Publications by authors named "Linda Highfield"
[This corrects the article DOI: 10.1017/cts.2024.
View Article and Find Full Text PDFIntroduction: The focus on social determinants of health (SDOH) and their impact on health outcomes is evident in U.S. federal actions by Centers for Medicare & Medicaid Services and Office of National Coordinator for Health Information Technology.
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- Minority populations in the U.S. are increasing, highlighting the need for ongoing analysis of cultural contexts in health disparities.
- This study aimed to develop a Cultural Context Index (CCI) using geospatial data to assess social health determinants across diverse communities in 73,682 census tracts.
- The findings indicate that areas with the greatest need for culturally competent health care have higher rates of poor physical and mental health, particularly in metropolitan regions with significant Black and Hispanic populations.
Objective: Medication discrepancies between clinical systems may pose a patient safety hazard. In this paper, we identify challenges and quantify medication discrepancies across transitions of care.
Methods: We used structured clinical data and free-text hospital discharge summaries to compare active medications' lists at four time points: preadmission (outpatient), at-admission (inpatient), at-discharge (inpatient), and postdischarge (outpatient).
Article Synopsis
- Provider-based interventions aimed at promoting HPV vaccination were systematically reviewed to evaluate their effectiveness and costs from studies published between 2007 and 2021.
- The meta-analysis of 32 studies revealed significant increases in HPV vaccine initiation rates (3.7%) and the percentage of patients receiving their next dose (9.4%) due to strategies like provider training and reminders.
- Despite these positive outcomes, limitations such as high heterogeneity among studies and a low number of studies hindered comparative analysis of different interventions; continual implementation is crucial for sustained success.
Article Synopsis
- The text discusses various Health-Related Social Needs (HRSN) interventions in the U.S., particularly focusing on the CMS Accountable Health Communities (AHC) Model, which aims to address patients' social needs through screening and referrals.
- A qualitative assessment using the Consolidated Framework for Implementation Research (CFIR) was conducted to evaluate the implementation of AHC strategies across different organizations, identifying barriers and facilitators.
- Findings revealed that while organizations generally saw the AHC Model as compatible and identified several facilitators for its implementation, they also encountered barriers across all examined implementation strategies.
Food insecurity is prevalent and associated with poor health outcomes, but little is known about its geographical nature. The aim of this study is to utilize geospatial modeling of individual-level food insecurity screening data ascertained in health care settings to test for neighborhood hot and cold spots of food insecurity in a large metropolitan area, and then compare these hot spot neighborhoods to cold spot neighborhoods in terms of the CDC's Social Vulnerability Index. In this cross-sectional secondary data analysis, we geocoded the home addresses of 6,749 unique participants screened for food insecurity at health care locations participating in CMS's Accountable Health Communities (AHC) Model, as implemented in Houston, TX.
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- Teach Back is a communication strategy that enhances patient understanding and retention of health information, leading to better health outcomes and reduced hospital readmissions.
- Community Health Workers (CHWs) are essential in addressing patient needs but lack appropriate training in Teach Back methods tailored to their roles.
- A pilot training program developed by a collaboration of academic and clinical partners successfully increased CHWs' confidence in using Teach Back, highlighting the need for ongoing evaluation and adaptation of training for effective application in their daily work.
Article Synopsis
- Training programs for community health workers (CHWs) were developed to improve patient communication skills, particularly for those with low health literacy, filling a gap in their training curriculum.
- The training was conducted through three 2-hour WebEx sessions, focusing on active listening, Teach Back, and action planning, with both theoretical and practical components.
- Post-training surveys indicated CHWs felt more confident in active listening and Teach Back skills but questioned the relevance of action planning; they and clinical leaders expressed a need for tools to better incorporate these skills into clinical practice.
Article Synopsis
- * The study tested machine learning models to predict HRSN status for Medicare and Medicaid beneficiaries, finding that these models performed better than the standard method based on Medicaid coverage alone, with the best model achieving an AUC of 0.68.
- * While the machine learning approach can help prioritize patients for screening, relying solely on these models may miss a significant number of patients, indicating a need for further research to improve HRSN predictions.
Article Synopsis
- Integration of health-related social needs (HRSNs) data into clinical practice aims to enhance healthcare, with the Accountable Health Communities (AHC) Model being a key initiative to gather data on HRSNs in the U.S.
- The study from the Greater Houston AHC focused on the frequency of HRSNs and their relationship with sociodemographic factors, using a sample of Medicare and Medicaid beneficiaries to analyze self-reported emergency department (ED) utilization.
- Key findings showed that over half of participants reported at least one HRSN, with food insecurity being the most prevalent, and those with multiple HRSNs were significantly more likely to visit the ED multiple times.
The Peace of Mind Program is an evidence-based intervention to improve mammography appointment adherence in underserved women. The aim of this study was to assess effectiveness of the intervention and implementation of the intervention in safety net clinics. The intervention was implemented through a non-randomized stepped wedge cluster hybrid study design with 19 Federally Qualified Health Centers and charity care clinics within the Greater Houston area.
