Browsing by Subject "Healthcare Disparities"
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Item Acute myocardial infarction in women: does a gender gap persist?(2018-03-16) Collins, Laura J.Item Assess Effectiveness of Opioid Prescription Policies for Acute Pain Management(2022-05-01T05:00:00.000Z) Machchhar, Arti; Reed, W. Gary; Phelps, Eleanor; Kandil, EnasBACKGROUND: In 2017, the Department of Health and Human Services (HHS) declared the Opioid Crisis a public health emergency. Regulatory agencies and institutions have adopted several guidelines to ensure opioids are prescribed appropriately. In October 2014, the DEA changed the schedule of hydrocodone combination products (HCPs) from schedule III to schedule II narcotics. This led to a substantial rise in Tylenol 3 prescriptions at the University of Texas at Southwestern Medical Center (UTSW) due to the institutional guideline that prevents residents from prescribing schedule II narcotics without documented approval from an attending physician. OBJECTIVE: We sought to evaluate whether the UTSW guideline preventing residents from prescribing schedule II narcotics serves to improve patient safety and pain management. METHODS: Prescription data and associated patient demographic data was pulled directly from the UTSW electronic medical record (EMR) for one year prior to and following the rescheduling of HCPs. Additional data was pulled for the 2019 and 2020 calendar years. The proportion of T3 and schedule II narcotic prescriptions was calculated for all time periods and stratified for age, race, provider type, and department. RESULTS: One year before the rescheduling of hydrocodone, the vast majority of prescriptions were schedule II narcotics at 98.92% and T3 was very rarely prescribed at 1.08%. In 2014 - 2015 following the rescheduling of HCPs, there was an overall decrease in opioid prescriptions and the proportion of T3 prescriptions rose to 49.94%. In 2019 and 2020, the overall number of opioid prescriptions increased to 17,297 in 2019 and 15,395 in 2020 and the proportion of T3 prescriptions decreased to 37.12% and 33.89% respectively. CONCLUSION: The rescheduling of HCPs led to the dramatic shift in Tylenol 3 prescriptions, indicating that regulatory agencies and institutional guidelines are driving prescribing habits. Tylenol 3 is being prescribed at a significant rate however, information regarding its addictive potential, metabolic effects, and potential adverse effects remains relatively unknown. The drug policies and institutional guidelines discussed disproportionately affect people of color and lower socioeconomic class.Item Case studies in bias in medicine: audience participation required(2021-10-08) Capers, Quinn, IV; Jamshed, Namirah; Estelle, Carolee; Shoultz, Thomas; Islam, AnaItem Improving survival & reducing racial disparities in cardiac arrest(2023-05-19) Girotra, SaketItem Preparing physicians for an evolving demographic landscape(2018-12-14) Nesbitt, Shawna D.Item Race and kidney function: the fuss, fuzziness, fiction, facts, and fix(2022-02-04) Powe, Neil R.Item Redrawing the boundaries of medicine: the case for social determinants of health(2016-10-28) Nguyen, Oanh KieuItem Reflections on a Single Institution Cochlear Implant Experience(2020-05-01T05:00:00.000Z) Schauwecker, Natalie Marie-Rose; Hunter, Jacob B.; Kutz, J. Walter; Isaacson, BrandonOBJECTIVE: To utilize cochlear implant (CI) outcomes to further explore health disparities, hearing preservation (HP) surgery, and standardization of pre- and post-operative CI assessment, with the goal of predicting and improving CI outcomes, including quality of life. STUDY DESIGN: Retrospective chart review of adult patients who underwent CI evaluation and surgery at a single institution between 2009 and 2018. MAIN OUTCOME MEASURES: Improvement in open sentence testing postoperatively, according to patient marital status, race, and gender, as well as HP status. RESULTS: Post-operative performance: Of the 402 total patients who underwent CI during the study period, 372 were followed and programmed at the institution. A total of 87% of these patients achieved "good performance" with their CI, based upon an improvement in post-operative open sentence testing ≥10%. Patient demographics, including gender, age, marital status, and race did not significantly affect whether a patient achieved higher post-operative performance levels. Unmarried patients saw poorer outcomes, but this did not reach significance (37.5% vs 24.3%, p = 0.2123). HEARING PRESERVATION: HP surgery evolved during the study period, with modern "soft surgery" technique defined by perioperative steroids, round window cochleostomy, and atraumatic CI insertion. A slight majority of HP surgical patients maintained low frequency hearing postoperatively (54.2%). However, documentation of preserved