arabic native speakers (minority status, coded as 1), at a tertiary medical center in central Israel, who were accompanied by an informal caregiver. EEMC and HL were patients’ self-reported. 30-day-readmissions were retrieved from the healthcare organization. Logistic regression indicated that minority status was not associated with 30-day readmission when the mediator ICEEMC was not included (B=0.98; p>0.05). However, moderated mediation analysis indicated significant direct (B=-1.08; p=0.003) and indirect effect of minority status on readmission through high ICEEMC during hospitalization among patients who had informal caregivers with high HL level (Mediated effect (ME)=−0.62; CI= -1.07 to -0.29) but not among ones with low HL level (ME= 0.37; CI=-0.24 to 1.06). These findings suggest that caregivers’ high HL may be an essential factor in improving EEMC among minorities. Identifying informal caregivers with high HL level at time of admission to the hospital, and encouraging their involvement during patients’ hospital stay, might be a useful strategy to improve transitions and reducing 30-day readmission, especially among minority patients.

Tobacco use, knowledge of harms, and cessation support among patients with non-tobacco related cancers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24029-e24029
Author(s):  
Laura Vater ◽  
Anup Trikannad Ashwini Kumar ◽  
Neha Sehgal ◽  
Maria Khan ◽  
Kelsey Bullens ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Medical Center ◽  
Safety Net ◽  
Cancer Center ◽  
Prescribe Medication ◽  
Patients With Cancer ◽  
Quit Smoking ◽  
Increased Risk ◽  
Quit Attempts

e24029 Background: Continued cigarette smoking among patients with cancer leads to numerous adverse health outcomes, even among patients with non-tobacco-related cancers such as breast, colon, and prostate cancer. Continued smoking is associated with poorer response to cancer treatment, increased risk for treatment-related toxicities, and shorter overall survival. While some patients with a smoking-related cancer make efforts to quit smoking at the time of diagnosis, patients with other forms of cancer might not understand the negative effects of continued smoking. In this study, we assessed patient knowledge of the harms of continued smoking, previous cessation attempts, and cessation support. Methods: We surveyed 102 adults with breast, colon, and prostate cancer at three locations: an NCI-designated cancer center, an urban safety-net medical center, and a rural cancer center. Patients were asked about current smoking behaviors, beliefs about the harms of continued smoking, quit attempts and resources used, and cessation support. We also surveyed seven oncologists to assess beliefs about harms of continued smoking, cessation support provided to patients, training and confidence in cessation counseling, and barriers to providing cessation support. Results: Most patients (82%) agreed or strongly agreed that continued smoking may shorten life expectancy, and 70% agreed or strongly agreed that continued smoking increased the risk of getting a different type of cancer. Only 41% of patients agreed or strongly agreed that continued smoking may cause more side effects from cancer treatment, and only 40% agreed or strongly agreed that ongoing smoking may affect treatment response. The majority of patients (86%) had tried to quit smoking for good, with an average 4.1 quit attempts per patient. Patients reported that physicians advised them to quit the majority of the time (92%), prescribed medication 33% of the time, and followed up on cessation attempts 43% of the time. Overall, oncologists had higher knowledge of the harms of continued smoking on treatment outcomes and survival. Those in practice for 20 years or more had higher confidence in cessation counseling than those in practice less than 4 years. Oncologists described lack of time and lack of confidence in cessation counseling as barriers to providing more cessation support. Conclusions: Among 102 patients with breast, colon, and prostate cancer who currently smoke, there was incomplete knowledge of the harms of continued smoking. Oncologists believe that tobacco cessation is important and frequently advise patients to quit, however they less frequently prescribe medication or follow up on cessation efforts. Interventions are needed to educate patients with cancer about the harms of continued smoking and to provide further cessation support.

scholarly journals Increasing Knowledge and Health Literacy about Preterm Births in Underserved Communities: An Approach to Decrease Health Disparities, a Pilot Study

