ABSTRACT
In an original article, I analyzed a potential causal link between the policy of de-prosecution in Philadelphia and an increase in homicides. Utilizing the traditional synthetic control method with extensive descriptive data and a donor pool of the other 99 largest cities in the United States, the results demonstrated a statistically significant increase of over 74 homicides per year in Philadelphia during 2015-19 associated with de-prosecution (p<.05). A response addressing the original article on de-prosecution has been submitted. In this reply, I correct factual inaccuracies in the response, explain the validity of methodological choices, discuss the response's misinterpretation of certain quantitative issues, and expose the ideological purposes of the response. In addition, I have included updated parallel research addressing the issue of de-prosecution and examine the theoretical impact of the Covid-19 pandemic on the interaction between de-prosecution and homicides. © 2023 American Society of Criminology.
ABSTRACT
The COVID-19 pandemic presents unprecedented challenges for the US healthcare system, and the critical care settings are heavily impacted by the pressures of caring for COVID-19 patients. However, hospital pandemic preparedness has been hampered by a lack of disease specific planning guidelines. In this paper, we proposed a holistic modeling and analysis approach, with a system dynamics model to predict COVID-19 cases and a discrete-event simulation to evaluate hospital bed utilization, to support the hospital planning decisions. Our model was trained using the public data from the JHU Coronavirus Resource Center and was validated using historical patient census data from the University of Florida Health Jacksonville, Jacksonville, FL and public data from the Florida Department of Health (FDOH). Various experiments were conducted to investigate different control measures and the variants of the virus and their impact on the disease transmission, and subsequently, the hospital planning needs. Our proposed approach can be tailored to a given hospital setting of interest and is also generalizable to other hospitals to tackle the pandemic planning challenge. Note to Practitioners-We proposed a holistic modeling and analysis approach to support hospital preparedness and resource planning during the COVID-19 pandemic. To capture the highly dynamic pandemic environment, we developed a numerical method to estimate R-0, the effective basic reproductive rate, and used the most recent estimated data series of daily R-0 to project the change in R-0 in a short-term forecast window. The prediction of the daily confirmed cases in that forecast window were then obtained based on recursively solving the system dynamics model, and was validated to be very close to the real confirmed cases from the public record. This data-driven approach allows us to gain a systematic understanding of the common trends across different states and regions, and to evaluate the effect of the control measures like the stay-at-home order and the impact of the virus variants on the disease transmission behavior. Furthermore, the dynamic prediction allows us to evaluate the hospital resource needs during different stages of the pandemic. The insights obtained through this effort shed light on the impact of interventions (e.g., vaccines and control measures) on the hospital preparedness to support appropriate hospital resource allocation.
ABSTRACT
Background: Synchronous video visits (“telehealth”) were rapidly adopted to facilitate provision of cancer care during the COVID-19 pandemic, with little time to comprehensively assess patient and provider needs. Attitudes toward telehealth use during active treatment (vs. survivorship care) were largely unknown, as were perceptions of, experiences with, and needed support for telehealth use among older adults with cancer. Older adults in particular may face increased vulnerability to inequities in access to care due to limited digital literacy. Methods: We conducted surveys and semi-structured interviews with providers, staff, and older patients (age ≥60) from a comprehensive cancer center. Data collection occurred between Dec 2020 - Nov 2021. Results: We completed a total of 106 provider/staff surveys, 128 patient surveys, 20 provider/staff interviews, and 15 patient interviews. A majority of surveyed providers/staff felt that telehealth should “definitely be offered” during treatment-phase encounters (55.9% treatment follow-up;69.1% results communication;70.2% discussing treatment side effects). Similarly, most patients indicated they would be willing to have video visits with a member of their care team for: discussing treatment side-effects (73.5%), results communication (69.6%), and treatment follow-up (65.7%). Patients reported experiencing challenges with joining video visits (29%) and understanding the telehealth process (28%). Similarly, less than a third (30.8%) of providers/ staff agreed or strongly agreed that the institution did a good job of preparing patients for their first telehealth encounter. Patients felt the institution should do more to communicate the advantages of telehealth to older adults in handouts and videos, which included: engaging multiple family members in critical appointments (e.g., treatment decisions, end-of-life), seeing their doctor when they were too sick to travel, and reducing potential exposure to infectious disease at the clinic. Participants suggested several strategies to assist patients with limited digital literacy: offering video tutorials of the connection process, creating “fake appointments” to practice online connections, and hiring a digital navigator to assist with technical difficulties and setup of the online portal. Despite challenges, a majority of surveyed patients (65.7%) and providers/staff (76.9%) intend to continue using telehealth after the COVID-19 pandemic passes. Conclusions: Use of telehealth for cancer care was received positively by older patients and providers/staff. Taking targeted steps to enhance implementation could reduce barriers to care, including among older adults and other populations with limited digital literacy, thereby promoting greater equity of access to telehealth benefits beyond the pandemic.
