Advance care planning (ACP) is the process of guiding patients' selection of preferences for end-of-life care. It includes receiving information on the types of lifesustaining treatments available, deciding what types of treatment are wanted or not wanted, sharing personal values with loved ones, and completing an advance directive (National Hospice and Palliative Care Organization, n.d.

In 2017, 352 refugees were relocated to the Kansas City, Kansas area. As part of the relocation process, newly arrived refugees receive physical and mental health screenings. This study is a retrospective analysis of the results of 92 Refugee Health Screener-15 (RHS-15) surveys collected from February to December 2017 and interviews with the healthcare providers who administered the surveys in a primary care clinic. The most commonly reported mental health symptoms included the following: too much thinking or too many thoughts; muscle, bone, or joint pain; and crying easily. Thirty-seven refugee surveys (40%) indicated the need for follow-up mental health screening. A significant small correlation ( r = .22, p = .03) was found between female gender and the depression subscale of mental health symptoms. Provider interviews revealed challenges associated with conducting mental health screening of newly arrived refugees in a primary care setting.

Studies have suggested that extreme weather events have differential effects by age. By leveraging electronic medical records, we aim to analyze the environmental influence of extreme heat on the health of older adults. From our healthcare system’s de-identified data warehouse, we extracted a retrospective cohort of 108,192 patients who were ≥65 years of age as of 1/1/2018 with pre-existing chronic conditions including diabetes, COPD, cardiovascular disease, or kidney disease. Extreme heat event period was defined as 5/1/2018 to 9/1/2018 (79 days with temperature ≥90o; 15 days of moderately poor/poor air quality index (AQI) [≥75] values) and the comparison period was defined as 5/1/2019 to 9/1/2019 (51 days with temperature ≥90o; 0 days with moderately poor/poor AQI values) in the Kansas City area. We randomly partitioned the study cohort into two sets and demonstrated the two patient sets were statistically similar (p>0.05) with respect to their demographic and underlying health conditions. Finally, we compared the respiratory, cardiovascular, and renal health outcomes between the 2018 and the 2019 cohorts. Most patients were Caucasians, female and had comorbid conditions. Results showed significantly higher number of all-cause emergency department visits (p=0.04) and outpatient visits (p=<.001) during the extreme heat event period in 2018. Analyses also showed significantly higher number of outpatient visits due to upper respiratory diseases (p=0.008) and acute renal failure (p=0.01) in 2018. In conclusion, extreme heat increased use of healthcare services in older adults with chronic conditions.

Primary care settings have many opportunities to support patients who have anxiety and/or depression, but resources are often scarce. Our faculty team developed an education tool to support mental health awareness and provide suggested wellness activities. Health-care professionals from various disciplines and settings have demonstrated eagerness to use this tool with patients and with health-care students to improve resilience and mental wellness.