Israel's national HIE network Ofek: a robust infrastructure for clinical and population health

The national health information exchange (HIE) network in Israel is perhaps the world's best kept HIE secret. Few Israelis even know the network exists, yet this HIE network has broad adoption across Israel's health system, and it has facilitated many landmark studies on HIE in the biomedical literature. This case study highlights the development, implementation, and evolution of Israel's national HIE network. What began as a vision within one health maintenance organization (HMO) about 20 years ago now connects most hospitals in the country as well as many ambulatory care facilities. At its center is a focus on using a de-centralized, federated network to deliver comprehensive, virtual medical records to clinicians on demand within their electronic medical record system for use in supporting patient care. The network evolved to support COVID-19 and other national priorities. Moving forward, the Israeli national HIE network will play a critical role in supporting the nation's digital health strategy, and will focus on advanced functionalities, including common clinical terminologies and advanced analytics. © 2023 Elsevier Inc. All rights reserved.

Comprehensive medication management services provided via telehealth or hybrid models: A scoping review

Comprehensive medication management (CMM) is increasingly provided by health care teams through telehealth or hybrid modalities. The purpose of this scoping literature review was to assess the published literature and examine the economic, clinical, and humanistic outcomes of CMM services provided by pharmacists via telehealth or hybrid modalities. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Randomized controlled trials (RCTs) and observational studies were included if they: reported on economic, clinical, or humanistic outcomes;were conducted via telehealth or hybrid modalities;included a pharmacist on their interprofessional team;and evaluated CMM services. The search was conducted between January 1, 2000, and September 28, 2021. The search strategy was adapted for use in Medline (PubMed);Embase;Cochrane;Cumulative Index to Nursing and Allied Health Literature;PsychINFO;International Pharmaceutical s;Scopus;and grey literature. Four reviewers extracted data using a screening tool developed for this study and reviewed for risk of bias. Authors screened 3500 articles, from which 11 studies met the inclusion criteria (9 observational studies, 2 RCTs). In seven studies, clinical outcomes improved with telehealth CMM interventions compared to either usual care, face-to-face CMM, or educational controls, as shown by the statistically significant changes in chronic disease clinical outcomes. Two studies evaluated and found increased patient and provider satisfaction. One study described a source of revenue for a telehealth CMM service. Overall, study results indicate that telehealth CMM services, in select cases, may be associated with improved clinical outcomes, but the methods of the included studies were not homogenous enough to conclude that telehealth or hybrid modalities were superior to in-person CMM. To understand the full impact on the Quadruple Aim, additional research is needed to investigate the financial outcomes of CMM conducted using telehealth or hybrid technologies.Copyright © 2022 Pharmacotherapy Publications, Inc.

Differences in Telehealth During COVID-19 Between Commercial and Medicaid Enrollees

Objectives: To compare how in-person evaluation and management (E&M) visits and telehealth use differed during the COVID-19 pandemic between commercially insured and Medicaid enrollees, and to assess how insurance plan type—fee-for-service (FFS) vs managed care (MC)—and enrollee characteristics contributed to these differences. Study Design: Retrospective cohort analysis of 2019 and 2020 data from the commercially insured California Public Employees' Retirement System (CalPERS) and the California Medicaid program (Medi-Cal). Am J Manag Care. 2023;29(1):In Press _____ Takeaway Points * Increased use of telehealth during the COVID-19 pandemic has raised concerns about equitable access among lower-resourced populations, but few direct comparisons of telehealth use exist. * Compared with enrollees in a large, commercially insured managed care plan, Medicaid managed care enrollees had lower use of telehealth. * However, compared with enrollees in a large, commercially insured fee-for-service plan, Medicaid fee-for-service enrollees had higher use of telehealth. * Both insurer and plan type interact to affect uptake of telehealth, indicating heterogeneity that policy makers may wish to address when writing future telehealth policies. _____ The COVID-19 pandemic prompted a large shift to the provision of telehealth, due to benefits that include reduced risks of COVID-19 transmission and more convenient access to care. CalPERS enrollees select their insurance plan from several options, including a fully integrated health plan offered by Kaiser Permanente, several non-Kaiser health maintenance organization (HMO) plans, and preferred provider organization (PPO) plans.

