Pathways to potentially preventable hospitalizations for diabetes and heart failure: a qualitative analysis of patient perspectives

Sentell, Tetine; Seto, Todd B.; Young, Malia; Vawer, May; Quensell, Michelle L; Braun, Kathryn L.; Taira, Deborah A.

doi:10.1186/s12913-016-1511-6

Cited by 22 publications

(40 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, Hawai'i data shows an increase in chronic diseases and obesity over time [20]. The state has notable health disparities; compared to Whites, Native Hawaiians, Filipinos, and other Pacific Islanders are diagnosed with diabetes at earlier ages, have higher rates of hospitalizations for preventable chronic conditions and shorter longevity [19,21,22]. While Hawai'i's official poverty rate is very low, when cost-ofliving is factored in, in 2017 Hawai'i had the 10th highest poverty rate of all states, [23] and rural populations and lower income communities in the state have similar poor outcomes [19,24].…”

Section: Hawai'i Contextmentioning

confidence: 99%

The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

et al. 2020

View full text Add to dashboard Cite

Background: The Healthy Hawai'i Initiative was created in 2000 with tobacco settlement funds as a theory-based statewide effort to promote health-supporting environments through systems and policy change. Still active today, it is imbedded explicitly in a multi-sectoral, social ecological approach, effectively striving to build a culture of health before this was the name for such an ambitious effort. Methods: From interviews with key informants, we analyze two decades of the Healthy Hawai'i Initiative (HHI) in the context of the Robert Wood Johnson Foundation (RWJF) Culture of Health Action Framework (CHAF). We list HHI accomplishments and examine how the Initiative achieved notable policy and environmental changes supportive of population health. Results: The Healthy Hawai'i Initiative started with an elaborate concept-mapping process that resulted in a common vision about making "the healthy choice the easiest choice." Early on, the Initiative recognized that making health a shared value beyond the initial stakeholders required coalition and capacity building across a broad range of governmental and nonprofit actors. HHI coalitions were designed to promote grassroots mobilization and to link community leaders across sectors, and at their height, included over 500 members across all main islands of the state. Coalitions were particularly important for mobilizing rural communities. Additionally, the Initiative emphasized accessibility to public health data, published research, and evaluation reports, which strengthened the engagement to meet the shared vision and goals between diverse sector partners and HHI. Over the past two decades, HHI has capitalized on relationship building, data sharing, and storytelling to encourage a shared value of health among lawmakers, efforts which are believed to have led to the development of health policy champions. All of these factors combined, which centered on developing health as a shared value, have been fundamental to the success of the other three action areas of the CHAF over time. Conclusions: This evidence can provide critical insights for other communities at earlier stages of implementing broad, diverse, multifaceted system change and fills a key evidence gap around building a culture of health from a mature program in a notably multicultural state.

show abstract

Section: Hawai'i Contextmentioning

confidence: 99%

The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

et al. 2020

View full text Add to dashboard Cite

show abstract

“…They make up two of the five major racial/ethnic groups in Hawai'i, the study location, comprising an estimated 38.5% (21.3% Native Hawaiian and 17.2% Filipino) of the state's total population [45]. Compared to the other major racial/ethnic groups in Hawai'i, Native Hawaiians and Filipinos often have poorer health outcomes, including high rates of chronic conditions and maternal and child health inequities, as well as significant socioeconomic challenges and limited access to high quality, culturally relevant health care [46][47][48][49][50]. The consequences of these inequities include an over 10-year gap in life expectancy between Native Hawaiians and Chinese, the longest lived racial/ethnic group in the state, and a 6-year gap between Filipinos and Chinese [45].…”

Section: Study Focusmentioning

confidence: 99%

Considering Health Literacy, Health Decision Making, and Health Communication in the Social Networks of Vulnerable New Mothers in Hawai‘i: A Pilot Feasibility Study

