An Assessment of the Social Determinants of Health in an Urban Emergency Department

Ordonez, Edgardo; Dowdell, Katherine; Navejar, Natasha; Dongarwar, Deepa; Itani, Aya; Salihu, Hamisu M.

doi:10.5811/westjem.2021.4.50476

Cited by 10 publications

(8 citation statements)

References 32 publications

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“…Texas did not expand Medicaid coverage under the Affordable Care Act, and most patients in this health system are underinsured or use a county financial assistance program (FAP) for medical services within the hospital system. 31 , 32 This study received institutional review board approval.…”

Section: Methodsmentioning

confidence: 99%

Patient-Centered Outcomes of an Emergency Department Social and Medical Resource Intervention

Gupta

Wang

et al. 2022

WestJEM

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Introduction: Few studies have examined the impact of emergency department (ED) social interventions on patient outcomes and revisits, especially in underserved populations. Our objective in this study was to characterize a volunteer initiative that provided community medical and social resources at ED discharge and its effect on ED revisit rates and adherence to follow-up appointments at a large, county hospital ED. Methods: We performed a cross-sectional analysis of ED patients who received medical and social resources and an educational intervention at discharge between September 2017–June 2018. Demographic information, the number of ED return visits, and outpatient follow-up appointment adherence within 30 and 90 days of ED discharge were obtained from electronic health records. We obtained data regarding patient utilization of resources via telephone follow-up communication. We used logistic regression analyses to evaluate associations between patient characteristics, reported resource utilization, and revisit outcomes. Results: Most patients (55.3% of 494 participants) identified as Latino/Hispanic, and 49.4% received healthcare assistance through a local governmental program. A majority of patients (83.6%) received at least one medical or social resource, with most requesting more than one. Patients provided with a medical or social resource were associated with a higher 90-day follow-up appointment adherence (odds ratio [OR] 2.56; 95% confidence interval [CI] 1.05-6.25, and OR 4.75; 95% CI 1.49-15.20], respectively), and the provision of both resources was associated with lower odds of ED revisit within 30 days (OR 0.50; 95% CI 0.27-0.95). Males and those enrolled in the healthcare assistance program had higher odds of ED revisits, while Hispanic/Latino and Spanish-speaking patients had lower odds of revisits. Conclusion: An ED discharge intervention providing medical and social resources may be associated with improved follow-up adherence and reduced ED revisit rates in underserved populations.

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Section: Methodsmentioning

confidence: 99%

Patient-Centered Outcomes of an Emergency Department Social and Medical Resource Intervention

Gupta

Wang

et al. 2022

WestJEM

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“…Second, although personality traits are not typically assessed in healthcare settings currently, there is a precedent for doing so given that other personality-related questions are often asked in routine care settings as screeners (e.g., "to what extent have you felt sad lately" as a screener for depression) and recent research has begun to examine the utility of assessing social determinants of health in healthcare settings (e.g., Ordonez et al, 2021). Incorporating personality assessment into healthcare systems in an efficient manner would be necessary before direct healthcare applications are possible.…”

Section: Implications For Healthcare Delivery and Policymentioning

confidence: 99%

Personality traits and healthcare use: A coordinated analysis of 15 international samples

