Letter to the Editor Response: Exploring COVID-19 Vaccine Hesitancy Among Stakeholders in African American and Latinx Communities in the Deep South Through the Lens of the Health Belief Model.

The purpose of this submission to respond to a Letter to the Editor recently submitted regarding our manuscript, "Exploring COVID-19 Vaccine Hesitancy among Stakeholders in African American and Latinx Communities in the Deep South through the Lens of the Health Belief Model" published in the American Journal of Health Promotion in February, 2022. The manuscript reported on a study that had as its purpose to qualitatively explore perceptions related to COVID-19 vaccination intention among African American and Latinx participants and suggest potential intervention strategies.

COVID-19 Vaccine Knowledge, Attitudes, and Practices in Alabama: The Case for Primary Health Care Providers.

OBJECTIVE: To examine knowledge, attitudes, and practices about COVID-19 in Alabama, with a primary focus on vaccination perception and utilization. DESIGN: We used a COVID-19 Knowledge, Attitudes, and Practices survey and recruited adult Alabama residents in April-May 2021. PARTICIPANTS: Initial surveys from 1324 Alabamian participants were considered for analysis; after careful review of incomplete responses, 953 were ultimately included for analysis. MAIN OUTCOME MEASURE: Vaccine behavior and hesitancy comprise a self-reported response contained in the survey instrument. Three primary vaccine groups were used to assess differences in demographic characteristics, health status, perception of susceptibility and severity of COVID-19, sources of information, and trust about COVID-19. RESULTS: Of the 953 survey participants included for analysis, 951 had self-identified vaccine status in which 153 (16.1%) reported to have received the vaccine at the time of the survey, 375 (39.4%) were very likely or somewhat likely to get an approved COVID-19 vaccine if it was offered, and 423 (44.5%) were somewhat unlikely or very unlikely to get an approved COVID-19 vaccine. Health care providers were the most trusted sources of information, regardless of vaccine status. For participants unlikely to receive a vaccine, social media and local news sources were consistently more trusted and utilized than those who were vaccinated or were likely to be. CONCLUSIONS: The perceptions among unvaccinated participants are actionable and provide teachable opportunities to decrease vaccine apprehension.

Inpatient Telehealth and Coronavirus Disease 2019 Outcomes: Experiences in Alabama.

Background: During the early months of the coronavirus disease 2019 (COVID-19) pandemic, hospitals were concerned about preserving personal protective equipment. UAB Hospital Medicine designed a strategy to outfit acute care patient rooms on a COVID-19 unit with telemedicine technology to allow for remote clinician rounding. Objective: To describe one hospital's experience with inpatient telehealth and compare outcomes between patients with and without inpatient telehealth visits. Design and Methods: Retrospective chart review of patients admitted to UAB Hospital Medicine with COVID-19 between March 16, 2020 and April 24, 2020. Logistic and negative binomial regression models were used to examine the relationship between telehealth visits and the likelihood of a subsequent transfer to the intensive care unit (ICU), ventilation, and number of ICU days. Clinician interviews provided additional insight into the telehealth implementation. Findings: One-quarter of the patients received a telehealth visit. Half were admitted to the ICU, and one-third received ventilation. Regression models did not identify statistically significant differences in transfer to the ICU, number of ICU days, and ventilation between patients with and without telehealth visits. Older age and increased respiratory rate were associated with higher odds of ICU admission. Patients with a cough were associated with lower odds of ventilation and fewer ICU days. Discussion: Implementation challenges included difficulties associated with assisting patients with operating the tablets. However, clinicians noted that there was a great benefit to patients being able to see an unmasked physician. Furthermore, the telehealth program proved to be a viable strategy for connecting patients in isolation with their families. Findings can inform the future development of inpatient telemedicine strategies.

Physician, Nurse, and Advanced Practice Provider Perspectives on the Rapid Transition to Inpatient and Outpatient Telemedicine.

Background: Many health systems transitioned rapidly to using inpatient and outpatient telemedicine during the COVID-19 pandemic. Prior research has examined clinician satisfaction and experiences with telemedicine in a siloed approach for specific provider types. Less is known about how experiences with the rapid transition to telemedicine affected the entire clinical team, and how this contributed to their overall distress. Methods: A survey was conducted within a large academic medical center in the Southeastern United States during June of 2020. The survey asked about experiences with inpatient and outpatient telemedicine and overall distress. Analysis of variance was calculated to examine differences in experiences among physicians, nurses, and advanced practice providers (APPs) with both inpatient and outpatient telemedicine. Multivariate regression analysis was conducted to determine whether reported telemedicine stressors were associated with changes in overall distress scores. Qualitative comments provided during the survey were included to illustrate the quantitative findings. Results: Of the 1130 survey respondents, 237 indicated that they used telemedicine. Telemedicine use was not statistically significantly associated with overall distress scores. The APPs indicated the greatest satisfaction with telemedicine, followed by physicians and then nurses. Team members differed on their perceptions of quality of care and safety for inpatient and outpatient telemedicine. Physicians (70%) and APPs (64%) felt safer having the option to use inpatient telemedicine, whereas only 26% of nurses reported the same. Overall, >70% of physicians and APPs would like to continue having the option to use inpatient and outpatient telemedicine in the future, whereas <50% of nurses reported the same. Discussion: These results suggest that telemedicine holds promise for providing care beyond the pandemic, and it may be a mechanism to improve flexibility, autonomy, and expand patient access. Implementation of new technologies must consider the experiences of the entire team, rather than a siloed approach to determining satisfaction with the changes.

