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The Children’s Mercy Kansas City Research Institute announced on Monday that it is building what it calls the “most advanced genomic sequencing system in the world.” 

This claim refers to the work Children’s Mercy is doing through its Genomic Answers for Kids (GA4K) program. The health system rolled out the program three years ago with the goal of collecting genomic data and health information for 30,000 children and their families — it expects to create a database of at least 100,000 genomes over seven years. GA4K is already enjoying a significant milestone: providing 1,000 children with rare disease diagnoses based on its genome sequencing.

The program is unique because it uses 5-base genomic sequencing. This is a novel technology that combines multiple genomic technologies that have been used before into a single test, Dr. Tomi Pastinen, the director of Children’s Mercy Kansas City’s genomic medicine center, said in an interview.

“What 5-base genomic sequencing allows us to immediately do in the clinical space is replace multiple, usually successive genetic tests that are carried out on a patient into a single combined test and speeds up the analysis of multiple different types of genetic diseases,” he said.

Beyond the ability to diagnose all types of genetic diseases, 5-base genomic sequencing opens up our ability to “read the genome beyond the currently interpreted clinical genome,” Dr. Pastinen added. 

Genomic sequencing tests currently interpret only the protein coding part of the genome, which Dr. Pastinen claimed makes up only about 2% of the human genome. The use of 5-base genomic sequencing unveils the 98% of the genome that is currently not clinically analyzed. This is important because 60% cases involving children in which physicians suspect genetic disease remain unsolved with current genetic testing methods, Dr. Pastinen said.

On average, about 30-40% of pediatric rare disease cases receive a diagnosis, according to Dr. Pastinen. He said 5-base sequencing can help that percentage inch closer to half.

Dr. Pastinen claimed that the database being built for GA4K is the first of its kind for a couple reasons. The first is its scale, and the second is its comprehensiveness. While there have been pediatric rare disease studies that focus on specific indications, this program collects data from as many pediatric patients as possible who have been evaluated for an unsolved disease, Dr. Pastinen said.

This data comes from Children’s Mercy patients, as well as patients at the 17 partner institutions that take part in GA4K, two of which include NYU Langone Health and the University of Nebraska Medical Center, Dr. Pastinen said. These partners send their patients’ genomic samples for testing at Children’s Mercy.

“The program is unique because of the depth of data per patient — and because it’s dynamic,” Dr. Pasinen said. “And what that means is that we actually query the genome over the lifetime of the patient. The patient and their medical record lives with us. If there are changes in the medical record or changes in our understanding of the genome, we update the analysis in real time and actually share the data in real time with the scientific community and physician scientists.”

The 5-base sequencing used in GA4K expands upon previous work conducted by pediatric hospitals to better understand rare diseases in children. For example, San Diego-based Rady Children’s Institute for Genomic Medicine has also been a pioneer in the space, with a strong precision medicine program that deploys rapid genomic sequencing to quickly and accurately diagnose patients as early as possible. This program was championed by Dr. Stephen Kingsmore, who served as director of Children’s Mercy’s center for pediatric genomic medicine from 2011-2015.

Photo: Andy, Getty Images

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How is the patient journey impacted when individuals have an estimate of care costs before their visit?

Providers are under increased pressure to publicly disclose the price of products and services they offer, in part driven by recent federal price transparency regulations. For example, the Hospital Price Transparency rule took effect on January 1, 2021, and is intended to make it easier for consumers to shop and compare prices across hospitals, as well as estimate the cost of care before going to the hospital. The rule stipulates that hospitals’ standard charges, including the rates they negotiate with insurance companies and the discounted price they are willing to accept directly from a patient if paid in cash, must be publicly available, free of charge, and presented in a consumer-friendly display.

While the federal rule applies to hospitals, it highlights the increased awareness and growing demand for price transparency across all care settings. Adding to consumers’ awareness around price transparency is the No Surprises Act, which took effect Jan. 1, 2022. This act is intended to protect consumers from excessive out-of-pocket costs when getting emergency care and non-emergency care from out-of-network providers at in-network facilities. As more providers seek to comply with new laws, healthcare consumers are likely to obtain a heightened awareness of price transparency and expect more transparency from their providers, regardless of care setting.

