Identifying individual social needs during intake for diabetes Self-Management education and support services in the Detroit, Michigan area.

The American Diabetes Association has recommended that diabetes self-management education and support (DSMES) teams improve diabetes outcomes by identifying and responding to patients' social needs. This study examines demographic patterns in how hemoglobin A1c (A1c) is related to individual social needs, reported urgency of those needs, and interest in obtaining assistance. A total of 1125 unique persons who had been referred for DSMES and had completed a social needs screener via our electronic medical record were included. The majority (51.9 %) had an A1c < 8 % at their most recent assessment and most respondents (52.5 %) reported having at least 1 unmet social need (n = 591), Those who reported having at least 1 social need, tended to have higher A1c levels compared with those who reported no social needs (median of 8.0 % versus 7.7 %; p < 0.05). Among Black individuals the associations were stronger (median A1c of 8.2 % among those with versus 7.2 % among those without a reported social need; p < 0.05). However, among White individuals, there was no difference in A1c between these two groups. Among those who reported a social need, those who also reported they needed assistance (35.7 %) tended to have higher A1c levels than those who did not (median 8.3 % versus 7.8 %; p < 0.10). This relationship did not vary by race. Ongoing study of the relationship between unmet social needs and glycemic control is warranted to help identify effective clinical workflows to help providers incorporate consideration of social needs into their medical decision making.

Disparities in Use of Virtual Primary Care During the Early COVID-19 Pandemic.

Background: The COVID-19 pandemic increased the use of virtual health care. However, certain factors may disparately affect some patients' utilization of virtual care. Associations between age, racial categories (White or Black), and socioeconomic disadvantage were evaluated during the early COVID-19 pandemic. Methods: This cross-sectional retrospective study included adult patients with virtual or in-person primary care encounters at a large, midwestern hospital system with widespread urban and suburban offices between March 1, 2020, and June 30, 2020. Virtual visits included synchronous video and telephone visits and asynchronous patient portal E-visits. Chi-squared tests and multivariable logistic analysis assessed the associations between ages and racial categories, and area deprivation index with the use of virtual versus in-person primary care. Results: Of 72,153 patient encounters, 43.0% were virtual visits, 54.6% were White patients, and 45.4% were Black. Across equivalent age ranges, black patients were slightly less likely to utilize virtual care than similarly aged White patients, but not consistently across virtual modalities. Women were more likely to use virtual care across all modalities, and individuals >65 years were more likely to use telephone visits and less likely to use video and E-visits, regardless of race. Patients residing in areas with the greatest socioeconomic advantage were more likely to utilize video and E-visits. Conclusions: Differential patterns of utilization emerged across racial categories and age ranges, suggesting that racial disparities are exacerbated depending upon patient age and mode of utilization.

A Scoping Review of Strategies to Increase Black Enrollment and Retention in Cancer Clinical Trials.

To address health disparities faced by Black patients with cancer, it is critical that researchers conducting cancer clinical trials (CCTs) equitably recruit and retain Black participants, develop strategies toward this aim, and document associated outcomes. This narrative scoping literature review, as part of a larger study, aimed to identify, describe, and categorize strategies and interventions intended to improve the recruitment and retention of Black participants with breast, lung, prostate, colorectal, or multiple myeloma cancer into CCTs. We conducted comprehensive searches in PubMed, Embase, Cochrane Library, PsycInfo, CINAHL, Scopus, and Web of Science with three main concepts: Black persons, neoplasms, and clinical trial recruitment. The search resulted in 1,506 articles, of which 15 met inclusion criteria. Five main categories of recruitment and retention strategies and interventions were identified based on their specific population focus and type of approach: (1) participant identification, (2) provider awareness/resources, (3) focused research staff interventions, (4) patient and community-focused awareness strategies, and (5) participant-directed resources. Thirteen studies had recruitment acceptance rates of over 30%. Eight studies with acceptance rates of ≥ 50% reported implementing ≥ 5 strategies, with an average use of seven strategies across multiple categories. Five studies with acceptance rates ≥ 50% implemented strategies in ≥ 3 categories. Four studies reported retention rates ≥ 74%. Three studies with reported retention rates ≥ 74% used strategies in ≥ 3 categories, and all included strategies aimed at meeting participant needs beyond the study. Our results show that many efforts that aim to increase the recruitment and retention of Black participants into CCTs have great potential, but the most promising strategies use a multiprong approach.

Assessing the Adequacy of Obstructive Sleep Apnea Diagnosis for High-Risk Patients in Primary Care.

