Assessing medical students' confidence in promoting high value care in clinical practice.

Background: Medical students who are exposed to value-based care early in their education may be more likely to practice it. Our study aimed to understand medical students' knowledge of and ability to implement the principles of high-value care in clinical settings. Additionally, we assessed students' confidence in using high-value care practices to both influence care decisions and educate patients. Methods: We surveyed third-year medical students at Texas A&M School of Medicine during their clerkship rotations using a 7-question Likert-scale survey. Students were asked to evaluate their confidence in performing cost-conscious high-value care behaviors. Results: Of the 114 students offered the survey, 34 (30%) completed it fully. The greatest variance in response occurred in students' attitudes toward their role in controlling healthcare costs. Half of respondents agreed or strongly agreed that they played a part in cost control as medical students, with 35% somewhat or strongly disagreeing. A majority of students felt confident initiating a conversation about costs with patients, while 21% somewhat or strongly disagreed that they were confident. Conclusion: Overall, our results reveal that the main area lacking in students' education in value-based care is instilling the belief that they, as medical students, have a role to play in controlling healthcare costs.

The lingering impact of Hurricane Katrina: Examining the physical health, mental health, and racial equity impacts of disaster response.

PURPOSE: The purpose of the research discussed in this paper is to better understand the negative health outcomes resulting from Hurricane Katrina and the disaster response that followed. This understanding can inform future disaster response. DESIGN: We conducted 10 in-depth interviews with individuals who lived in New Orleans at the time of Hurricane Katrina. We conducted thematic analysis on the interview content and identified patterns across all 10 interviews. FINDINGS: Four primary patterns emerged across all interviews. These were: (1) Federal Emergency Management Agency's (FEMA) response to the crisis created greater physical and mental health hazards for interviewees; (2) Hurricane Katrina led to long-term mental health issues for interviewees, even those who evacuated before the storm; (3) displacement from homes following the storm typically resulted in overcrowded living conditions, which increased interviewees' risk of infectious disease; and (4) the discrimination faced by interviewees in the months and years following Hurricane Katrina had a profound and lasting impact on their well-being. ORIGINALITY: Numerous studies have been conducted to understand the mental health impacts of disaster and a limited number have looked at the physical health impacts or the threat of infectious disease. This study is unique because it incorporates both mental and physical health impacts, but also examines how disaster response itself plays a role in health outcomes for survivors. Additionally, this paper also incorporates the role of racial inequities in disaster response and how those inequities impact survivor health.

The lingering impact of Hurricane Katrina: Examining the physical health, mental health, and racial equity impacts of disaster response.

PURPOSE: The purpose of the research discussed in this paper is to better understand the negative health outcomes resulting from Hurricane Katrina and the disaster response that followed. This understanding can inform future disaster response. DESIGN: We conducted 10 in-depth interviews with individuals who lived in New Orleans at the time of Hurricane Katrina. We conducted thematic analysis on the interview content and identified patterns across all 10 interviews. FINDINGS: Four primary patterns emerged across all interviews. These were: (1) FEMA's response to the crisis created greater physical and mental health hazards for interviewees; (2) Hurricane Katrina led to long-term mental health issues for interviewees, even those who evacuated before the storm; (3) displacement from homes following the storm typically resulted in overcrowded living conditions, which increased interviewees' risk of infectious disease; and (4) the discrimination faced by interviewees in the months and years following Hurricane Katrina had a profound and lasting impact on their well-being. ORIGINALITY: Numerous studies have been conducted to understand the mental health impacts of disaster and a limited number have looked at the physical health impacts or the threat of infectious disease. This study is unique because it incorporates both mental and physical health impacts, but also examines how disaster response itself plays a role in health outcomes for survivors. Additionally, this paper also incorporates the role of racial inequities in disaster response and how those inequities impact survivor health.

The cost of a "benign" condition: Healthcare utilization and infectious outcomes in young children with primary autoimmune neutropenia.

BACKGROUND: Autoimmune neutropenia (AIN) is a common cause of chronic neutropenia in childhood. Despite an expected benign clinical course, many patients undergo extensive evaluation. Data on healthcare utilization and rates of bloodstream infections in young patients with AIN are limited. METHODS: All patients with a diagnosis code of leukopenia, neutropenia, or AIN followed within the outpatient hematology clinic of a single institution from 2014 to 2016 were identified. Patients aged ≤5 years with absolute neutrophil count (ANC) ≤500/µL persisting for ≥3 months, a clinical diagnosis of AIN, and documented resolution of neutropenia were included. Data on clinical management, including infectious outcomes and emergency center (EC) encounters, were collected. RESULTS: Forty-three patients with AIN (18 male [42%], median age at diagnosis 12 months) met eligibility criteria. Children were followed by hematology for a median duration of 18 (range, 2-85) months. Diagnostic evaluations were variable. Thirty patients (70%) had ≥ 1 EC encounters for evaluation of isolated fever with a total of 113 EC encounters for the overall cohort. Patients with ANC < 500/µL and isolated fever were admitted for observation, which resulted in 24 hospitalizations in 16 patients. Of 138 blood cultures drawn, two were positive, both later determined to be contaminants. CONCLUSION: At a large tertiary care center, no bloodstream infections were identified in a cohort of 43 children with AIN presenting to the EC for assessment of fever. A less-intensive, more cost-effective management paradigm, which continues to prioritize patient safety, among young children with AIN is needed.