Browsing by Subject "Health Status Disparities"
Now showing 1 - 6 of 6
- Results Per Page
- Sort Options
Item Decreased Emergency Department Utilization by Lower Socioeconomic Status Population as a Result of the COVID-19 Pandemic(2022-05) Plumber, Arifa; Chang, Mary; Marshall, Amanda L.; Idris, Ahamed H.BACKGROUND: The SARS-CoV-2 (virus which causes COVID-19) pandemic has resulted in lower emergency department (ED) volumes. It precipitated business and school closures along with the implementation of physical distancing measures, which culminated in a Shelter-in-Place Order (SIPO) issued for a major urban area county in March 2020. OBJECTIVE: The objective of this study was to determine the effect of the COVID-19 pandemic on access to health care by patients of different socioeconomic status by examining differences in ED volume by zip code stratified by the SocioNeeds Index, a measure of socioeconomic need correlated with poor health outcomes. Our hypothesis was that decrease in patient visits due to the SIPO was not uniform across Dallas County but was based on socioeconomic need and proximity to Parkland's ED. METHODS: This retrospective chart review examines whether there was a quantitative change in patient visits to an urban, tertiary county hospital (Parkland or PMH) ED from 2019-2020 by zip code. The inclusion criterion was any ED visit from a patient with a zip code within Dallas County, and the exclusion criterion was any blank, alphanumeric, or PO box zip codes including zip codes located outside of Dallas County. The SocioNeeds Index, which rates each zip code by demographic factors relative to others in the county, was used as a proxy for the socioeconomic status of residents of each zip code. We mapped daily patient visits by zip code for four phases: Phase 1 was the three months preceding the first COVID-19 case's announcement in Dallas, Phase 2 began with the first COVID case, Phase 3 encompassed when the SIPO was in effect for Dallas County, and Phase 4 comprised the three months following the expiration of the SIPO. We compared this data to records over the same time period from the previous year to control for seasonal variation in the absence of a pandemic. RESULTS: There were 275,756 ED patient visits included in this study. We identified a statistically significant decrease in ED visits among patients from all zip codes during the pandemic: 24% between Phase 1 and 4 (p<0.0001) in 2020. Additionally, there was a decrease in visits after the first case in Dallas: Phase 2 (-14%, p<0.0001), Phase 3 (-41%, p<0.0001) and Phase 4 (-25%, p<0.0001) when compared to 2019 but an increase in visits (36%, p< 0.0001) in 2020 once the SIPO expired. Zip codes with highest SNI ranks (highest needs communities) were found to have greater reductions in visits during the SIPO and more sluggish recoveries after the expiration of the SIPO in comparison to those zip codes with the lowest needs. An examination of the geographic distribution of self-reported zip codes indicated that most communities in Dallas County saw a reduction in patient visits over Phases 2 and 3 (especially zip codes further from the ED) and an increase in visits during Phase 4 although not to pre-pandemic values. These changes, however, were not uniform across the county and were tied to socioeconomic factors and proximity of residence to PMH. CONCLUSION: Our hypothesis was supported by the results obtained: a significant decrease in ED visits was observed during the pandemic relative to a non-pandemic year among patients in most zip codes except those with the highest socioeconomic status, suggesting that the threat of the virus and SIPO deterred patients disproportionately from the higher socioeconomic needs communities from accessing healthcare. These results could have implications for future pandemic public health messaging and targeted outreach to communities with barriers to healthcare access.Item How the health and rights framework evolved and how that affects clinical research(2020-01-14) Inrig, StephenWhile the World Health Organization's (WHO) constitution defined "the highest attainable standard of health" as "a fundamental right of every human being" as early as 1946, it was not until the late 1980s, amidst the AIDS pandemic, that WHO representatives developed the "Health and Human Rights Framework" as a lens through which to understand and address inequalities in the global burden of disease. While the concept itself met with broad and rapid approval, several factors made it difficult to operationalize in health delivery. Beginning in the early 2000s, however, practitioners have made important strides in operationalizing these concepts in ways that have positively influenced local and global health delivery. This talk explores the development of "health and human rights" concepts over time, giving particular attention to the implications they have on drug research, clinical research ethics, the pharmaceutical industry, and the right to access medicines.Item Proviso partners for health: a model for REAL cultural consciousness(2019-03-12) Hatchett, Lena A.Proviso Partners for Health is a multi-sector coalition convened by the Loyola University Stritch School of Medicine. Over the last three years, our team has established a health and economic opportunity movement with low income communities of color. The vision is to establish sustainable local policies, systems and environmental strategies to promote community health, well-being and equity. The REAL framework for equity includes, 1) resilience, 2) economics, 3) accountability, and 4) love. First, the presentation will introduce our practice of shared power and shared leadership as a vital role for sustainability. Second, trust and relationship building to leverage organizational assets is discussed. The lessons learned will guide ethical analysis of trust and collaboration among cross-sector partners from schools, community, and public health care to explore pathway towards sustainability.Item The role of race in lung function interpretation: a modern view(2023-01-20) Kaminsky, David A.Item Structural competency: new frameworks to understand and respond to inequities in health(2023-04-11) Holmes, Seth M.Research on disparities in health and in medical care demonstrates that social, economic, and political inequities are key drivers of poor health outcomes. The influence of such inequities on health has long been noted by clinicians and public health practitioners, but such content has been incorporated unevenly into clinical training and clinical ethics. Recently proposed by clinicians, ethicists, and medical social scientists, the framework of "structural competency" offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. This lecture will cover key terms and primary domains of structural competency to allow medical practitioners, ethicists, and researchers to perceive and respond to social inequities in health in new ways.Item Understanding and addressing health disparities in liver disease and liver cancer(2022-05-20) Rich, Nicole