For outpatient practices, providers have an opportunity to get ahead of this evolution in healthcare consumer expectations by offering patients a new type of care journey that includes an option for pre-service cost estimates.

Two patient journeys

To understand the difference that pre-service cost estimates can deliver for patients, providers, and staff, consider two separate journeys that patients might follow: One is a more traditional route with the patient only paying their co-pay at the time of service. The other journey provides the patient with a cost estimate for care at the time of check-in.

In the traditional journey, the patient shows up for an appointment and upon check-in at the front desk is asked to provide her co-pay amount, without regard for other charges that could be paid up-front. Insurance companies have shifted their plan design away from copay-driven plans to high-deductible health plans, with deductibles routinely being in the $3,000 to$5,000 range (and sometimes as high as $12,000). When a patient is on a high-deductible health plan, the provider collects $0 before or immediately after the service is rendered, with the rest left at risk. After the visit is complete, a staff member files a claim with the patient’s insurance company, the patient is billed for the balance due – and then begins the provider’s waiting game to receive payment for the funds they are owed.

Some patients may pay their providers the day they receive a bill; however, a far more likely outcome is that payment is delayed because patients generally prioritize payments for rent, car payments, groceries and other monthly expenses over medical bills. Surprise bills can be particularly problematic for patients who have high-deductible plans and learn they owe significant out-of-pocket costs. Surprise bills can also be costly for providers, who often must devote valuable staff resources to work collections and chase down payments.

In contrast, consider the journey of a patient who has the option of taking advantage of digital tools that estimate the out-of-pocket costs before the visit, based on expected visit type and past history. With this approach, providers can collect not only co-pay due at check-in but, also the probable out-of-pocket cost estimate. In addition, staff can store the patient’s credit card information at the time of service, then automatically bill for any balance due after the claim is adjudicated.

For patients, this greater price transparency can yield better, more-informed decision-making and facilitate budgeting for medical costs. For example, when informed of expected costs up-front, the patient is in a much better position to decide if they should move forward with treatment now, or if they could postpone until a future date, and budget accordingly. Having the cost information prior to treatment also enables patients and clinicians to have a frank conversation about treatment options and timing.

Providers that collect the patient’s full payment at the time of service get their money sooner and also free staff members from time-consuming collection efforts. Fewer accounts have to be turned over to collection agencies, meaning a greater portion of collections stay with the practice.

Pre-service cost estimates are an essential component of providers’ broader pre-service check-in process and facilitate a more automated patient journey that delivers greater price transparency, reduces financial friction for patients, and increases the likelihood for prompt collections.

Photo: champc, Getty Images

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Medications that treat opioid use disorder (OUD) — such as methadone, buprenorphine and extended-release naltrexone — are life-saving drugs that have been proven to decrease opioid overdoses by more than half. However, 86.6% of people who have OUD are not receiving these medications, according to a study published Thursday in the International Journal of Drug Policy.

For the study, researchers at NYU Grossman School of Medicine analyzed two databases: a publicly available one that tracked the dispensing of OUD medications by licensed methadone clinics and a private one that tracked prescriptions filled for buprenorphine and extended-release naltrexone. Through their analysis, they found that although the use of medications for OUD has more than doubled over the last 10 years, the use of these medications is still far too low to keep up with the opioid overdose fatality rates that have been soaring during the past decade — a trend driven mainly by the rise of synthetic opioids like fentanyl.

When the researchers looked at the data state-by-state, they found utilization of medication for OUD varied significantly. OUD medication treatment rates were at their lowest in South Dakota and highest in Vermont. But even in states with the highest rates of use, at least half of people who could benefit from OUD medications were still not receiving them.

There are three key ways to address this problem, Noa Krawczyk, the study’s lead author, said in an interview. 

One is by relaxing tight regulations on methadone dispensing. Methadone is one of the most effective ways to treat OUD, according to Krawczyk, but the medication can only be dispensed from licensed opioid treatment programs (OTPs). She pointed out that about 80% of U.S. counties do not even have an OTP. When it comes to expanding access to methadone, providers and harm reduction advocates pretty much have their hands tied, as federal law stipulates that the medication can only be dispensed through these programs.