Delaying or avoiding medical care due to the COVID-19 pandemic

Delaying or avoiding medical treatment is a common and possibly dangerous consequence of the COVID-19 pandemic. Certain demographic, medical or social groups were found reporting higher rates of avoiding medical care. Patients should be specifically targeted in advertising and interactions that encourage people to return to their previous behavior concerning their health maintenance. Technology advances, especially telemedicine, should be implemented widely to overcome pandemic fears and provide a new platform for treating patients in this complex era. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

BNT162b2 vaccine effectiveness in preventing asymptomatic infection with SARS-CoV-2 virus: A nationwide historical cohort study

Background: There is strong evidence regarding the efficacy and effectiveness of BNT162b2 vaccine in preventing symptomatic infection with SARS-CoV-2 virus. There is a relative paucity of data regarding effectiveness in preventing asymptomatic infection. Research question: What is the real-world effectiveness of BNT162b2 vaccine in preventing symptomatic and asymptomatic infection with SARS-CoV-2 virus? Methods: In this real-world observational study, we identified a subpopulation of individuals in a large health maintenance organisation who were repeatedly tested for SARS-CoV-2 infection by PCR. We included these individuals in the study cohort and compared those vaccinated with BNT162b2 mRNA vaccine to the unvaccinated ones. A positive SARSCoV- 2 PCR test result was used as the outcome. Follow-up period was from 1 January 2021 until 11 February 2021. Result(s): In the cohort, 6286 individuals were included. Seven days following the second vaccine dose, a rate of six positive PCR tests per 10,000 person-days was recorded, compared with a rate of 53 positive tests per 10,000 person-days for the unvaccinated group. The estimated vaccine effectiveness against infection with SARS-CoV-2 virus after two vaccine doses was 89% (95% confidence interval 82-94%). The estimated effectiveness two weeks following the first vaccine dose was 61% (95% confidence interval 49-71%). Conclusion(s): In this study, vaccination with BNT162b2 reduced infection rates among individuals who underwent screening by frequent SARS-CoV-2 PCR testing. Using a cohort of frequently tested individuals reduced the indication bias for the PCR testing, which enabled estimation of infection rates.

Hypertension care during the COVID-19 pandemic in an integrated health care system.

Retention in hypertension care, medication adherence, and blood pressure (BP) may have been affected by the COVID-19 pandemic. In a retrospective cohort study of 64 766 individuals with treated hypertension from an integrated health care system, we compared hypertension care during the year pre-COVID-19 (March 2019-February 2020) and the first year of COVID-19 (March 2020-February 2021). Retention in hypertension care was defined as receiving clinical BP measurements during COVID-19. Medication adherence was measured using prescription refills. Clinical care was assessed by in-person and virtual visits and changes in systolic and diastolic BP. The cohort had a mean age of 67.8 (12.2) years, 51.2% were women, and 73.5% were White. In 60 757 individuals with BP measurements pre-COVID-19, 16618 (27.4%) had no BP measurements during COVID-19. Medication adherence declined from 86.0% to 80.8% (p < .001). In-person primary care visits decreased from 2.7 (2.7) to 1.4 (1.9) per year, while virtual contacts increased from 9.5 (12.2) to 11.2 (14.2) per year (both p < .001). Among individuals with BP measurements, mean (SD) systolic BP was 126.5 mm Hg (11.8) pre-COVID-19 and 127.3 mm Hg (12.6) during COVID-19 (p = .14). Mean diastolic BP was 73.5 mm Hg (8.5) pre-COVID-19 and 73.5 mm Hg (8.7) during COVID-19 (p = .77). Even in this integrated health care system, many individuals did not receive clinical BP monitoring during COVID-19. Most individuals who remained in care maintained pre-COVID BP. Targeted outreach may be necessary to restore care continuity and hypertension control at the population level.

Gender Differences in Routine Health Maintenance Examinations Before and During the COVID-19 Pandemic.

PURPOSE: Adolescent and young adult (AYA) males historically have lower healthcare utilization than their female peers. METHODS: Electronic health record data from an Adolescent/Young Adult Medicine outpatient practice were reviewed to assess gender differences in routine health maintenance examinations before and during the COVID-19 pandemic. RESULTS: Routine health maintenance examinations decreased for both males and females during the pandemic. However, a two-proportion z-test demonstrated that established male patients were statistically less likely (p < .01) to have a routine health maintenance examination from December 2020 to December 2021 than their female counterparts. DISCUSSION: AYA males are at a higher risk for persistent disengagement in healthcare and exacerbates future gender gaps in healthcare utilization. Primary care providers need to focus efforts on re-engaging all young people in preventive care, with specific efforts tailored to AYA males.

