Closing the Gap: A Comparison of Engagement Interventions to Achieve Equitable Breast Cancer Screening in Rural Illinois.

Mammography screening rates are typically lower in those with less economic advantage (EA). This study, conducted at an integrated health care system covering a mixed rurality population, assessed the ability of interventions (text messages linking to a Web microsite, digital health care workers, and a community health fair) to affect mammography screening rates and disparity in those rates among different EA populations. Payor type served as a proxy for greater (commercially insured) versus lower (Medicaid insured) EA. 4,342 subjects were included across the preintervention ("Pre") and postintervention ("Post") periods. Interventions were prospectively applied to all Medicaid subjects and randomly selected commercial subjects. Applying interventions only to lower EA subjects reversed the screening rate disparity (2.6% Pre vs. -3.7% Post, odds ratio [OR] 2.4 P < 0.01). When intervention arms ("Least," "More," "Most") were equally applied, screening rates in both EA groups significantly increased in the More arm (Medicaid OR = 2.04 P = 0.04, Commercial OR = 3.08 P < 0.01) and Most arm (Medicaid OR 2.57 P < 0.01, Commercial OR 2.33 P < 0.01), but not in the Least (text-only) arm (Medicaid OR 1.83 P = 0.11, Commercial OR 1.72 P = 0.09), although this text-only arm was inadequately powered to detect a difference. In summary, targeting interventions to those with lower EA reversed screening rate disparities, text messaging combined with other interventions improved screening rates in both groups, and future research is needed to determine whether interventions can simultaneously improve screening rates for all without worsening the disparity.

Access to Care: End-to-End Digital Response for COVID-19 Care Delivery.

The coronavirus disease 2019 pandemic disrupted health care, requiring organizational leaders to act quickly to manage the health-related concerns of individuals and communities. The ability to offer a variety of digitally enabled telehealth services with 24/7 access to nurse practitioners and physician assistants allowed us to care for patients in their homes. It reduced the spread of the virus, protected our employees from further disease spread, and provided early interventions to those in need. The roles of nurse practitioner leaders, the enacted strategies, and patient outcomes demonstrate the impact of an innovative digital care delivery model on care across the continuum.

Impact of disease-specific orientation on new graduate nurse satisfaction and knowledge retention.

Transition from student to novice nurse can be especially challenging, and a weak orientation can further complicate this difficult time for new graduate nurses. The neuroscience field is complex, and orientation can cause new nurses to lack a comprehensive understanding of their specialty, resulting in a task-focused approach to bedside care. Using a convenience sample and both qualitative and quantitative data, this study implements a disease-specific orientation track for new graduate nurses to spotlight the most common neurological diagnoses and disorders while concentrating on building an understanding of how to provide the best care possible to these patients. This article reports the outcomes achieved from the first phase of the study including improved clinical competence, readiness and retention of knowledge, overall satisfaction with orientation, and increased comfort level in caring for the neurological patient. In addition, the feedback and information gathered have provided a foundation for the project to be tailored and continued to further improve these results with future new graduate nurses on the neuroscience unit.