This is not the case in other countries, Krawczyk noted. For example, in the U.K., patients can receive a prescription for methadone from their physician and pick it up at the pharmacy, just as they would obtain any other chronic medication. Having a similar system in the U.S. would make the life-saving medication much more widely available, Krawczyk said.

Another change the U.S. healthcare system should make to increase access to OUD medication is removing the special waiver requirements physicians need to prescribe buprenorphine. In order to prescribe buprenorphine in this country, providers need the X waiver, a requirement mandated by Congress in 2000 that necessitates physicians receive a day’s training before they can prescribe the drug.

Last year, a bipartisan group of six members of Congress introduced the Mainstreaming Addiction Treatment (MAT) Act to eliminate the X-waiver. The bill cited a National Institutes of Health study that showed France’s opioid overdose deaths declined by 79 percent over a four-year period after the country took similar measures to make buprenorphine prescription possible without a waiver. Krawczyk said passing this bill would not only free up bureaucratic hurdles, but also eliminate “the sense that buprenorphine is a very complicated treatment when it’s really not.”

The final change needed to increase access to OUD medication is expanding the deployment of these medications in mobile health clinics and community-based organizations, as well as within the criminal justice system. In order to accomplish this, the medical community will have to work on decreasing stigma around OUD, Krawczyk declared. She pointed out that many providers have stigma against people with OUD because they were never trained to understand the condition in medical school.

“If you work at any hospital or community clinic, you’re going to run into patients with substance use disorders,” Krawczyk said. “So it’s really pretty disgraceful that we don’t spend more time training our doctors about this. Opioid use disorder is the only chronic disorder that’s treated in this way — no other chronic medications require a special license or have to be provided in these specific settings.”

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The staffing crisis among U.S. healthcare workers continues to make headlines, with senior care and nursing suffering the worst employee deficits. More than 100,00 registered nurses left the workforce in 2021, the worst exodus the career had seen in more than four decades.

The workplace climate of excessive burnout and rapid turnover is causing new graduates to enter the nursing profession in a state of anxiety, according to a recent report from nurse staffing platform Incredible Health. The two main sources of this anxiety are worries about inadequate onboarding processes and being overworked as a result of staffing shortages, said Incredible Health CEO Iman Abuzeid.

To conduct its study, Incredible Health analyzed data from recent nursing graduates and 400,000 nurses on its platform. Most of these recent graduates and new nurses were part of Gen Z.

Sufficient training is one of the most important aspects Gen Z nurses are looking for in a job, the report found. Since Gen Z nurses are young, career-oriented individuals, they want their training to not only be comprehensive and unhurried, but also open up a clear path towards eventually becoming a specialized nurse, according to Abuzeid.

“Many new graduate nurses have aspirations to move very quickly into specialty areas, such as an emergency medicine program,” she said. “So training programs that emphasize specialized skills tend to be what they prefer, and the ability for nurses to enter those areas sooner rather than later is definitely a preference.”

The report showed that nearly eight in every 10 nurses entering the field have found their training to be overwhelming, rushed or not as informative as they had hoped. Some Gen Z nurses also lamented the fact that they were not trained by experienced nurses, but rather fellow recent graduates. 

This anecdotal data is concerning, especially because 41% of new nurses reported that onboarding training was the most important resource their employer can provide, Abuzeid pointed out. One respondent said staffing shortages are the clear culprit that have forced hospitals to forgo the resources they would usually give new nursing hires, leaving herself and her peers without “a formal orientation that’s long enough for a new graduate.” 

The report also found that two-thirds of new nurse graduates feel burnt out within their first six months of employment. Staffing shortages cause new nurses to take on an excessive amount of overtime shifts that lead not only to stress and anxiety, but could also lead to diminished care quality, Abuzeid pointed out.

“When you’re overworked as a nurse, you’re more likely to make mistakes, and your patient mortality can go up,” she said. “Frankly, that’s very stressful. Nurses care about patient safety, and it tends to decrease in understaffed units.”

Nursing is already a stressful and high-stakes job, and the added stressors of its workforce crisis are causing many new nurses to rethink their career choice — 55% of new nursing graduates said they do not plan to stick with the profession until retirement.

