Examining the Relationship Between Rurality, Risk Perception, and COVID-19 Vaccine Willingness Among Rural Latinos in Arizona and California.

This study aimed to investigate the relationship between rurality and risk perception of getting or transmitting COVID-19 and willingness to get the COVID-19 vaccine in a sample of Latinos across Arizona and California's Central Valley (n = 419). The results revealed that rural Latinos are more concerned about getting and transmitting COVID-19, but less willing to get vaccinated. Our findings suggest that perceptions of risk alone do not play a sole role in influencing risk management behavior among rural Latinos. While rural Latinos may have heightened perception of the risks associated with COVID-19, vaccine hesitancy persists due to a variety of structural and cultural factors. These factors included limited access to healthcare facilities, language barriers, concerns about vaccine safety and effectiveness, and cultural factors such as strong family and community ties. The study highlights the need for culturally-tailored education and outreach efforts that address the specific needs and concerns of this community to increase vaccination rates and reduce the disproportionate burden of COVID-19 among Latino communities living in rural areas.

Why is the Implementation of Beta-Lactam Therapeutic Drug Monitoring for the Critically Ill Falling Short? A Multicenter Mixed-Methods Study.

BACKGROUND: Beta-lactam therapeutic drug monitoring (BL TDM; drug level testing) can facilitate improved outcomes in critically ill patients. However, only 10%-20% of hospitals have implemented BL TDM. This study aimed to characterize provider perceptions and key considerations for successfully implementing BL TDM. METHODS: This was a sequential mixed-methods study from 2020 to 2021 of diverse stakeholders at 3 academic medical centers with varying degrees of BL TDM implementation (not implemented, partially implemented, and fully implemented). Stakeholders were surveyed, and a proportion of participants completed semistructured interviews. Themes were identified, and findings were contextualized with implementation science frameworks. RESULTS: Most of the 138 survey respondents perceived that BL TDM was relevant to their practice and improved medication effectiveness and safety. Integrated with interview data from 30 individuals, 2 implementation themes were identified: individual internalization and organizational features. Individuals needed to internalize, make sense of, and agree to BL TDM implementation, which was positively influenced by repeated exposure to evidence and expertise. The process of internalization appeared more complex with BL TDM than with other antibiotics (ie, vancomycin). Organizational considerations relevant to BL TDM implementation (eg, infrastructure, personnel) were similar to those identified in other TDM settings. CONCLUSIONS: Broad enthusiasm for BL TDM among participants was found. Prior literature suggested that assay availability was the primary barrier to implementation; however, the data revealed many more individual and organizational attributes, which impacted the BL TDM implementation. Internalization should particularly be focused on to improve the adoption of this evidence-based practice.

Innovations in clinical documentation integrity practice: Continual adaptation in a data-intensive healthcare organisation.

BACKGROUND: Numbers of clinical documentation integrity specialists (CDIS) and CDI programs have increased rapidly. CDIS review patient records concurrently with patient admissions and visits to ensure that information is accurate, complete and non-ambiguous, and query clinicians when they see opportunities for improving data. The occupation was initially focused on improving data for reimbursement, but rapid changes to clinical coding requirements, technologies and payment systems led to a quickly evolving role for CDI programs and changes in CDIS practice. OBJECTIVE: This case study seeks to uncover the ongoing innovation and adaptation occurring in a CDI program by tracing the evolution of a single CDI program over time. METHOD: We present a case study of the CDI program at the HonorHealth hospital system in Arizona. RESULTS: The HonorHealth CDI program holds a unique hybrid expertise and role within the healthcare organisation that allows it to rapidly adapt to support emergent demands both internal and external to the organisation, such as supporting accurate data collection for the COVID-19 pandemic. CONCLUSION: CDIS are a vital component in present data-intensive resourcing efforts. The hybrid expertise of CDIS and capacity for adaption and relationship building has enabled the HonorHealth CDI program to adapt rapidly to meet a growing array of clinical documentation integrity needs, including emergent needs during the COVID-19 pandemic. IMPLICATIONS: The HonorHealth case study can guide other CDI programs in adaptation of the CDI role and practices in response to changing organisational needs.

