Publications by authors named "John F Steiner"
Introduction: Social health is increasingly a focus of healthcare systems. Representative and intersectional analyses of individuals' social risks such as food, housing, transportation, and financial insecurity and their interest in receiving assistance from the healthcare system (social needs) can provide healthcare organizations with more nuanced estimates that can lead to more effective interventions.
Methods: The authors conducted cross-sectional survey of a representative sample of 43,936 Kaiser Permanente members in December 2019-September 2020.
Objective: To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among nonhospitalized children with community-acquired pneumonia.
Study Design: In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2 months through 17 years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record.
Background: Missed colonoscopy appointments delay screening and treatment for gastrointestinal disorders. Prior nonadherence with other care components may be associated with missed colonoscopy appointments.
Objective: To assess variability in prior adherence behaviors and their association with missed colonoscopy appointments.
Importance: Most undocumented immigrants with kidney failure rely on emergency dialysis (defined as dialysis after a patient presents as critically ill) and experience significant depression and anxiety and high mortality. Culturally and language-concordant peer support group interventions may be associated with reduced depression and anxiety and may provide emotional support.
Objective: To investigate the feasibility and acceptability of a single-group peer support group intervention.
Background: The strategies patients use to organize medications (eg, pill dispenser) may be reflected in adherence measured at follow-up. We studied whether medication organization strategies patients use at home are associated with adherence measured using pharmacy-fills, self-report, and pill counts.
Design: Secondary analysis of data from a prospective randomized clinical trial.
Background: Medically tailored meals (MTM) may be beneficial to patients after hospital discharge.
Objective: To determine if 2 versus 4 weeks of MTM posthospitalization will improve patient outcomes.
Design: Randomized unblinded trial.
Hypertension care during the COVID-19 pandemic in an integrated health care system.
J Clin Hypertens (Greenwich)
April 2023
Article Synopsis
- The study analyzed the impact of the COVID-19 pandemic on hypertension care, medication adherence, and blood pressure in 64,766 individuals from an integrated health care system.
- A significant drop in medication adherence was noted, falling from 86.0% to 80.8%, while in-person visits decreased and virtual consultations increased during the pandemic.
- Many patients missed clinical blood pressure measurements, highlighting the need for targeted outreach to ensure continuity of care and better hypertension control post-pandemic.
Objective: The objective of this program evaluation was to measure the impact of a medically tailored meals (MTM) intervention on participants' self-reported recovery and satisfaction while recovering from a recent hospitalization.
Design: A qualitative design was employed using a brief survey among all participants at the end of the intervention and phone interviews with a subset of participants.
Sample: Participants in this study were recently discharged from the hospital and were members of (redacted for review) who had received 2-4 weeks of MTM.
In the United States, hypertension is more common among individuals from racial and ethnic minority groups. Hypertension control rates are also lower for minority group members compared with White Americans. However, little research has employed well-established theoretical perspectives on health behavior, such as the Theory of Planned Behavior (TPB) and the Model of Goal-Directed Behavior (MGB), to better understand racial differences in rates of hypertension control.
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- Health systems are trying to help people deal with tough social situations to make healthcare better.
- A survey was done with Kaiser Permanente members in Southern California to see how their social risks and need for help changed over time.
- The study found that people's social risks stayed pretty consistent, but their desire for help changed more often; also, only housing problems led to more emergency care later.
Objective: To determine whether a multicomponent intervention focused on early peanut introduction was associated with a lower peanut allergy incidence in young children.
Methods: The study cohort comprised all children born January 1, 2013 through December 31, 2018 receiving care at a large health care organization. Intervention activities occurred over 16 months and included provider educational programs, electronic health record tools, and new patient instructions.
Background: Burnout among clinicians is common and can undermine quality of care, patient outcomes, and workforce preservation, but sources of burnout or protective factors unique to clinicians working in safety-net settings are less well understood. Understanding these clinician experiences may inform interventions to reduce burnout.
Objective: To describe clinician perspectives on sources of burnout in a safety-net healthcare system.