In order to reverse this trend, Abuzeid thinks employers will have to adapt to Gen Z nurses’ needs quickly. To do this, providers must first ensure they can offer comprehensive training led by experienced nurses. They must also invest heavily in career advanced training in order to be able to hire and retain more nurses, Abuzeid said.

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I was on a flight from Chicago to Sacramento when the lymph nodes in my neck swelled up, cutting off my airway. The flight crew wanted to do an emergency landing to get me to a hospital as soon as possible. I began to panic — not because I couldn’t breathe but because I was terrified about how much it would cost to do an emergency landing. Not to mention the price for the ambulance ride and the bill from an out-of-state emergency room that may or may not be in my network.

I was 24 years old, and, like many Americans, I had learned to avoid any kind of medical care unless it was a true emergency, fully embracing an “out of sight, out of mind” mentality when it came to my health.

Despite my fears, the pilot and crew insisted on making the emergency landing. I spent four days in a Salt Lake City hospital. It wasn’t clear what caused my lymph nodes to swell, and I was told to follow up with my primary care provider when I returned to California. The next 18 months involved frequent mid-day trips to my doctor’s office for lab testing, resulting in taking off several weeks from work and an accumulation of medical debt that took years to recover from!

Sadly, not a whole lot has changed in health care. The biggest improvement has been health care’s rapid adoption of digital health, which has improved access by leaps and bounds for countless Americans. But even so, it’s not enough. Today, 78% of Americans still avoid or delay medical services, and 29% avoid or delay basic preventative care.

When patients miss their appointments, continuity of care is interrupted. Acute illnesses are more likely to go untreated and become chronic conditions with complications. For Americans already living with chronic conditions, skipped appointments, screenings, or lab work can have catastrophic effects on health outcomes.

Most Americans aren’t deliberately avoiding or delaying medical care. Instead, existing U.S. health care models — including digital-first models — continue to place too much burden on the patient.  Rather than asking patients to jump through hoops to seek  care, health care professionals should be asking themselves, “what can we do to make the patient experience frictionless and pleasant?”

What health care professionals can do right now to improve patient care 

Plenty of people with health insurance, like the 24-year-old me, are still racked by the financial fear of outrageous medical bills and deterred by the inconvenience of pursuing care.

It doesn’t have to be this way. Here are five actions health care providers and payers can take to reduce friction and ease the burden off of patients.

  1. Educate patients

Education is the first step in helping reduce the burden of care on the patient. It’s a relatively easy and simple action for health care providers to take: inform patients of their options for more convenient services and facilitate the next (or first) steps to move patients through their care plan. This could mean referring them to a pharmacy that offers delivery, or a lab testing service that will meet them at their home.

  1. Encourage patient buy-in

While patient education is essential in creating an improved consumer experience, it alone won’t be enough to change behaviors and improve access. Following up on a care plan’s instructions may sound simple from the health care provider’s perspective, but even small steps can seem overwhelming or unnecessary for patients. One of the primary reasons patients don’t follow through with essential preventative screenings, maintenance medications for chronic conditions, or time-consuming diagnostics is that they don’t believe they “need” it. They can’t see or feel a problem, so they don’t prioritize getting care.

Sometimes patients need a little nudge of encouragement from their health care providers. The nudges can take the shape of benefits or incentives that prioritize convenience and holistic health options. With the proper encouragement, patients will be more likely to feel invested in their health care plan.

  1. Cost transparency

This one is painful. Most of us have experienced it: that unexpected arrival of a medical bill in the hundreds — if not thousands — of dollars for a procedure you thought was covered. I know this one well. It begins with a sinking feeling in the stomach, like a gut punch, that soon gives way to seething anger that the health care system is rigged and unfair.

Surprise medical bills are a major deterrent for patients and recognizing this, recently Congress has passed a law to prevent this from happening. Even when it’s a serious medical emergency, like what happened to me and my lymph nodes at 40,000 feet in the air, the fear of insanely high medical bills influences our decisions on how we should get care. The solution is cost transparency. Patients need to know precisely how much the care will cost and why certain procedures are priced the way they are.

