Neighborhood Deprivation and Association With Medical Complications, Emergency Department Use, and Readmissions in Shoulder Arthroplasty Patients.

Background: Social determinants of health are prognostic indicators for patients undergoing orthopedic procedures. Purpose: Using the area deprivation index (ADI), a validated, weighted index of material deprivation and poverty (a 0%-to-100% scale, with higher percentages indicating greater disadvantage), we sought to evaluate whether there are associations in shoulder arthroplasty patients between higher ADI and rates of (1) medical complications, (2) emergency department (ED) utilizations, (3) readmissions, and (4) costs. Methods: We queried the PearlDiver nationwide database for patients who had undergone primary shoulder arthroplasty from 2010 to 2020. Patients from regions associated with high ADI (95%+) were 1:1 propensity matched to a comparison group by age, sex, and Elixhauser Comorbidity Index. This yielded 49,440 patients in total. Outcomes included 90-day complications, ED utilizations, readmissions, and costs. Logistic regression models computed odds ratios (ORs) of ADI on the dependent variables. P values of < .05 were significant. Results: Patients from high ADI regions showed higher rates and odds of complications than those in the comparison group (10.84% vs 9.45%; OR: 1.10), including acute kidney injuries (1.73% vs 1.38%; OR: 1.23), urinary tract infections (3.19% vs 2.80%; OR: 1.13), and respiratory failures (0.49% vs 0.33%; OR: 1.44), but not increased ED visits (2.66% vs 2.71%; OR: 0.99) or readmissions (3.07% vs 2.96%; OR: 1.03). Patients from high ADI regions incurred higher costs on day of surgery ($8251 vs $7337) and at 90 days ($10,999 vs $9752). Conclusions: This 10-year retrospective database study found that patients from high ADI regions undergoing primary shoulder arthroplasty had increased rates of all 90-day medical complications, suggesting that measures of social determinants of health could inform health care policy and improve post-discharge care in these patients.

Disparities in pain management among transgender patients presenting to the emergency department for abdominal pain.

OBJECTIVE: Transgender and gender-diverse (TGD) individuals have a gender identity or expression that differs from the sex assigned to them at birth. They are an underserved population who experience health care inequities. Our primary objective was to identify if there are treatment differences between TGD and cisgender lesbian/gay/bisexual/queer (LGBQ) or heterosexual individuals presenting with abdominal pain to the emergency department (ED). METHODS: Retrospective observational cohort study of patients ≥12 years of age presenting to 21 EDs within a health care system with a chief complaint of abdominal pain between 2018 and 2022. TGD patients were matched 1:1:1:1 to cisgender LGBQ women and men and cisgender heterosexual women and men, respectively. Propensity score matching covariates included age, ED site, mental health history, and gastrointestinal history. The primary outcome was pain assessment within 60 min of arrival. The secondary outcome was analgesics administered in the ED. RESULTS: We identified 300 TGD patients, of whom 300 TGD patients were successfully matched for a total cohort of 1300 patients. The median (IQR) age was 25 (20-32) years and most patients were treated in a community ED (58.2%). There was no difference between groups in pain assessment within 60 min of arrival (59.0% TGD vs. 63.2% non TGD, p = 0.19). There were no differences in the number of times pain was assessed (median [IQR] 2 [1-3] vs. 2 [1-4], p = 0.31) or the severity of pain between groups (5.5 [4-7] vs. 6 [4-7], p = 0.11). TGD patients were more likely to receive nonsteroidal anti-inflammatory drugs (32.0% vs. 24.9%, p = 0.015) and less likely to receive opioids than non-TGD patients (24.7% vs. 36.9%, p = <0.001). TGD and nonbinary patients, along with LGBQ cisgender women (24.7%) and heterosexual cisgender women (34%), were less likely to receive opioids than LGBQ cisgender men (54%) and heterosexual cisgender men (42.3%, p < 0.01). CONCLUSION: There was no difference in frequency of pain assessment, regardless of gender identity or sexual orientation. More cisgender men, compared to TGD and cisgender women, received opioids for their pain.

The importance of pathway programs in increasing diversity in dermatology: Efforts made by the American Academy of Dermatology.