Hybrid Education in the Context of the Covid-19 Pandemic: Peculiarities of Training Humanitarian Specialists

The global Covid-19 pandemic has changed the established approaches and methods of the educational space. The education system was forced to obey the requirements and regulations implemented by the authorities to prevent spreading infectious diseases. Therefore, the evaluation of the training of humanitarian specialists requires thorough study and analysis. The study aims to consider the components of hybrid education within humanitarian education;to establish students' assessment of hybrid education. The research methodology is based on an integrated approach-the method of pedagogical experiment, statistical methods, and descriptive methods allowed to form an empirical basis. The hypothesis of the study lies in the fact that adaptation to hybrid learning involves the use of digital technologies. They include software, educational platforms, social networks, and tools for non-formal humanitarian education. However, education still requires full-time education and practical experience, which is challenging to obtain virtually. The result of the study determines the effectiveness of hybrid forms of learning using the capabilities of digital technologies for the training of a specialist in the humanities. The study involves: conducting experiments to solve the problem of training humanitarian specialists in the era of the pandemic and researching the right balance between studying at university and home. The primary purpose of such training is to maintain readiness for professional activities, reduce stress among students and teachers, and avoid professional combustion, which has become a fundamental problem of training during a pandemic. The study results made it possible to note that the majority of surveyed students have a positive attitude to the new conditions and methods of organizing the educational process. At the same time, students recognized the advantage of non-formal education. The article proved that the main problem of the implemented education systems for students was the lack of possibility of personal communication "student-student" and "student-teacher". A comparative description of forms of education (classical and hybrid) is provided. The main problem that is not solved by the introduction of hybrid education is the ineffective use of academic support, which is basic for humanitarian specialties. Based on the survey, a decreasing-increasing trend in the attendance of classes according to the mixed form of education was revealed, and the intensity of attendance increases before the final control of knowledge. © Copyright for this article is retained by the author(s), with first publication rights granted to the journal.

Health Surveillance in a Down Syndrome Specialty Clinic: Implementation of Electronic Health Record Integrations During the Coronavirus Disease 2019 Pandemic.

OBJECTIVE: To address gaps in routine recommended care for children with Down syndrome, through quality improvement during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: A retrospective chart review of patients with Down syndrome was conducted. Records of visits to the Massachusetts General Hospital Down Syndrome Program were assessed for adherence to 5 components of the 2011 American Academy of Pediatrics (AAP) Clinical Report, "Health Supervision for Children with Down Syndrome." The impact of 2 major changes was analyzed using statistical process control charts: a planned intervention of integrations to the electronic health record for routine health maintenance with age-based logic based on a diagnosis of Down syndrome, created and implemented in July 2020; and a natural disruption in care due to the COVID-19 pandemic, starting in March 2020. RESULTS: From December 2018 to March 2022, 433 patients with Down syndrome had 940 visits. During the COVID-19 pandemic, adherence to the audiology component decreased (from 58% to 45%, P < .001); composite adherence decreased but later improved. Ophthalmology evaluation remained stable. Improvement in adherence to 3 components (thyroid-stimulating hormone, hemoglobin, sleep study ever) in July 2020 coincided with electronic health record integrations. Total adherence to the 5 AAP guideline components was greater for follow-up visits compared with new patient visits (69% and 61%, respectively; P < .01). CONCLUSIONS: The COVID-19 pandemic influenced adherence to components of the AAP Health supervision for children with Down syndrome, but improvements in adherence coincided with implementation of our intervention and reopening after the COVID-19 pandemic.

Delaying or avoiding medical care due to the COVID-19 pandemic

Delaying or avoiding medical treatment is a common and possibly dangerous consequence of the COVID-19 pandemic. Certain demographic, medical or social groups were found reporting higher rates of avoiding medical care. Patients should be specifically targeted in advertising and interactions that encourage people to return to their previous behavior concerning their health maintenance. Technology advances, especially telemedicine, should be implemented widely to overcome pandemic fears and provide a new platform for treating patients in this complex era. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

"TRANSFER FOR HIGHER LEVEL OF CARE": AN EXCUSE TO GET RID OF UNINSURED PATIENTS?

