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1.
Milbank Q ; 100(3): 673-701, 2022 09.
Article in English | MEDLINE | ID: covidwho-2052138

ABSTRACT

Policy Points Hospital-at-Home (HaH) is a home-based alternative for acute care that has expanded significantly under COVID-19 regulatory flexibilities. The post-pandemic policy agenda for HaH will require consideration of multistakeholder perspectives, including patient, caregiver, provider, clinical operations, technology, equity, legal, quality, and payer. Key policy challenges include reaching a consensus on program standards, clarifying caregivers' issues, creating sustainable reimbursement mechanisms, and mitigating potential equity concerns. Key policy prescriptions include creating a national surveillance system for quality and safety, clarifying legal standards for care in the home, and deploying payment reforms through value-based models.


Subject(s)
COVID-19 , COVID-19/epidemiology , Caregivers , Hospitals , Humans , Reimbursement Mechanisms
2.
J Clin Transl Sci ; 6(1): e94, 2022.
Article in English | MEDLINE | ID: covidwho-1984312

ABSTRACT

The Recruitment Innovation Center (RIC) has created a toolkit of novel strategies to engage potential participants in response to recruitment and retention challenges associated with COVID-19 studies. The toolkit contains pragmatic, generalizable resources to help research teams increase awareness of clinical trials and opportunities to participate; produce culturally sensitive and engaging recruitment materials; improve consent and return of results processes; and enhance recruitment of individuals from populations disproportionately impacted by COVID-19. This resource, the "RIC COVID-19 Recruitment and Retention Toolkit," is available free online. We describe the toolkit and the community feedback used to author and curate this resource.

4.
Acad Med ; 96(11): 1507-1512, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1493989

ABSTRACT

The harsh realities of racial inequities related to COVID-19 and civil unrest following police killings of unarmed Black men and women in the United States in 2020 heightened awareness of racial injustices around the world. Racism is deeply embedded in academic medicine, yet the nobility of medicine and nursing has helped health care professionals distance themselves from racism. Vanderbilt University Medical Center (VUMC), like many U.S. academic medical centers, affirmed its commitment to racial equity in summer 2020. A Racial Equity Task Force was charged with identifying barriers to achieving racial equity at the medical center and medical school and recommending key actions to rectify long-standing racial inequities. The task force, composed of students, staff, and faculty, produced more than 60 recommendations, and its work brought to light critical areas that need to be addressed in academic medicine broadly. To dismantle structural racism, academic medicine must: (1) confront medicine's racist past, which has embedded racial inequities in the U.S. health care system; (2) develop and require health care professionals to possess core competencies in the health impacts of structural racism; (3) recognize race as a sociocultural and political construct, and commit to debiologizing its use; (4) invest in benefits and resources for health care workers in lower-paid roles, in which racial and ethnic minorities are often overrepresented; and (5) commit to antiracism at all levels, including changing institutional policies, starting at the executive leadership level with a vision, metrics, and accountability.


Subject(s)
Academic Medical Centers/ethics , COVID-19/ethnology , Minority Groups/statistics & numerical data , Racism/ethnology , Schools, Medical/statistics & numerical data , Academic Medical Centers/organization & administration , African Americans/ethnology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Delivery of Health Care/ethics , Female , Health Personnel/ethics , Humans , Male , SARS-CoV-2/genetics , Schools, Medical/ethics , United States/epidemiology
5.
J Am Med Inform Assoc ; 28(9): 2013-2016, 2021 08 13.
Article in English | MEDLINE | ID: covidwho-1377973

ABSTRACT

Open discussions of social justice and health inequities may be an uncommon focus within information technology science, business, and health care delivery partnerships. However, the COVID-19 pandemic-which disproportionately affected Black, indigenous, and people of color-has reinforced the need to examine and define roles that technology partners should play to lead anti-racism efforts through our work. In our perspective piece, we describe the imperative to prioritize TechQuity-equity and social justice as a technology business strategy-through collaborating in partnerships that focus on eliminating racial and social inequities.


