Public Health Foundations for Radiology Resident Education: Healthcare Disparities in Radiology.

Increasing recognition within the medical literature and by the Accreditation Council for Graduate Medical Education has been attributed to the need for enhanced resident education on concepts related to public health and health equity. Despite increasing documentation of pervasive inequalities within the scope of radiology, dedicated curricula designed to improve cultural competency and understanding of healthcare disparities among radiology trainees remains sparse. With relatively fewer patient interactions, radiology trainees are particularly susceptible to insufficient contextual awareness of how socioeconomic factors influence patient health and behaviors, physician recommendations, and ultimately clinical outcomes. The purpose of this article is to provide a high-yield background of foundational health equity and disparity concepts for radiology trainees, from which additional educational curricula may be derived. Specifically, this article will discuss the fundamental socioeconomic factors known to contribute to discrepant access and use of imaging services, followed by areas in radiology with well-documented disparities of which trainees should be aware. Lastly, previous and current strategies for addressing disparities in radiology will be discussed with the ultimate goal of stimulating trainee participation and the development of novel approaches.

A Comparison of Two Mouse Frailty Assessment Tools.

The mouse clinical frailty index and the mouse frailty phenotype assessment are two recently developed tools used to assess frailty in mice. The objectives of this study were to investigate whether the same mice are identified as frail with both tools and to examine the association of each of the assessment tools with age and frailty-related outcomes. Frailty was measured using both tools in old (~24 months; n = 36) C57BL/6 male mice. After 2 weeks, blood pressure and heart rate were measured and serum samples were collected for analysis of alanine aminotransferase, creatinine, and albumin levels. The mouse frailty phenotype assessment identified no mice as frail but modification of the assessment tool identified six mice as frail. The mouse clinical frailty index identified 16 mice as frail and the agreement between the two scales was 50.0%. Increasing clinical frailty index scores were correlated with low serum alanine aminotransferase, as well as decreased heart rate, and reduced heart rate variance. We conclude that, consistent with equivalent frailty assessment scales in humans, both tools have value but do not necessarily identify the same mice as frail.

Quality of care provided in a special needs plan using a nurse care manager model.

OBJECTIVES: To comprehensively evaluate the quality of care provided in special needs plans (SNPs; Medicare Advantage plans that aim to provide specialized care for complex older adults) and specifically the nurse care management model in the community setting. DESIGN: We adapted 107 process-of-care quality measures across 12 conditions from the Assessing Care of Vulnerable Elders set to obtain a clinically detailed evaluation of the quality of care received by complex older enrollees in a dual eligible Evercare SNP. We abstracted 13 months of primary care medical records to delineate quality of care provided by physicians and whether there was value added from the nurse care manager model. SETTING: Dual eligible Evercare SNP located in central Florida. PARTICIPANTS: Two-hundred thirty-one vulnerable older enrollees in the SNP who had complex disease. RESULTS: Based on physician medical records alone, the 231 high-risk participants (mean age 77, 67% women) received recommended care for 53% of 5,569 evaluated clinical circumstances, ranging from 12% for end-of-life care to 78% for diabetes mellitus. In fewer than 40% of these clinical circumstances was recommended care provided for dementia, falls, and urinary incontinence. In a second analysis accounting for care provided by both the Evercare nurse and the physician, recommended care was provided to patients in 69% of the 5,684 evaluated clinical circumstances. CONCLUSION: Comprehensive quality measurement applied to vulnerable older adults enrolled in one mature SNP showed that the Evercare nurse model addresses important deficits in physician care for geriatric conditions. Such measurement should be applied to other SNP models and to compare SNP care with that for complex, older, fee-for-service Medicare cohorts.

Improving health care for assisted living residents.

PURPOSE: The purpose of this article is to explore how medical care is delivered to older people in assisted living (AL) settings and to suggest ways for improving it. DESIGN AND METHODS: We present a review of the limited research available on health care for older AL residents and on building testable models of better ways to organize primary health care and other health services for AL residents. RESULTS: AL residents are frequently frail older persons who need good chronic care. The predominant care models today do not respond adequately to this challenge. Medical care for AL residents is currently practiced very much like that for persons living in the community. The potential for using the aggregation of patients has not been effectively tapped. We review some managed care models from other elements of long-term care to look for ways that might be adapted. However, the current funding approach emphasizes living settings rather than inherent client characteristics. IMPLICATIONS: A research agenda might include ways to improve communication between AL and medical providers and to get AL staff more actively involved in daily care. Research support might produce the data necessary to entice the Centers for Medicare & Medicaid Services into changing its current reimbursement policies to create a climate better suited to delivering good chronic disease care in AL facilities.