Key Factors Promoting Rapid Implementation of Virtual Screening Modalities for the COVID-19 Pandemic Response.

BACKGROUND: The COVID-19 (C-19) pandemic required swift response from health care organizations to mitigate spread and impact. A large integrated health network rapidly deployed and operationalized multiple access channels to the community, allowing assessment and triage to occur virtually. These channels were characterized by swift implementation of virtual models, including asynchronous e-visits and video visits for C-19 screening. PURPOSE: (1) Evaluate implementation characteristics of C-19 screening e-visits and video visits. (2) Identify volume of C-19 screening and other care provided via e-visits and video visits. (3) Discuss future implications of expanded virtual access models. METHODS: Retrospective analysis of implementation data for C-19 screening e-visits and video visits, including operational characteristics and visit/screening volumes conducted. RESULTS: Virtual channels were implemented and rapidly expanded during the first week C-19 testing was made available. During the study period, primary care clinicians conducted 10,673 e-visits and 31,226 video visits with 9,126 and 26,009 patients, respectively. Within these 2 virtual modalities, 4,267 C-19 tests were ordered (10% of visits). Four hundred forty-eight clinicians supported 24/7 access to these virtual modalities. DISCUSSION: Given ongoing patient interest and opportunity, virtual health care services will continue to be available for an expanded number of symptoms and diagnoses.

Costs and benefits of Wolbachia infection in immature Aedes albopictus depend upon sex and competition level.

Bacterial endosymbionts induce various effects on hosts and can dramatically impact host fitness and development. An example is provided by obligate, maternally-inherited Wolbachia, which infect a broad range of invertebrates. Wolbachia are capable of altering host reproduction, thereby promoting infection spread. Wolbachia also pose direct physiological costs and benefits to hosts, complicating their categorization as parasites or mutualists. This study examines for an effect of Wolbachia infection in intra-specific larval competition by Aedes albopictus mosquitoes, with the goal of examining for an impact of Wolbachia infection in mixed populations. Similar to prior work examining for an influence of Wolbachia infection on the fitness of A. albopictus in adults, the results presented here support the hypothesized impact of Wolbachia across all life stages, including immatures. The differential competitiveness of infected larvae detected in our experiments indicates that Wolbachia infected A. albopictus females are less competitive relative to uninfected females when competing under highly competitive conditions. In contrast, under low competitive pressures, infected females experience higher survivorship. Thus, Wolbachia infection shifts from parasitism to mutualism as a function of developmental conditions. Results are discussed in relation to the invasion and persistence of Wolbachia in A. albopictus populations. The results are important to the evolution of stable Wolbachia symbioses, including Wolbachia invasion of an uninfected population. The resulting infection dynamics that occur in an infected population are discussed.

The Effect of Primary Care Team Realignment on Point-of-Care Screening.

Reporting primary care quality measures is an essential component of value-based care delivery and is part of the strategy to bend the health care cost curve. As primary care physicians are increasingly pressed for time, incorporating ancillary staff screening into pre-visit workflows can increase screening rates, but can pose a challenge in large practice settings. The objective was to improve screening rates for depression and falls risk at a large, urban primary care practice. Jefferson Family Medicine Associates is a practice in downtown Philadelphia that serves 35,000 patients and provides approximately 80,000 visits annually. The majority of patients are African American. Screening responsibilities were realigned within medical assistant workflows, and a training program was designed and implemented to ensure its success and sustainability. Monthly Group Practice Reporting Option data on depression screening and falls risk screening was collected from January 1, 2015, to October 31, 2016. The primary outcome measures were the rate of depression screening and falls risk screening performed for patients who had a visit during the study period. The average monthly depression screening rate changed from 1.41% pre intervention to 49.77% post intervention (z = -100.65; P < .001). The average monthly falls screening rate changed from 19.23% pre intervention to 61.33% post intervention (z = -77.97, P < .001). This workflow redesign, training model, and implementation was successful at increasing screening rates for depression and falls risk, and may benefit other practices that hope to accomplish similar quality measure improvements.