Delay of routine health care during the COVID-19 pandemic: A theoretical model of individuals' risk assessment and decision making.

Delaying routine health care has been prevalent during the COIVD-19 pandemic. Macro-level data from this period reveals that U.S. patients under-utilized routine health care services such as primary care visits, preventative tests, screenings, routine optometry care, dental appointments, and visits for chronic disease management. Yet, there is a gap in research on how and why patients understand risks associated with seeking or delaying routing health care during an infectious disease pandemic. Our research addresses this gap based on semi-structured interviews with 40 participants living in regions across the United States. By building upon Unger-Saldaña and Infante-Castañeda's model of delayed health care, we extend this model by articulating how health care delays happen during an infectious disease pandemic. Specifically, we show how perceptions of uncertainty and subjective risk assessments shape people's decisions to delay routine health care while they operate at two levels, internal and external to one's social bubble, interacting with each other.

Pathway mapping as a tool to address police use of force in behavioral health crisis.

Police use of force is a significant problem in many communities, particularly related to episodes of behavioral health crisis where police are called to respond. Fragmentation of the behavioral health care system creates a revolving door where many residents with behavioral health challenges cycle in and out of the system, often accessing services via the 9-1-1 emergency system during a crisis episode. This work leverages ethnographic and participatory techniques to build a pathway map in order to represent and characterize the behavioral health crisis system in metropolitan Phoenix, Arizona, United States. Map findings illustrate that many nominally existing connections are functionally distant when viewed through the lens of a clinical handoff. The resulting pathway map can be used as a planning and confirmatory tool for community members, practitioners, and policymakers to address challenges in behavioral health and public safety.

Do patients with high versus low treatment and illness burden have different needs? A mixed-methods study of patients living on dialysis.

BACKGROUND: Approximately 750,000 people in the U.S. live with end-stage kidney disease (ESKD); the majority receive dialysis. Despite the importance of adherence to dialysis, it remains suboptimal, and one contributor may be patients' insufficient capacity to cope with their treatment and illness burden. However, it is unclear what, if any, differences exist between patients reporting high versus low treatment and illness burden. METHODS: We sought to understand these differences using a mixed methods, explanatory sequential design. We enrolled adult patients receiving dialysis, including in-center hemodialysis, home hemodialysis, and peritoneal dialysis. Descriptive patient characteristics were collected. Participants' treatment and illness burden was measured using the Illness Intrusiveness Scale (IIS). Participants scoring in the highest quartile were defined as having high burden, and participants scoring in the lowest quartile as having low burden. Participants in both quartiles were invited to participate in interviews and observations. RESULTS: Quantitatively, participants in the high burden group were significantly younger (mean = 48.4 years vs. 68.6 years respectively, p = <0.001). No other quantitative differences were observed. Qualitatively, we found differences in patient self-management practices, such as the high burden group having difficulty establishing a new rhythm of life to cope with dialysis, greater disruption in social roles and self-perception, fewer appraisal focused coping strategies, more difficulty maintaining social networks, and more negatively portrayed experiences early in their dialysis journey. CONCLUSIONS AND RELEVANCE: Patients on dialysis reporting the greatest illness and treatment burden have difficulties that their low-burden counterparts do not report, which may be amenable to intervention.

The qualculative dimension of healthcare data interoperability.

Research on interoperability and information exchange between information technology systems touts the use of secondary data for a variety of purposes, including research, management, quality improvement, and accountability. However, many studies have pointed out that this is difficult to achieve in practice. Hence, this article aims to examine the causes for this by reporting an ethnographic study of the data work performed by medical records coders and birth certificate clerks working in a hospital system to uncover the practices of creating administrative data (e.g. secondary data). The article illustrates that clerks and coders use situated qualitative judgments of the accuracy and authority of different primary medical accounts. Coders and clerks also employ their understandings of the importance of different future uses of data as they make crucial decisions about how much discretion to exercise in producing accurate data and how much effort to put toward clarifying problematic medical data. These findings suggest that information technology systems designed for interoperability and secondary data also need to be designed in ways that support the qualculative practices of data workers in order to succeed, including making future uses of data clear to data workers and finding ways to minimize conflicting data before data workers encounter it.