  1. Prioritize convenient care for patients of lower socioeconomic status

All patients should be afforded the options for convenient, at-home, and virtual health care offerings. However, not all patients have equitable access to health care. Health care providers should place a special emphasis on prioritizing convenience and improving accessibility for those who face social barriers to care, such as lack of transportation, inability to take time off work, child care issues, food insecurity, and unstable housing.

This requires health care providers to build a system to identify those in need and then prioritize education, incentives, and encouragement with rigor and determination.

  1. Digital communication

Make it as easy as possible for patients to communicate with health care professionals, schedule appointments, and get prescription renewals right from their smartphone. At this point, digital communication is a no-brainer. But still, many providers don’t have digital communication systems implemented or in widespread use. Having a direct line of communication with your care team is incredibly empowering for patients. Plus, it is extremely convenient for patients to access basic care services and request referrals. For me, having to make a phone call and make a visit in person to get simple things like a prescription renewal or referral is a huge deterrent to timely care.

Removing barriers to care won’t be easy, and it won’t happen overnight, but by having a consumer-driven health mindset, we can make health care more equitable. Whatever we can do to make health care more accessible for the patient, we should do it. Period.

Photo: wenmei Zhou, Getty Images

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phone, text, texting, cell phone, smartphone

The rising levels of both type 1 and type 2 diabetes in American youth is quickly becoming a major public health concern. Data from the Centers for Disease Control and Prevention shows that 210,000 of the estimated 26.9 million Americans with diagnosed diabetes in 2018 were children and adolescents younger than age 20.

To help address this problem, New York City-based Mount Sinai is adopting a tech approach. It is partnering with mPulse Mobile, a company that sells its AI-based mobile patient messaging platform to health plans and health systems. Together with a group of teenage community members, the two partners have created a text message-based youth diabetes prevention program focused on integrating healthy behaviors into teens’ lives.

The partnership began after Dr. Nita Vangeepuram, a pediatrician and researcher at Mount Sinai, attended a webinar near the tail end of 2017 in which mPulse was explaining its technology. She reached out to the company to see how they could collaborate to address rising levels of youth diabetes, which she thinks is a widely overlooked issue in medicine. Chris Nicholson, mPulse’s founder and CEO, said he still remembers a shocking statistic Dr. Vangeepuram shared with him during those initial talks: that roughly half of U.S. youth are projected to have diabetes by 2050 unless healthcare providers deploy targeted interventions.

To “bend the trend,” as Nicholson put it, Mount Sinai and mPulse began working with a group of teenage community members living in East Harlem to develop text messaging campaigns focused on diabetes prevention. The partners wanted to work with East Harlem teens for two reasons, the first being that the neighborhood has one of the highest rates of diabetes in New York CIty. The other reason is that the area is racially diverse — an important consideration Black and Brown communities are more vulnerable to diabetes. 

Before developing the texting program, Dr. Vangeepuram conducted qualitative research with teenage subjects to determine which mobile technology is most effective at reaching teens. They reported they would rather access health content through texting than social media or apps. Teens told her that they preferred texting because it was a mode of communication they already used frequently and it did not require them to log in or download something.

Mount Sinai and mPulse involved East Harlem teens throughout the entire process of building the texting program, employing an approach Dr. Vangeepuram called the “youth participatory action research framework.” She said this refers to the idea that young people should be actively involved in research meant to create a positive change in their health.

The “community action board” of teens helped Mount Sinai researchers and mPulse develop a texting program that comprises five buckets: goal setting, cultivating healthy behaviors, maintaining motivation, tailored diet and exercise guidance and a photo diary. The messaging content was created based on what the youth community members said would best speak to their needs as it pertains to their financial circumstances, home life and busy schedules. 

Once a teen who is enrolled in the program engages with the texts, mPulse’s algorithm continually tailors its messages based on relevancy, according to Nicholson. For example, some teens enrolled in the program receive tailored exercise plans that can fit into their class and work schedules.

“When we learn something about an individual — when they communicate a barrier — we must present them with the next best action, a strategy that can combat that barrier or come at it from a different perspective,” Nicholson said.

