Disparities in COVID-19 Hospitalization at the Intersection of Race and Ethnicity and Income.

BACKGROUND: Existing studies have elucidated racial and ethnic disparities in COVID-19 hospitalizations, but few have examined disparities at the intersection of race and ethnicity and income. METHODS: We used a population-based probability survey of non-institutionalized adults in Michigan with a polymerase chain reaction-positive SARS-CoV-2 test before November 16, 2020. We categorized respondents by race and ethnicity and annual household income: low-income (< $50,000) Non-Hispanic (NH) Black, high-income (≥ $50,000) NH Black, low-income Hispanic, high-income Hispanic, low-income NH White, and high-income NH White. We used modified Poisson regression models, adjusting for sex, age group, survey mode, and sample wave, to estimate COVID-19 hospitalization prevalence ratios by race and ethnicity and income. RESULTS: Over half of the analytic sample (n = 1593) was female (54.9%) and age 45 or older (52.5%), with 14.5% hospitalized for COVID-19. Hospitalization was most prevalent among low-income (32.9%) and high-income (31.2%) Non-Hispanic (NH) Black adults, followed by low-income NH White (15.3%), low-income Hispanic (12.9%), high-income NH White (9.6%), and high-income Hispanic adults (8.8%). In adjusted models, NH Black adults, regardless of income (low-income prevalence ratio [PR]: 1.86, 95% CI: 1.36-2.54; high-income PR: 1.57, 95% CI: 1.07-2.31), and low-income NH White adults (PR: 1.52, 95% CI: 1.12-2.07), had higher prevalence of hospitalization compared to high-income NH White adults. We observed no significant difference in the prevalence of hospitalization among Hispanic adults relative to high-income NH White adults. CONCLUSIONS: We observed disparities in COVID-19 hospitalization at the intersection of race and ethnicity and income for NH Black adults and low-income NH White adults relative to high-income NH White adults, but not for Hispanic adults.

Positive Implications of Weekly Marketing Entrepreneur Pitch Competition Assignments

Purpose of the Study: Marketing educators look for ways to provide experiential learning opportunities in their courses to build application and evaluation skills as well as keep students engaged in the course. This was especially true during the COVID pandemic where instructors were forced to innovate quickly and change the design of their courses. Instructors are provided a weekly assignment that could be applied to their marketing or retailing courses where students work in small teams acting as entrepreneurs by pitching marketing recommendations to real small business owners. Method/Design and Sample: An end of the semester survey was conducted to gauge student perceptions about the marketing entrepreneur pitch competition assignments completed throughout the semester. Students completing several questions pertaining to the variables of interest as well as collecting demographic data. The sample comprised of 25 students completing an upper-level marketing elective, Marketing for Entrepreneurs. They were from a medium-sized, regional, public university in the Midwestern part of the United States. Results: Students provided positive feedback about the assignment. It received high ratings for being fun and helpfulness as well as students being likely to take another course in the future offering similar assignments. Additionally, students rated being satisfied with the assignment overall. Value to Marketing Educators: The COVID pandemic has shifted online educators to be able to adapt to teaching in-person, hybrid, and online courses. This assignment provides students an experiential learning opportunity that could be completed in any of these formats. Several positive outcomes are associated with the assignment that educators value. © 2021, Marketing Management Association. All rights reserved.

Virtual platforms as a vehicle to promote international collaboration.

This survey study was conducted to better consider ways that the Society of Maternal-Fetal Medicine (SMFM) can increase their international outreach. Most survey respondents indicated that international representation could be improved and cited barriers of cost and physical distance to annual meetings. This study highlights support for continuation of virtual conferencing to improve international representation and proposes a hybrid model of scientific engagement moving forward.

Using Tweets to Assess Mental Well-being of EssentialWorkers During the COVID-19 Pandemic

The Covid-19 pandemic has led to large-scale lifestyle changes and increased social isolation and stress on a societal level. This has had a unique impact on US "essential workers" (EWs) - who continue working outside their homes to provide critical services, such as hospital and infrastructure employees. We examine the use of Twitter by EWs as a step toward understanding the pandemic's impact on their mental well-being, as compared to the population as a whole. We found that EWs authored a higher ratio of mental health related tweets during the pandemic than the average user, but authored fewer tweets with Covid related keywords than average users. Despite this, sentiment analysis showed that, on average, EWs' tweets yield a more positive sentiment score than average Twitter users, both before and during the pandemic. Based on these initial insights, we highlight our future aims to investigate individual differences in this impact to EWs.

Prioritized Access to COVID-19 Vaccines among Vulnerable Communities Increases Vaccination Rates

