5 results
Telemedicine and health disparities: Association between the area deprivation index and primary care telemedicine utilization during the COVID-19 pandemic
- Mina Ostovari, Zugui Zhang, Vishal Patel, Claudine Jurkovitz
-
- Journal:
- Journal of Clinical and Translational Science / Volume 7 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 10 July 2023, e168
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Introduction:
The rapid implementation of telemedicine during the COVID-19 pandemic may have exacerbated the existing health disparities. This study investigated the association between the area deprivation index (ADI), which serves as a measure of socioeconomic deprivation within a geographic area, and the utilization of telemedicine in primary care.
Methods:The study data source was electronic health records. The study population consisted of patients with at least one primary care visit between March 2020 and December 2021. The primary outcome of interest was the visit modality (office, phone, and video). The exposure of interest was the ADI score grouped into quartiles (one to four, with one being the least deprived). The confounders included patient sociodemographic characteristics (e.g., age, gender, race, ethnicity, insurance coverage, marital status). We utilized generalized estimating equations to compare the utilization of telemedicine visits with office visits, as well as phone visits with video visits.
Results:The study population included 41,583 patients with 127,165 office visits, 39,484 phone visits, and 20,268 video visits. Compared to patients in less disadvantaged neighborhoods (ADI quartile = one), patients in more disadvantaged neighborhoods (ADI = two, three, or four) had higher odds of using phone visits vs office visits, lower odds of using video visits vs office visits, and higher odds of using phone visits vs video visits.
Conclusions:Patients who resided in socioeconomically disadvantaged neighborhoods mainly relied on phone consultations for telemedicine visits with their primary care provider. Patient-level interventions are essential for achieving equitable access to digital healthcare, particularly for low-income individuals.
69567 Association between area deprivation index and long-term diabetic complications in a population of diabetic patients’
- Riza C. Li, Kevin Ndura, Claudine T. Jurkovitz
-
- Journal:
- Journal of Clinical and Translational Science / Volume 5 / Issue s1 / March 2021
- Published online by Cambridge University Press:
- 30 March 2021, pp. 123-124
-
- Article
-
- You have access Access
- Open access
- Export citation
-
ABSTRACT IMPACT: To improve care and services for patients with chronic disease, health systems are focusing on evaluating social determinants of health of populations at risk; this information is currently not available in electronic health records (EHR) but we show that it could be accessed by linking area deprivation index to EHR. OBJECTIVES/GOALS: To inform care delivery and policy, health care systems are studying ways of improving social determinants of health (SDoH) in patients with chronic disease such as diabetes (DM). Our goal was to better characterize the SDoH of a cohort of DM patients by using the area deprivation index (ADI). METHODS/STUDY POPULATION: Our study population included DM patients seen in primary care practices in 2013-2017. We integrated ADI levels to data extracted from electronic health records (EHR). ADI ranks neighborhoods by socioeconomic status calculated from income, education, employment and housing quality. ADI has 10 levels that we grouped into 5 categories of 2 levels. Addresses were geocoded using ArcMap to obtain census block groups information. We used multivariable logistic regression to calculate odds ratios (OR) and 95% confidence intervals [], with diabetic complications as a binary dependent variable, ADI levels as the exposure, and demographics, smoking status and number of comorbidities as confounders. RESULTS/ANTICIPATED RESULTS: Our study population included 8,558 patients: 56% were female, 61% white, 31% black, 28% were on Medicare, 66% on commercial insurance, median age was 55 years, 57% never smoked, 10% had no comorbidities, 42% had 3 or more comorbidities, and 37% developed diabetic-related complications. After evaluating collinearity and adjusting for confounders, our multivariable analysis showed that worsening ADI was associated with higher likelihood of complications. Compared to ADI level 1&2 (least disadvantaged), the ORs for patients residing in neighborhoods with ADI levels 3&4, 5&6, 7&8, 9&10 (most disadvantaged) were respectively 1.01 [0.88-1.16), 1.20 [1.04-1.39], 1.15 [0.99-1.33], 1.30 [1.11-1.52]. DISCUSSION/SIGNIFICANCE OF FINDINGS: Neighborhood ADI could provide precious information to health care providers when associated to the EHR. We found that neighborhoods with ADI level 9&10, which is not collected in the EHR, was significantly associated with a higher burden of disease. ADI could serve as a proxy for evaluating SDoH.
