Health, Equity, and COVID Outcomes
Health, Equity, and COVID Outcomes
Diabetes
Type 2 Diabetes screening program
Disparities related to race, ethnicity, and socioeconomic factors have been presented in type 2 diabetes (T2D) for decades. Currently, there are 8.5 million individuals in the U.S. who were unaware their diagnosis, highlighting the importance of early recognition in slowing down the progression of the disease and its potential complications. Urban emergency departments (EDs) usually serve as the primary source of care for racial and ethnic minorities as well as underserved patients, who face the greatest prevalence of T2D. Building upon the accomplishments of our institution’s HIV and HCV screening initiatives in the emergency department, and with the support by the HEPP pilot program, we conducted T2D screening program in the ED setting.
A best practice alert (BPA) was built into the electronic medical record (EMR) that flagged ED patients who met the screening criteria for T2D. The providers had the option to add hemoglobin A1c (HbA1C) order if blood was drawn. In the pilot study, among the 8441 ED patients, the BPA triggered test for 2576, and 2074 patients had a HbA1c result. Approximately half of the results (52%, n=1085) were abnormal. 70% of those abnormal results were prediabetes (HbA1c 5.7-6.4) and 30% were diabetes (HbA1c≥6.5). Among the 352 patients who were contacted by telephone successfully, the average age was 52.2 years,55% were female, 65% were non-Hispanic Black, 20% were Hispanic, and 15% were Non-Hispanic White/Other. Half were on either Medicare or Medicaid, and 4% were uninsured.
The T2D screening program were implemented in our emergency department successfully to detect a significant portion of patients who had undiagnosed prediabetes and T2D. The majority of those patients are from racial/ethnic minority backgrounds as well as those with low-income status. Future research is focused on the linkage of these new patients to diabetes education and care. It is also important to establish a cohort of participants with no prediabetes and those with prediabetes to found mechanisms of diabetes progression through assessing environmental exposures and genetics.
Office of Health Equity - UI Health
Outpatient Transportation Pilot
Access to transportation is a documented social determinant of health (SDOH). Patients without access to reliable transportation are more likely to cancel appointments for primary and specialty care as well as follow-ups. Conditions that go untreated or deviate from the standard treatment plan may result in the patient requiring more acute care later, with higher risk of adverse outcomes. Alleviating this barrier for our low-income patients will result in more access that is equitable to healthcare and, in turn, better health outcomes.
The vision for the outpatient transportation pilot is to utilize rideshare for eligible patients. Providers will be able to refer patients within the electronic health record. Non-clinical staff will be able to contact the program via phone and email to refer patients for transportation assistance. There are 2 rideshare platforms that we will be testing during the pilot phase: Kaizen (which we currently use for our inpatient PRONTO program) and Roundtrip. The pilot will allow us to evaluate which platform best meets our needs for efficient transportation arrangement, rideshare issue resolution, and data reporting.
We have hired 2 transportation coordinators and 1 program director for the pilot. As we get the pilot up and running, we will better understand the volume of patients that will use the service and can scale accordingly. The pilot is expected to run in select clinics for at least 90 days, allowing us to validate our optimization the program’s workflows. Once the pilot is deemed successful, we will expand the outpatient transportation service to all our clinics at our Outpatient Care Center (OCC) and Specialty Care Building (SCB).
Sickle Cell Project
Continuous Remote Patient Monitoring in Patients with Sickle Cell Disease
Short description of the project: Delays in acute management of vaso-occlusive crisis in patients with sickle cell disease may increase rates of hospitalization and prolong lengths of hospital stay. This clinical project started as a partnership between the emergency and sickle cell departments within UI Health and Blue Cross Blue Shield of Illinois (BCBSIL) to place continuous remote monitoring devices for patients with Sickle Cell disease and develop an operational plan that improves pain control and reduces need for hospitalization.
Impact: The intended impact was to reduce Emergency Department/Acute Care visits and hospitalizations in the cohort while effectively managing the patient’s pain.
Metrics:
– Successful enrollment of sickle cell patients
– Reduction of Emergency Department Visits/Reduction of Hospital Admissions
Highlights:
Remote monitoring data provides valuable physiologic information on patients before they have an event.
UI Health Advanced Practice Providers can successfully administer the program and provide clinical support.
Overall, patients adopt the technology well, although some did have a steep learning curve and difficulty with compliance. Some patients need more support than others.
Mobile Health Platform
Mobile Health Accessibility for Socioeconomically Disadvantaged COVID Research Participants
Short description of the project: Digital tools have the potential to enhance the precision and efficiency of research. However, they can also impose challenges, especially for socioeconomically disadvantaged individuals. Our study seeks to assess the degree and types of assistance participants require navigating these digital platforms. We will also take a deeper look into the participants who decline to utilize the digital tools even with the additional assistance with structured interviews to understand what barriers exist in more detail. Specifically, we aim to identify and compare the challenges faced by individuals with high and low Social Vulnerability Index (SVI) scores.
Impact: The intended impact of the program would be to prepare digital tools that could help reduce barriers and improve participants’ enrollment and engagement with the mobile health platform.
Metrics:
- Response and success rate with mobile health platform.
- Effort needed to engage this population in mobile health.
- Number of participants reached, the number who could not be reached, number of refusals, any technological barriers faced by participants and reasons of refusals, and the final number of participants successfully connected to the app, number of participants who already have a wearable health device, and the number who expressed interest in using such a device.
- Creating the tool/strategy/digital or non-digital aid
- Completion of interviews, and a report with a summary of qualitative results.
- The number (and characteristics) of participants that downloaded, installed and logged in to the app, and the frequency of subsequent engagement with the app.