A HOSPITAL-BASED COMMUNITY HEALTH WORKER PILOT PROGRAM FOR THE LATINX COMMUNITY DURING THE COVID-19 PANDEMIC

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.

ADDRESSING SOCIAL NEEDS TO ENABLE SUCCESSFUL CARE TRANSITIONS FOR PATIENTS HOSPITALIZED WITH COVID-19: THE CRITICAL ROLE OF COMMUNITY HEALTH WORKERS

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.

“IT'S BEEN TRAUMATIC”: THE IMPACT OF COVID-19 ON HOSPITAL-BASED HEALTHCARE WORKERS IN AUSTIN

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.

Characterization of the Nasopharyngeal Microbiota of COVID-19 Patients According to Disease Severity

Purpose Increasing evidence indicates a possible relationship between the pathogenesis of COVID-19 and the nasopharyngeal microbiota. This study aimed to compare the nasopharyngeal microbiota of COVID-19 patients with different disease severity. Methods & Materials A comparative study was performed on patients classified into four groups according to their disease severity. A total of 26 patients were recruited for each of the following study groups. Group 1 (G1): patients with a confirmatory diagnosis of SARS-CoV-2 and hospitalized in the ICU. Group 2 (G2): patients with a confirmatory diagnosis of SARS-CoV-2 and hospitalized in regular hospitalization wards. Group 3 (G3): patients with a confirmatory diagnosis of SARS-CoV-2 who were not hospitalized and had mild or no symptoms. Group 4 (G4): healthy patients with a negative result for SARS-CoV-2. The diagnosis of SARS-CoV-2 was performed by reverse-transcriptase polymerase chain reaction (RT-PCR). The nasopharyngeal microbiota was characterized using polymerase chain reaction (PCR) targeting 13 representative bacteria genus. Results The detection of some bacteria genus was significantly more frequent in the hospitalized groups compared to healthy subjects. This is the case of Lactobacillus with 96.15% in G1, 96.15% in G2, 23.08% in G3 and 15.38% in G4. Similarly, Prevotella presented 96.15% in G1, 80.77 in G2, 0.00% in G3 and 19.23% in G4. Veilonella, Bacteroidetes and Firmicutes presented a similar prevalence. On the other hand, the detection of Eubacterium was more frequent among asymptomatic and healthy subjects, with 3.85% in G1, 19.23% in G2, 50.00% in G3 and 30.77% in G4. The relative abundance of the bacteria was evaluated and Lactobacillus and Veilonella were predominant in both of the hospitalized groups (G1 and G2). On the other hand, Actinobacteria and Eubacterium were predominant in the asymptomatic and healthy groups (G3 and G4) Conclusion In conclusion a unique nasopharyngeal microbiota profile was found in COVID-19 patients with different disease severity. Lactobacillus, Prevotella, Veilonella, Bacteroidetes and Firmicutes were the predominant bacteria genus in critical and hospitalized patients. While. Eubacterium and Actinobacteria were predominant in the groups of asymptomatic and healthy subjects. Further longitudinal studies are required to determine the prognostic role of the nasopharyngeal microbiota.

Worse outcomes of out-of-hospital cardiac arrest in covid-19 versus non-covid-19: A systematic review and meta analysis dyutima

