Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study.

BACKGROUND: During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources. OBJECTIVE: This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles. METHODS: In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group. RESULTS: The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful. CONCLUSIONS: UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings.

Gender Differences in National Institutes of Health Grant Submissions Before and During the COVID-19 Pandemic.

Introduction: Emerging data suggest that the COVID-19 pandemic has disproportionately impacted women in academic medicine, potentially eliminating recent gains that have been made toward gender equity. This study examined possible pandemic-related gender disparities in research grant submissions, one of the most important criteria for academic promotion and tenure evaluations. Methods: Data were collected from two major academic institutions (one private and one public) on the gender and academic rank of faculty principal investigators who submitted new grants to the National Institutes of Health (NIH) during COVID-19 (March 1st, 2020, through August 31, 2020) compared with a matched period in 2019 (March 1st, 2019, through August 31, 2019). t-Tests and chi-square analyses compared the gender distribution of individuals who submitted grants during the two periods of examination. Results: In 2019 (prepandemic), there was no significant difference in the average number of grants submitted by women compared with men faculty. In contrast, women faculty submitted significantly fewer grants in 2020 (during the pandemic) than men. Men were also significantly more likely than women to submit grants in both 2019 and 2020 compared with submitting in 2019 only, suggesting men faculty may have been more likely than their women colleagues to sustain their productivity in grant submissions during the pandemic. Discussion: Women's loss of extramural funding may compound over time, as it impedes new data collection, research progress, and academic advancement. Efforts to support women's research productivity and career trajectories are urgently needed in the following years of pandemic recovery.

Hepatitis C Screening Among Medicaid Patients With Schizophrenia, 2002-2012.

OBJECTIVE: Although people with schizophrenia are disproportionately affected by Hepatitis C virus (HCV) compared to the general population, HCV screening among US Medicaid recipients with schizophrenia has not been characterized. Following 1998 CDC recommendations for screening in high-risk populations, we estimated the proportion of Medicaid recipients with and without schizophrenia screened for HCV across states and over time. Examining patterns of screening will inform the current public health imperative to test all adults for HCV now that safer and more effective treatments are available. METHODS: Data are drawn from 1 353 424 Medicaid recipients aged 15-64 years with schizophrenia and frequency-matched controls from 2002 to 2012. Participants with known HCV infection one year prior and those dual-eligible for Medicare were excluded. Multivariable logistic regression estimated associations between predictor variables and HCV screening. RESULTS: HCV screening was low (<4%) but increased over time. Individuals with schizophrenia consistently showed higher screening compared to controls across years and states. Several demographic and clinical characteristics predicted higher screening, especially comorbid HIV (OR = 6.5; 95% CI = 6.0-7.0). Outpatient medical care utilization increased screening by nearly double in 2002 (OR = 1.8; CI = 1.7-1.9) and almost triple in 2012 (OR = 2.7; CI = 2.6-2.9). CONCLUSIONS: Low screening was a missed opportunity to improve HCV prevention efforts and reduce liver-related mortality among people with schizophrenia. Greater COVID-19 disease severity in HCV patients and the availability of effective HCV treatments increase the urgency to improve HCV screening. Eliminating Medicaid restrictions and expanding statewide HIV policies to include HCV would have multiple public health benefits, particularly for people with schizophrenia.