Background: The National Diabetes Prevention Program (DPP) offer significant promise to decrease diabtes and address obesity. However, there remains a gap between the health systems that identify ...patients who would benefit from the DPP and the community-based organizations that provide the DPP. In this study, we aim to improvie utilization of the DPP through the development of a bidirectional electronic referral (eReferral) between a large health system and local YMCA. Methods: This was a single site quasi-experimental design in which the intervention was the creation of an eReferral to the DPP and provider education campaign. EHR data was used to evalaute the intervention using the CFIR framework. Results: For reach, approximately 16% of eligible patients (178/1105) were referred during the 15 month pilot. Patient who were referred were younger (51.6 vs 54.5, F(l,1103) = 6.66, p = 0.018) with higher BMI (36.0 vs 33.9, F (1,1103) = 10.5, p = 0.001) compared to those who were eligible but not referred. Sex assigned a birth, ethnicity, and race did not differ as a function of referral. For effectiveness, 20% of patients who were referred to the YMCA enrolled in a DPP. for adoption, 92% of providers (33/36) placed at least one referral (range 127, median = 2). For fidelity, 100% of referrals were received and processed by the YMCA if they were entered correctly but 24% of referrrals were not entered correctly (42/178) and thus were not routed correctly. For adaptations, we did not continue an intial retrospective referral process due to low referral-to-enrollment conversion and updated the referral to include eligiblity criteria. For maintenance, about 6 months after our provider education campaign, referrals dropped off (coincided with staff turnover). Utilization was improved with a reminder of the resource in the clinic newsletter. Because EPIC continues to have updates, some oversight is needed to ensure referrals are continuing to work correctly. Conclusions: A bidirectional eReferral offers an acceptable, feasible method to connect patients with a community-based DPP and shows significant promise for improving population-level health, although additional refinment of the process is needed to ensure high fidelity and improve referral-to-enrollment rates.
Routine adolescent physical activity is a well-established predictor of positive health across the lifespan, although wide disparities in youth physical activity engagement persist across sex and ...race/ethnicity. Transportation barriers may be related to adolescents’ ability to access physical activity opportunities. This study examines the association between neighborhood public transportation usage and adolescent physical activity using a national sample.
Cross-sectional data were drawn from the Family Life, Activity, Sun, Health, and Eating study (2014), a national sample of adolescents aged 12–17 years. Linear regression examined the association between neighborhood public transportation usage on the basis of neighborhood-level public transportation use and individual-level youth moderate-to-vigorous physical activity minutes per week. Models were developed for weekday, weekend, and combined moderate-to-vigorous physical activity for all youth and across sex and race/ethnicity subgroups. Analyses were run in 2020.
The final analytic data set included 1,247 adolescents aged 12–17 years (71% non-Hispanic White, 49% male, mean age=14.52 SD=1.59 years). Adjusted models showed a stronger magnitude of association between high neighborhood public transportation usage and both weekday (β=8.79, 95% CI=1.00, 16.59) and combined (β=13.74, 95% CI=1.14, 26.35) moderate-to-vigorous physical activity than between low/moderate neighborhood public transportation usage and moderate-to-vigorous physical activity. The magnitude of the neighborhood public transportation usage–moderate-to-vigorous physical activity association was strongest among non-Hispanic Black and Hispanic adolescent girls.
This study found an association between neighborhood public transportation usage and adolescent moderate-to-vigorous physical activity, particularly among non-Hispanic Black and Hispanic adolescent girls. Findings from this research have the potential to inform targeted interventions for promoting adolescent physical activity to ultimately reduce chronic health disparities across the lifespan.
