Principles of Justice, Equity, Diversity, and Inclusion in Health Care Distance Simulation Education: Consensus Building via the Nominal Group Technique.

PURPOSE: Health care distance simulation (HCDS) replicates professional encounters through an immersive experience overseen by experts and in which technological infrastructure enriches the learning activity. As HCDS has gained traction, so has the movement to provide inclusive and accessible simulation experiences for all participants. However, established guidelines for best practices in HCDS regarding justice, equity, diversity, and inclusion (JEDI) are lacking. This study aimed to generate consensus statements on JEDI principles in synchronous HCDS education using the nominal group technique (NGT). METHOD: Professionals with experience in HCDS education were invited to generate, record, discuss, and vote on ideas that they considered best practices for JEDI. This process was followed by a thematic analysis of the NGT discussion to provide a deeper understanding of the final consensus statements. An independent group of HCDS educators individually reviewed and recorded their agreement or disagreement with the consensus statements created by the NGT process. RESULTS: Eleven independent experts agreed on 6 key practices for JEDI in HCDS. Educators need to (1) be aware of JEDI principles, (2) be able to define and differentiate JEDI, (3) model JEDI in their environment, (4) have expertise and comfort facilitating conversations and debriefing around JEDI issues, (5) be advocates within their organizations to ensure equitable educational experiences, and (6) achieve JEDI without compromising educational objectives. Experts were divided on the approach to technology to ensure equitable learning experiences: some believed that the most basic technology accessible to all learners should be used, and some believed that the technology used should be determined by the competency of the students or faculty. CONCLUSIONS: Structural and institutional barriers in HCDS education persist despite agreement on key JEDI practices. Conclusive research is needed to guide the optimal policy in HCDS toward creating equitable learning experiences while bridging the digital divide.

Associations of Cost Sharing With Rheumatoid Arthritis Disease Burden.

OBJECTIVE: To evaluate the regional variation of cost sharing and associations with rheumatoid arthritis (RA) disease burden in the US. METHODS: Patients with RA from rheumatology practices in Northeast, South, and West US regions were evaluated. Sociodemographics, RA disease status, and comorbidities were collected, and Rheumatic Disease Comorbidity Index (RDCI) score was calculated. Primary insurance types and copay for office visits (OVs) and medications were documented. Univariable pairwise differences between regions were conducted, and multivariable regression models were estimated to evaluate associations of RDCI with insurance, geographical region, and race. RESULTS: In a cohort of 402 predominantly female, White patients with RA, most received government versus private sponsored primary insurance (40% vs. 27.9%). Disease activity and RDCI were highest for patients in the South region, where copays for OVs were more frequently more than $25. Copays for OVs and medications were less than $10 in 45% and 31.8% of observations, respectively, and more prevalent in the Northeast and West patient subsets than in the South subset. Overall, RDCI score was significantly higher for OV copays less than $10 as well as for medication copays less than $25, both independent of region or race. Additionally, RDCI was significantly lower for privately insured than Medicare individuals (RDCI -0.78, 95% CI [-0.41 to -1.15], P < 0.001) and Medicaid (RDCI -0.83, 95% CI [-0.13 to -1.54], P = 0.020), independent of region and race. CONCLUSION: Cost sharing may not facilitate optimum care for patients with RA, especially in the Southern regions. More support may be required of government insurance plans to accommodate patients with RA with a high disease burden.