To measure the impact of the program, Dr. Vangeepuram said her team will look at metrics such as how many teens enroll in the program, how often they respond to messages and how many users stay engaged over a long period of time. Down the road, the team will look at metrics such as East Harlem teens’ weight and hemoglobin A1C levels to determine how much of an impact their program is having on teenage diabetes rates.

Dr. Vangeepuram readily admitted the irony that the program is trying to reduce teenage diabetes through screens, the very thing that is blasted as the culprit causing the American childhood obesity epidemic. 

“We’re sort of spinning this idea on its head to figure out how we can actually use these tools, to our benefit,” she said. “It’s an exciting thing to think about. If teens are texting anyway, we might as well do good with it.

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On the heels of a coordinated care agreement with Anthem, St. Louis-based Mercy is partnering with another health insurer.

On Thursday, the health system announced it was entering into an agreement with Louisville, Kentucky-based Humana to expand patient access to virtual health resources.

Per the new agreement, Humana’s Medicare Advantage members who are patients at Mercy facilities and physician practices will gain in-network access to Mercy Virtual. Staffed with more than 300 clinicians, Mercy Virtual offers 24/7 telehealth services, including virtual primary care at home.

In addition, the agreement links provider reimbursement to quality of care, shifting the payment model for Mercy physicians from fee-for-service to value-based compensation.

“Mercy is committed to working with our communities to improve healthcare while also reducing the total cost of care,” said Shannon Sock, Mercy’s executive vice president, chief strategist and CFO, in a news release. “Strong payer relationships, like this one with Humana, will help in our long-term journey to provide more seamless care for our patients. Together we can make a real difference for patients, which is especially critical during this pandemic.”

The new agreement brings together an insurer with a sizeable membership and a vast healthcare organization.

Mercy includes more than 40 acute care, managed and specialty hospitals, urgent care locations, imaging centers and pharmacies, as well as 4,000 primary and specialty care clinicians in Arkansas, Kansas, Missouri and Oklahoma. And, as of January, Humana’s Medicare Advantage membership totaled more than 4.8 million.

“This agreement unites two organizations striving to offer care that is more accessible, personalized and coordinated — a commitment that is more important than ever right now,” said Jeremy Gaskill, Humana regional Medicare president, in a news release.

The news of the partnership between Humana and Mercy comes just a few weeks after the health system entered into a cooperative care agreement with Anthem. That partnership includes a closer alignment between clinical care and reimbursement as well as increased data flow between Mercy and Anthem.

As the healthcare industry moves toward value-based care, provider-payer partnerships that aim to improve care quality have become more popular.

For example, at the end of last year, Salt Lake City-based Intermountain Healthcare and UnitedHealthcare established an accountable care organization with the goal of improving care coordination and health outcomes for the payer’s Medicare Advantage members. In another instance, Butler Hospital, a mental health facility, partnered with Blue Cross & Blue Shield of Rhode Island to reduce hospital readmissions.

“If either a payer or provider is looking to fill a gap and expand optionality of services for partners or members, these types of innovative partnerships are beneficial because they provide both parties an opportunity to quickly refine and build versus recreating the wheel,” said Nick Donkar, PricewaterhouseCoopers’ health services deals leader. “This strategy enables a win-win solution in short order.”

Provider-payer partnerships will likely continue into the future to help both entities fill gaps as they think about improving care in a virtual environment, he said.

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Gaining insights into social factors affecting patients’ lives can be used to augment healthcare delivery in a big way.

That’s according to Dr. Courtney Lyles, an associate professor at the University of California San Francisco, who helped create an expansive social determinants of health-focused data visualization platform. She discussed the platform and its development at the Workgroup for Electronic Data Interchange’s The Quest for Health Equity virtual conference on Feb. 23.

The platform, UCSF Health Atlas, was released last April. Focused on California-based data, it is designed to enable researchers to explore neighborhood-level characteristics and see how they relate to health outcomes. It also includes data on Covid-19.

“It’s pretty clear, and Covid has made it even more clear, that health is really impacted by place,” said Lyles, who is also co-principal investigator of the UCSF Population Health Data Initiative. “Where we live, including our physical and social environment, directly influences health outcomes.”