Our country's population continues to diversify, highlighting the need for an equally diverse physician workforce to care for patients. Unfortunately, the percentage of underrepresented minority residents in dermatology has remained relatively unchanged over the past several years. To address this disparity, the American Academy of Dermatology created the Pathways Programs to focus on early exposure to dermatology, skill-building workshops, research, and mentorship. The overarching goal is to increase the number of underrepresented minority dermatologists, which will result in improved patient care and mitigation of healthcare disparities.

Disparities in the Use of Annual Heart Health Screenings Among Latino, Black, and Asian Immigrants: Evidence from the 2011 to 2018 National Health Interview Survey.

BACKGROUND: Immigrants are disproportionately affected by cardiovascular disease burden. Heart health screenings, including blood pressure, fasting blood glucose (FBG), and blood cholesterol screenings, can help identify cardiovascular disease risk. Evidence on heart health screenings among diverse immigrant groups is still limited. This study examined the disparities in heart health screenings among the immigrant population compared with US-born White adults. METHODS AND RESULTS: A cross-sectional design was used to analyze data from the 2011 to 2018 National Health Interview Survey. Generalized linear models with Poisson distribution were applied to compare the prevalence of annual blood pressure, fasting blood glucose, and blood cholesterol screenings among Latino, Black, and Asian immigrants and US-born White adults. The analysis included 145 149 adults (83.60% US-born White adults, 9.55% Latino immigrants, 1.89% Black immigrants, and 4.96% Asian immigrants), with a mean age of 50 years and 53.62% women. Latino (adjusted odds ratio [aOR], 0.92 [95% CI, 0.91-0.93]) and Asian (aOR, 0.93 [95% CI, 0.92-0.94]) immigrants were less likely to have blood pressure screening than US-born White adults. Latino (aOR, 1.22 [95% CI, 1.19-1.25]), Black (aOR, 1.15 [95% CI, 1.09-1.21]), and Asian (aOR, 1.12 [95% CI, 1.08-1.15]) immigrants were more likely to have fasting blood glucose screening, and Latino (aOR, 1.11 [95% CI, 1.09-1.13]), Black or (aOR, 1.12 [95% CI, 1.09-1.16]), and Asian (aOR, 1.05 [95% CI, 1.04-1.07]) immigrants were more likely to have blood cholesterol screening than US-born White adults. CONCLUSIONS: Latino and Asian immigrants have lower odds of annual blood pressure screenings than US-born White adults. More studies exploring facilitators and barriers to the accessibility and use of heart health screenings are needed.

Disparities in infectious disease-related health care utilization between Medicaid-enrolled American Indians and non-Hispanic Whites-Lessons from the first 16 months of coronavirus disease 2019 and a decade of flu seasons.

OBJECTIVE: To understand why American Indian and Alaskan Native (AIAN) populations have had exceptionally high COVID-19 mortality, we compare patterns of healthcare utilization and outcomes for two serious infectious respiratory diseases-Influenza-like-illness (ILI) and coronavirus disease 2019 (COVID-19)-between American Indian and Alaskan Native (AIAN) populations (as identified in Medicaid data) and non-Hispanic Whites over the 2009-2021 period. STUDY SETTING AND DESIGN: We select all people under the age of 65 years identified as non-Hispanic White or AIAN in the New York State Medicaid claims data between 2009 and 2021. We analyze data across 10 ILI cohorts (between September 2009 and August 2020) and 4 COVID-19 cohorts (March-June 2020, July-September 2020, October-December 2020, and January-June 2021). We examine mortality and utilization rates using logistic regressions, adjusting for demographic characteristics, prior chronic conditions, and geographic location (including residence near a reservation). We stratify the analysis by rural vs. nonrural counties. DATA SOURCES AND ANALYTIC SAMPLE: We use the New York State Medicaid claims data for the analysis. PRINCIPAL FINDINGS: We find that even among Medicaid beneficiaries, who are similar in socioeconomic status and identical in health insurance coverage, AIAN populations have much lower rates of use of outpatient services and much higher rates of acute (inpatient and emergency room) service utilization for both ILI and COVID-19 than non-Hispanic Whites. Prior to COVID-19, demographic and health status-adjusted all-cause mortality rates, including from ILI, were lower among American Indians than among non-Hispanic Whites on New York State Medicaid, but this pattern reversed during the COVID-19 pandemic. Both findings are driven by nonrural counties. We did not observe significant differences in all-cause mortality and acute service utilization comparing AIAN to non-Hispanic Whites in rural areas. CONCLUSION: The utilization and mortality disparities we identify within the Medicaid population highlight the need to move beyond insurance in addressing poor health outcomes in the American Indian population.