Willroth¹,

Luo²,

Atherton³

et al. 2023

Preprint

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Some people use healthcare services more than others. Identifying factors associated with healthcare use has the potential to improve the effectiveness, efficiency, and equity of healthcare. In line with the Andersen behavioral model of healthcare utilization and initial empirical findings, personality traits may be key predisposing factors associated with healthcare use. Across 15 samples, the present study examined cross-sectional and prospective associations between Big Five personality traits and the likelihood of dental visits, general medical practitioner visits, and hospitalizations. Using coordinated data analysis, we estimated models within each of 15 samples individually (sample Ns ranged from 516 to 305,762), and then calculated weighted mean effect sizes using random effects meta-analysis across samples (total N = 358,803). According to the synthesized results, people higher in conscientiousness, agreeableness, extraversion, and openness, and lower in neuroticism were more likely to visit the dentist; people higher in neuroticism were more likely to visit general medical practitioners; and people lower in conscientiousness and agreeableness and higher in neuroticism were more likely to be hospitalized. Associations tended to be small with odds ratios around 1.20 (rs ≈ .05). These findings provide evidence across 15 international samples for small but consistent associations between personality traits and healthcare use and demonstrate that personality-healthcare associations differ by type of care. We discuss directions for future research, including examining more specific personality facets (e.g., productiveness vs. responsibility) as well as important dimensions of healthcare (e.g., preventative vs. reactive care; acute vs. chronic care).

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“…9 More importantly, overall vaccine hesitancy observed in the general population has been linked to the level of hesitancy among HCWs in general. 10 To date, only two studies have explicitly addressed COVID-19 vaccine hesitancy and immunization rates of EMS personnel. In a cross-sectional survey of US firefighters and EMS personnel, Caban-Martinez et al reported that over half of their respondents were either uncertain or unlikely to receive the vaccine.…”

Section: Introductionmentioning

confidence: 99%

Predictors of COVID-19 Vaccination Among EMS Personnel

Hubble

Renkiewicz

Hunter

et al. 2022

WestJEM

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Introduction: Unvaccinated emergency medical services (EMS) personnel are at increased risk of contracting coronavirus disease 2019 (COVID-19) and potentially transmitting the virus to their families, coworkers, and patients. Effective vaccines for the severe acute respiratory syndrome coronavirus 2 virus exist; however, vaccination rates among EMS professionals remain largely unknown. Consequently, we sought to document vaccination rates of EMS professionals and identify predictors of vaccination uptake. Methods: We conducted a cross-sectional survey of North Carolina EMS professionals after the COVID-19 vaccines were widely available. The survey assessed vaccination status as well as beliefs regarding COVID-19 illness and vaccine effectiveness. Prediction of vaccine uptake was modeled using logistic regression. Results: A total of 860 EMS professionals completed the survey, of whom 74.7% reported receiving the COVID-19 vaccination. Most respondents believed that COVID-19 is a serious threat to the population, that they are personally at higher risk of infection, that vaccine side effects are outweighed by illness prevention, and the vaccine is safe and effective. Despite this, only 18.7% supported mandatory vaccination for EMS professionals. Statistically significant differences were observed between the vaccinated and unvaccinated groups regarding vaccine safety and effectiveness, recall of employer vaccine recommendation, perceived risk of infection, degree of threat to the population, and trust in government to take actions to limit the spread of disease. Unvaccinated respondents cited reasons such as belief in personal health and natural immunity as protectors against infection, concerns about vaccine safety and effectiveness, inadequate vaccine knowledge, and lack of an employer mandate for declining the vaccine. Predictors of vaccination included belief in vaccine safety (odds ratio [OR] 5.5, P=<0.001) and effectiveness (OR 4.6, P=<0.001); importance of vaccination to protect patients (OR 15.5, P=<0.001); perceived personal risk of infection (OR 1.8, P=0.04); previous receipt of influenza vaccine (OR 2.5, P=0.003); and sufficient knowledge to make an informed decision about vaccination (OR 2.4, P=0.024). Conclusion: In this survey of EMS professionals, over a quarter remained unvaccinated for COVID-19. Given the identified predictors of vaccine acceptance, EMS systems should focus on countering misinformation through employee educational campaigns as well as on developing policies regarding workforce immunization requirements.

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An Assessment of the Social Determinants of Health in an Urban Emergency Department

Cited by 10 publications

References 32 publications

Patient-Centered Outcomes of an Emergency Department Social and Medical Resource Intervention

Patient-Centered Outcomes of an Emergency Department Social and Medical Resource Intervention

Personality traits and healthcare use: A coordinated analysis of 15 international samples

Predictors of COVID-19 Vaccination Among EMS Personnel

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