Sentell

Agner

Pitt

et al. 2020

IJERPH

View full text Add to dashboard Cite

Health literacy is understudied in the context of social networks. Our pilot study goal was to consider this research gap among vulnerable, low-income mothers of minority ethnic background in the state of Hawai‘i, USA. Recruitment followed a modified snowball sampling approach. First, we identified and interviewed seven mothers (“egos”) in a state-sponsored home visiting program. We then sought to interview individuals whom each mother said was part of her health decision-making network (“first-level alters”) and all individuals whom the first-level alters said were part of their health decision-making networks (“second-level alters”). Health literacy was self-reported using a validated item. A total of 18 people were interviewed, including all mothers (n = 7), 35% of the first-level alters (n = 7/20), and 36% of the second-level alters (n = 4/11). On average, the mothers made health decisions with 2.9 people (range: 1-6); partners/spouses and mothers/mothers-in-law were most common. One mother had low health literacy; her two first-level alters also had low health literacy. Across the full sample, the average number of people in individuals’ health decision networks was 2.5 (range: 0–7); 39% of those interviewed had low health literacy. This can inform the design of future studies and successful interventions to improve health literacy.

show abstract

“…40 The provision of culturally competent patient care despite differences is ripe for intervention, as multiple other studies have also identified the critical intersection with patient outcomes, perceived trust, and mutual respect. 28,41,42 Time constraints perplex and trouble both patients and providers. Both parties agree that more time during a visit enables a greater understanding of patients' life circumstances, while the current time constraints seemingly threaten patientphysician relationships.…”

Section: Iscussionmentioning

confidence: 99%

Importance of Communication and Relationships: Addressing Disparities in Hospitalizations for African-American Patients in Academic Primary Care

et al. 2019

View full text Add to dashboard Cite

BACKGROUND: There are many interventions to facilitate seamless continuity of care for patients in transition from hospital back to primary care; however, disparities remain in readmission rates for vulnerable populations, especially African-Americans. OBJECTIVES: We set out to investigate the association of race and ethnicity with 30-day readmission in our urban academic setting and to identify factors that could be leveraged in primary care to address disparities in hospitalizations. METHODS/APPROACH: Using data originally collected for quality improvement purposes, we evaluated 30-day readmission rates for our primary care patients (January 1, 2013-September 30, 2014) by race and ethnicity, adjusting for demographic and clinical characteristics. Then, using inductive and deductive methods, we coded semi-structured interviews with 24 African-American primary care patients who were discharged from the Medicine or Cardiology service at our tertiary care hospital during the study period. KEY RESULTS: African-Americans had the highest readmission rate (21.7%) and a higher adjusted odds of readmission (1.37; 95% CI 1.04-1.81) compared to Whites. Five major themes emerged as having potential to be leveraged in primary care to help prevent multiple hospitalizations: (1) dependable patient-physician relationships, (2) healthcare coordination across settings, (3) continuity with one primary care provider (PCP), (4) disease selfmanagement, and (5) trust in resident physicians. Participants also made several recommendations to keep patients like themselves from returning to the hospital: increased time to tell their story during their primary care visit, more direct patient-physician communication during the visit, and improved access between visits. CONCLUSIONS: While African-American patients in our practice experience higher rates of hospital readmissions than their White counterparts, they emphasize the significance of their PCP relationship and communication to enhance disease management and prevent hospitalizations. Ongoing efforts are needed to establish and implement best practice communication trainings for patients at increased risk of hospitalization, particularly for resident physicians.

show abstract

Pathways to potentially preventable hospitalizations for diabetes and heart failure: a qualitative analysis of patient perspectives

Cited by 22 publications

References 30 publications

The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

Considering Health Literacy, Health Decision Making, and Health Communication in the Social Networks of Vulnerable New Mothers in Hawai‘i: A Pilot Feasibility Study

Importance of Communication and Relationships: Addressing Disparities in Hospitalizations for African-American Patients in Academic Primary Care

Contact Info

Product

Resources

About