Article Synopsis
- The study aimed to explore how pre-pregnancy diabetes, gestational diabetes, body mass index, and social factors at the county level relate to infant macrosomia among American Indian/Alaska Native women receiving care from the Indian Health Service.
- Data was collected from 1,136 births in 2011, using mixed models to analyze the relationships between maternal health status, social determinants, and macrosomia.
- Findings revealed that younger mothers, higher rates of overweight/obesity, and certain diabetes conditions increased the likelihood of having larger infants, highlighting critical health disparities in this population.
Article Synopsis
- - The study investigates how social determinants of health (SDOH) influence overweight and obesity rates among American Indian and Alaska Native (AI/AN) children aged 2-11 who used Indian Health Service between 2010 and 2014.
- - About 49% of the children were classified as overweight or obese, with severe obesity at 20% for ages 6-11, revealing a notable impact of poverty on these health outcomes.
- - Findings suggest that higher poverty levels correlate with increased chances of being overweight/obese, indicating the need for targeted efforts in research and policy to tackle economic instability among young AI/AN populations.
Article Synopsis
- Scientists studied how feelings of loneliness in older people affected their mental health, like feelings of sadness and anxiety.
- They looked at 24,666 individuals aged 65 and older over two years, classifying them based on their loneliness levels.
- Results showed that being newly lonely can make people feel more depressed and anxious, while those who felt less lonely had improvements in their mood.
Importance: Latinx individuals in the United States have lower COVID-19 vaccination rates and higher rates of COVID-19 infections, hospitalizations, and deaths than non-Latinx White individuals. Little is known about the perspectives of Latinx adults who had not received the COVID-19 vaccination and were hospitalized for COVID-19.
Objective: To describe the perspectives of Latinx individuals who were unvaccinated and subsequently hospitalized for COVID-19.
Racial and Ethnic Equity in Care for Hypertension and Diabetes in an Urban Indian Health Organization.
J Racial Ethn Health Disparities
June 2023
Approximately 70% of American Indian/Alaska Native (AI/AN) individuals reside in urban areas. Urban Indian Health Organizations (UIHOs) provide culturally engaged primary care for AI/AN patients and members of other racial and ethnic groups who have experienced disparities in diabetes and hypertension care, and are commonly affected by social and economic barriers to care. We assessed whether disparities were present between the racial and ethnic groups served by the largest UIHO in the USA.
View Article and Find Full Text PDFObjective: American Indian and Alaska Native peoples (AI/AN) have a disproportionately high rate of obesity, but little is known about the social determinants of obesity among older AI/AN. Thus, our study assessed social determinants of obesity in AI/AN aged ≥ 50 years.
Design: We conducted a cross-sectional analysis using multivariate generalised linear mixed models to identify social determinants associated with the risk of being classified as obese (BMI ≥ 30·0 kg/m).
Background: Social vulnerability indicators are associated with health care inequities and may similarly impede ongoing participation in research studies. We evaluated the association of social vulnerability indicators and research participant attrition in a trial focused on reducing health disparities.
Methods: Self-identified White or Black adults enrolled in the HYVALUE trial (Hypertension and VALUEs), a randomized trial testing a values-affirmation intervention on medication adherence, from February 2017 to September 2019 were included.
Purpose: Because social conditions such as food insecurity and housing instability shape health outcomes, health systems are increasingly screening for and addressing patients' social risks. This study documented the prevalence of social risks and examined the desire for assistance in addressing those risks in a US-based integrated delivery system.
Methods: A survey was administered to Kaiser Permanente members on subsidized exchange health insurance plans (2018-2019).
Transition to Virtual Asthma Care During the COVID-19 Pandemic: An Observational Study.
J Allergy Clin Immunol Pract
June 2022
Background: The COVID-19 pandemic increased reliance on virtual care for patients with persistent asthma.
Objective: This retrospective cohort study assessed changes from in-person to virtual care during the pandemic. In patients with persistent asthma, compared with the same period before the pandemic.