Browsing by Subject "Population health"

Now showing 1 - 10 of 22
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    192. Health Equity Starts with Us: Recommendations from the Indiana Clinical and Translational Sciences Institute Racial Justice and Health Equity Task Force
    (Cambridge University Press, 2022) Sotto-Santiago, Sylk; Tucker Edmonds, Brownsyne; Wiehe, Sarah; Moe, Sharon
    OBJECTIVES/GOALS: The Indiana CTSI Strategy Committee charged the Racial Justice and Health Equity Taskforce to identify priorities with short-term and long-term goals consistent with the I-CTSI mission. In addition, I-CTSI leadership asked for a general description of current state and the resources necessary to achieve the proposed goals. METHODS/STUDY POPULATION: The Taskforce applied an inclusive excellence model to the way we look at the I-CTSI structure, policies, and programs while performing an environmental scan within and across I-CTSI partner institutions. In order to reach equitable solutions and consensus, listening tours were held with partner stakeholders guided by the SOAR framework for strategic planning. This approach allowed us to assess current resources, needs, and gaps across the system, along with a baseline of measures currently monitored. Taskforce members openly discussed strengths and opportunities for enhancement of current programs and services. In addition, these conversations offered an opportunity to disrupt existing practices and through collective agency we identified priority areas that promote equity, diversity and inclusion. RESULTS/ANTICIPATED RESULTS: The Taskforce identified recurring themes in conversations with all partners, which led to the formation of three working groups that examined recruitment broadly: workforce, staffing, and research participation; professional development across all stakeholders from community members to I-CTSI staff; and data-centered metrics informing current state, decision-making, and accountability. Recommendations included these priorities, content, and implementation strategies. The Taskforce delivered a report to the I-CTSI leadership fostering the promotion of diversity, equity and inclusion along with a systematic collection of gender, race, and ethnicity data for individuals utilizing I-CTSI services and resources requiring additional metrics and tracking. DISCUSSION/SIGNIFICANCE: The pandemic shed light on the manner in which marginalized groups are rendered particularly vulnerable to death and disease by systemic and structural racism. The I-CTSI recognized that we cannot advance population health without attending to root causes of inequity and that includes our internal structure. We offer a potential model for other CTSAs.
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    56656 Programmatic Enhancements to Advance Racial Equity in Indiana (IN) CTSI
    (Cambridge University Press, 2021) Tucker Edmonds, Brownsyne; Robb, Sheri; Hurley, Thomas; Carroll, Aaron; Obstetrics and Gynecology, School of Medicine
    ABSTRACT IMPACT: We present new programs aimed at training, retaining and preparing a diverse cadre of scientists to lead the field in transforming population health and advancing health equity. OBJECTIVES/GOALS: To mitigate biases inherent to the R01 grant funding process, trainees from backgrounds underrepresented in medicine (URM) may benefit from enhanced mentorship and a longer ‘runway’ to funding. As such, we have deployed two synergistic programs that aim to support URM retention and advancement. METHODS/STUDY POPULATION: The URM Program for Advising in Research and Development (UPwARD) pairs URM trainees with 2 mentors: 1) an institutional leader from outside their discipline to serve as an internal advocate and 2) an external eminent scholar who will facilitate the scholar’s development and prominence within their discipline. Additionally, the KL2 Program to Launch URM Success (KL2 PLUS) offers URM trainees a third year of funding to focus on scholarship, grant writing and leadership development. Four specific training components of KL2 PLUS include: 1) PLUS II Seminar Series, 2) Faculty Success Program, 3) attendance at the AAMC Minority Faculty Leadership Conference, and 4) CTSI Committee Service. RESULTS/ANTICIPATED RESULTS: Along with measures of productivity (papers, grants, K to R transition), we will utilize social network analyses and measures of collaboration, retention, and future CTSI engagement to evaluate the programs “success’‘ as both are designed to enhance trainee scholarly development and expand their professional and social networks. UPwARD does so by supporting engagement with external mentors at professional meetings and travel to present work across institutions. PLUS writing accountability groups will enhance publication rates and grant submissions, while also building connections with other URM faculty. Trainees also serve on IN CTSI committees to groom talent for future IN CTSI leadership. DISCUSSION/SIGNIFICANCE OF FINDINGS: Systemic inequities underlie the ‘leaky pipeline’ challenge we face in cultivating a diverse cadre of senior scientists and independent investigators. With intentional programming and targeted investments, IN CTSI aims to advance more equitable funding outcomes and diverse leadership.