The emergence of new data work occupations in healthcare: The case of medical scribes.

PURPOSE: Increasing demand for more and better documentation as well as digitalization of healthcare entail shifts in competencies and roles of healthcare occupations and professions. As a result of this data-centric technological development, new kinds of work and occupations emerge of which medical scribes are an example. To investigate and provide a case of an emergent occupation focused on 'data work', we describe the emergence, growth and stabilization of medical scribes, outline their history and provide a literature overview. METHOD: We conducted a review of the literature on medical scribes in academic journals until 2017. These publications are categorized according to the country of study, medical specialization, method, focus, attitude to the use of medical scribes, and the reasons given for the use of medical scribes. We outline the history of the emergence of medical scribes and provide a summary of the existing research publications on medical scribes. FINDINGS: We identified 60 papers of which a majority are based on cases from the USA; conducted in emergency departments; based on quantitative methods; focus on economic feasibility and satisfaction; are positive towards the use of medical scribes; and link the use of medical scribes to the implementation of electronic health records (EHR). There is a distinct lack of research on medical scribes themselves and their interaction with physicians, patients, and EHR. CONCLUSIONS: Medical scribes have emerged as a new data-work occupation as a response to increased demands for documentation and digitalization through EHRs. Research on medical scribes has hitherto focused on efficiency and economic feasibility of scribes, and there is a need to look into the interaction of medical scribes with physicians and patients as well as look at opportunities for redesign of EHR. More generally, there is a need to look beyond the most prominent professions such as physicians and nurses in discussions of digitization and datafication of healthcare, and investigate how new and previous tasks are (re)distributed between occupations and professions.

Evaluating an interdisciplinary undergraduate training program in health promotion research.

BACKGROUND: The University of California at Irvine Interdisciplinary Summer Undergraduate Research Experience (ID-SURE) program had three objectives: (1) designing an interdisciplinary health promotion training curriculum for undergraduate research fellows; (2) developing measures for evaluating and assessing program-related educational processes and products; and (3) comparing these educational process and product measures between groups of students who did or did not receive the training. METHODS: A total of 101 students participated in the ID-SURE program during 2005, 2006, and 2007. A longitudinal research design was employed whereby students' interdisciplinary attitudes and behaviors were assessed at the beginning and end of the training program. The interdisciplinary and intellectual qualities of students' academic and research products were assessed at the conclusion of the training activities. In addition, ID-SURE participants' interdisciplinary attitudes, behaviors, and research products were compared to those of 70 participants in another fellowship program that did not have an interdisciplinary training component. RESULTS: Exposing undergraduate research fellows to the interdisciplinary curriculum led to increased participation in, and positive attitudes about, interdisciplinary classroom and laboratory activities. Products, such as the integrative and interdisciplinary quality of student research projects, showed no differences when compared to those of undergraduates who were not exposed to the interdisciplinary curriculum. However, undergraduates exposed to the training engaged in more interdisciplinary behaviors at the end of the program than students who were not trained in interdisciplinary research techniques. CONCLUSIONS: The findings from this study offer evidence for the efficacy of the ID-SURE program for training undergraduate students in transdisciplinary concepts, methods, and skills that are needed for effective scientific collaboration. Additionally, this study makes two important contributions to the development and evaluation of interdisciplinary health research training programs: (1) It presents and evaluates a novel curriculum for training undergraduate students in interdisciplinary theories, concepts, and methods of health promotion that can be replicated in other settings and contexts; (2) It provides and tests the reliability of new measures for evaluating interdisciplinary collaborative processes and develops objective criteria for rating the integrative and intellectual quality of students' research products.