Synergistic Disparities and Public Health Mitigation of COVID-19 in the Rural United States

Chillag, Kata; Lee, Lisa M.

doi:10.1007/s11673-020-10049-0

Cited by 9 publications

(14 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The rate and volume of testing (Figure) illustrates the health center's critical role in communities where immediate plant closures, mass testing, and aggressive contact tracing can occur within just a few days of outbreak detection ( Günther et al, 2020 ; Waltenburg et al, 2020 ). The potential for an outbreak to affect a rural community rapidly and deeply, with a spiral of unemployment, economic hardship, and morbidity if not managed quickly, exemplifies the problem of “synergistic disparities” that has disproportionately affected rural and racial/ethnic minority populations during the pandemic ( Chillag & Lee, 2020 ; Hawkins, 2020 ; Laurencin & McClinton, 2020 ). FQHCs, with their unique and deep connections, can become informants and facilitators for outbreak responses sensitive to local constraints.…”

Section: Discussionmentioning

confidence: 99%

“…FEDERALLY QUALIFIED Health Centers (FQHCs) have been essential in novel coronavirus-2019 (COVID-19) response in medically underserved communities, which are among the highest COVID-19 risk populations outside of long-term care facilities ( Chillag & Lee, 2020 ; Halperin et al, 2021 ; Laurencin & McClinton, 2020 ; Romero et al, 2020 ). As key primary care providers for medically underserved populations, one of the roles of FQHCs is surveillance for, identification of, and response to infection outbreaks ( O'Sullivan et al, 2020 ; Rust et al, 2009 ).…”

mentioning

confidence: 99%

“…They have the advantage of readily available and detailed data that reveal the sociodemographic, clinical, and risk-related characteristics of both individuals and the community ( O'Sullivan et al, 2020 ; Sloane et al, 2006 ; Torner et al, 2019 ). As such they have the ability to identify potential hotspots, engage stakeholders, and reach subsector populations with synergistic risk factors ( Chillag & Lee, 2020 ; Hawkins, 2020 ). In fact, frontline health care workers in FQHCs are often the first to obtain information about symptom clusters emerging among their patient population, often in advance of formal reporting systems.…”

mentioning

confidence: 99%

See 2 more Smart Citations

The Role of a Federally Qualified Health Center in Identification and Management of an Occupational COVID-19 Outbreak

Castro

Sloane

2021

Journal of Ambulatory Care Management

View full text Add to dashboard Cite

Federally Qualified Health Centers (FQHCs) have been essential in response to COVID-19 outbreaks among vulnerable populations. Our rural FQHC had a primary role in early detection of and response to a poultry plant-related outbreak at the outset of the pandemic that disproportionately and gravely affected the local Hispanic community. The health center activated a rapid local response that included the community's first mass testing event and first acute respiratory treatment clinic, both of which were central to abatement. Lessons learned from this experience provide important guidance for the potential role of FQHCs in infection outbreak preparedness in marginalized communities.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

The Role of a Federally Qualified Health Center in Identification and Management of an Occupational COVID-19 Outbreak

Castro

Sloane

2021

Journal of Ambulatory Care Management

View full text Add to dashboard Cite

show abstract

“…Lastly, positive relationships and collaborations with rural clinical partners and community stakeholders provide framework for efforts to reduce rural health inequity and facilitate implementation of programs aimed to increase culturally competent provider coverage across all communities. [22,28,29]…”

Section: Lessons Learnedmentioning

confidence: 99%

Collaboration, culture and communication: Preparing the next generation to provide rural primary health care