Health Equity and Social Determinants of Health.

Health equity in medicine is critical to improving safety and quality of care for all patients. In order to achieve this, it is important that anesthesiologists understand the social barriers that exist for our patients in receiving high-quality and safe care, also known as social determinants of health. It is also important to understand social vulnerabilities to alleviate their impact on health outcomes in perioperative care. Beyond the social factors that impact the patient experience, it is important to understand, educate, and optimize those factors that impact delivery of high-quality and equitable care within our control as health care professionals.

Impact of Virtual Navigation on the Education and Access of Patients with Cancer: A National Mixed Methods Investigation.

Introduction: Despite growing evidence of efficacy, oncology patient navigation is not ubiquitously offered. Navigation may reduce barriers to cancer care, yet geographic location may limit patient access. To overcome geographical barriers and increase patient education in oncology, our medical center developed a virtual navigation program. Objective: To examine the efficacy of the Virtual Navigation Program designed to increase patient access and education across local and national contexts. Methods: In this mixed-methods study, a total of 105 individuals completed an online survey administered nationally to oncology patients who used the navigation program. Clinical and demographic data were collected. Nonparametric tests were used for group comparisons (Wilcoxon Signed-Ranks test). Results: Virtual navigation increased access as the majority of patients utilized the Virtual Navigation Program beyond the local area; 42% of patients were local; 58% were patients located across the US. 55 (52%) were female; 25% were non-White. Pancreatic cancer was the largest tumor type: 51 (49%). Patients agreed the virtual cancer education helped them make critical health choices (mean 4.89 SD = 84); understand their diagnosis (mean 4.44 SD = .77); were able to make informed decisions (mean 4.43 SD = .83), and empowered to manage their cancer care (mean 4.58 SD = .82). Post navigation, the user experience survey revealed significant increases in a subset of patients' cancer knowledge (P < 0.001), access to quality cancer education (P = 0.045), decision-making in cancer care (P < 0.05), and coordinated cancer care (P = 0.03). Conclusion: This study explores a unique role that virtual navigation may play in helping accommodate healthcare for many cancer patients in underserved areas. The use of innovative aspects of research and education in virtual navigation may be successful in promoting patient empowerment in the cancer continuum. Internet-strategies are needed to inform sustainable patient navigation in low-resource contexts.

Gender and Racial Demographic Trends in the US Laryngology Workforce (1993-2022).

OBJECTIVES: To analyze demographic trends in laryngology fellowship training in the United States from 1993 to 2022, comparing periods before and after formalization of the fellowship within the National Resident Matching Program (NRMP) in 2012. METHODS: A national database of fellowship-trained laryngologists (FTLs) and non-fellowship-trained laryngologists (nFTLs) practicing primarily laryngology was created by methodically compiling laryngologists via Internet search, with corroboration by regional laryngologists and vetting by senior laryngologists on this manuscript. Demographic variables included residency and/or fellowship graduation year, gender, race and ethnicity inferred through individuals' photos and surnames. NRMP match data from 2012 to 2022 were obtained from the American Laryngological Association. RESULTS: An average of 21 programs offered 23 positions in the NRMP match, with 14 programs (66.4%) filling 16 positions (68.8%) from 2012 to 2022. The 10-year FTL growth rate decreased from 25.4% (1993-2002) to 10.5% and 6.6% in subsequent periods. In May 2023, there were 349 active laryngologists, including 303 FTLs, in the United States. A total of 189 (62.4%) FTLs were men, 114 (37.6%) were women; 201 (66.2%) were White, 102 (33.8%) were non-White. Between the pre-NRMP and post-NRMP periods, the percentage of male FTLs decreased from 71.5% to 55.5%, female FTLs increased from 28.5% to 44.5%, and White FTLs decreased from 69.2% to 64.2%. Chi-squared analysis yielded a statistically significant association between gender and training period for FTLs (p = 0.004), but no statistically significant difference between race and training period. CONCLUSIONS: The post-NRMP period saw an expansion of laryngology fellowships and workforce diversification, reflecting trends observed in otolaryngology and medicine overall. LEVEL OF EVIDENCE: NA Laryngoscope, 2024.