In the age of COVID-19, online physical education (OLPE) has emerged as a major part of the day-to-day professional practice of P-12 physical education teachers and physical education teacher ...education (PETE) faculty. Yet little is known about what would optimize an OLPE resource from the perspective of physical educators. This study addressed this knowledge gap. A convenience sample of P-12 physical education teachers (n = 9) and PETE faculty (n = 10) was recruited to participate in six focus groups. Data were qualitatively analyzed with both deductive techniques and inductive techniques and themes across both participant groups (physical education teachers and PETE faculty) and by group were identified. Across-group themes included generally negative views of OLPE, concerns of equity and context, thoughts on assessment, and design ideas for virtual resources. Within groups, P-12 physical educators shared concerns about grading and providing meaningful feedback, whereas PETE faculty focused on ensuring that OLPE was designed and delivered considering best practices. This study builds on a nascent line of inquiry that informs the development of an OLPE resource to meets physical educators' professional needs during the pandemic and into an inevitable future where virtual teaching and learning are status quo.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Light smoking significantly increases the risk of all-cause mortality.•Light smoking appears to be driven by conditioned cues and nicotine delivery.•Cue-based treatment can be integrated into the ...real world through text messaging systems.•Cue-based treatment was feasible and accepted among light smokers.
Light smoking (smoking ≤ 10 cigarettes per day or on some days) has become increasingly prevalent in the US and increases morbidity and mortality. Many light smokers do not experience significant nicotine withdrawal but instead smoke in response to cues. Minimal evidence exists supporting interventions to help light smokers quit smoking.
We present results from a proof-of-concept pilot study designed to evaluate the feasibility and acceptability of a cue-based smoking cessation intervention targeted to light daily and intermittent smokers. Participants were randomized to one of two arms: Arm 1) standard smoking cessation treatment or Arm 2) standard smoking cessation treatment + enhanced cue-based treatment that included interactive texting to extend cue exposure treatment to real-world settings and cue management counseling.Outcomes included feasibility (number of participants who were recruited and who completed the intervention), acceptability (intervention ratings), and preliminary efficacy (7-day point prevalence abstinence).
We randomized 24 English and Spanish-speaking light smokers, 13 to the treatment arm and 11 to the control arm. Across both arms, 77% attended all counseling sessions, 90% rated these sessions as very useful and 100% said that they would recommend the intervention to a friend. 15% in the treatment arm had biochemically-validated smoking abstinence compared to 0% in the standard counseling arm.
Results from this proof-of-concept study demonstrated that a cue-based intervention is feasible and acceptable among light smokers and suggests the need for a fully powered study to assess this approach.
This study is registered at www.clinicaltrials.gov NCT03416621.
Patients with diabetes at risk of food insecurity face cost barriers to healthy eating and, as a result, poor health outcomes. Population health management strategies are needed to improve food ...security in real-world health system settings. We seek to test the effect of a prescription produce program, ‘Eat Well’ on cardiometabolic health and healthcare utilization. We will also assess the implementation of an automated, affirmative outreach strategy.
We will recruit approximately 2400 patients from an integrated academic health system in the southeastern United States as part of a two-arm parallel hybrid type 1 pragmatic randomized controlled trial. Patients with diabetes, at risk for food insecurity, and a recent hemoglobin A1c reading will be eligible to participate. The intervention arm receives, ‘Eat Well’, which provides a debit card with $80 (added monthly) for 12 months valid for fresh, frozen, or canned fruits and vegetables across grocery retailers. The control arm does not. Both arms receive educational resources with diabetes nutrition and self-management materials, and information on existing care management resources. Using an intent-to-treat analysis, primary outcomes include hemoglobin A1C levels and emergency department visits in the 12 months following enrollment. Reach and fidelity data will be collected to assess implementation.
Addressing food insecurity, particularly among those at heightened cardiometabolic risk, is critical to equitable and effective population health management. Pragmatic trials provide important insights into the effectiveness and implementation of ‘Eat Well’ and approaches like it in real-world settings.
ClinicalTrials.gov Identifier: NCT05896644; Clinical Trial Registration Date: 2023-06-09.
The Dietary Approaches to Stop Hypertension (DASH) eating plan improves hypertension in Black individuals and is associated with favorable chronic kidney disease (CKD) outcomes. Yet, adherence to ...DASH is low among US adults in general, particularly among Black Americans. We assessed perceptions about DASH, its cultural compatibility, and barriers and facilitators to DASH adherence in Black adults with CKD.