Subject(s)
COVID-19 , Racism , Humans , Pandemics , SARS-CoV-2 , Technology
6.
J Clin Transl Sci ; 5(1): e100, 2021 Apr 20.
Article in English | MEDLINE | ID: covidwho-1253823

ABSTRACT

INTRODUCTION: The COVID-19 pandemic prompted the development and implementation of hundreds of clinical trials across the USA. The Trial Innovation Network (TIN), funded by the National Center for Advancing Translational Sciences, was an established clinical research network that pivoted to respond to the pandemic. METHODS: The TIN's three Trial Innovation Centers, Recruitment Innovation Center, and 66 Clinical and Translational Science Award Hub institutions, collaborated to adapt to the pandemic's rapidly changing landscape, playing central roles in the planning and execution of pivotal studies addressing COVID-19. Our objective was to summarize the results of these collaborations and lessons learned. RESULTS: The TIN provided 29 COVID-related consults between March 2020 and December 2020, including 6 trial participation expressions of interest and 8 community engagement studios from the Recruitment Innovation Center. Key lessons learned from these experiences include the benefits of leveraging an established infrastructure, innovations surrounding remote research activities, data harmonization and central safety reviews, and early community engagement and involvement. CONCLUSIONS: Our experience highlighted the benefits and challenges of a multi-institutional approach to clinical research during a pandemic.

7.
J Health Polit Policy Law ; 45(6): 921-935, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-1116995

ABSTRACT

The novel coronavirus pandemic has set in high relief the entrenched health, social, racial, political, and economic inequities within American society as the incidence of severe morbidity and mortality from the disease caused by the virus appears to be much greater in black and other racial/ethnic minority populations, within homeless and incarcerated populations, and in lower-income communities in general. The reality is that the United States is ill equipped to realize health equity in prevention and control efforts for any type of health outcome, including an infectious disease pandemic. In this article, the authors address an important question: When new waves of the current pandemic emerge, or another novel pandemic emerges, how can the United States be better prepared and also ensure a rapid response that reduces rather than exacerbates social and health inequities? The authors argue for a health equity framework to pandemic preparedness that is grounded in meaningful community engagement and that, while recognizing the fundamental causes of social and health inequity, has a clear focus on upstream and midstream preparedness and downstream rapid response efforts that put social and health equity at the forefront.


Subject(s)
COVID-19/epidemiology , Health Equity , Pandemics , Public Health , Humans , Needs Assessment , Social Determinants of Health , United States/epidemiology
8.
Infection Control & Hospital Epidemiology ; : 1-8, 2020.
Article in English | WHO COVID | ID: covidwho-1017043

ABSTRACT

A review. Equipoise in translational research and in clin. practice means there is essential uncertainty in terms of benefit or risk resulting from the use of a particular therapy. The interplay between equipoise and ethics form one of the essential foundations of clin. research;one notable clin. ethicist succinctly characterized equipoise as "a clin. necessary condition in all cases of clin. research.". In the setting of COVID-19, there are no therapies with known effect. We rely on supportive care only. To be clear: 100% of pharmacol. therapies in use today are not established for this disease and no evidence exists that any treatment is more helpful than harmful, a critical premise underlying the ethical practice of medicine. Fundamentally, a firm evidence base on which to decide the appropriate path for the patients in our care is lacking, and the abundance of anecdote -- normally a hypothesis generation mechanism -- can get in the way of our societal need to understand the risks and benefits of untested therapies through well controlled, randomized trials. The challenges facing us in the current pandemic are undeniably urgent, but do not preclude systematic and thorough evaluation of risk and benefit. This call is echoed by others advocating for design and completion of high-quality trials to evaluate the safety and efficacy of all therapies under consideration for COVID-19.

9.
Trends Mol Med ; 27(2): 97-100, 2021 02.
Article in English | MEDLINE | ID: covidwho-927683

ABSTRACT

The striking imbalance between disease incidence and mortality among minorities across health conditions, including coronavirus disease 2019 (COVID-19) highlights their under-inclusion in research. Here, we propose actions that can be adopted by the biomedical scientific community to address long-standing ethical and scientific barriers to equitable representation of diverse populations in research.


Subject(s)
COVID-19/epidemiology , Epidemiologic Research Design , African Americans , Humans , Incidence , Mortality , Research , SARS-CoV-2 , Social Justice/trends
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