INTRODUCTION: The exact prevalence of obstructive sleep apnea (OSA) is unknown, and primary care providers are left with conflicting guidance on screening criteria from various institutions. The purpose of this study was to identify health care gaps in OSA diagnosis for patients at high risk of OSA. METHODS: A retrospective medical record review was performed assessing adult patients (≥ 18 years) who had outpatient visits in family medicine clinics, located in the cities of Detroit, Troy, and Commerce, Michigan in 2018. The primary outcome was the number of patients assessed for OSA. Patients determined as high risk for OSA had at least 3 of the following criteria: (1) hypertension, (2) age 50 years and older, (3) male gender, and (4) body mass index > 35 kg/m2. Statistical approach included univariate and logistic regression analysis. Manual chart review of 200 randomly selected records was performed to determine the most common reasons for OSA screening. RESULTS: Out of 30,022 patients, 4,911 (16.4%) were at high risk for OSA, of which 1,524 (31.0%) were assessed for OSA. Logistic regression analysis of high-risk patients revealed that male sex (odds ratio, 1.84; 95% CI, 1.51-2.26; P < .001) and body mass index > 35 kg/m2 (odds ratio, 4.96; 95% CI, 4.04-6.09; P < .001) were significantly associated with OSA evaluation. Race was not associated with OSA assessment. CONCLUSION: Because many individuals at high risk for OSA are not referred for evaluation, improved guidance on OSA screening based on objective risk factors is needed.

Identifying factors affecting diabetes education program participation within a metro Detroit integrated health system.

Diabetes self-management education and support (DSMES) can help people achieve optimal disease control, yet these services often remain underutilized. People referred to these programs by their provider can become disengaged in the program at several key steps. This study applies Classification and Regression Tree analysis to 3796 people with diabetes at a single health system based in the Detroit metropolitan area who were referred for DSMES provided by the health system to determine demographic patterns of those who were successfully contacted to schedule program intake appointments, those who did not attend their intake appointment, and those who began but did not complete their personalized DSMES program. White people > 43 years of age, those with a prior A1C value > 8.9 and those with Medicaid insurance had the highest rate of not being successfully contacted for their intake appointment. Those who did not attend their intake appointment tended to have Medicaid insurance, be younger than 48 years, and have A1C > 8.1. Within the Medicare or private insurance groups, those who did not attend were more likely to be female, of Black race and not partnered. Older males with a lower A1C (≤8.3%) had the lowest rate (34.0%) of failing to complete their DSMES plan. The data showed that almost half of those referred were not successfully contacted. The overall low completion rate of 13.2% confirms the need to examine factors predictive of participation and completion. This study highlights process improvement changes to improve personalization of outreach and engagement.

Diabetes mellitus and hyperglycemia control on the risk of colorectal adenomatous polyps: a retrospective cohort study.

BACKGROUND: Colorectal cancer (CRC) develops from colorectal adenomatous polyps. This study is to determine if diabetes mellitus (DM), its treatment, and hemoglobin A1c (HbA1c) level are associated with increased risk of colorectal adenomatous polyps. METHODS: This was a retrospective cohort study that included patients who had at least one colonoscopy and were continuously enrolled in a single managed care organization during a 10-year period (2002-2012). Of these patients (N = 11,933), 1800 were randomly selected for chart review to examine the details of colonoscopy and pathology findings and to confirm the diagnosis of DM. Multivariable logistic regression analyses were performed to assess the associations between DM, its treatment, HbA1c level and adenomatous polyps (our main outcome). RESULTS: Among the total of 11,933 patients with a mean (standard deviation) age of 56 (± 8.8) years, 2306 (19.3%) had DM and 75 (0.6%) had CRC. Among the 1800 under chart review, 445 (24.7%) had DM, 11 (0.6%) had CRC and 537 (29.8%) had adenomatous polyps. In bivariate analysis, patients with DM had 1.45 odds of developing adenomatous polyps compared to those without DM. This effect was attenuated (odds ratio = 1.25, 95% CI: 0.96-1.62, p = 0.09) after adjusting for confounders such as age, gender, race/ethnicity, and body mass index. There was no significant association between type or duration of DM treatment or HbA1c level and adenomatous polyps. CONCLUSIONS: Our study confirmed the known increased risk of adenomatous polyps with advancing age, male gender, Hispanic race/ethnicity and higher body mass index. Although it suggested an association between DM and adenomatous polyps, a statistically significant association was not observed after controlling for other potential confounders. Further studies with a larger sample size are needed to further elucidate this relationship.

