Newly Acquired Burnout During the Coronavirus Disease 2019 (COVID-19) Pandemic: A Retrospective Cohort Study on the Experiences of New York State Primary Care Clinicians.

The well-being of primary care clinicians represents an area of increasing interest amid concerns that the COVID-19 pandemic may have exacerbated already high prevalence rates of clinician burnout. This retrospective cohort study was designed to identify demographic, clinical, and work-specific factors that may have contributed to newly acquired burnout after the onset of the COVID-19 pandemic. An anonymous web-based questionnaire distributed in August 2020 to New York State (NYS) primary care clinicians, via email outreach and newsletters, produced 1,499 NYS primary care clinician survey respondents. Burnout assessment was measured pre-pandemic and early in the pandemic using a validated single-item question with a 5-point scale ranging from (1) enjoy work to (5) completely burned out. Demographic and work factors were assessed via the self-reporting questionnaire. Thirty percent of 1,499 survey respondents reported newly acquired burnout during the early pandemic period. This was more often reported by clinicians who were women, were younger than 56 years old, had adult dependents, practiced in New York City, had dual roles (patient care and administration), and were employees. Lack of control in the workplace prior to the pandemic was predictive of burnout early in the pandemic, while work control changes experienced following the pandemic were associated with newly acquired burnout. Low response rate and potential recall bias represent limitations. These findings demonstrate that reporting of burnout increased among primary care clinicians during the pandemic, partially due to varied and numerous work environment and systemic factors.

Road traffic density and recurrent asthma emergency department visits among Medicaid enrollees in New York State 2005-2015.

BACKGROUND: Environmental exposures such as traffic may contribute to asthma morbidity including recurrent emergency department (ED) visits. However, these associations are often confounded by socioeconomic status and health care access. OBJECTIVE: This study aims to assess the association between traffic density and recurrence of asthma ED visits in the primarily low income Medicaid population in New York State (NYS) between 2005 and 2015. METHODS: The primary outcome of interest was a recurrent asthma ED visit within 1-year of index visit. Traffic densities (weighted for truck traffic) were spatially linked based on home addresses. Bivariate and multivariate logistic regression analyses were conducted to identify factors predicting recurrent asthma ED visits. RESULTS: In a multivariate model, Medicaid recipients living within 300-m of a high traffic density area were at a statistically significant risk of a recurrent asthma ED visit compared to those in a low traffic density area (OR = 1.31; 95% CI:1.24,1.38). Additionally, we evaluated effect measure modification for risk of recurrent asthma visits associated with traffic exposure by socio-demographic factors. The highest risk was found for those exposed to high traffic and being male (OR = 1.87; 95% CI:1.46,2.39), receiving cash assistance (OR = 2.11; 95% CI:1.65,2.72), receiving supplemental security income (OR = 2.21; 95% CI:1.66,2.96) and being in the 18.44 age group (OR = 1.59;95% CI 1.48,1.70) was associated with the highest risk of recurrent asthma ED visit. Black non-Hispanics (OR = 2.35; 95% CI:1.70,3.24), Hispanics (OR = 2.13; 95% CI:1.49,3.04) and those with race listed as "Other" (OR = 1.89 95% CI:1.13,3.16) in high traffic areas had higher risk of recurrent asthma ED visits as compared to White non-Hispanics in low traffic areas. CONCLUSION: We observed significant persistent disparities in asthma morbidity related to traffic exposure and race/ethnicity in a low-income population. Our findings suggest that even within a primarily low-income study population, socioeconomic differences persist. These differences in susceptibility in the extremely low-income group may not be apparent in health studies that use Medicaid enrollment as a proxy for low SES.

The impact of financial incentives on utilization and outcomes of diabetes prevention programs among Medicaid managed care adults in New York state.

Diabetes prevalence has risen rapidly and has become a global health challenge. The Diabetes Prevention Program (DPP) has been shown to prevent or delay the development of diabetes among individuals with prediabetes. Yet, diabetes prevention studies within the Medicaid population are limited and results are mixed. This study aimed to evaluate the impact of different financial incentive strategies on the utilization of the DPP for Medicaid managed care adults in New York State. A four-arm randomized controlled trial was conducted among Medicaid managed care adult enrollees diagnosed with prediabetes and/or obesity. Study participants were offered a 16-week DPP with various incentive strategies based on class attendance and weight loss as follows: Attendance-Only, Weight-Loss Only, and both Attendance and Weight-Loss. A control group was offered DPP with no incentives for attendance or weight loss. We evaluated the impact of incentives on achievement of the program completion and weight-loss milestone. Participants who received incentives for the Attendance-Only class were least likely to be lost to follow-up, more likely to complete the program, and had two times higher percentage of meeting the weight-loss milestone compared to the control group. Results for the other incentive cohorts were mixed. A strong positive association was observed for participants who attended 9 or more classes and weight-loss regardless of incentive strategies. Providing monetary incentives for DPP class attendance had a positive impact on program completion and achieving the weight-loss milestone. However, the results from this study indicate that participant enrollment and retention remained challenges despite the incentives.

Eliminating Disparities in Asthma Care: Identifying Broad Challenges in Quality Improvement.

Racial disparities in asthma care persist in New York State's Medicaid Program. African Americans with asthma experience higher rates of emergency department visits and inpatient hospitalizations, coupled with lower rates of long-term control medication use compared to other racial/ethnic groups. Within this context, and with funding from the Centers for Disease Control and Prevention, the New York State Department of Health designed and implemented the Eliminating Disparities in Asthma Care (EDAC) Collaborative to improve the quality of asthma care delivered in 7 provider sites located in Central Brooklyn, New York. EDAC was a partnership of the New York State Medicaid and Asthma Control Programs, 6 New York City-based managed care plans, and community-based health care providers. Over the 5-year funding period, improvements in documented asthma severity diagnosis and control classification were observed. This article describes the EDAC approach, successes, and challenges.