ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Despite accounting for only 34% of the population in Austin, Latinx individuals made up 50% of those who tested positive for coronavirus, 54% of COVID-related hospitalizations, and 51% of COVID-related deaths between March and June 2020. Of hospitalized patients, 40% had never seen a primary care physician (PCP), had high rates of previously undiagnosed health conditions and significant health-related social needs (HRSNs). DESCRIPTION OF PROGRAM/INTERVENTION: We implemented an interdisciplinary pilot program at a local academic teaching hospital to improve community outcomes and address HRSNs. The intervention is led by a bilingual community health worker (CHW), and includes discharge follow-up with patients hospitalized with COVID-19. As the pandemic ebbed and flowed across multiple surges, we expanded the intervention to Latinx patients with other complex health conditions. The full sample was included in the analysis. MEASURES OF SUCCESS: This is a mixed-method evaluation, which includes quantitative patient data (n=96), as well as qualitative data from hospital-based, healthcare professionals (n=26) that collaborated with the CHW. Quantitative data includes patient demographics (age, gender, race, education & insurance), HRSNs, community referrals and primary care followup. Qualitative data was collected via focus groups with case managers, hospitalists, residents and palliative care team members. Focus groups were approximately 60 minutes long, and we used content analysis to identify themes. FINDINGS TO DATE: The majority of patients were hospitalized for COVID-19 (n= 67, 70%) while the rest were diagnosed with other acute conditions. Average length of stay (LOS) was 13.8 days and the median LOS was 8 days. Mean age was 50.6 years, 66% of patients were male and 79% spoke Spanish. Half of the patients had less than a high school education, while 20% had more than a high school education. One-third of patients were employed while the rest were either seeking employment (16%) or nonworking (50%). The majority of patients were either uninsured (42%) or had county-based health coverage for the uninsured (30%). The top HRSNs included food (47%), rental assistance (36%) and utility assistance (36%). Almost half of patients attended a follow up with a PCP. Initial qualitative themes fall into three categories: 1) the role of a CHW, 2) the benefits of a CHW in the hospital and 3) growth opportunities. KEY LESSONS FOR DISSEMINATION: This pilot program demonstrated the capacity for CHWs to raise the hospital scope of care, particularly within the context of COVID-19. CHWs are experts in assessing and addressing HRSNs and can provide complementary services to inpatient care teams. CHWs provide culturally appropriate, transitional care to patients with chronic illnesses, which directly addresses the socioeconomic barriers to receiving continuity of care. Additional and diverse funding mechanism are needed to expand the presence of CHWs in hospital settings and increase the capacity to serve more patients.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: The COVID-19 pandemic highlights the disproportionate burden of disease on communities made vulnerable by structural inequities. The pandemic has increased economic hardship, including housing instability, food insecurity and ability to pay bills. Hospitalization for COVID-19 is an opportunity to address unmet healthrelated social needs (HRSNs) and connect patients with community resources. DESCRIPTION OF PROGRAM/INTERVENTION: Community health workers (CHWs) play a critical role in response to public health crises. To address the inequitable burden of COVID-19 on Austin's Latinx population, we implemented a pilot program at an academic hospital where a CHW helps patients navigate care transitions and address unmet HRSNs. The care team referred patients with COVID-19 to the CHW, who met with patients to establish rapport, provide language-concordant communication between the care team and patient/family, deliver health promotion education, and assess HRSNs. MEASURES OF SUCCESS: This includes three typical cases describing key components of the CHW pilot program. CHWs connected patients and families to community resources and facilitated discharge planning and connection with primary care providers. The CHWs continued to follow patients for at least 45 days after discharge to assist with care coordination. We provide qualitative data from patients and healthcare professionals. FINDINGS TO DATE: Patient 1 is a 38-year-old day laborer with hypertension hospitalized with COVID-19 pneumonia. His family of four is undocumented and faced economic insecurity due to loss of work from the pandemic. The CHW assisted with utilities, bills, food and rent through coordination with local organizations to provide direct financial assistance to the family. Patient 2 is a 45-year-old woman with diabetes hospitalized with COVID-19 pneumonia. She is a mother of three children, two with disabilities. In addition to financial insecurity, she identified transportation as a primary HRSN. The CHW arranged financial resources to fix their car, which allowed the family to access school and clinic resources. Patient 3 is a 36-year-old man hospitalized with COVID-19 pneumonia. The CHW connected the family, including three children, with their school social worker, enabling access to financial support for utilities, food and clothes. The CHW arranged free food delivery to their home for four months. The CHW also secured county-based indigent care coverage for the patient, enabling hospital follow-up with a primary care provider. The patient's wife noted, because of the CHW, “We never felt alone” and now feel “capable of navigating a health system that we never felt we had access to.” KEY LESSONS FOR DISSEMINATION: CHWs, as patient advocates and skilled care navigators, build trust, establish longitudinal relationships with patients and address unmet HRSNs that can enable successful care transitions. CHWs can alleviate the disproportionate burden of COVID-19 on individuals with unmet HRSNs. Supporting the work of CHWs within hospital care teams can improve care transitions.