Recognizing Privilege and Bias: An Interactive Exercise to Expand Health Care Providers' Personal Awareness.

PROBLEM: Despite increasing awareness of the social determinants of health, health care disparities among sociocultural groups persist. Health care providers' unconscious bias resulting from unrecognized social privilege is one contributor to these disparities. APPROACH: In 2009, Henry Ford Health System initiated the Healthcare Equity Campaign both to raise employees' awareness of inequalities related to the social determinants of health and to increase their motivation to reduce them. After conducting awareness-raising activities to increase employees' understanding of the social determinants of health, a curriculum team developed the interactive Privilege and Responsibility Curricular Exercise (PRCE) and incorporated it into a series of trainings. The team designed the exercise to enhance participants' awareness of privilege in their lives and work, to improve their understanding of the impact of privilege on their own and others' lived experiences as a step beyond cultural competence toward cultural humility, and to encourage them to leverage their advantages to reduce health care inequities. OUTCOMES: About 300 participants of diverse professional and personal backgrounds from across the health system completed the training between the spring of 2009 and the spring of 2012, and many provided qualitative feedback about the exercise. Evaluations showed the exercise's potential as a powerful learning experience that might enhance a variety of equity- or diversity-related trainings, and also showed that participants considered the PRCE a highlight of the training. NEXT STEPS: The PRCE is worthy of additional study and could prove valuable to other organizations.

John Henryism, socioeconomic position, and blood pressure in a multi-ethnic urban community.

OBJECTIVES: The John Henryism (JH) hypothesis suggests that, under adverse social and economic conditions, high-effort coping styles that reflect hard work and determination may contribute to elevated blood pressure. Results from tests of this hypothesis have been mixed, with variations by region, urban versus rural areas, race, gender, and age. The majority of studies reporting that socioeconomic position modifies associations between JH and blood pressure have been for non-Latino Blacks in rural communities. In contrast, most studies conducted in urban areas report little support for the JH hypothesis. Few studies have been conducted in samples that include Latinos. We extend previous research by testing the JH hypothesis in a multi-ethnic, low-to-moderate income urban community. DESIGN: We used multivariate linear regression to test the hypothesis that associations between JH and blood pressure were modified by income, education, or labor force status in a multi-ethnic (non-Latino Black, Latino, non-Latino White) sample (N=703) in Detroit, Michigan. The outcome measures were systolic (SBP) and diastolic blood pressure (DBP). RESULTS: John Henryism was associated with higher SBP (ß=3.92, P=.05), but not DBP (ß=1.85, P=.13). These associations did not differ by income, education, or labor force status. Results did not differ by race or ethnicity. CONCLUSIONS: John Henryism is positively associated with SBP in this multi-ethnic, low-to-moderate income sample. This association did not differ by income, education, or labor force status. Results are consistent with studies conducted in urban communities, finding limited evidence that associations between JH and blood pressure vary by socioeconomic position.

Variations in hypertension-related outcomes among Blacks, Whites and Hispanics in two large urban areas and in the United States.

OBJECTIVE: This study compared the hypertension prevalence, awareness, treatment and control in Chicago, Illinois and Detroit, Michigan to that of the general United States population (aged > or = 25 years) for the period 2001-2003. We examined whether and how much 1) urban populations have less favorable hypertension-related outcomes and 2) the rates of racial/ethnic minorities lag behind those of Whites in order to determine if the national data understate the magnitude of hypertension-related outcomes and racial/ethnic disparities in two large cities in the Midwestern region of the United States and perhaps others. METHODS: Unstandardized and standardized hypertension-related outcome rates were estimated. RESULTS: The hypertension-related outcomes among Chicago and Detroit residents lag behind the United States by 8%-14% and 10%-18% points, respectively. Additionally, this study highlights the complexity of the racial/ethnic differences in hypertension-related outcomes, where within each population, Blacks were more likely to have hypertension and to be aware of their hypertension status than Whites, and no less likely to be treated. Conversely, Hispanics were less likely to have hypertension and also less likely to be aware of their status when they do have hypertension when compared to Whites. CONCLUSION: At a time when efficacious treatment for hypertension has been available for more than 50 years, continued racial/ethnic differences in the prevalence, awareness, treatment and control of hypertension is among public health's greatest challenges. To achieve the proposed national hypertension-related goals, future policies must consider the social context of hypertension within central cities of urban areas.