Challenges to health care access in the US are forcing local policymakers and service delivery systems to find novel ways to address the shortage of primary care clinicians. The uninsured and underinsured face the greatest obstacles in accessing services. Geographic information systems mapping software was used to illustrate health disparities in Alachua County, FL; galvanize a community response; and direct reallocation of resources. The University of Florida Family Data Center created "hot spot" density maps of important health and social indicators to highlight the location of disparities at the neighborhood level. Maps were produced for Medicaid births, teen births, low birth weight, domestic violence incidents, child maltreatment reports, unexcused school absences, and juvenile justice referrals. Maps were widely shared with community partners, including local elected officials, law enforcement, educators, child welfare agencies, health care providers, and service organizations. This data sharing resulted in advocacy efforts to bring resources to the greatest-need neighborhoods in the county. Novel public-private partnerships were forged between the local library district, children and family service providers, and university administrators. Two major changes are detailed: a family resource center built in the neighborhood of greatest need and a mobile clinic staffed by physicians, nurses, physician assistants, health educators, and student and faculty volunteers. Density maps have several advantages. They require minimal explanation. Anyone familiar with local geographic features can quickly identify locations displaying health disparities. Personalizing health disparities by locating them geographically allows a community to translate data to action to improve health care access.

BackgroundHospital overcrowding and operating above capacity have occurred frequently throughout the COVID-19 pandemic. Both phenomena can lead to worsened patient outcomes; thus, it is imperative to find solutions that tackle both. Our goal was to create a treatment protocol for a subset of patients with mild to moderate COVID-19 infection that would combat inpatient overcrowding by diverting these patients to an emergency department (ED) observation unit (EDOU). This protocol was based on dynamic treatment guidelines and required regular updates to allow our team to provide the most up-to-date care throughout the pandemic. MethodsThis study is a retrospective chart review of all adult patients seen at two large suburban EDs for symptoms related to COVID-19 from April 2020 to January 2022. We subsequently identified adult patients who met the criteria for treatment with our COVID-19 protocol and were placed in our observation unit. These patients were identified using a flag for the protocol order set within our electronic medical record. Primary outcomes include the need for hospital admission, bounce back rate, and death rate. ResultsA total of 2,417 patients were treated in our ED observation units using our COVID-19 protocol. Our study population was evenly divided by gender, while a majority self-identified as white (76%). Five hundred two patients (20.8%) required admission to the hospital, and of these, 55 (11%) patients required intensive care unit (ICU) level of care. A total of 27 (1.1%) patients died. No deaths occurred for patients that remained within our ED observation units. Bounce back rates at the 48-hour, 72-hour, and seven-day marks were 3.6%, 4.6%, and 7.9%, respectively. Finally, we calculated a total of 284 inpatient days saved with the implementation of our protocol. ConclusionThis study shows that our newly created protocol is effective in that it reduces the need for inpatient hospital admissions and results in low bounce back rates. Protocol-driven care in ED observation units can be a powerful tool against hospital overcrowding. Creating such protocols offers opportunities for hospital systems to provide efficient care at a significant cost savings without sacrificing quality of care. Our COVID-19 treatment protocol can be replicated by other hospital systems within their own ED observation units should any future similar outbreaks occur.

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