Good therapeutic connections and patient psychological safety: A qualitative survey study.

Background: Therapeutic connections (TCs) between patients and care providers are important for achieving desired patient outcomes. For patients, TC is associated with greater health self-efficacy, better health status, mental health status, and higher satisfaction with providers.

Purpose: The aim of the study was to examine patients' descriptions of what signals to them they have a TC with their care provider.

Shared Decision-Making and Emergency Department Use Among People With High Blood Pressure.

Introduction: Forty-seven percent of all adults in the US have a diagnosis of high blood pressure. Among all US emergency department (ED) users, an estimated 45% have high blood pressure. The success of high blood pressure interventions in reducing ED visits is partially predicated on patients' adherence to treatment plans.

Factors associated with food insecurity among the chronically ill population during the COVID-19 pandemic in the United States.

Introduction: Little is known about food insecurity among Americans with chronic diseases, one of the vulnerable groups in health care. Factors influencing food insecurity among this population group are especially poorly understood.

Methods: Using data from the COVID Impact Survey, this cross-sectional study sought to examine food insecurity among adults with chronic diseases in the United States and to identify factors associated with their risks for food insecurity during the COVID-19 pandemic.

Influence of Social Determinants of Health on Heart Failure Outcomes: A Systematic Review.

Background Prior research suggests an association between clinical outcomes in heart failure (HF) and social determinants of health (SDoH). Because providers should identify and address SDoH in care delivery, we evaluated how SDoH have been defined, measured, and evaluated in studies that examine HF outcomes. Methods and Results Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, databases were searched for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH on outcomes.

Promoting informed prostate cancer screening decision-making for African American men in a community-based setting.

Purpose: Current screening guidelines for prostate cancer (PCa) encourage men to make individual screening decisions after consulting with their primary care provider to weigh the risks and benefits of undergoing prostate specific antigen (PSA) testing, but many men at high risk of PCa diagnosis (notably African American men) are more likely to be uninsured and lack a primary care provider. An academic-community partnership redesigned its community-based screening program to ensure access to services for African American men, incorporating a session with a trained clinical educator in community settings, designed to increase knowledge and promote informed decision-making regarding PSA testing. This study evaluated effects of the intervention on decision-making outcomes.

Community Health Worker Impact on Knowledge, Antenatal Care, And Birth Outcomes: A Systematic Review.

Objectives: Community health worker (CHW) interventions have been shown to be effective in areas of maternal and child health (MCH), mostly in relation to infant and neonatal mortality. The specific aims of this review were to expand outcomes to include improving knowledge related to pregnancy and infant health and the receipt of antenatal care (ANC), along with birth outcomes. We also summarized the role, characteristics and activities of CHWs in interventions conducted in settings with demonstrated improvements in key MCH outcomes.

Using Collective Impact to Develop a Community-Led Initiative for Improving Black Infant Mortality.

The United States has one of the highest infant mortality rates among developed countries. When stratified by race, disparities are more evident: Black infant mortality rates are 2.5 times higher than non-Hispanic white infants.

Testing the Cognitive Reserve Index Questionnaire in an Alzheimer's Disease Population.

Background: Alzheimer's disease (AD) is the 6th leading cause of death in the United States and has no cure or progression prevention. The Cognitive Reserve (CR) theory poses that constant brain activity earlier in life later helps to deter pathological changes in the brain, delaying the onset of disease symptoms.

Objective: To determine the reliability and validity of the Cognitive Reserve Index questionnaire (CRIq) in AD patients.

Problems paying medical bills and mental health symptoms post-Affordable Care Act.

Healthcare affordability is a worry for many Americans. We examine whether the relationship between having problems paying medical bills and mental health problems changed as the Affordable Care Act (ACA) was implemented, which increased health insurance coverage. Data from the 2013-2016 Health Reform Monitoring Survey, a survey of Americans aged 18-64, were used.

Race/Ethnic Variations in Predictors of Health Consciousness Within the Cancer Prevention Context.

Purpose: Although the literature establishes a link between health consciousness (HC) and prevention behavior, less explored are the individual, social, and health characteristics that are associated with increased HC. Similarly, underexamined is the influence of race and ethnicity on the relationship of these characteristics to higher levels of HC.

Design: This cross-sectional study aims to identify and assess the relative importance of factors associated with higher levels of HC, highlighting the role of race and ethnicity.

Examining peer support and survivorship for African American women with breast cancer.

Objective: More than 3.5 million female breast cancer (BrCa) survivors live in the United States, and the number continues to grow. Health status and quality of life among survivors are variable, and African American (AA) survivors suffer disproportionately from BrCa morbidity and mortality.

Association Between Perceived Discrimination and Emergency Department Use Among Safety-Net Patients in the Southwestern United States.

Objectives: Patients' perceptions of how they are treated in their interactions with the healthcare system represent important and valid measures of healthcare quality that may influence health utilization, outcomes, and costs. Perceived discrimination or the sense of being treated unfairly is an important patient perception known to adversely affect health, but the relation of such perceptions to health-seeking behaviors related to low-acuity emergency department (ED) use is unclear. The objectives of this exploratory study were to describe the prevalence and nature of perceived discrimination or perceived unfair treatment (PD/PUT), and to examine the association of PD/PUT with healthcare utilization among adult safety-net patients in the southwestern United States who sought ED treatment for low-acuity conditions.

Exploring the Value Proposition of Primary Care for Safety-Net Patients Who Utilize Emergency Departments to Address Unmet Needs.

Background: An underlying assumption of strategies intended to promote appropriate primary care over emergency department (ED) use for ongoing health care needs is that patients will understand the "value proposition" of primary care: that they will receive specific benefits from primary care providers over and above what they receive from EDs. However, there is evidence that this value proposition may be unclear to safety-net patients. The goals of this study are to describe factors motivating ED use for low-acuity conditions; describe similarities and differences in usual source of care (USOC) experiences, by ED versus non-ED setting; and assess awareness and perceptions of the patient-centered medical home (PCMH) concept among safety-net patients.

Are cancer-related decision aids appropriate for socially disadvantaged patients? A systematic review of US randomized controlled trials.

Background: Shared decision-making (SDM) is considered a key component of high quality cancer care and may be supported by patient decision aids (PtDAs). Many patients, however, face multiple social disadvantages that may influence their ability to fully participate in SDM or to use PtDAs; additionally, these social disadvantages are among the determinants of health associated with greater cancer risk, unwarranted variations in care and worse outcomes. The purpose of this systematic review is to describe the extent to which disadvantaged social groups in the United States (US) have been included in trials of cancer-related PtDAs and to highlight strategies, lessons learned and future opportunities for developing and evaluating PtDAs that are appropriate for disadvantaged populations.

Reducing preventable emergency department utilization and costs by using community health workers as patient navigators.

Primary care-related emergency department (PCR-ED) utilization, including for conditions that are preventable or treatable with appropriate primary care, is associated with decreased efficiency of and increased costs to the health system. Many PCR-ED users experience actual or perceived problems accessing appropriate, ongoing sources of medical care. Patient navigation, an intervention used most often in the cancer care continuum, may help to address these barriers among medically underserved populations, such as those who are low income, uninsured, publicly insured, or recent U.

The role of patient navigators in eliminating health disparities.

Despite many important efforts to increase equity in the US health care system, not all Americans have equal access to health care-or similar health outcomes. With the goal of lowering costs and increasing accessibility to health care, the nation's new health care reform legislation includes certain provisions that expand health insurance coverage to uninsured and underinsured populations, promote medical homes, and support coordination of care. These provisions may help narrow existing health care disparities.