Adaptation of a Tailored Lung Cancer Screening Decision Aid for People With HIV.

BACKGROUND: People with HIV are both at elevated risk of lung cancer and at high risk of multimorbidity, which makes shared decision-making (SDM) for lung cancer screening (LCS) in people with HIV complex. Currently no known tools have been adapted for SDM in people with HIV. RESEARCH QUESTION: Can an SDM decision aid be adapted to include HIV-specific measures with input from both people with HIV and their providers? STUDY DESIGN AND METHODS: This study used qualitative methods including focus groups of people with HIV and interviews with HIV care providers to adapt and iterate an SDM tool for people with HIV. Eligible participants were those with HIV enrolled in an HIV primary care clinic who met age and smoking eligibility criteria for LCS and HIV care providers at the clinic. Both the focus groups and interviews included semistructured discussions of SDM and decision aid elements for people with HIV. We used a framework-guided thematic analysis, mapping themes onto the Health Equity Implementation framework. RESULTS: Forty-three people with HIV participated in eight focus groups; 10 providers were interviewed. Key themes from patients included broad interest in adapting LCS SDM specifically for people with HIV, a preference for clear LCS recommendations, and the need for positive framing emphasizing survival. Providers were enthusiastic about personalized LCS risk assessments and point-of-care tools. Both patients and providers gave mixed views on the usefulness of HIV-specific risk measures in patient-facing tools. Themes were used to adapt a personalized and flexible SDM tool for LCS in people with HIV. INTERPRETATION: People with HIV and providers were enthusiastic about specific tools for SDM that are personalized and tailored for people with HIV, that make recommendations, and that inform LCS decision-making. Divergent views on presenting patient-facing quantitative risk assessments suggests that these elements could be optional but available for review. This tool may have usefulness in complex decision-making for LCS in this population and currently is being evaluated in a pilot prospective trial.

Racial and ethnic differences in healthcare access and utilization among U.S. adults with melanoma and keratinocyte carcinomas in the NIH All of Us Research Program.

There is a paucity of information on racial and ethnic disparities relating to barriers to care in healthcare access and utilization in patients with cutaneous malignancies. We conducted a cross-sectional analysis of adults with melanoma, basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) in the National Institutes of Health (NIH) All of Us Research Program collected between May 2018 and July 2022. Participants included adults (aged 18 or older) with cutaneous malignancy who completed the Health Care Access and Utilization survey. We identified 5,817 adults who were diagnosed with BCC (67%), cSCC (28.9%), and melanoma (23.9%). Non-Hispanic Black (NHB) and Hispanic patients were more likely than non-Hispanic White (NHW) patients to delay a primary care visit due to cost (p = 0.005 and p = 0.015, respectively). NHB patients were also more likely to delay care due to lack of transportation (p < 0.001). NHB and Hispanic patients were more likely to place importance on seeing a provider from the same background (NHB p < 0.002; Hispanic p = 0.002) and also were more likely to report never being able to see such a provider (NHB p < 0.001; Hispanic p = 0.002). Medicaid/Medicare patients, non-college graduates, and those with lower incomes also faced increased barriers to care, including delays due to cost and transportation issues. People of color with cutaneous malignancies are more likely to delay care in seeing primary care providers due to cost or transportation issues. This study provides important insights on disproportionate healthcare usage among racial/ethnic groups that may help mitigate healthcare disparities.

Socioeconomic Determinants of Health and Reflux Management: Insights from a Tertiary Medical Center.

