A novel inpatient PA staffing model for a community hospital.

OBJECTIVE: We sought to create a novel physician assistant (PA) and physician hospital medicine co-management strategy, employing a 3:1 PA:physician structure, under which the physician oversees all PA patients, but without a separate independent panel. METHODS: This is a retrospective cohort pre-post design, comparing metrics for a traditional physician-only hospitalist model with a PA-physician team model. Outcomes included length of stay (LOS), readmissions, discharge destination, patient satisfaction, and in-hospital mortality. RESULTS: LOS for patients under the PA-physician model (74 hours) was lower than for the physician-only model (83 hours; P < .001). The PA-physician model team discharged more patients home than to another facility (PA-physician 77.6%, physician-only 74.3%; P = .03). Thirty-day readmissions were about 10% (P = .97) and patients reported respectful treatment in about 80% (P = .53) of cases in each cohort. CONCLUSIONS: Our 3:1 PA-physician model team showed equal to superior outcomes compared with the physician-only hospitalist model.

Patient Empowerment Among Transgender and Gender Diverse Youth.

Purpose: Patient empowerment is becoming increasingly important as health care moves toward more collaborative models of care. The goal of this study was to evaluate and characterize patient empowerment in a sample of transgender/gender-diverse/nonbinary (TGDNB) youth aged 14-24 who have had at least one conversation with a medical health care provider about gender-affirming care. Methods: We adapted a health care empowerment scale for use with TGDNB young people and collected patient empowerment and sociodemographic data among TGDNB youth in the United States over an 8-week period in the spring of 2022. Overall and domain-specific empowerment (including knowledge and understanding, control, identity, decision-making, and supporting others) were assessed on a four-point scale from a low of 1 to a high of 4. Results: A total of 177 youth completed the survey. Mean age was 18.4 ± 3.0 years, the sample was 39.5% gender-diverse/nonbinary, 16.4% transfemme, 44.1% transmasc, and 81.9% White. Average empowerment was 0.22 points higher in youth with supportive caregivers than those without (99% confidence interval [CI] 0.05-0.38, p < 0.001) and 0.20 points higher in youth who sought gender-affirming mental health support (99% CI 0.04-0.36, p = 0.001). Caregiver support increased youths' sense of control over their health/health care (estimated increase 0.29, 99% CI 0.09-0.50, p < 0.001), and mental health support increased youths' decision-making agency by 0.30 points (99% CI 0.06-0.53, p = 0.001). Conclusions: This is the first study to assess patient empowerment in TGDNB youth. Several sociodemographic factors were significantly associated with overall and domain-level empowerment. Further work in this area, both longitudinal and in larger samples, is warranted.

Lessons from Grassroots Efforts to Increase Gender-Affirming Medical Care for Transgender and Gender Diverse Youth in the Community Health Care Setting.

Increasingly, transgender and gender diverse (TGD) youth are seeking gender-affirming medical care. Most multidisciplinary gender-affirming pediatric clinics are located in academic facilities in urban areas. To improve access to care and advance the field, grassroots establishment-without targeted funding or explicitly trained gender health providers-of multidisciplinary gender health clinics in rural and community health care settings can increase care access and lay the foundation for dedicated funding, staff, and clinic space. In this perspective piece, we share our grassroots process of establishing a multidisciplinary gender health clinic in the community setting, highlighting critical turning points that facilitated our clinic's rapid growth. Our experience can provide important lessons learned for community health care systems seeking to establish programs that will serve TGD youth.

COVID-19 and inequities in colorectal and cervical cancer screening and diagnosis in Washington State.

INTRODUCTION: Studies have shown that cancer screenings dropped dramatically following the onset of the coronavirus diseases 2019 (COVID-19) pandemic. In this study, we examined differences in rates of cervical and colorectal cancer (CRC) screening and diagnosis indicators before and during the first year of the COVID-19 pandemic. METHODOLOGY: We used retrospective data from a large healthcare system in Washington State. Targeted screening data included completed cancer screenings for both CRC (colonoscopy) and cervical cancer (Papanicolaou test (Pap test)). We analyzed and compared the rate of uptake of colorectal (colonoscopies) and cervical cancer (Pap) screenings done pre-COVID-19 (April 1, 2019-March 31, 2020) and during the pandemic (April 1, 2020-March 31, 2021). RESULTS: A total of 26,081 (12.7%) patients underwent colonoscopies in the pre-COVID-19 period, compared to only 15,708 (7.4%) patients during the pandemic, showing a 39.8% decrease. A total of 238 patients were referred to medical oncology for CRC compared to only 155 patients during the first year of the pandemic, a reduction of 34%. In the pre-COVID-19 period, 22,395 (10.7%) women were administered PAP tests compared to 20,455 (9.6%) women during the pandemic, for a 7.4% reduction. period 1780 women were referred to colposcopy, compared to only 1680 patients during the pandemic, for a 4.3% reduction. CONCLUSION: Interruption in screening and subsequent delay in diagnosis during the pandemic will likely lead to later-stage diagnoses for both CRC and cervical cancer, which is known to result in decreased survival. IMPACT: The results emphasize the need to prioritize cancer screening, particularly for those at higher risk.

Sex Differences in Comorbid Mental and Substance Use Disorders Among Primary Care Patients With Opioid Use Disorder.

OBJECTIVE: The authors sought to characterize the 3-year prevalence of mental disorders and nonnicotine substance use disorders among male and female primary care patients with documented opioid use disorder across large U.S. health systems. METHODS: This retrospective study used 2014-2016 data from patients ages ≥16 years in six health systems. Diagnoses were obtained from electronic health records or claims data; opioid use disorder treatment with buprenorphine or injectable extended-release naltrexone was determined through prescription and procedure data. Adjusted prevalence of comorbid conditions among patients with opioid use disorder (with or without treatment), stratified by sex, was estimated by fitting logistic regression models for each condition and applying marginal standardization. RESULTS: Females (53.2%, N=7,431) and males (46.8%, N=6,548) had a similar prevalence of opioid use disorder. Comorbid mental disorders among those with opioid use disorder were more prevalent among females (86.4% vs. 74.3%, respectively), whereas comorbid other substance use disorders (excluding nicotine) were more common among males (51.9% vs. 60.9%, respectively). These differences held for those receiving medication treatment for opioid use disorder, with mental disorders being more common among treated females (83% vs. 71%) and other substance use disorders more common among treated males (68% vs. 63%). Among patients with a single mental health condition comorbid with opioid use disorder, females were less likely than males to receive medication treatment for opioid use disorder (15% vs. 20%, respectively). CONCLUSIONS: The high rate of comorbid conditions among patients with opioid use disorder indicates a strong need to supply primary care providers with adequate resources for integrated opioid use disorder treatment.