Browsing by Subject "Social Determinants of Health"

Now showing 1 - 6 of 6
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    Development of a FHIR Based Application Programming Interface for Aggregate-Level Social Determinants of Health
    (AMIA Informatics summit 2019 Conference Proceedings, 2019-03-25) Kasthurirathne, Suranga N.; Cormer, Karen F.; Devadasan, Neil; Biondich, Paul G.
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    In the Weeds: Identifying the Underlying Etiology in a Patient with Suspected Hypertrophic Obstructive Cardiomyopathy
    (2024-03-22) Wojciechowska, Klaudia; Denning, Ellen; Bice, Caroline; Nadeem, Manahil; Robles, Maria
    BACKGROUND Many cases of Hypertrophic Obstructive Cardiomyopathy (HOCM) go undetected or are underdiagnosed. Patients are typically young athletes who experience decreased cardiac output, syncope with exercise, or sudden death. The disease is diagnosed with echo but cannot be certain unless a gene mutation is identified. This creates challenges for those who do not fit the classic profile nor have an identified gene mutation. METHODS A 57 y.o. black female presented with a heart murmur. A referral was made to cardiology where imaging results pointed to HOCM, but due to a history of hypertension (HTN) and missing medical records, an underlying etiology of hypertrophy secondary to HTN could not be ruled out. Genetic testing for HOCM was negative despite the patient’s extensive family history of cardiac disease. Due to these conflicting findings, a cardiac MRI was performed. While HTN could not be ruled out as a contributing factor, HOCM was placed as the leading differential. RESULTS The fragmentation of the patient’s medical records meant that the duration of the murmur and HTN is unknown. In addition, each cardiology provider had different interpretations of the radiologic imaging. The led to difficulties obtaining a diagnosis of HOCM vs HCM due to HTN. Given that the patient did not fit the classic demographic presentation of HOCM, it is possible that the diagnosis was not initially considered. By the time a full work-up had been conducted, her HTN had been poorly controlled for years and therefore delineating the root cause of HOCM was difficult. Lastly, the patient tested negative for the 24 gene mutations linked to HOCM, despite an extensive family history of cardiac disease. This highlights that there are likely more unknown mutations and there is a need for improved diagnostic criteria independent of genetic tests. CONCLUSION This case demonstrates the importance of keeping an expanded differential diagnosis, maintaining coherent and comprehensive medical records, and pursuing prompt diagnoses.
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    Primary Care Case Conferences to Mitigate Social Determinants of Health: A Case Study from One FQHC System
    (2021) Yeager, Valerie A.; Taylor, Heather L.; Menachemi, Nir; Haut, Dawn P.; Halverson, Paul K.; Vest, Joshua R.
    Objective: Given the increasing difficulty healthcare providers face in addressing patients’ complex social circumstances and underlying health needs, organizations are considering team-based approaches including case conferences. We sought to document various perspectives on the facilitators and challenges of conducting case conferences in primary care settings. Study Design: Qualitative study using semi-structured telephone interviews Methods: We conducted 22 qualitative interviews with members of case conferencing teams, including physicians, nurses, and social workers from a Federally Qualified Health Clinic, as well as local county public health nurses. Interviews were recorded, transcribed, and reviewed using thematic coding to identify key themes/subthemes. Results: Participants reported perceived benefits to patients, providers, and healthcare organizations including better care, increased inter-professional communication, and shared knowledge. Perceived challenges related to underlying organizational processes and priorities. Perceived facilitators for successful case conferences included generating and maintaining a list of patients to discuss during case conference sessions and team members being prepared to actively participate in addressing tasks and patient needs during each session. Participants offered recommendations for further improving case conferences for patients, providers, and organizations. Conclusions: Case conferences may be a feasible approach to understanding patient’s complex social needs. Participants reported that case conferences may help mitigate the effects of these social issues and that they foster better inter-professional communication and care planning in primary care. The case conference model requires administrative support and organizational resources to be successful. Future research should explore how case conferences fit into a larger population health organizational strategy so that they are resourced commensurately.