ABSTRACT
BACKGROUND: COVID-19 has uniquely impacted the United States due to an under-resourced and over-burdened public health system. As the pandemic has ebbed and flowed across multiple surges, it has profoundly affected healthcare infrastructure. Multiple reports have noted a marked increase in burnout and compassion fatigue among healthcare professionals (HCPs) during COVID-19, which can adversely impact clinical care. However, the majority of studies have focused only on physicians or nurses in international settings;there is very little research on the experiences of HCPs in the U.S. This study explores the impact of a two-year pandemic on HCPs in terms of compassion, burnout and secondary trauma. METHODS: This is a mixed-method assessment of hospital HCPs (n=26) during COVID-19 including case managers, hospitalists, residents and palliative care team members. Quantitative data include HCP demographics (age, gender, race & education) as well as compassion, burnout and secondary trauma as measured by the Professional Quality of Life (ProQOL) Scale. Qualitative data was collected via 60-minute focus groups with HCPs, and content analysis was used to identify themes. RESULTS: Mean age was 35.2 years and 73% identified as female. The majority of HCPs identified as white (n=21) and 20% as Latinx, while one person identified as Black and four as Asian. About one-third of HCPs spoke Spanish. The majority were physicians (n=15, 58%), while three were social workers, three were registered nurses, one was an advanced practice nurse practitioner and one was a chaplain. HCPs had worked in healthcare for amean of 6.8 years (median=3) with a max of 38 years. Compassion, burnout and secondary trauma survey scores fell within the average range across HCPs. However, qualitative interviews identified burnout as a major theme amongst HCPs. Multiple factors associated with burnout were identified, including the unpredictability of COVID-19, high death rates, understaffing, unfilled positions, long working hours, social isolation and the politicization of COVID-19. CONCLUSIONS: Traditional compassion, fatigue and burnout surveys such as the ProQOL may not fully capture the complexities of how COVID-19 has affected healthcare professionals. Our qualitative data provides rich descriptions of compassion fatigue and burnout that were not captured by the survey data. Due to the unpredictable nature of the pandemic, as well as the large swings in hospitalization numbers, it is possible that the survey data did not reflect the level of burnout or compassion fatigue since data was collected at the end of the delta surge. It is also possible that HCPs most affected by secondary trauma or burnout have left the healthcare field, as supported by current literature. Larger scale assessments of healthcare professionals in the U.S. are warranted to further understand the impact of the COVID-19 pandemic on healthcare professionals, organizational factors leading to compassion fatigue or burnout, and potential policy solutions.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Health care for individuals experiencing homelessness is typically fragmented and passive, and illequipped to meet the complex needs of this population. DESCRIPTION OF PROGRAM/INTERVENTION: The Mobile, Medical, and Mental Health Care Team (M3 Team) is a mobile, patient-centered, integrated care model for people experiencing chronic homelessness with a chronic medical condition, serious mental illness, and substance use disorders. M3 innovates in three ways: 1) M3 is mobile and patient-centered, meeting people where they are - both geographically and in their readiness for engagement;2) M3 is integrated and holistic, integrating primary care, behavioral health care, and health-related social needs across public medical and mental health systems;3) M3 focuses on racial equity to include provider training, prioritization of Black clients, and data disaggregation by race and ethnicity. MEASURES OF SUCCESS: We conducted quarterly assessments of enrolled patients using two standardized scales: (1) self-reported functioning and mental health symptoms using the Behavior and Symptom Identification Scale (BASIS-24), and (2) substance use using the Addiction Severity Index (ASI) drug and alcohol use scales. To assess changes in the dependent variables over time, we used repeated measures ANOVA with time, gender, race, ethnicity, number of comorbidities, and an indicator of whether the measurement was taken before or after the start of the COVID-19 pandemic as independent variables. We also evaluated emergency department utilization and hospitalizations, 6 and 12 months pre- and post-enrollment on the M3 Team (unadjusted results presented here, adjusted analyses currently ongoing and will be presented if accepted). We also tracked enrollment in social programs. FINDINGS TO DATE: 54 clients were enrolled between August 2019 and December 2022. In the 6 months following the start of M3 enrollment, participants experienced decreases in mean severity of mental health symptoms related to depression and functioning (-0.205, p=0.011) and self-harm (-0.055, p=0.008), as well as alcohol use (-0.120, p=0.007) and drug use (-0.065, p=0.001). In the 18 months following M3 initiation, mean severity of symptoms related to depression and functioning (-0.372, p=0.003), self-harm (-0.073, p=0.019), emotional lability (-0.114, p=0.014), and drug use (-0.080, p=0.005) decreased while other domains were not significantly different from baseline values. On average, ED visits post enrollment were significantly lower than pre-enrollment for the 6-month and 12-month measures by 51% and 43%, respectively. Hospitalizations pre- and post-enrollment were not significantly different. Enrollment in a variety of social service programs increased over the enrollment period. KEY LESSONS FOR DISSEMINATION: Delivery models that integrate primary care, behavioral health care, and social services hold promise for improving behavioral health outcomes, reducing ER utilization, and addressing social needs of individuals with complex health needs who are experiencing homelessness.
ABSTRACT
In this opinion paper, we argue that global health crises are also information crises. Using as an example the coronavirus disease 2019 (COVID-19) epidemic, we (a) examine challenges associated with what we term "global information crises";(b) recommend changes needed for the field of information science to play a leading role in such crises;and (c) propose actionable items for short- and long-term research, education, and practice in information science.