4476 Association between socioeconomic status and comorbid conditions in a population of diabetes patients
- Riza Li, Kevin Ndura, Claudine Jurkovitz
-
- Journal:
- Journal of Clinical and Translational Science / Volume 4 / Issue s1 / June 2020
- Published online by Cambridge University Press:
- 29 July 2020, pp. 22-23
-
- Article
-
- You have access Access
- Open access
- Export citation
-
OBJECTIVES/GOALS: To reduce hospitalizations, health care systems are studying ways of improving social determinants of health (SDoH) in patients with chronic disease such as diabetes (DM). Our goal was to better characterize the SDoH of a cohort of DM patients by using socio-economic information from census data. METHODS/STUDY POPULATION: Our study population included DM patients seen in primary care practices of a large health care system in 2013-2017. We integrated socio-economic status (SES) information from the American Factfinder to data extracted from the electronic health record (EHR). Addresses for the cohort were geocoded using ArcMap to obtain the census tract information for median income, poverty status, educational level, and supplemental food benefits using American Community Survey 5-Year estimates. We used multivariable logistic regression to calculate odds ratio (OR) and 95% confidence intervals [], with 3+ comorbidities as the dependent variable and demographic and SES variables as independent variables. RESULTS/ANTICIPATED RESULTS: Our study population included 13,782 patients: 53% were female, 65% white, 28% Black, 27% were on Medicare, 3% on Medicaid, median age was 60, 53% had 3+ comorbidities. Median income was $66,243, poverty level 6%, receiving food benefits 8%, no high school degree 8%, and bachelor’s degree or higher 30%. After evaluating collinearity, our multivariable analysis showed that patients with 3+ comorbidities were more likely to have income < $52,000 (lower quartile) versus $84,001 (upper quartile), OR = 1.2 [1.0-1.4]; be female, OR = 1.6 [1.4-1.7]; divorced or widowed versus married, OR = 1.5 [1.3-1.7], 1.4 [1.3-1.6]; and be on Medicare, Medicaid or both, OR = 2.4 [2.2-2.6], 2.2 [1.8-2.6], 6.0 [4.5-8.3]. DISCUSSION/SIGNIFICANCE OF IMPACT: Census tract-based SES could provide invaluable information to health care providers when associated to the EHR. We found that median income, which is not collected in the EHR, was significantly associated with a higher burden of disease. Census tract SES could serve as a proxy for evaluating SDoH.
3459 Modeling Emergency Department Length of Stay of Patients With Substance Use Disorder Using an Accelerated Failure Time Model
- Keshab Subedi, Zugui Zhang, Terry Horton, Claudine Jurkovitz
-
- Journal:
- Journal of Clinical and Translational Science / Volume 3 / Issue s1 / March 2019
- Published online by Cambridge University Press:
- 26 March 2019, p. 49
-
- Article
-
- You have access Access
- Open access
- Export citation
-
OBJECTIVES/SPECIFIC AIMS: Emergency department (ED) length of stay (LOS) is one of the important indicators of quality and efficiency of ED service delivery and is reported to be both cause and result of ED crowding. Increased ED LOS is associated with ED crowding, increases service cost and sometimes poor patient outcome. Substance abuse is one of the major determinants of morbidity, mortality and healthcare needs. Substance abuse may confound the healthcare and service needs of patients in the ED irrespective of primary purpose of their ED visit and may lengthen the ED LOS. The aim of this study was to evaluate the effect of patients’ demographic and clinical characteristics and of different patient-related activities such as screening brief intervention and referral to treatment (SBIRT) on the ED LOS of patients discharged from the ED with a diagnosis of substance abuse. METHODS/STUDY POPULATION: We conducted a retrospective data analysis of electronic health records. The study population included 26971 patients who visited our hospital ED between 2013 and 2017, had a history of substance abuse and were discharged from the ED. An accelerated failure time (AFT) model was used to analyze the influence of covariates on patient ED LOS. The predictor factors in the model included age, gender, ED arrival shift and weekday, diagnosis history of mental health and drug use, acuity triage level from 1 to 5, with 1 being worse severity, and whether any lab tests were ordered, SBIRT intervention and whether patient was homeless. The AFT model is an alternative to the Cox Proportional Hazard Ratio model, which directly models the log of ED LOS as a function of a vector of covariates. The model defines the increase or decrease in LOS with the changes in the covariate levels as an acceleration factor or time ratio (TR). RESULTS/ANTICIPATED RESULTS: The overall median ED LOS was 4 hours with IQR of 4.2 hours. The average age of the study population was 39.3 years, 58.6% of the patients were male and 57% where White; 63.4% had a history of drug use; 43% had a history of mental health issue, and 0.4% were homeless. In the analysis using the AFT model, increased age (a year increase, TR =1.01, p =0.008), female sex (TR=1.044, P<0.001), SBIRT (TR=1.525, P <0.001), history of mental health issue (TR=1.117, P<0.00), evening arrival (evening vs night, TR=1.04, p=0.006), history of drug use (drug vs alcohol only, TR=1.04, p=0.001), higher acuity (triage level 1 vs 5, TR=2.795, p <0.001) and homelessness (TR=1.073, P = 0.021) lengthened the ED LOS. In contrast, weekend arrival (TR=0.956, p=0.004) and day shift arrival (day vs night, TR=0.958, p=0.004) shortened the ED LOS. DISCUSSION/SIGNIFICANCE OF IMPACT: We identified gender, age, SBIRT, arrival shift, weekend arrival, mental health status, substance abuse, acuity level and homelessness to be significant predictor of ED LOS. The fact that SBIRT increased the LOS should be balanced with the advantages of engaging patients into substance use disorder treatment. Understanding the determinants of ED LOS in this population may provide useful information for physicians or patients to better anticipate an individual’s LOS and to help administrators plan the ED staffing and other resources mobilization.