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    Association Between Subjective Cognitive Decline and Twice-Weekly Muscle-Strengthening Activities in Middle-Aged and Older US Adults: An Analysis of the 2019 Behavioral Risk Factor Surveillance System
    (Sage, 2024) Schroeder, Matthew W.; Waring, Molly E.; Fowler, Nicole R.; Mace, Ryan A.; Pagoto, Sherry L.; Medicine, School of Medicine
    Purpose: Adults with subjective cognitive decline (SCD), the self-reported concern of reduced cognitive function, are recommended to do physical activity for its brain health benefits. US adults aged ≥45 with SCD are less likely to meet the American College of Sports Medicine (ACSM) aerobic activity recommendations. Their engagement in muscle-strengthening activities is unknown. We aimed to identify if US adults aged ≥45 with SCD are less likely to do twice-weekly muscle-strengthening activities compared to those without SCD. Design: Secondary analysis of the 2019 Behavioral Risk Factor Surveillance System (BRFSS) data. Sample: 114 164 respondents, representing approximately 59 million US adults aged ≥45. Measures: SCD was indicated if the respondent reported confusion or memory loss during the past 12 months (yes/no). Respondents reported the frequency of muscle-strengthening activities, which we categorized as meeting the ACSM's recommendations (2+ times per week) or not (<2 times per week). Analysis: Crude and adjusted logistic regression models controlling for variables associated with SCD and muscle-strengthening activities. The models used sample weights to represent US adults in the included 31 states and Washington D.C. Results: US adults aged ≥45 with SCD were less likely to do twice-weekly muscle-strengthening activities than those without SCD (28.6% [SE: .8%] vs 33.5% [SE: .3%], adjusted OR, .9; 95% CI: .9-1.0). Conclusion: Primary care providers should encourage middle-aged and older patients to engage in muscle-strengthening and aerobic activities.
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    Building Cancer Control Capacity in Health Professionals Through Telementoring: A Survey Study of a Cancer Prevention and Survivorship Care ECHO Program
    (IOS Press, 2022) Milgrom, Zheng Z.; Severance, Tyler S.; Scanlon, Caitlin M.; Carson, Anyé T.; Vik, Terry A.; Duwve, Joan M.; Dixon, Brian E.; Mendonca, Eneida A.; Pediatrics, School of Medicine
    Project Extension for Community Healthcare Outcomes (Project ECHO©) was developed to democratize knowledge among health professionals in underserved communities. Evidence supporting the use of this model for cancer control is limited. Using surveys adapted from Moore’s evaluation framework, we evaluated the training outcomes of an ECHO program on cancer prevention and survivorship care. The study provides preliminary evidence that the ECHO model is a feasible way to build cancer control capacity among the healthcare workforce.
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    Capabilities and Limitations of Student-Led Free Vision Screening Programs in the United States
    (Association for Research in Vision and Ophthalmology (ARVO), 2024) Devanathan, Nirupama; Scheive, Melanie; Nawash, Baraa S.; Selvam, Amrish; Murphy, Alec; Morrow, McKenna; Anant, Shruti; Chen, Nickolas; Martin, Elizabeth A.; Kruger, Jessica S.; Yung, Chi-Wah Rudy; Johnson, Thomas V.; Ophthalmology, School of Medicine
    Purpose: The Consortium of Student-Led Eye Clinics (CSLEC), founded in 2021, administered a comprehensive survey to document the types of services, most common diagnoses, and follow-up care protocols offered by student-led free vision screening programs (SLFVSP) in the United States. Methods: An 81-question institutional review board (IRB)-approved survey was administered to student-led vision screening eye clinics from October 1, 2022 to February 24, 2023. Results: Sixteen SLFVSPs were included in the final analysis, of which 81% (n = 13) conducted variations of fundoscopic examinations and 75% (n = 12) measured intraocular pressure. Cataracts and diabetic retinopathy were reported as the most frequent diagnoses by the majority of SLFVSPs (n = 9, 56%); non-mobile SLFVSPs more commonly reported cataract as a frequent diagnosis (P < 0.05). Most patients screened at participating programs were uninsured or met federal poverty guidelines. Prescription glasses were offered by 56% of the programs (n = 9). SLFVSPs that directly scheduled follow-up appointments reported higher attendance rates (66.5%) than those that only sent referrals (20%). Transportation was the most cited barrier for follow-up appointment attendance. Conclusions: SLFVSPs, one community vision screening initiative subtype, vary significantly in scope and capabilities of identifying vision threatening disease. The follow-up infrastructure is not uniformly robust and represents a key target for improving care delivery to at-risk populations. Translational relevance: The CSLEC aims to develop a consensus-based standardization for the scope of screening services, offer guidelines for diagnostic criteria, promote real-time data stewardship, and identify means to improve follow-up care mechanisms in member communities.
