Advocacy in Action: a Comprehensive Student-Led Proactive Outreach to Patients at Highest Risk.

INTRODUCTION: COVID-19 disrupted access to critical healthcare and resources for many, especially affecting patients at safety-net hospitals who rely on regular care for multiple complex conditions. Students realized they could support patients from the sidelines by helping navigate abrupt healthcare changes and proactively addressing needs at home. AIM: To comprehensively identify and meet the clinical and social needs of Atlanta, Georgia's patients at highest risk, left without their usual access to healthcare, through proactive telephonic outreach. SETTING AND PATIENTS: Medical and Physician's Assistant students from Emory and Morehouse Schools of Medicine partnered with Grady Health System, Atlanta's safety-net hospital. Artificial intelligence prioritized over 15,000 patients by risk of morbidity and mortality from COVID-19. PROGRAM DESCRIPTION: In this novel program, students performed telephonic outreach to thousands of patients at highest risk of poor outcomes from COVID-19. Students used a custom REDCap form that served as both a call script and data collection tool. It provided step-by-step guidance to (1) screen for COVID-19 and educate on prevention; (2) help patients navigate health system changes to fill gaps in care; and (3) identify and address social needs. Based on patients' responses, the form prompted tailored reminders for next steps and connections to medical and social resources. PROGRAM EVALUATION: In the program's first 16 months, students made 7,988 calls, of which 3,354 were answered. Over half (53%) of patients had at least one need requiring action: 48% health and 16% social. DISCUSSION: This proactive, novel initiative identified substantial clinical and social need among patients at highest risk for poor outcomes and filled a pressing health system gap exacerbated by COVID-19. Simultaneously, interprofessional students gained applied exposure to health systems sciences. This program can serve as a model for rapid, cost-effective, high-yield outreach to promote patient health at home both during and beyond the pandemic.

Student-faculty co-creation of experiential learning in health systems science.

INTRODUCTION: Health Systems Science (HSS) teaches students critical skills to navigate complex health systems, yet medical schools often find it difficult to integrate into their curriculum due to limited time and student disinterest. Co-developing content with students and teaching through appropriate experiential learning can improve student engagement in HSS coursework. METHODS: Medical students and faculty co-developed a patient outreach initiative during the early phases of the COVID-19 pandemic and integrated that experience into a new experiential HSS elective beginning May 2020. Students called patients identified as high-risk for adverse health outcomes and followed a script to connect patients to healthcare and social services. Subsequently, this initiative was integrated into the required third-year primary care clerkship. RESULTS: A total of 255 students participated in HSS experiential learning through the elective and clerkship from May 2020 through July 2021. Students reached 3,212 patients, encountering a breadth of medical, social, and health systems issues; navigated the EMR; engaged interdisciplinary professionals; and proposed opportunities for health systems improvement. DISCUSSION AND CONCLUSION: This educational intervention demonstrated the opportunity to partner with student-led initiatives, coproducing meaningful educational experiences for the learners within the confines of a busy medical curriculum.

Untangling the Impacts of Climate Change on Waterborne Diseases: a Systematic Review of Relationships between Diarrheal Diseases and Temperature, Rainfall, Flooding, and Drought.

Global climate change is expected to affect waterborne enteric diseases, yet to date there has been no comprehensive, systematic review of the epidemiological literature examining the relationship between meteorological conditions and diarrheal diseases. We searched PubMed, Embase, Web of Science, and the Cochrane Collection for studies describing the relationship between diarrheal diseases and four meteorological conditions that are expected to increase with climate change: ambient temperature, heavy rainfall, drought, and flooding. We synthesized key areas of agreement and evaluated the biological plausibility of these findings, drawing from a diverse, multidisciplinary evidence base. We identified 141 articles that met our inclusion criteria. Key areas of agreement include a positive association between ambient temperature and diarrheal diseases, with the exception of viral diarrhea and an increase in diarrheal disease following heavy rainfall and flooding events. Insufficient evidence was available to evaluate the effects of drought on diarrhea. There is evidence to support the biological plausibility of these associations, but publication bias is an ongoing concern. Future research evaluating whether interventions, such as improved water and sanitation access, modify risk would further our understanding of the potential impacts of climate change on diarrheal diseases and aid in the prioritization of adaptation measures.

A systematic review and meta-analysis of ambient temperature and diarrhoeal diseases.

BACKGROUND: Global climate change is expected to increase the risk of diarrhoeal diseases, a leading cause of childhood mortality. However, there is considerable uncertainty about the magnitude of these effects and which populations bear the greatest risks. METHODS: We conducted a systematic review using defined search terms across four major databases and, additionally, examined the references of 54 review articles captured by the search. We evaluated sources of heterogeneity by pathogen taxon, exposure measure, study quality, country income level and regional climate, and estimated pooled effect estimates for the subgroups identified in the heterogeneity analysis, using meta-analysis methods. RESULTS: We identified 26 studies with 49 estimates. Pathogen taxa were a source of heterogeneity. There was a positive association between ambient temperature and all-cause diarrhoea (incidence rate ratio (IRR) 1.07; 95% confidence interval (CI) 1.03, 1.10) and bacterial diarrhoea (IRR 1.07; 95% CI 1.04, 1.10), but not viral diarrhoea (IRR 0.96; 95% CI 0.82, 1.11). These associations were observed in low-, middle- and high-income countries. Only one study of protozoan diarrhoea was identified. CONCLUSIONS: Changes in temperature due to global climate change can and may already be affecting diarrhoeal disease incidence. The vulnerability of populations may depend, in part, on local pathogen distribution. However, evidence of publication bias and the uneven geographical distribution of studies limit the precision and generalizability of the pooled estimates.