2015 ◽  
Vol 8 (1) ◽  
pp. 83 ◽  
Author(s):  
Allison A. Vanderbilt ◽  
Marcie S. Wright ◽  
Alisa E. Brewer ◽  
Lydia K. Murithi ◽  
PonJola Coney
Keyword(s):  
Health Disparities ◽  
Preterm Birth ◽  
Health Literacy ◽  
Pilot Study ◽  
Health Knowledge ◽  
Preterm Births ◽  
Fetal Mortality ◽  
Provider Communication ◽  
Underserved Communities ◽  
Metro Area

<p><strong>INTRODUCTION:</strong> Health disparities can negatively impact subsets of the population who have systematically experienced greater socioeconomic obstacles to health. For example, health disparities between ethnic and racial groups continue to grow due to the widening gap in large declines in infant and fetal mortality among Caucasians compared to Black non-Hispanic or African Americans. According to the American Congress of Obstetricians and Gynecologists, preterm birth remains a leading cause of infant morbidity and mortality. The purpose of our study is to determine if the computer-based educational modules related to preterm birth health literacy and health disparity with a pre-test and post-test can effectively increase health knowledge of our participants in targeted underserved communities within the Richmond-metro area.</p> <p><strong>METHODS:</strong> This was a pilot study in the Richmond-Metro area. Participants were required to be over the age of 18, and had to electronically give consent. Descriptive statistics, means and standard deviations, and Paired <em>t-</em>tests were conducted in SPSS 22.0.</p> <p><strong>RESULTS:</strong> There were 140 participants in the pilot study. <em>P &lt;</em>.05 was set as significant and all four modules had a <em>P </em>&lt;.000. The males were <em>not </em>significant with modules: Let’s Talk Patient &amp; Provider Communication <em>P </em>&lt;.132 and It Takes a Village<em> P</em> &lt;.066. Preterm birth status yes all of the findings were statistically significant <em>P</em>&lt;.000. Preterm birth status no Let’s Talk Patients &amp; Provider Communication was not significant <em>P </em>&lt;.106.</p> <p><strong>CONCLUSION:</strong> Overall, researchers found that with a strong research methodology and strong content relevant to the community, the participants demonstrated an increase in their knowledge in health literacy and preterm birth.</p>

Health literacy

2020 ◽  
Vol 13 (8) ◽  
pp. 490-494
Author(s):  
Johanna Reilly
Keyword(s):  
Social Skills ◽  
Health Literacy ◽  
Health Information ◽  
Good Health ◽  
World Health Organisation ◽  
Poor Health ◽  
World Health ◽  
The World ◽  
Poor Health Literacy ◽  
Gain Access

Health literacy has been defined by the World Health Organisation as ‘The cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.’ Doctors need to assess and take into account a patient’s health literacy when communicating information. Poor health literacy is more common than doctors may appreciate, and health information is often produced at a level that many people may struggle to understand.

scholarly journals Health Literacy and Recall of Postoperative Instructions in Patients Undergoing the Lapidus Procedure

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142094022
Author(s):  
Jonathan H. Garfinkel ◽  
Amelia Hummel ◽  
Jonathan Day ◽  
Andrew Roney ◽  
Mackenzie Jones ◽  
...  
Keyword(s):  
Health Literacy ◽  
Objective Measure ◽  
Senior Author ◽  
Bachelor's Degree ◽  
Level Of Evidence ◽  
Verbal Instructions ◽  
Level Ii ◽  
Before And After ◽  
History Of ◽  
Poor Health Literacy

Background: Active participation in patients’ own care is essential for success after Lapidus procedure. Poor health literacy, comprehension, and retention of patient instructions may be correlated with patient participation. Currently, there is no objective measure of how well patients internalize and retain instructions before and after a Lapidus procedure. We performed this study to assess how much of the information given to patients preoperatively was able to be recalled at the first postoperative visit. Methods: All patients between ages 18 and 88 years undergoing a Lapidus procedure for hallux valgus by the senior author between June 2016 and July 2018 were considered eligible for inclusion. Patients were excluded if they had a history of previous bunion surgery or if the procedure was part of a flatfoot reconstruction. Patients were given written and verbal instructions at the preoperative visit. Demographic and comprehension surveys were administered at their first visit approximately 2 weeks postoperatively. A total of 50 patients, of which 42 (84%) were female and 43 (86%) had a bachelor’s degree or higher, were enrolled. Results: Mean overall score on the comprehension survey was 6.2/8 (±1.2), mean procedure subscore was 1.8/3 (±0.64), and mean postoperative protocol subscore was 4.4/5 (±0.8). The most frequently missed question asked patients to identify the joint fused in the procedure. Conclusion: Although comprehension and retention of instructions given preoperatively was quite high in our well-educated cohort, our findings highlight the importance of delivering clear instructions preoperatively and reinforcing these instructions often. Level of Evidence: Level II, prospective cohort study.