2381: Characterizing delayed transition to adult care in children with chronic kidney disease
- Sarahfaye Dolman, Richard Caplan, Mitchell R. Fawcett, Jr, Edward Ewen, Joshua Zaritsky, H. Timothy Bunnell, Rubeen Israni, Sidney J. Swanson, Claudine Jurkovitz
-
- Journal:
- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, pp. 75-76
-
- Article
-
- You have access Access
- Open access
- Export citation
-
OBJECTIVES/SPECIFIC AIMS: As part of a larger effort to create a longitudinal record of care for patients with chronic kidney disease (CKD) in Delaware, we assessed transitions of care from pediatric to adult care. This study examined the length of time between last pediatric contact and first contact in the adult system in order to determine characteristics associated with delayed transition to adult care. METHODS/STUDY POPULATION: Patients who receive pediatric care at the Nemours/Alfred I. duPont Hospital for Children (Nemours) are transitioned to adult care between the ages of 18 and 21. Our study population consists of all patients seen in the Nephrology unit at Nemours for CKD, hypertension (HTN), or diabetes who turned 21 years old between 2007 and 2013. Records of office visits from Nemours, Christiana Care Health System (CCHS), and Nephrology Associates, P.A. (NAPA) were transformed into the OMOP common data model and merged. Patients who had at least 1 record in the Nemours EHR of pediatric care before age 21 and had at least 1 record in the CCHS or NAPA adult EHRs were considered transitioned. To identify characteristics associated with delayed transition to adult care, we compared gender, race, ethnicity, age, comorbidities, and level of kidney function at the last pediatric visit between patients whose transition gap was less than 1 year and patients whose gap was 1 year or more. Kidney function was estimated by calculating glomerular filtration rate (GFR). Nemours estimates GFR in children using the revised Schwartz equation, which is based on serum creatinine and height. To calculate adult GFR, we used the CKD-Epi equation, which is based on serum creatinine, age, sex, and race and is widely used to derive adult GFR. As kidney function declines, GFR decreases. We used Fisher exact test to compare categorical variables and t-test to compare age and GFR. RESULTS/ANTICIPATED RESULTS: We found only 109 (25%) patients who had records in our adult offices out of the 440 Nemours patients in our data set. Of the 109 transitioned patients, 54 had office visits at CCHS, 37 at NAPA, and 18 at both locations. Examining the office visits of the 109 transitioned patients, 34 (31%) had an overlap in visits defined as an office visit at CCHS or NAPA before the last office visit at Nemours, and 75 (69%) did not have an overlap. The median gap between last pediatric and first adult office visit for the 75 patients without an overlap was 615 days (range 8–3495 d). Only 6 (6%) of the 109 transitioned patients had overlapping GFR measurements from pediatric to adult care, and all of the adult GFR calculations (CKD-Epi) were greater than the pediatric GFR calculations (Schwartz). The difference between child and adult GFR ranged from 8.2 to 87.1 mL/minute per 1.72 m2. DISCUSSION/SIGNIFICANCE OF IMPACT: During the transition from pediatric care to adult care, many young adults with CKD experience declines in health outcomes and comorbidities such as diabetes and HTN complicate self-management. Lack of overlap between pediatric and adult care office visits indicates a delay in executing this transition. In our population of 109 transitioned patients, 69% did not have an overlap in care, and 50% of those without overlap had a gap of more than 615 days (1 y, 8 mo). Our analysis suggests that young adults who are younger at last pediatric office visit are more likely to delay transitioning to adult care. Transitioning from the nurturing environment of pediatric care to adult care is a complex process and could be challenging for young adults with CKD. Transition clinics may be necessary to improve the coordination of care and help these young adults keep their physician appointments.