The interactive platform includes more than 150 social determinates of health variables at different levels of granularity down to the census tract level, which includes between 1,200 and 8,000 people. The platform draws from several sources including the American Community Survey from the Census Bureau, CalEnviroScreen developed by the California Environmental Protection Agency and the California Department of Public Health.

But one of the main challenges of developing a platform like this is deciding what publicly available data to include from the massive trove that is available, said Lyles.

To create Health Atlas, UCSF relied heavily on the Health People 2020 framework created by the Office of Disease Prevention and Health Promotion. This framework helped the UCSF team think through five domains of social factors, said Lyles. These domains were:

  • Demographic characteristics
  • Socioeconomic factors
  • Community characteristics
  • Neighborhood characteristics
  • Health and healthcare indicators

The UCSF team then went in and selected useful variables within each of the five domains. For example, within the community domain, the team selected individual variables like language and foreign-born status as well as wider variables like population density and household composition — that is, people living in households with children versus single-adult households versus seniors living alone.

“Thinking about those variables has really been interesting,” said Lyles. “[It allowed us to] think through what matters for population health and health equity risk.”

Combining all this data on an interactive map enables researchers and clinicians to drill down into granular data on any one variable, and also compare different variables, she said.

UCSF has gone a step further and made it possible to link that social determinants of health data with its EHR data. For example, UCSF combined the two to gain insights into racial disparities in hypertension outcomes. Eliminating this disparity was a pre-Covid goal for the health system, Lyles said.

First, the team extracted every single address that existed within UCSF’s EHR, and then they geo-coded those addresses onto latitude and longitude. They assigned census tract identifiers to those geo-coded addresses so that they could be linked out to the publicly available datasets. Finally, they gathered clinical and demographic data for patients with hypertension receiving care within the system.

By combining all this the system was able to track hypertension patients by race, neighborhood and socioeconomic status in San Francisco on the map and compare these variables with health outcomes, Lyles said. They found that Black patients are concentrated in certain neighborhoods, and they’re struggling with hypertension control.

“This is not showing us something that perhaps we didn’t know already about structural disparities in care or structural disparities in our society,” Lyles said.

But it does show the urgent need for including place-based strategies in health systems’ disparity reduction and quality improvement programs.

“When you put it out there in a visual display, it actually gives you even more impetus to think about neighborhoods you want to target, or [places where] you might think differently about your interventions moving forward,” she said.

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As 2021 dawned and vaccine distribution has picked up, many people had one overarching question on their minds: how and when will they get vaccinated.

At the same time, providers have had to grapple with another question:  how to best approach for this historic, monumental task.

For Stamford Health in Connecticut, the way forward was clear: Leverage existing partnerships with the city of Stamford, community organizations and the state to distribute the much-anticipated vaccines.

The health system has been sharing data and information with the city of Stamford throughout the pandemic, including positivity rates, hospitalizations and other key metrics, said Kathleen Silard, CEO of Stamford Health, in a phone interview. Stamford Health and the city worked collaboratively to set up testing sites, and in the last few months, they also worked together to set up vaccination sites — including one at an old hospital on Stamford Health’s campus.

“The collaboration [with the city] really is to pool our resources, because we know, together we are better,” Silard said.

The health system began vaccinating healthcare workers, first responders and other eligible essential workers on Dec. 17, when the state was in Phase 1a of its vaccine rollout. Back on Jan. 18, it began vaccinating people older than 75 and recently added those older than 65 to the list, as part of Phase 1b of the rollout.

So far, the health system has administered around 27,000 vaccines, and is averaging between 750 and 930 doses a day, Silard said. But Stamford Health has ambitious plans to increase this number three-fold.

The health system is planning to open a new, much larger, site around March 1, which will enable the provider to administer up to 3,000 doses a day, she said.

But getting shots in people’s arms is not without its challenges.

Vaccine availability has been one of the biggest hurdles the health system has faced, but working closely with Connecticut Gov. Ned Lamont and his team has helped the system get the doses and resources it needs, Silard said.

Aside from uncertainty with vaccine availability that has since receded into the background, Stamford Health is tackling a more intractable problem: vaccine hesitancy and health inequity. Both present a formidable barrier to its 3,000-a-day vaccination goal.