Exploring COVID-19 Vaccine Hesitancy Among Stakeholders in African American and Latinx Communities in the Deep South Through the Lens of the Health Belief Model.

PURPOSE: The purpose of this study was to qualitatively explore perceptions related to COVID-19 vaccination intention among African American and Latinx participants and suggest intervention strategies. APPROACH: Ninety minute virtual focus groups (N = 8), segmented by county, race and ethnicity were conducted with stakeholders from 3 vulnerable Alabama counties. PARTICIPANTS: Participants (N = 67) were primarily African American and Latinx, at least 19 years, and residents or stakeholders in Jefferson, Mobile, and Dallas counties. SETTING: Focus groups took place virtually over Zoom. METHODS: The semi-structured guide explored perceptions of COVID-19, with an emphasis on barriers and facilitators to vaccine uptake. Focus groups lasted approximately 90 minutes and were audio recorded, transcribed, and analyzed by a team of 3 investigators, according to the guidelines of Thematic Analysis using NVivo 12. To provide guidance in the development of interventions to decrease vaccine hesitancy, we examined how themes fit with the constructs of the Health Belief Model. RESULTS: We found that primary themes driving COVID-19 vaccine hesitancy, ordered from most to least discussed, are mistrust, fear, and lack of information. Additionally, interventions to decrease vaccine hesitancy should be multi-modal, community engaged, and provide consistent, comprehensive messages delivered by trusted sources.

Modeling Patient Risk for Hospital-Acquired Pressure Injuries During COVID-19: A Retrospective Study.

BACKGROUND: COVID-19 negatively impacts many organ systems including the skin. One of the most significant skin-associated adverse events related to hospitalization are pressure injuries. PURPOSE: The aim of this study was to determine 8 risk factors that would place hospitalized patients at a higher risk for hospital-acquired pressure injuries (HAPIs) during the COVID-19 pandemic. METHODS: A retrospective, descriptive analysis was conducted in an urban academic health science center located in the southeastern United States. RESULTS: There were 247 of 23 093 patients who had pressure injuries and 1053 patients who had a positive COVID-19 diagnosis. Based on the generalized estimating equation model, diagnosis of COVID-19, age, male gender, risk of mortality, severity of illness, and length of stay are statistically significant factors associated with the development of HAPIs. CONCLUSIONS: Further study should explore pathology of COVID-19 skin changes and what interventions are effective against HAPIs in the COVID-19 population taking into consideration current treatments.

The University of Alabama at Birmingham COVID-19 Collaborative Outcomes Research Enterprise: Developing an institutional learning health system in response to the global pandemic.

Introduction: As a local response to the COVID-19 global pandemic, the University of Alabama at Birmingham (UAB) established the UAB COVID-19 Collaborative Outcomes Research Enterprise (CORE), an institutional learning health system (LHS) to achieve an integrated health services outcomes and research response. Methods: We developed a network of expertise and capabilities to rapidly develop and deploy an institutional-level interdisciplinary LHS. Based upon a scoping review of the literature and the Knowledge to Action Framework, we adopted a LHS framework identifying contributors and components necessary to developing a system within and between the university academic and medical centers. We used social network analysis to examine the emergence of informal work patterns and diversified network capabilities based on the LHS framework. Results: This experience report details three principal characteristics of the UAB COVID-19 CORE LHS development: (a) identifying network contributors and components; (b) building the institutional network; and (c) diversifying network capabilities. Contributors and committees were identified from seven components of LHS: (a) collaborative and executive leadership committee, (b) research coordinating committee, (c) oversight and ethics committee, (d) thematic scientific working groups, (e) programmatic working groups, (f) informatics capabilities, and (g) patient advisory groups. Evolving from the topical interests of the initial CORE participants, scientific working groups emerged to support the learning system network. Programmatic working groups were charged with developing a comprehensive and mutually accessible COVID-19 database. Discussion: Our LHS framework allowed for effective integration of multiple academic and medical centers into a cohesive institutional-level learning system. Network analysis indicated diversity of institutional disciplines, professional rank, and topical focus pertaining to COVID-19, with each center leveraging existing institutional responsibilities to minimize gaps in network capabilities. Conclusion: Incorporating an adapted LHS framework designed for academic medical centers served as a foundational resource supporting further institutional-level efforts to develop agile and responsive learning networks.

Learning During Crisis: The Impact of COVID-19 on Hospital-Acquired Pressure Injury Incidence.

ABSTRACT: The impact of COVID-19, on the health and safety of patients, staff, and healthcare organizations, has yet to be fully uncovered. Patient adverse events, such as hospital-acquired pressure injuries (HAPIs), have been problematic for decades. The introduction of a pandemic to an environment that is potentially at-risk for adverse events may result in unintended patient safety and quality concerns. We use the learning health system framework to motivate our understanding of the impact of the COVID-19 pandemic on the incidence of HAPIs within our health system. Using a retrospective, observational design, we used descriptive statistics to evaluate trends in HAPI from March to July 2020. Hospital-acquired pressure injury numbers have fluctuated from a steady increase from March-May 2020, hitting a peak high of 90 cases in the month of May. However, the trend in the total all stage HAPIs began to decline in June 2020, with a low of 51 in July, the lowest number since March 2020. Patients evaluated in this study did not have a longitudinal increase in HAPIs from March-July 2020 during the COVID-19 pandemic, despite similarities in illness severity between the two time points. Our experience has demonstrated the ability of our organizational leaders to learn quickly during crisis.