We conducted focus groups and semistructured individual interviews involving 22 Black men and women with CKD Stages 3-4 from outpatient clinics at a US academic medical center. Transcripts of audio-recorded interviews were analyzed using thematic analysis.
Among participants (2 focus groups N = 8 and 5 and 9 individual interviews), 13 (59%) had CKD Stage 3, 13 (59%) were female, the median age was 61 years, and 19 (90%) had hypertension. After receiving information about DASH, participants perceived it as culturally compatible based on 3 emergent themes: (1) Black individuals already eat DASH-recommended foods ("Blacks eat pretty much like this"), (2) traditional recipes (e.g., southern or soul food) can be modified into healthy versions ("you can come up with decent substitutes to make it just as good"), and ( 3) diet is not uniform among Black individuals ("I can't say that I eat traditional"). Perceived barriers to DASH adherence included unfamiliarity with serving sizes, poor cooking skills, unsupportive household members, and high cost of healthy food. Eleven (52%) reported after paying monthly bills that they "rarely" or "never" had leftover money to purchase healthy food. Perceived facilitators included having local access to healthy food, living alone or with supportive household members, and having willpower and internal/external motivation for change.
Black adults with CKD viewed DASH as a healthy, culturally compatible diet. Recognizing that diet in Black adults is not uniform, interventions should emphasize person-centered, rather than stereotypically culture-centered, approaches to DASH adherence.
Introduction Efforts to improve population health by being responsive to patients’ social and economic conditions will benefit from care models and technologies that assess and address unmet social ...needs. In 2019, NCCARE360 launched in North Carolina as the first statewide digital care coordination network to “close the loop” on referrals between community-based organizations (CBOs), health service providers, and social service agencies. The platform creates a shared network for sending and receiving electronic referrals and track client outcomes. Methods As a case study, we compare NCCARE360 resolution rates for community resource referrals originating from a large integrated health system primarily in Durham County from September 1, 2020, through February 28, 2021. In the first year, COVID-19 Support Services Program (COVID-SSP) funding was available to reimburse associated CBOs for providing food assistance and case management services. We compared this with the same period the following year after funds had been exhausted. We present frontline implementation experiences and highlight opportunities, challenges, and recommendations for NCCARE360 implementation. Results Multi-level considerations for individual end users, organizations adopting the platform, and policymakers are presented. Additionally, we find that when COVID-SSP funding was available, more referrals were placed (3,220 cases) and referrals were more likely to be resolved (88% resolution rate) when compared to the same time frame when funds were no longer available (860 cases; 30% resolution rate). These results underscore the importance of reimbursement mechanisms and funding. Limitations The examination of referral rates is observational and may not generalize to other contexts. Conclusion The shift to value-based care is an opportunity to embrace structural solutions to health and social care fragmentation. There is also an opportunity to realize the potential of NCCARE360 and efforts like it to contain costs and improve health outcomes and equity.
BACKGROUNDSocial inequity is a primary driver of health disparities, creating multiple barriers to good health. These inequities were exacerbated during the coronavirus disease 2019 (COVID-19) ...pandemic, with Latinx communities suffering more than others. Grassroots collaborations have long existed to address disparities. OBJECTIVEWe describe the creation and work of the Latinx Advocacy Team and Interdisciplinary Network for COVID-19 (LATIN-19; http://latin19.org/), a multisector coalition in North Carolina created to address the unique challenges of COVID-19 in the Latinx community. METHODSWe discuss challenges and solutions that LATIN-19 addressed and the impact of LATIN-19 on community partners and members. RESULTSLATIN-19 learned of challenges including, lack of awareness, need for data systems to track disparities, the need to increase access to resources, the need for policy changes, and the need to coordinate services by community organizations. CONCLUSIONSLATIN-19 represents a grassroots organization that has had an impact on community and community organizations that spans beyond COVID-19.
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