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    Characteristics of Veterans with non-VA encounters enrolled in a trial of standards-based, interoperable event notification and care coordination
    (American Board of Family Medicine, 2021) Kartje, Rebecca; Dixon, Brian E.; Schwartzkopf, Ashley L.; Guerrero, Vivian; Judon, Kimberly M.; Yi, Joanne C.; Boockvar, Kenneth; Epidemiology, School of Public Health
    Introduction: Understanding how veterans use Veterans Affairs (VA) for primary care and non-VA for acute care can help policy makers predict future health care resource use. We aimed to describe characteristics of veterans enrolled in a multisite clinical trial of non-VA acute event notifications and care coordination and to identify patient factors associated with non-VA acute care. Methods: Characteristics of 565 veterans enrolled in a prospective cluster randomized trial at the Bronx and Indianapolis VA Medical Centers were obtained by interview and chart review. Results: Veterans' mean age was 75.8 years old, 98.3% were male, and 39.2% self-identified as a minority race; 81.2% reported receiving the majority of care at the VA. There were 197 (34.9%) veterans for whom a non-VA acute care alert was received. Patient characteristics significantly associated with greater odds of a non-VA alert included older age (OR = 1.05; 95% CI, 1.04-1.05); majority of care received is non-VA (OR = 1.83; 95% CI, 1.06-3.15); private insurance (OR = 1.39; 95% CI, 1.19-1.62); and higher income (OR = 4.01; 95% CI, 2.68-5.98). Conclusions: We identified several patient-level factors associated with non-VA acute care that can inform the design of VA services and policies for veterans with non-VA acute care encounters and reintegration back into the VA system.
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    Development of a population‐level prediction model for intensive care unit (ICU) survivorship and mortality in older adults: A population‐based cohort study
    (Wiley, 2023-10-19) Khan, Sikandar H.; Perkins, Anthony J.; Fuchita, Mikita; Holler, Emma; Ortiz, Damaris; Boustani, Malaz; Khan, Babar A.; Gao, Sujuan; Medicine, School of Medicine
    Background and aims: Given the growing utilization of critical care services by an aging population, development of population-level risk models which predict intensive care unit (ICU) survivorship and mortality may offer advantages for researchers and health systems. Our objective was to develop a risk model for ICU survivorship and mortality among community dwelling older adults. Methods: This was a population-based cohort study of 48,127 patients who were 50 years and older with at least one primary care visit between January 1, 2017, and December 31, 2017. We used electronic health record (EHR) data to identify variables predictive of ICU survivorship. Results: ICU admission and mortality within 2 years after index primary care visit date were used to divide patients into three groups of "alive without ICU admission", "ICU survivors," and "death." Multinomial logistic regression was used to identify EHR predictive variables for the three patient outcomes. Cross-validation by randomly splitting the data into derivation and validation data sets (60:40 split) was used to identify predictor variables and validate model performance using area under the receiver operating characteristics (AUC) curve. In our overall sample, 92.2% of patients were alive without ICU admission, 6.2% were admitted to the ICU at least once and survived, and 1.6% died. Greater deciles of age over 50 years, diagnoses of chronic obstructive pulmonary disorder or chronic heart failure, and laboratory abnormalities in alkaline phosphatase, hematocrit, and albumin contributed highest risk score weights for mortality. Risk scores derived from the model discriminated between patients that died versus remained alive without ICU admission (AUC = 0.858), and between ICU survivors versus alive without ICU admission (AUC = 0.765). Conclusion: Our risk scores provide a feasible and scalable tool for researchers and health systems to identify patient cohorts at increased risk for ICU admission and survivorship. Further studies are needed to prospectively validate the risk scores in other patient populations.