scholarly journals 3532 Vitamin D assay utilization and outcomes in pregnant women in an urban safety net medical center: a retrospective cohort study

2019 ◽  
Vol 3 (s1) ◽  
pp. 30-30
Author(s):  
Grace Hyojung Yoon ◽  
Michael Holick ◽  
Arash Hossein
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Low Income ◽  
Medical Center ◽  
Safety Net ◽  
Vitamin D Supplementation ◽  
Vitamin D Levels ◽  
Urban Safety ◽  
Study Population ◽  
Boston Medical

OBJECTIVES/SPECIFIC AIMS: The goals of this retrospective cohort study is threefold: 1) to assess how many pregnant women at Boston Medical Center from 2012 to 2017 have had their vitamin D status checked prior to and during pregnancy, 2) determine associations between vitamin D levels, birth outcomes and demographics and 3) assess how many of those found to have lower than satisfactory vitamin D levels (<30ng/mL) received interventions, including receiving vitamin D supplementation and/or being referred to an appropriate specialist such as an endocrinologist or a nutritionist. METHODS/STUDY POPULATION: Our study population is mothers over age 18 who received care at Boston Medical Center during their pregnancy from 2012 to 2017. Our primary outcomes are vitamin D utilization rates and associations between vitamin D levels with clinical outcomes during pregnancy and at birth. Secondary outcomes are demographic predictors of mothers who receive vitamin D testing and those who have complications associated with low vitamin D. We will conduct multiple linear regressions to check for associations between vitamin D levels, birth outcomes and demographic variables. We will adjust vitamin D levels with maternal BMI. De-identified clinical data was gathered from Boston University Medical Center’s (BUMC) Clinical Data Warehouse. This retrospective study was approved with a HIPAA waiver by the BUMC Institutional Data Warehouse. All statistical analysis was completed using SAS version 9.4 and was primarily done by the student PI and reviewed by Dr. Hossein, the co-investigator who is trained as a statistician and geneticist. The team also utilized Boston University’s Biostatistics, Epidemiology & Research Design (BERD) team to check the feasibility of the statistical methods. RESULTS/ANTICIPATED RESULTS: We anticipate that our descriptive demographic data will reflect the medical center’s predominantly black/Hispanic and low-income profile. Based on previous literature, we expect low vitamin D levels to have positive associations with gestational diabetes, pre-eclampsia, and preterm birth. Analyses are currently actively in progress and we expect to have results before the ACTS conference date in March, 2019. DISCUSSION/SIGNIFICANCE OF IMPACT: Vitamin D is an essential part of the human body system. It is well documented in current literature that vitamin D is correlated with bone health, mental health and maternal health. Moreover, there is evidence that maternal vitamin D supplementation prevents vitamin D deficiency in newborns. Previous literature suggests that low vitamin D may be associated with gestational diabetes, pre-eclampsia, and pre-term births. Boston Medical Center is Massachusetts’ largest urban medical center and acts as its only safety-net hospital, serving predominantly low-income and socially marginalized patient populations. There is limited existing research on assessment of maternal vitamin D in urban hospital settings. Pregnant women rarely receive vitamin D screenings as part of their prenatal checkups as current national and regional guidelines do not require pregnant women to be screened for vitamin D deficiency or insufficiency. The results will demonstrate the potential effects vitamin D supplementation, or lack thereof, in expectant mothers living in urban, safety net communities. We hope to inform prenatal care practices and attitudes of vitamin D supplementation in maternal health with the results of our study.

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