Introduction: A surge in incidence of out-of-hospital cardiac arrest (OHCA) has been reported during COVID-19 outbreak in certain countries. However, limited data exists on a comparison of outcomes among COVID-19 positive OHCA patients vs. non-COVID-19 OHCA patients. Therefore, we aimed to perform a meta-analysis comparing characteristics and outcome of COVID-19 OHCA vs COVID-19 negative OHCA patients. Methods: We reviewed PubMed/Medline, SCOPUS, and EMBASE until April 2021 using relevant keywords COVID-19, SARS-CoV-2, “out of hospital cardiac arrest” or OHCA to identify studies that included outcomes data on OHCA with COVID-19 positive and negative status. Random-effects models were obtained to perform a meta-analysis. I statistics was used for heterogeneity. Results: Of 5789 OHCA patients included from 6 studies, patients who were COVID-19 positive comprised of 61.46% males while COVID-19 negative patients included 63.37% of males (p=0.2). COVID-19 OHCA patients were younger (Mean±SD, 68.94±17.93 vs 70.23±17.93, p=0.03) compared to COVID-19 negative patients. Incidence of OHCA at home/private address was higher (OR=1.92, 95%CI:1.52-2.43), while shockable rhythm (OR=0.34, 95%-CI:0.24-0.46) and use of AED (OR=0.77, 95%CI 0.61-0.97) were less frequently noted in COVID-19 patients (p<0.0001). As shown in Fig. 1, return of spontaneous circulation did not differ significantly (OR=1.01, 95%CI:0.85-1.20, p<0.92);however, survival to admission (OR=0.64, 95%CI:0.48-0.86, p<0.01), and survival to discharge (OR=0.28, 95%CI:0.13-0.59, p<0.01) were significantly lower in COVID-19 OHCA admissions compared to non-COVID-19 OHCA admissions. Conclusions: This meta-analysis demonstrated that the SARS-CoV-2 infection in OHCA patients was associated with poorer outcomes as compared to COVID-19 negative OHCA admissions. Future studies are warranted to assess long-term residual effects of COVID-19 on OHCA risk and outcomes.

Perception of teaching performance in the virtual learning environment

This article aims to analyze the perception of the students of the professional school of business administration about the teaching performance in the virtual learning environment during the COVID-19 pandemic. When developing the research, it was determined that there is a good teaching performance, according to the perception of the students. However, it was identified that the factors of domain of the topic and class session management, present a better perception in this context of virtual learning;while the didactic strategies factor is the one that presents a not so favorable perception. In addition, through a comparative analysis, it was determined that the didactic strategies and planning factors have suffered a negative variation with respect to the perception per teacher, when moving from face-to-face to virtual learning, since, of the total of 17 specialty teachers, seven of them one negative variation. These results are validated by the linear regression test, where an R2 value of 0.965 is calculated, with respect to the didactic strategies factor. It means that this factor influences 96.5% on the perception of students with the global factor and an R2 value of 0.921 for the planning factor, which indicates an influence of 92.1%. © 2021, Institute of Advanced Engineering and Science. All rights reserved.

Satisfaction and Shortfall of OB-GYN Physicians and Radiologists

Ultrasound is pivotal to the practice of obstetrics-gynecology (OB-GYN). In the US, physicians who perform ultrasound are facing the unprecedented need for their services and skills. OB-GYNs, in particular, have been challenged to meet rising demands in women’s healthcare, as a result of an increasing female population, while the supply of physicians is not keeping pace. The ACOG projects current shortages will continue to grow to a deficit of up to 22,000 OB-GYNs by 2050. The future of the OB-GYN workforce is compromised by an aging OB-GYN population, insufficient OB-GYN residency positions, and a decreasing number of young physicians choosing to specialize in OB-GYN. As a consequence of mismatched supply and demand, practicing OB-GYNs are experiencing alarming rates of medical burnout, jeopardizing their mental health and wellness. The COVID-19 pandemic has further exacerbated risks to mental health;however, OB-GYNs have reported higher levels of burnout compared to other specialties, both before and after the pandemic. This article examines the threats to OB-GYN’s central role in the provision of OB-GYN ultrasound, including factors contributing to insufficient growth of the OB-GYN workforce, and the resulting impacts on practicing OB-GYNs’ job satisfaction and overall well-being. Data on medical burnout affecting OB-GYNs, both before and after the COVID-19 pandemic, is presented along with a comparison of job satisfaction and wellness data collected from OB-GYNs and radiologists–the two groups of specialists performing female pelvic and OB ultrasound exams in the US. Understanding the factors that discourage medical graduates from entering into OB-GYN residencies is critical, not only for recruitment but for the development of strategies to support currently practicing OB-GYNs. Prevention of medical burn-out among OB-GYNs will be essential to keep OB-GYNs practicing through retirement age while attracting others to the specialty. The creation of rewarding work environments, which allow for a healthy work-life balance, will be essential to meeting the demand for specialized women’s health and reproductive care. Protecting the well-being of those practicing now, will be instrumental to the development of a sufficient OB-GYN workforce, and ensure its central role in the provision of OB-GYN ultrasound.