View Article and Find Full Text PDFThrough an academic-community partnership, an evidence-based intervention to reduce mammography appointment no-show rates in underserved women was expanded to safety net clinics. The partnership implemented four strategies to improve the adoption and scale-up of evidence-based interventions with Federally Qualified Health Centers and charity care clinics: (1) an outreach email blast targeting the community partner member clinics to increase program awareness, (2) an adoption video encouraging enrollment in the program, (3) an outreach webinar educating the community partner member clinics about the program, encouraging enrollment and outlining adoption steps, and (4) an adoption survey adapted from Consolidated Framework for Implementation Research constructs from the Cancer Prevention and Control Research Network for cancer control interventions with Federally Qualified Health Centers. The development of academic-community partnerships can lead to successful adoption of evidence-based interventions particularly in safety net clinics.
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- Informing patients about kidney transplantation options significantly boosts their chances of enrolling on the waiting list and receiving live donor transplants, especially in nonprofit dialysis centers.
- For-profit dialysis centers show lower rates of enrollment and transplant receipt, despite offering more information; however, the effectiveness of this information appears to be less impactful compared to nonprofit centers.
- The study suggests a need for standardized guidelines for sharing transplantation information to ensure all patients receive quality and effective education, regardless of the center's ownership.
Understanding Pediatric Surgery Cancellation: Geospatial Analysis.
J Med Internet Res
September 2021
Background: Day-of-surgery cancellation (DoSC) represents a substantial wastage of hospital resources and can cause significant inconvenience to patients and families. Cancellation is reported to impact between 2% and 20% of the 50 million procedures performed annually in American hospitals. Up to 85% of cancellations may be amenable to the modification of patients' and families' behaviors.
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- Multi-level stakeholder engagement is crucial in clinical research, helping customize evidence-based interventions for effective implementation and sustainability.* ! -
- Strategies for engaging stakeholders include building trust, clear communication, and actively seeking feedback to enhance intervention outcomes.* ! -
- A framework based on established research constructs was developed to guide these engagement strategies, demonstrating successful alignment with real-world mammography initiatives for underserved women.* !
Objectives: This study explored the contributions of social determinants of health (SDOH) to measures of population health-specifically cost, hospitalization rates, rate of emergency department utilization, and health status-in Texas.
Study Design: The study associated common SDOH metrics from public data sources (county specific) with health plan enrollment data (including demographics, counties, and zip codes) and medical and pharmaceutical annual claims data.
Methods: Following correlation analyses to reduce variables, the contribution of each SDOH individually and by category to the health outcomes was evaluated.
Article Synopsis
- The study explores the integration of complementary and integrative medicine (CIM) therapies in a large urban pediatric hospital, aiming to understand the perspectives of healthcare providers, parents, and administrators.
- Conducted through medical ethnography, the research utilized interviews, observations, and document reviews over a six-month period during the implementation of an Integrative Medicine Pain Consult Service.
- Key findings identified factors facilitating CIM integration (like alignment with parental and community beliefs) and barriers at various levels (such as inter-professional challenges and lack of insurance reimbursement), suggesting future strategies for effective implementation.
The Accountable Health Communities (AHC) Model was designed to address the health-related social needs of Centers for Medicare & Medicaid Services beneficiaries. Bridge organizations across the AHC Model have identified lack of technical assistance and peer planning as potential barriers to Model success, particularly around patient navigation. The technical assistance and peer planning literature lacks an organizing, conceptual framework, but implementation science frameworks could serve as useful guides.
View Article and Find Full Text PDFBackground: Complementary and Integrative Medicine (CIM) shows positive clinical benefit with minimal side effects, yet, challenges to effective integration of CIM providers in biomedical health care settings remain. This study aimed to better understand the role evidence played in the process of integration of complementary therapies into a large urban pediatric hospital from the perspective of patients, caregivers, providers, and administrators through applied medical ethnography.
Methods: An ethnography was conducted over the course of 6 months in a large urban pediatric hospital in the Southern United States.
Burden of Illness, Primary Care Use, and Medication Utilization among US-México Border Children with Wheezing.
J Racial Ethn Health Disparities
June 2019
Objective: Among high-risk, underserved populations, such as children living along the US-México border, suffering from asthma-like symptoms without an asthma diagnosis can result in a high burden of illness. We estimated the prevalence of physician-diagnosed and possible undiagnosed asthma among students with histories of wheezing in the US-México border community of El Paso, Texas, and evaluated their burden of illness, primary care use, and medication utilization.
Methods: We analyzed cross-sectional survey data collected in May 2012.
Article Synopsis
- The text discusses the challenges in understanding how to effectively adopt, implement, and maintain evidence-based interventions (EBIs) in clinical settings, particularly in the context of mammography adherence.
- It highlights the use of Intervention Mapping (IM) as a structured approach to plan and design the implementation of health interventions, with a focus on scaling up screening programs in healthcare clinics.
- The paper specifically outlines the development of an implementation intervention for the adapted Peace of Mind Program (PMP), utilizing IM and the Consolidated Framework for Implementation Research (CFIR) to guide the planning process through community collaboration and targeted objectives.
Article Synopsis
- Some researchers believe that the lower rates of asthma seen in Mexican descent individuals could be due to under-diagnosis and stress the need to consider race and ethnicity factors, including acculturation's impact on asthma.
- A study involving 1,095 Hispanic students found that the diagnosed asthma rate (15%) is higher than national (7.6%) and state (6.8%) averages for Hispanic children in 2012.
- While preliminary analyses showed a link between asthma status and acculturation, more complex analyses did not support this; hence, it's suggested that there is an underappreciated asthma burden among Hispanic children in El Paso County and that more research is needed on how acculturation affects asthma.