Background. Based on national recommendations,1 Beth Israel Lahey Health (BILH) in Eastern Massachusetts (MA) prioritized vulnerable communities in our distribution of COVID-19 vaccines. We hypothesized that creating prioritized access to appointments for patients in these communities would increase the likelihood vaccination. Methods. The BILH health system sent vaccine invitations first to patients of two clinics in vulnerable neighborhoods in Boston (Wave 1), followed by other patients from vulnerable communities (Wave 2) up to 1 day later, and then by all other patients (Wave 3) after up to 1 more day later. To identify whether early access/prioritization increased the likelihood of receipt of vaccine at any site or a vaccine at a BILH clinic, we compared patients in Wave 1 in a single community with high cumulative incidence of COVID-19 (Dorchester) to patients in Wave 2 during a period of limited vaccine access, 1/27/21-2/24/21. Each wave was modeled using logistic regression, adjusted for language and race. By taking the difference between these two differences, we are left with the impact of early vaccination invitation in Wave 1 for a subset of our most vulnerable patients (termed difference-in-differences;Stata SE 16.0). Results. In our study of Waves 1 and 2, we offered vaccinations to 24,410 patients. Of those, 6,712 (27.5%) scheduled the vaccine at BILH (Table 1). Patients in Wave 1 were much more likely to be vaccinated at BILH than patients in Wave 2. Patients offered the vaccine in Wave 1 and living in Dorchester were 1.7 percentage points more likely to be vaccinated at all (p=0.445) and 9.4 percentage points more likely to be vaccinated at BILH than another site in MA (p-value = 0.001), relative to patients living outside of Dorchester and offered the vaccine in Wave 2 (Table 2). The coefficient of interest is on Wave1∗Dorchester, 0.094. This indicates that residents of Dorchester who were offered the vaccine in Wave 1 were 9.4 percentage points more likely to receive the vaccine at BILH, given that they were vaccinated, relative to patients living outside of Dorchester and offered the vaccine in Wave 2. Conclusion. Patients residing in an urban community given prioritized access to vaccination had a higher likelihood of vaccination at our health system, given that they were vaccinated, than patients in other urban communities without prioritized access. We provide an example of a successful effort to move towards equity in access to COVID-19- vaccines, in contrast to larger national trends.2,3 Health systems can use a prioritization approach to improve vaccination equity.

Patient perceptions of a student-led remote hypertension education program

Introduction: The COVID-19 pandemic has drastically changed healthcare, promoting a shift to remote services. Managing long-term therapy conditions, like hypertension, became increasingly difficult due to limited access to care. During these unprecedented times, two community pharmacies collaborated with a school of pharmacy to develop a new remote program to encourage patient centered disease state management. Objectives: The primary objective was to describe patient perceptions of participating in a student-led, remote hypertension education program. The secondary objective was to gain insight on perceptions of the program's impact on current lifestyle. Methods: Second- and third-year pharmacy students worked with faculty preceptors to develop and remotely deliver an 8-week curriculum. During each call, students educated on a topic and set S.M.A.R.T. (Specific, Measurable, Achievable, Realistic, and Timely) goals. After completing the program, participants were interviewed regarding their experience. This study was a qualitative design using semi-structured interviews. Participants in the program were interviewed by trained investigators. All interviews were recorded, transcribed, and thematically coded to address study outcomes. Results: A total of 12 participant interviews were conducted with all participants 50 years of age or older and a majority having a diagnosis of hypertension for greater than 20 years. From the interviews, six dominant themes were identified. Themes were: (a) students were knowledgeable, professional, and engaged;(b) participants felt comfortable communicating with the students and developed a positive relationship;(c) participants expressed having a positive impact on the students' education;(d) the program was organized;(e) participants reported positive lifestyle changes or reinforced habits that they plan to continue, and (f) the remote nature of the program was convenient, but face-to-face interaction was missed. Conclusion: Participants had an overwhelmingly positive experience completing the program. Utilizing students for development and implementation allowed the pharmacies to offer an additional clinical service and was a factor that impacted patient engagement and participation.

A multidisciplinary telemedicine model for management of coronavirus disease 2019 (COVID-19) in obstetrical patients.

Background: The COVID-19 pandemic caused by the SARS-CoV-2 has increased the demand for inpatient healthcare resources; however, approximately 80% of patients with COVID-19 have a mild clinical presentation and can be managed at home. Objective: This study aimed to describe the feasibility and clinical and process outcomes associated with a multidisciplinary telemedicine surveillance model to triage and manage obstetrical patients with known exposures and symptoms of COVID-19. Study Design: We implemented a multidisciplinary telemedicine surveillance model with obstetrical physicians and nurses to standardize ambulatory care for obstetrical patients with confirmed or suspected COVID-19 based on the symptoms or exposures at an urban academic tertiary care center with multiple hospital-affiliated and community-based practices. All pregnant or postpartum patients with COVID-19 symptoms, exposures, or hospitalization were eligible for inclusion in the program. Patients were assessed by means of regular nursing phone calls and were managed according to illness severity. Patient characteristics and clinical and process outcomes were abstracted from the electronic medical record. Results: A total of 135 patients were enrolled in the multidisciplinary telemedicine model from March 17 to April 19, 2020, of whom 130 were pregnant and 5 were recently postpartum. In this study, 116 of 135 patients (86%) were managed solely in the outpatient setting and did not require an in-person evaluation; 9 patients were ultimately admitted after ambulatory or urgent evaluations, and 10 patients were observed after hospital discharge. Although only 50% of the patients were tested secondary to limitations in ambulatory testing, 1 in 3 of those patients received positive results for SARS-CoV-2 (N=22, 16% of entire cohort). Patients were enrolled in the telemedicine model for a median of 7 days (interquartile range, 4-8) and averaged 1 phone call daily, resulting in 891 nursing calls and 20 physician calls over 1 month. Conclusion: A multidisciplinary telemedicine surveillance model for outpatient management of obstetrical patients with COVID-19 symptoms and exposures is feasible and resulted in rates of ambulatory management similar to those seen in nonpregnant patients. A centralized model for telemedicine surveillance of obstetrical patients with COVID-19 symptoms may preserve inpatient resources and prevent avoidable staff and patient exposures, particularly in centers with multiple ambulatory practice settings.