OBJECTIVES: To assess the correlation of social determinants of health (SDOH) with the general care patterns related to gastroesophageal reflux disease and laryngopharyngeal reflux. Determine correlation of SDOH on utilization rates for medication, reflux testing and surgical intervention for patients diagnosed with reflux. Describe overall care patterns for gastroesophageal reflux disease care at a tertiary academic facility. STUDY DESIGN: Retrospective chart review. METHODS: Patient demographics (age, sex, race, ethnicity, and insurance status) were extracted for adults diagnosed with reflux between 2009 and 2019. Odds ratios (ORs) for the associations between sociodemographic factors and reflux treatment pathways were determined by chi-square analyses. RESULTS: A total of 143,786 patients were evaluated during the study period with a diagnosis code of reflux. A subgroup of 40,754 patients had objective reflux testing including Bravo, dual pH-impedance, manometry, esophagogastroduodenoscopy (EGD) and esophagram, but no significant difference in utilization rates was found. A total of 239 patients who failed medical management underwent fundoplication. White (OR 2.43, 95% confidence interval [CI] 1.56-3.70) and female (OR 1.37, 95% CI 1.05-1.79) patients were more likely to undergo fundoplication than Black (OR 0.42, 95% CI 0.25-0.70) and male (OR 0.72, 95% CI 0.55-0.95) patients. Patients with private insurance (OR 1.58, 95% CI 1.23-2.04) were more likely to undergo fundoplication than those with public insurance (OR 0.65, 95% CI 0.50-0.84). Male patients were less likely to undergo fundoplication (OR 0.69, 95% CI 0.49-0.98) among patients evaluated for reflux with EGD. CONCLUSIONS: SDOH correlate with patterns of reflux evaluation and management at our tertiary care center. LEVEL OF EVIDENCE: IV Laryngoscope, 2024.

Motivators of and barriers to in-person health care and video telehealth utilization among older Black adults: a qualitative study.

OBJECTIVE: Older Black adults continue to experience heightened rates of chronic illness and poor health outcomes. Further, older Black adults must navigate interlocking systems of oppression (e.g. racism, ageism, ableism, and classism etc.) that impact their healthcare utilization. Telehealth has emerged as a common health care modality, which presents unique concerns for aging populations. DESIGN: The present study explored the motivators of and barriers to in-person healthcare and video telehealth use among a sample of predominantly lower-income, older Black adults. The researchers collaborated with community scientists to recruit, facilitate focus groups and provide technological support for participants. Sixteen virtual focus groups were conducted (n = 147) with older Black adults aged 55-84 years. The researchers utilized a thematic analysis approach to identify twelve distinct themes. RESULTS: Participants identified the following as motivators to using in-person health care: improved patient-provider relationships, increased community support, and more culturally sensitive resources. Limited accessibility, discrimination and resulting distrust, and poor patient-provider communication were identified as barriers to in-person health care use. E-health literacy and accessibility both emerged as motivators of and barriers to using telehealth, while disinterest in telehealth and impersonal patient-provider relationships were noted as additional barriers. CONCLUSION: These findings provide key implications for reducing the burden of health care inequity for older Black adults. Future implementation research should use equity-focused frameworks such as the patient-centered culturally sensitive health care (PC-CSHC) model. Additionally, collaboration with the community is necessary to create and implement the necessary culturally sensitive health interventions.

Integrated Care in a Large Public System Improves Simple Kidney Stone Management.

OBJECTIVE: In the Los Angeles County Department of Health Services-the second largest public health care system in the United States-clinical integration allows specialists and primary care providers to collaboratively provide specialty care. We used time-driven activity-based costing to compare patient burden and cost of kidney stone diagnosis, workup, and management with and without clinical integration. METHODS: We interviewed and observed teams of physicians and staff to understand workflow practices and personnel, space, material, and device requirements for stone care in the 2 models. We created process maps that outline the entire arc of care and used time-driven activity-based costing to calculate the all-inclusive costs of kidney stone diagnosis, workup, and scheduling for surgical treatment. RESULTS: The total cost of kidney stone treatment per stone episode in the integrated pathway was $499.04, compared with $699.81 in the traditional, nonintegrated pathway, a difference of 29%. The number of steps needed to arrive at operating room scheduling was 11 with integration and 14 without it. CONCLUSIONS: Clinical integration resulted in more efficient and cost-effective care from patient, provider, and health system perspectives. Integrated care may improve access to specialty care and increase the value of care and reduce treatment burden on patients.

Benzodiazepine Utilization in Ischemic Stroke Survivors: Analyzing Initial Excess Supply and Longitudinal Trends.