SESSION TITLE: Actionable Improvements in Safety and Quality SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The overall mortality rate for patients ‘transfered’ to the medical intensive care units is thought to be significantly higher than the mortality rate amongst those admitted directly. (1) It has also been suggested that uninsured critically ill patients have a higher probability of being ‘transferred’ to other hospitals as well as a higher mortality rate. (2, 3) We aim to determine whether insurance coverage impacts the transfer of critically ill patients. METHODS: This study was conducted at a quaternary care hospital which is also a regional transfer center. We accessed the public data for the year 2020 through our institutions Transfer Center Dashboard, System Analytics. The two aspects of transferred patients we focused upon were: 1) Hospital service (subspecialty care required) and 2) Financial class. Major subspecialties included in the study were: Pulmonology, Internal Medicine, Neurosurgery, Cardiology, and Neurology. Our study was a patient safety project, hence it qualified for IRB exemption. We classified the percentage of transfers as ‘Accepted’, ‘Declined’, or ‘Canceled’;and determined the insurance status of the patient. RESULTS: We found a total of 3552 patients transfers were initiated. 31.9% (1136) transfer patients were accepted, 46.79% (1662) transfers were declined, and 21.23% (754) were canceled due to reasons including unsafe transfer, acceptance at other institutions, or death prior to transfer. Major categories for transfers were Pulmonology (16.1%), other Internal Medicine related diseases (15.3%), and Neurosurgery (11.8%) were the subspecialties with the highest rate of transfers. In terms of financial class, we determined that 44.81% (n=509) of the ICU transfers had no insurance, 27.81% (n=316) had Medicare support, and 17.81% (n=202) had managed care through a health maintenance organization (HMO);the remaining 9.59% had other insurance plans. We used a binomial test to determine the probability of a transfer under no insurance (p) with the formula p + q=1, across the total number of transfer requests (n). K was the number of actual transfers that occurred. Total transfer requests were n=3552, actual transfers were k=1136 and transfers without insurance were 509/44.8%, converted into p=0.45 with a resulting q of 0.55.For z-test, we used the formula z = ((K - np) +- 0.5) / √npq = 15.58. Our one-tailed probability of exactly, or fewer than, 1136(K) out of 3552(n) was p <.000001. Our study was limited because of the COVID-19 pandemic occurring in the same year. CONCLUSIONS: Based on our results, we conclude that the ‘uninsured’ patients are more susceptible to getting transferred to other institutions. CLINICAL IMPLICATIONS: Critically ill ‘uninsured’ patients are selctively subjected to be transfered to other hospitals for higher level of care. These transfers may have significant health implications thereby resulting in higher morbidity and mortality in unisured populations. DISCLOSURES: No relevant relationships by Joodi Akhtar No relevant relationships by Sahar Fatima Advisory Committee Member relationship with Astra Zeneca Please note: 24 months Added 03/16/2022 by FAISAL MASUD, value=Honoraria Advisory Committee Member relationship with Teleflex Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee Advisory Committee Member relationship with La Jolla Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee No relevant relationships by Iqbal Ratnani No relevant relationships by Salim Surani No relevant relationships by Anza Zahid

Modes of construction of nosocomial infection control professional staff team in prefecture-level medical institutions of Jiangsu Province under COVID-19 pandemic

OBJECTIVE: To explore the construction mode of full-time staff for infection control in prefecture-level cities under the background of the COVID-19 pandemic, and to lay a foundation for infection control of epidemic prevention and control and medical safety. METHODS: A three-level collaborative promotion system which was led by the health administrative department, undertaken by the hospital association, and cooperated by the quality control center was established. Refinement of the promotion measures was taken from six aspects, including the number of full-time staff, team management, ability improvement, echelon construction, development space and discipline construction and so on. Specifically, the construction and assessment of full-time personnel was strengthened, training courses on nosocomial infection management in primary-level medical institutions was carried out, a youth backbone echelon was established, the treatment of full-time staff was guaranteed and the department of infection management was incorporated into the management of medical technology departments in an exploratory way, the evaluation standard of municipal key clinical specialties was formulated and the evaluation was organized, and the department of nosocomial infection with strong comprehensive strength would be built and supported as a "municipal clinial key specialty project". RESULTS: The total number of full-time staff for infection control in the secondary and tertiary medical institutions in the city had increased to 102, and the ratio of person to bed had increased to 1:76 and 1:173, respectively, both higher than the provincial average level. The self-assessment of the cultural atmosphere of infection control in hospitals and the leaders' emphasis on infection control of 60.34% and 63.79% full-time staff increased significantly. The infection control management department of the two third-grade first-class hospitals ware selected as the first batch of municipal key clinical specialties and received construction funds. The full-time staff had achieved zero breakthroughs in the provincial projects and municipal talent projects. CONCLUSION: By establishing a three-level collaborative promotion system of "Health and Health Commission-Hospital Association-Quality Control Center", the ability of full-time staff and their sense of belonging could be improved significantly with a policy support from the aspects of discipline development, treatment and promotion channels, et al., providing ideas and models for ordinary prefecture-level cities to build professional infection control management team.

Therapeutic nihilism is inadequate in geriatric medicine.