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    Rehabilitation Research at the National Institutes of Health: Moving the Field Forward (Executive Summary)
    (Oxford University Press, 2017-04-01) Frontera, Walter R.; Bean, Jonathan F.; Damiano, Diane; Ehrlich-Jones, Linda; Fried-Oken, Melanie; Jette, Alan; Jung, Ranu; Lieber, Rick L.; Malec, James F.; Mueller, Michael J.; Ottenbacher, Kenneth J.; Tansey, Keith E.; Thompson, Aiko; Physical Medicine and Rehabilitation, School of Medicine
    Approximately 53 million Americans live with a disability. For decades, the National Institutes of Health (NIH) has been conducting and supporting research to discover new ways to minimize disability and enhance the quality of life of people with disabilities. After the passage of the American With Disabilities Act, the NIH established the National Center for Medical Rehabilitation Research with the goal of developing and implementing a rehabilitation research agenda. Currently, a total of 17 institutes and centers at NIH invest more than $500 million per year in rehabilitation research. Recently, the director of NIH, Dr Francis Collins, appointed a Blue Ribbon Panel to evaluate the status of rehabilitation research across institutes and centers. As a follow-up to the work of that panel, NIH recently organized a conference under the title “Rehabilitation Research at NIH: Moving the Field Forward.” This report is a summary of the discussions and proposals that will help guide rehabilitation research at NIH in the near future. This article is being published almost simultaneously in the following six journals: American Journal of Occupational Therapy, American Journal of Physical Medicine and Rehabilitation, Archives of Physical Medicine and Rehabilitation, Neurorehabilitation and Neural Repair, Physical Therapy, and Rehabilitation Psychology. Citation information is as follows: Frontera WR, Bean JF, Damiano D, et al. Am J Phys Med Rehabil. 2017;97(4):393–403.
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    Social determinants of health associated with epilepsy treatment adherence in the United States: A scoping review
    (Elsevier, 2021-11) von Gaudecker, Jane; Buelow, Janice; Miller, Wendy; Tanner, Andrea; Austin, Joan
    Purpose: The aim of this paper is to share the results of a scoping review in which we examined the Social Determinants of Health (SDoH) that are associated with anti-seizure medication (ASM) treatment adherence among people living with epilepsy in the United States. Methods: Our review was informed by the methods of Arksey and O’Malley (2005) for a scoping review. A total of in 3,826 articles were identified for reference through a literature search, of which 17 publications were deemed relevant to our scoping review. The final articles were mapped using the Epilepsy SDoH Conceptual Framework to identify gaps. Findings: Our review suggests that there are multidimensional associations of SDoH in ASM adherence. The SDoH were interrelated. Race/ethnicity and socioeconomic status appeared to have major associations with ASM adherence. Several gaps in the literature were identified, including inadequately exploring the effect that each SDoH has on treatment adherence, and the methods used for assessment. Conclusions: Future longitudinal research to address the identified gaps would foster interventions that promote ASM adherence among vulnerable populations living with epilepsy.
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    Social Determinants of Health Associated with Inpatient Admissions for Congestive Heart Failure, Diabetes, Chronic Obstructive Pulmonary Disease, and Asthma
    (2023-07) Deckbar, John Quentin; DeMichael, Kelly; Gad, Wael; Guerrero, Jonathan; Muvuka, Baraka
    Introduction: The CDC and American Lung Association estimate that congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disorder (COPD), and asthma (COPD/asthma) cost Americans $30.7 billion, $327 billion, and $50 billion respectively each year. They account for most inpatient readmissions at St. Mary Medical Center (SMMC), an urban hospital in Northwest Indiana. There is need for further research on the social, behavioral, and demographic determinants associated with these conditions. This study examined the social, behavioral, and demographic determinants associated with inpatient admission for CHF, diabetes, COPD/asthma in SMMC’s service area.  Methods: This retrospective study was part of a multi-phased Community-Based Participatory Research partnership between SMMC and Indiana University School of Medicine Northwest. SMMC implemented a pilot screening and referral program to assess social determinants of health in their service area as part of their Hospital Readmission Reduction Program. This study included data from 10,953 inpatient admissions between January 2021 to March 2023, majority of whom were transferred from the emergency department. Data analysis consisted of univariate, bivariate (Chi-square), and multivariate (binary logistic regression) analysis in SPSS 29.0. Results: Bivariate analysis revealed a statistically significant association between CHF and smoking, age, insurance type, and income. Diabetes was significantly associated with smoking, smokeless tobacco use, age group, race, income, and sex. COPD/asthma was significantly associated with smoking, age group, transportation needs, stress, insurance, ethnicity, and sex. Multivariate analysis found the following significant associations: age group with both CHF (p<0.001) and diabetes (p<0.001), former smoking with both CHF (p = 0.007) and COPD/asthma (p = 0.049), current smoking with COPD/asthma (p = 0.016), and sex with diabetes (p <0.001).   Conclusions: These findings indicate significant associations between multiple socio-behavioral factors and admission for CHF, diabetes, COPD/asthma. Multi-risk-factor interventions may address these interactions and contribute to reducing readmission.