BACKGROUND: Benzodiazepines are commonly prescribed for post-acute ischemic stroke for anxiety, insomnia, and agitation. While guidelines discourage use in those aged ≥65 years, little is known about prescription patterns at the national level. METHODS: We analyzed a 20% sample of US Medicare claims from April 1, 2013, to September 30, 2021. We selected beneficiaries aged ≥65 years discharged alive following an acute ischemic stroke who had traditional Medicare coverage and 6 months' prior enrollment in Parts A (hospital insurance), B (Medical insurance), and D (drug coverage). We excluded those with prior benzodiazepine prescriptions, self-discharges, or discharge to skilled nursing facilities. We examined demographics, comorbidities, first prescription days' supply, cumulative incidences of benzodiazepine first prescription fills within 90 days after discharge, and geographic and yearly trends. RESULTS: We included 126 050 beneficiaries with a mean age of 78 years (SD, 8); 54% were female and 82% were White. Within 90 days, 6127 (4.9%) initiated a benzodiazepine. Among new prescriptions, lorazepam (40%) and alprazolam (33%) were the most prescribed. Most (76%) of first fills had a day's supply over 7 days and 55% between 15 and 30 days. Female initiation rates were higher (5.5% [95% CI, 5.3-5.7]) than male initiation rates (3.8% [95% CI, 3.6%-3.9%]). Rates were highest in the southeast (5.1% [95% CI, 4.8%-5.3%]) and lowest in the midwest (4.0% [95% CI, 3.8%-4.3%]), with a modest nationwide initiation decline from 2013 to 2021 (cumulative incidence difference, 1.6%). CONCLUSIONS: Despite a gradual decline in benzodiazepine initiation from 2013 to 2021, we noted excessive supplies in prescriptions post-acute ischemic stroke discharge, underscoring the need for improved policies.

An Analysis of the Otolaryngology Workforce in Pennsylvania.

Objective: This study aims to analyze the distribution of otolaryngologists between urban and rural counties in Pennsylvania. Study Design: Retrospective database. Setting: American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) database and Centers for Medicare and Medicaid Services (CMS) Database. Methods: The AAO-HNS database (Entnet.org) and the CMS Database were used to identify otolaryngologists, their primary location, and their state of training. The 2023 Rural-Urban Continuum Codes were used to classify metropolitan (codes 1-3) and nonmetropolitan counties (codes 4-9) and determine county populations. Results: A total of 388 otolaryngologists were identified across 67 Pennsylvania counties (33 metropolitan, 34 nonmetropolitan), 80% of which were male. There were 354 otolaryngologists in metropolitan counties serving 11.2 million people, with an average of 2.4 otolaryngologists per 100,000 people (/100 k). The majority of otolaryngologists (n = 235, 60.6%) are located in counties designated by code 1. There were 34 otolaryngologists in nonmetropolitan counties serving 1.8 million people, with an average of 2.4 otolaryngologists/100 k. Montour County (code 6) is home to a large academic center and accounts for 14/34 otolaryngologists in the nonmetropolitan counties. With the exception of Montour County, the remaining nonmetropolitan counties averaged 1.0 otolaryngologist/100 k. Only 3 metropolitan counties did not have otolaryngologists compared to 19 nonmetropolitan counties without otolaryngologists. Most otolaryngologists received their residency training in Pennsylvania (n = 177). New York (n = 35) and Maryland (n = 24) were the second most common states for training. Conclusion: There is a lack of otolaryngologists in rural counties of Pennsylvania, except in counties home to large academic centers.

Addressing Hypertension Disparities via Systems Dynamics: Insights From Community Health Connections.

Background and objective Hypertension remains a major public health challenge in the United States, disproportionately affecting various demographic groups. Significant disparities persist in hypertension prevalence and control due to interactions between socioeconomic factors, healthcare access, and systemic inequities. In this study, we aimed to determine the impact of socioeconomic and healthcare factors on hypertension control among patients at Community Health Connections (CHC), a Federally Qualified Health Center serving 36 communities in North Central Massachusetts, and identify effective interventions using systems dynamics modeling to promote health equity. Materials and methods This was a retrospective observational study using data from 2023 CHC patients, and the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Systems dynamics modeling was employed to visualize interactions among factors influencing hypertension outcomes. The study included 4,870 CHC patients. Participants were selected based on clinical records and comprised 3,690 White participants (76%), 464 Black/African American participants (10%), 108 Asian participants (2%), and 608 classified as Other/Non-reported (12%). The cohort included 2,490 males (51%) and 2,380 females (49%). Socioeconomic factors (e.g., race, age, insurance status) and healthcare access were the study variables. The primary outcome was hypertension control, defined as a blood pressure reading of <140/90 mmHg. The study measured control rates across different demographic groups and assessed the impact of socioeconomic and healthcare factors on these rates. Results Among the 4,870 CHC patients, 3,007 (62%) achieved hypertension control. The overall hypertension control rate varied significantly by race: White: 68.6%, Black/African American: 61.6%, Asian: 63.2%, and Other/Non-reported: 65.6%. Insured patients had a control rate of 67.7%, compared to 37.5% for uninsured patients (p<0.001). Systems dynamics models illustrated how socioeconomic disparities and healthcare access issues amplify health inequities. Key interventions identified include, but are not limited to, multidisciplinary care teams, community health worker programs, and telehealth services. Conclusions Addressing hypertension disparities among CHC patients requires a systemic approach integrating socioeconomic, healthcare, and policy-related interventions. Systems dynamics modeling provides a framework for designing and implementing targeted interventions, enhancing health equity, and improving hypertension control outcomes in underserved populations. Further research is needed to test the effectiveness of these interventions before their broad implementation.