Thomas

Caldera

Glymph

2021

JNEP

View full text Add to dashboard Cite

Background and objective: In an ever-changing landscape of health care needs and demands, the ability to provide care for rural communities is often overwhelming. Rural health care in a new decade demands targeted programs to improve recruitment, training, and sustained employment of primary care providers. This project served to address rural primary healthcare needs by the development of a project model to recruit, train, educate and evaluate Advanced Practice Registered Nurse students (APRN) students who were rigorously selected for a rural traineeship and practiced in rural counties. The evaluation of preceptors was also done to assist in retention and increased numbers of rural preceptors and clinical sites. This program was designed collaboratively and implemented with rural community partners and rural healthcare leaders.Methods: Graduate nursing students completed both a paper application and in person interviews to be selected for a rigorous 16-week clinical traineeship in the rural communities. Qualitative data were collected during interview and feedback sessions during their traineeship. Quantitative Data were collected on Process and Outcome Measures focused on learning objectives during their rural traineeship. These data were analyzed and evaluated to measure the effectiveness of program goals, outcomes, and sustainability of the program. Results and conclusions: The results support the structured process for selecting graduate students and with an innovative program design focused on rural culture and accessing resources for patients in these same rural areas. Both students and preceptors had improved performance and satisfaction over time. The results provide a road map to recreate programs with high clinical impact and increasing numbers of rural healthcare providers. Current follow-up data with APRN post program completion demonstrated increase in employment within rural areas post-graduation.

show abstract

“…Understanding the effectiveness of NIV relative to MV is critical as different regions of the United States and the world contend with record levels of COVID-19 cases and hospitalizations that stretch resource-limited healthcare settings to capacity [10,11]. Comparable or improved effectiveness of NIV in certain patients would support its use as an alternative to MV and aid healthcare settings with limited resources and personnel [10,11]. Moreover, identifying subpopulations who benefit from NIV would help inform clinicians deciding respiratory interventions for hypoxemic patients with COVID-19 and personalize their care.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive ventilation versus mechanical ventilation in hypoxemic patients with COVID-19

et al. 2021

View full text Add to dashboard Cite

Purpose Limited mechanical ventilators (MV) during the Coronavirus disease (COVID-19) pandemic have led to the use of non-invasive ventilation (NIV) in hypoxemic patients, which has not been studied well. We aimed to assess the association of NIV versus MV with mortality and morbidity during respiratory intervention among hypoxemic patients admitted with COVID-19. Methods We performed a retrospective multi-center cohort study across 5 hospitals during March-April 2020. Outcomes included mortality, severe COVID-19-related symptoms, time to discharge, and final oxygen saturation (SpO2) at the conclusion of the respiratory intervention. Multivariable regression of outcomes was conducted in all hypoxemic participants, 4 subgroups, and propensity-matched analysis. Results Of 2381 participants with laboratory-confirmed SARS-CoV-2, 688 were included in the study who were hypoxemic upon initiation of respiratory intervention. During the study period, 299 participants died (43%), 163 were admitted to the ICU (24%), and 121 experienced severe COVID-19-related symptoms (18%). Participants on MV had increased mortality than those on NIV (128/154 [83%] versus 171/534 [32%], OR = 30, 95% CI 16-60) with a mean survival of 6 versus 15 days, respectively. The MV group experienced more severe COVID-19-related symptoms [55/154 (36%) versus 66/534 (12%), OR = 4.3, 95% CI 2.7-6.8], longer time to discharge (mean 17 versus 7.1 days), and lower final SpO2 (92 versus 94%). Across all subgroups and propensity-matched analysis, MV was associated with a greater OR of death than NIV. Conclusions NIV was associated with lower respiratory intervention mortality and morbidity than MV. However, findings may be liable to unmeasured confounding and further study from randomized controlled trials is needed to definitively determine the role of NIV in hypoxemic patients with COVID-19. Keywords COVID-19 • SARS-CoV-2 • Non-invasive ventilation • Mechanical ventilation • Critical care outcomes Abbreviations ICU Intensive care unit MV Mechanical ventilation NIV Non-invasive ventilation SD Standard deviation COVID-19 Coronavirus disease OR Odds ratio RCT Randomized controlled trial * Ron Do

show abstract

Synergistic Disparities and Public Health Mitigation of COVID-19 in the Rural United States

Cited by 9 publications

References 44 publications

The Role of a Federally Qualified Health Center in Identification and Management of an Occupational COVID-19 Outbreak

The Role of a Federally Qualified Health Center in Identification and Management of an Occupational COVID-19 Outbreak

Collaboration, culture and communication: Preparing the next generation to provide rural primary health care

Non-invasive ventilation versus mechanical ventilation in hypoxemic patients with COVID-19

Contact Info

Product

Resources

About