Patients' wishes should guide therapeutic considerations in the face of options and necessities, particularly when an intervention carries the risk of death. Therefore, in the medical management of the young and the old, everything should be attempted as long as the patient has a strong will to live.

Difficulty in continuing home care after informal caregiver was exposed to the COVID-19: A case report.

Home care can present many challenges without management. During COVID-19 pandemic, when an informal caregiver becomes infected and had to isolate themselves, finding another caregiver becomes extremely challenging. For terminally ill patients, who relies on other for even minor tasks, interruption of care could pose severe negative consequences.

Humane organizing in a post-COVID-19 world: Learning from Buurtzorg's trust-based decentralization

This paper examines the enablers and consequences of less hierarchical organizing in which humane values are in focus as a path toward spirituality in the workplace. It describes Buurtzorg Nederland, a revolutionary case in home health care due to its radically decentralized structure and integrative, autonomous system of organizing. Data were collected by studying the responses of directors and nurses to the COVID-19 pandemic. A formative grounded theory methodology based on theoretical sampling using two additional qualitative data sets is used. The paper demonstrates that the simplification of organizational structures through integrative self-management helps to put the organization's purpose at the center. Even in times of COVID-19 pandemic, this decentralized organizational architecture is empowering. The core concept of integrating simplification is elaborated using the enablers of serving, attuning, and trusting, wherein the concept of trust emerges as foundational. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Organization of health care for prevention and control of COVID-19 infections in a reorganized hospital unit

During the 73rd session of the World Health Assembly, the Member States noted that the COVID-19 pandemic has highlighted the crucial role that healthcare professionals play in critical situations of this kind. For that reason, 2021 was designated as the year for raising the awareness of the need for increased efforts and financial investments in the preparation, education, occupational safety and practical application of the new knowledge and skills of all healthcare professionals, regardless of their workplace, in order to respond adequately to the pandemic and its consequences. The aim of the study was to prepare an algorithm for the organization of health care for prevention and control of COVID-19 infections in a reorganized hospital unit. To prepare the algorithm, we used a method of critical analysis and synthesis of scientific literature on the researched issue, a documentary method, and a set of norms (independent survey and monitoring). The practical application and understanding of the algorithm will reduce the stress and fear of the unknown among the healthcare professionals, and it will cut the time necessary to organize the diagnosis and treatment processes, and ensure the provision of safe and high quality health care.

Effectiveness of mRNA BNT162b2 Vaccine 6 Months after Vaccination among Patients in Large Health Maintenance Organization, Israel.

Israel experienced a new wave of coronavirus disease during June 2021, six months after implementing a national vaccination campaign. We conducted 3 discrete analyses using data from a large health maintenance organization in Israel to determine whether IgG levels of fully vaccinated persons decrease over time, describe the relationship between IgG titer and subsequent PCR-confirmed infection, and compare PCR-confirmed infection rates by period of vaccination. Mean IgG levels steadily decreased over the 6-month period in the total tested population and in all age groups. An inverse relationship was found between IgG titer and subsequent PCR-positive infection. Persons vaccinated during the first 2 months of the campaign were more likely to become infected than those subsequently vaccinated. The vaccinated group >60 years of age had lower initial IgG levels and were at greater risk for infection. The findings support the decision to add a booster vaccine for persons >60 years of age.

Attitudinal Barriers Hindering Adoption of Telepsychiatry among Mental Healthcare Professionals: Israel as a Case-Study.

Despite proven advantages for the use of telemedicine in psychiatry, mental healthcare professionals have shown deep-seated mistrust and suspicion of telepsychiatry, which hinders its widespread application. The current study examines the attitudes of Israeli mental health professionals towards telepsychiatry and seeks to uncover the effects of experience and organizational affiliation on its adoption. The methodology included qualitative and thematic analysis of 27 in-depth interviews with Israeli mental health professionals, focusing on three major themes-clinical quality, economic efficiency, and the effects on the work-life balance of healthcare professionals. The attitudes of mental health professionals were found to be widely divergent and sharply dichotomized regarding different aspects of telepsychiatry and its suitability for mental healthcare services. However, there was a general consensus that telemedicine may not fulfil its promise of being a panacea to the problems of modern public medicine. In addition, attitudes were related to hierarchical position, organizational affiliation, and personal experience with telepsychiatry. Specifically, organizational affiliation influenced experience with and support for the assimilation of telepsychiatry. The study also revealed the role of organizational leadership and culture in promoting or inhibiting the proliferation and adoption of innovative technologies and services in modern medicine.