To help combat vaccine hesitancy, Stamford Health is conducting outreach programs, including setting up panels with people who have already received the vaccine to talk about their experience, Silard said. The system is also participating in Stamford Mayor David Martin’s weekly Zoom calls to further educate the public on the vaccine.

The Covid-19 pandemic shone a harsh light on existing health disparities in the country, with people in minority racial groups and low-income populations most likely to get the disease and die from it.

Stamford Health has put together a task force, which includes health system members, city officials and members of community health organization Vita, to ensure that vaccines are being administered in an equitable manner, said Silard.

In addition, the health system is partnering closely with the National Association for the Advancement of Colored People and Building One Community, an organization that works with the undocumented community, to focus vaccine administration efforts on underserved populations.

Building One Community has developed a great deal of trust with a population that is typically hesitant to use healthcare services, said Dr. Anka Badurina, executive director of the organization, in a phone interview.

Through the pandemic, the organization has been working to ensure immigrant and underserved communities are included in response efforts — from testing to, now, vaccination.

One of its main areas of focus has been helping the elderly in these communities get registered for vaccine appointments, Badurina said. Those currently eligible often don’t have access to the internet or an email address, which is typically required for registration. Building One Community, which has interpreters on hand, helps them with the process.

Further, the organization helps organize transport to vaccination sites.

“Stamford Health partners with organizations like Building One Community [because] you have to go to those that have a trusted voice in the community,” Badurina said. “They are the ones that know where the community is and know exactly what the community is lacking.”

With the help of its community partners Stamford Health has established a “No Barriers” day, where members from minority groups and under-resourced communities can come to a vaccination site without an appointment, get registered and get vaccinated, Silard said. No individuals are asked about their immigration status or other questions that might keep people from coming to get vaccinated.

Stamford Health wants to eliminate any traditional barriers to vaccination to ensure that the largest swath of eligible individuals can get vaccinated, Silard said.

“We see [vaccine administration] as our moral, ethical responsibility to help fight this deadly disease,” she said.

Photo: LarisaBozhikova, Getty Images

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A major concern during the Covid-19 pandemic has been that Americans, especially those with underlying conditions, will delay necessary care. New survey results show this concern is not unfounded.

As of last September, about 40% of Americans with one or more chronic health conditions reported delaying or avoiding care, according to a new report from the Urban Institute and Robert Wood Johnson Foundation.

Report authors analyzed data from the second wave of the Urban Institute’s Coronavirus Tracking Survey, a nationally representative survey conducted Sept. 11-28, 2020. The survey polled 4,007 adults, ages 18 to 64 years.

About 36% of Americans said they delayed or did not receive healthcare due to a fear of exposure to the coronavirus or because a provider limited services during the pandemic, the report states. Black adults (39.7%) were more likely than white (34.3%) or Hispanic/Latinx (35.5%) adults to report delaying or forgoing care because of concerns about virus exposure.

About four in 10 adults with one or more chronic health conditions (40.7%) said they delayed or avoided care because of the pandemic, as compared with 26.4% of adults with no chronic conditions.

In addition, more than half of adults with both a physical and mental health condition (56.3%) reported delaying or avoiding healthcare due to the pandemic. About 43% of this group also reported delayed or forgoing multiple types of care.

The impacts of delaying or avoiding care were acutely felt by those with chronic conditions, the report shows. An estimated 23.2% of these adults reported that going without or delaying care worsened a health condition, 21% said it limited their ability to perform daily activities and 15.2% said it limited their ability to work.

Further, the report shows the kinds of care that Americans were avoiding. Dental care was the most common type of care adults delayed or did not receive because of the pandemic (25.3%), followed by seeing a general doctor or specialist (20.6%) and receiving preventive health screenings or medical tests (15.5%).

“Tackling unmet healthcare needs requires effectively assuaging fears about exposure to the coronavirus,” report authors concluded. Providers need to reassure patients that they are following public health guidelines and that these precautions can effectively prevent virus transmission.

“More data showing healthcare settings are not common sources of transmission and better communication with the public to promote the importance of seeking needed and routine care are also needed,” the authors wrote.

Photo: YinYang, Getty Images

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