hearing was limited, with only 53.7% of patients with recorded unaided audiograms. Analyzing speech perception outcomes, HP candidates, and patients who underwent "soft surgery," did not demonstrate significantly larger improvements with their post-operative open sentence testing when compared to patients who underwent standard CI, and were concurrently not HP candidates, during the study period (overall improvement: 41% vs 53% respectively, p = 0.10). Additionally, non-white hearing preservation candidates were less likely to retain low frequency hearing post-operatively, but this did not reach significance in the study population (22.2% vs 8.5%, p=0.0992). However, HP surgery, and overall CI surgery outcomes assessment was limited by lack of standardized documentation. CONCLUSIONS: Unmarried patients and non-white patients continue to warrant special attention post-operatively to ensure equability in CI. HP surgery has evolved over the past decade. All, patients, should also have their quality of life evaluated, with standard assessment through open sentence testing failing to demonstrate the added benefit of HP, and likely the overall benefit of any CI. There continues to be a need for standardization in CI evaluation, documentation, and follow-up to allow for larger outcomes based research. IRB: STU 032018-085 PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED: The field of CI is in need of large outcome based studies to better predict which patient factors, including demographics and HP status, may predict CI success. DESIRED RESULT: Systematic review of a decade of cochlear implantation outcomes in order to identify areas in which improvement will result in increased ability to assess outcomes, and augmented cochlear implant success leading to improved CI patient quality of life.Item Socioeconomic Disparities in Follow-up Care for Young Adults with Type 1 Diabetes and Impact on Glycemic Control(2018-01-23) Viroslav, Hannah; Hsu, Jesse; Long, Judith; Eiel, Jack; Agarwal, ShivamiBACKGROUND: Only 13% of young adults (YA) with type 1 diabetes (T1D), nationally, achieve the American Diabetes Association glycemic target of <7%. YA with T1D of low socioeconomic status (SES) have incrementally worse glycemic control, due to personal, social, and healthcare system factors. Engagement in regular diabetes follow-up has been shown to be beneficial in preventing acute complications and improving glycemic control in YA with T1D, but little is known whether disparities exist in follow-up care based on SES. The purpose of this study was to a) compare differences in diabetes follow-up patterns between low and higher SES YA with T1D and b) evaluate the impact of interrupted care on glycemic control. METHODS: 203 YA with T1D, 18-30 years, were recruited from the adult diabetes clinic at the University of Pennsylvania. Demographic, clinical, and follow-up visit data were extracted from medical charts. Low SES individuals were defined as having medical coverage under a federal or state-sponsored (public) insurance plan while higher SES individuals were defined as having coverage under a commercial (private) insurance plan. Baseline demographic and clinical characteristics were compared by insurance type. Multilevel mixed effects logistic and linear regression models were used to compare differences in follow-up rates and the impact on glycemic control. All models were adjusted for age, sex, race, diabetes duration, insulin regimen, and time in diabetes providerメs care. RESULTS: 203 participants were included for analysis. Mean age was 23.5 years and 55% were female. Forty-six percent (n=95) had public insurance and 53% (n=108) had private insurance; 42% (n=40) of publicly insured YA were black compared to 11% (n=12) of privately insured YA. Mean diabetes duration was 11.8 years with no significant difference between publicly and privately insured. Mean overall HbA1c was 9.0%, with mean HbA1c 9.9% for publicly insured and 8.8% for privately insured (p<0.001). Publicly insured YA were 1.5 times more likely to no show for scheduled visits (OR=1.53, p=0.009) and were 2.3 times more likely to be lost to diabetes follow-up after 6 months (OR 2.3, p<0.001), compared to privately insured YA. Glycemic control worsened substantially with each successive no show to a scheduled visit (HbA1c +1.10% per no show, p=0.001). CONCLUSION: Low SES YA with T1D are less likely to consistently follow up in diabetes care, are more likely to be completely lost to diabetes care after 6 months, and have worse glycemic control as a result of inconsistent follow-up, compared to higher SES YA. Further research needs to explore why disparities in follow-up exist, as well as innovative healthcare delivery modalities.Item Understanding and addressing health disparities in liver disease and liver cancer(2022-05-20) Rich, Nicole