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    Electronic Health Record (EHR)-Based Community Health Measures: An Exploratory Assessment of Perceived Usefulness by Local Health Departments
    (BMC, 2018-05-22) Comer, Karen F.; Gibson, P. Joseph; Zou, Jian; Rosenman, Marc; Dixon, Brian E.; Health Policy and Management, School of Public Health
    BACKGROUND: Given the widespread adoption of electronic health record (EHR) systems in health care organizations, public health agencies are interested in accessing EHR data to improve health assessment and surveillance. Yet there exist few examples in the U.S. of governmental health agencies using EHR data routinely to examine disease prevalence and other measures of community health. The objective of this study was to explore local health department (LHD) professionals' perceptions of the usefulness of EHR-based community health measures, and to examine these perceptions in the context of LHDs' current access and use of sub-county data, data aggregated at geographic levels smaller than county. METHODS: To explore perceived usefulness, we conducted an online survey of LHD professionals in Indiana. One hundred and thirty-three (133) individuals from thirty-one (31) LHDs participated. The survey asked about usefulness of specific community health measures as well as current access to and uses of sub-county population health data. Descriptive statistics were calculated to examine respondents' perceptions, access, and use. A one-way ANOVA (with pairwise comparisons) test was used to compare average scores by LHD size. RESULTS: Respondents overall indicated moderate agreement on which community health measures might be useful. Perceived usefulness of specific EHR-based community health measures varied by size of respondent's LHD [F(3, 88) = 3.56, p = 0.017]. Over 70% of survey respondents reported using community health data, but of those < 30% indicated they had access to sub-county level data. CONCLUSION: Respondents generally preferred familiar community health measures versus novel, EHR-based measures that are not in widespread use within health departments. Access to sub-county data is limited but strongly desired. Future research and development is needed as LHD staff gain access to EHR data and apply these data to support the core function of health assessment.
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    An evaluation of an Extension for Community Healthcare Outcomes (ECHO) intervention in cancer prevention and survivorship care
    (BMC, 2022-05-17) Milgrom, Zheng Z.; Severance, Tyler S.; Scanlon, Caitlin M.; Carson, Anyé T.; Janota, Andrea D.; Vik, Terry A.; Duwve, Joan M.; Dixon, Brian E.; Mendonca, Eneida A.; Pediatrics, School of Medicine
    To improve cancer care in Indiana, a telementoring program using the Extension for Community Healthcare Outcomes (ECHO) model was introduced in September 2019 to promote best-practice cancer prevention, screening, and survivorship care by primary care providers (PCPs). The aim of this study was to evaluate the program's educational outcomes in its pilot year, using Moore's Evaluation Framework for Continuing Medical Education and focusing on the program's impact on participants' knowledge, confidence, and professional practice. We collected data in 22 semi-structured interviews (13 PCPs and 9 non-PCPs) and 30 anonymous one-time surveys (14 PCPs and 16 non-PCPs) from the program participants (hub and spoke site members), as well as from members of the target audience who did not participate. In the first year, average attendance at each session was 2.5 PCPs and 12 non-PCP professionals. In spite of a relatively low PCP participation, the program received very positive satisfaction scores, and participants reported improvements in knowledge, confidence, and practice. Both program participants and target audience respondents particularly valued three features of the program: its conversational format, the real-life experiences gained, and the support received from a professional interdisciplinary community. PCPs reported preferring case discussions over didactics. Our results suggest that the Cancer ECHO program has benefits over other PCP-targetted cancer control interventions and could be an effective educational means of improving cancer control capacity among PCPs and others. Further study is warranted to explain the discrepancies among study participants' perceptions of the program's strengths and the relatively low PCP participation before undertaking a full-scale effectiveness study.
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    An Examination of How National Policies are Driving Population Health Outcomes and Organizational Change in Private and Public Sectors
    (2020-03) Hilts, Katy Ellis; Menachemi, Nir; Blackburn, Justin; Gibson, P. Joseph; Halverson, Paul K.; Yeager, Valerie A.
    The United States spends more on healthcare than any other country in the world, but still trails most other countries when it comes to important health indicators. There has been an increasing recognition that in order to address this discrepancy, the U.S. health system must begin to address the underlying social determinants contributing to poor health outcomes. In light of this, the concept of “population health” has emerged as a framework and model for how to better address the social determinants contributing to unhealthy behaviors and increased rates of morbidity and mortality in the U.S. Various national initiatives, including reform related to how doctors and hospitals are paid, have been developed with the purpose of increasing the adoption of strategies to address population health among public and private organizations. In this dissertation I attempt to assess how these national policies are driving behavior and outcomes related to improving population health in private and public sectors. It is comprised of three papers focused on 1) a systematic review of literature to assess how hospitals are responding to policies that encourage them to form partnerships to address population health, 2) a quantitative analysis of how the Affordable Care Act has impacted population health by addressing tobacco use with policies to increase Medicaid coverage for tobacco cessation services, and 3) an empirical examination to identify hospital strategic partnerships to address population health and determine hospital and market characteristics associated with these partnerships. The main findings of this study indicate that while there is a growing amount of peer reviewed literature focused on hospital partnerships for population health there is still a need for more generalizable studies with rigorous study designs in this area; Medicaid Expansion as a part of the Affordable Care Act is associated with lower prevalence of tobacco use; and policies, such as Accountable Care Organization and Bundled Payment models, may be influencing hospitals to engage with a broad set of partners to support population health activities. Collectively these studies provide new evidence to suggest that national policies may be driving behavior in private and public sectors related to population health.