ABSTRACT
Methods: We are fielding an online survey to approximately 2,000 Veterans using tele-WH services across 10 VHA facilities. The survey contains internally developed questions and validated patient-reported outcome measures (e.g., Perceived Stress Scale). Survey content was developed iteratively and refined based on Veteran feedback. The survey is collecting data on Veteran: (1) use of and interest in, (2) experiences and satisfaction with, (3) perceived outcomes of, and (4) sources of information about tele-WH services. Results: Data collection is underway. We will present data on the percent of respondents who: (1) used and (2) are interested in using each tele-WH service/therapy, (3) learned about tele-WH through various sources, (4) reported satisfaction with tele-WH services/therapies, and (5) reported that tele-WH participation helped them improve outcomes. We will use multivariate analyses to identify factors independently associated with use of tele-WH services and therapies, interest in future use, and perceived impacts on outcomes. Background: The Veterans Health Administration's (VHA) transformation into a 'Whole Health system of care' (WHS) has encompassed a shift in organizational culture, wherein care delivery is focused on Veteran goals and preferences rather than diagnoses alone. VHA's WHS includes offering commensurate services and therapies to Veterans, including complementary and integrative health services. In the wake of COVID-19, VHA rapidly shifted service delivery to a virtual format. For most Whole Health programs, the virtual format (i.e., 'tele-Whole Health' (tele-WH)) was a novel delivery platform. Our goal was to assess Veteran experiences with and perceptions of tele-WH services. Conclusion: Following the pandemic-related shift in services, interest in tele-WH continues to rise. Our data will provide insights regarding Veteran perceptions of tele-WH, including interest in continued use of tele-WH offerings and factors that can be addressed to facilitate participation. Such information can be used by healthcare institutions to plan future availability of tele-WH services.
ABSTRACT
Health care systems are at the front line to fight the COVID-19 pandemic. Emergent questions for each hospital are how many general ward and intensive care unit beds are needed, and additionally, how to optimally allocate these resources during demand surge to effectively save lives. However, hospital pandemic preparedness has been hampered by a lack of sufficiently specific planning guidelines. In this paper, we developed a hybrid computer simulation approach, with a system dynamic model to predict COVID-19 cases and a discrete-event simulation to evaluate hospital bed utilization and subsequently determine bed allocations. Two control policies, the type-dependent admission control policy and the early step-down policy, based on patient risk profiling, were proposed to lower the overall death rate of the patient population in need of intensive care. The model was validated using historical patient census data from the University of Florida Health Jacksonville, Jacksonville, FL. The allocation of hospital beds to low-risk and high-risk arrival patients to achieve the goal of reducing the death rate, while helping a maximum number of patients to recover was discussed. This decision support tool is tailored to a given hospital setting of interest and is generalizable to other hospitals to tackle the pandemic planning challenge. © 2021 IEEE.