Severe Maternal Morbidity: The Impact of Race on Tricare Beneficiaries.

Maternal morbidity and mortality rates in the United States have increased in the last two decades with a disproportionate impact on women of color. While numerous factors contribute to the inequities in pregnancy-related mortality, access to health insurance is among the most significant. Military Tricare models universal health care access; however, in studies looking at births in military treatment facilities, disparities still exist for women of color. This study analyzed maternal delivery outcomes for all women with Tricare coverage, including deliveries in the civilian sector. We analyzed data from 6.2 million births in the Centers for Disease Control (CDC) Wide-ranging Online Data for Epidemiology Research (WONDER) Linked Birth/Infant Death Records for 2017-2019. Data included all-cause morbidity (transfusions, perineal lacerations, uterine rupture, unplanned hysterectomy, and ICU admissions), severe maternal morbidity (SMM) excluding lacerations, and SMM excluding transfusion. Risk ratios were calculated by comparing overall maternal morbidity rates between Tricare, Medicaid, self-pay, and private insurance. In addition, risk ratios were calculated between insurance types stratified by race. In conclusion, there is an increased risk for women identifying as racial minorities for SMM and SMM excluding transfusion. While Tricare coverage seems to decrease the risk, the decrease is not significant and disparities in outcomes persist among women identifying as minorities. The risk of severe maternal morbidity remains elevated for women of color despite access to Tricare health insurance.

Telehealth Utilization to Address Health Care Disparities Among Asian Americans, Native Hawaiians, and Pacific Islanders: A Scoping Review.

Research has reported health care disparities, including low rates of health care utilization, among racial and ethnic minority groups compared to Whites. Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) have experienced these disparities, attributed to various barriers such as limited access to linguistically and culturally concordant health care services. Telehealth may offer a viable mode of health service delivery for AANHPIs. The coronavirus disease of 2019 (COVID-19) pandemic sparked the adoption of technology for receiving health services. However, the literature on telehealth utilization before and during the COVID-19 pandemic among AANHPIs is limited. To address this gap, we conducted a scoping review of telehealth intervention empirical studies serving AANHPIs published between January 2010 and February 2024, using five databases. Twenty-four articles met our inclusion criteria, which required the use of a telehealth intervention program, provision of disaggregated AANHPIs, and targeting of physical and/or mental health outcomes. Our review revealed positive findings of telehealth interventions in helping AANHPIs access health care, with a primary focus on education and consultation for self-management. The review highlighted a range of technological platforms used in AANHPIs telehealth interventions, including web-based, mobile, and blended approaches. Additionally, the review emphasized the need for improved access to technology and reduction in digital exclusion. The findings affirm the usefulness and potential of telehealth interventions, providing implications for how health professionals can serve AANHPIs. Telehealth technology offers the ability for greater accessibility and individualization to address health care disparities in AANHPIs.

Education and Training in Global Neurosurgery: Current State and Path Toward a Uniform Curriculum.

Education is a sustainable long-term measure to address the global burden of neurosurgical disease. Neurosurgery residencies in high-income countries are accredited by a regional governing body and incorporate various educational activities. Few opportunities for training may be present in low-income and middle-income countries due to a lack of neurosurgery residency programs, tuition, and health care workforce reductions. Core components of a neurosurgical training curriculum include operative room experience, clinical rounds, managing inpatients, and educational conferences. A gold standard for neurosurgical education is essential for creating comprehensive training experience, though training must be contextually appropriate.