Showing papers by "Marshall H. Chin published in 2012"

Health Disparities in Endocrine Disorders: Biological, Clinical, and Nonclinical Factors—An Endocrine Society Scientific Statement

Abstract: Objective: The aim was to provide a scholarly review of the published literature on biological, clinical, and nonclinical contributors to race/ethnic and sex disparities in endocrine disorders and to identify current gaps in knowledge as a focus for future research needs. Participants in Development of Scientific Statement: The Endocrine Society's Scientific Statement Task Force (SSTF) selected the leader of the statement development group (S.H.G.). She selected an eight-member writing group with expertise in endocrinology and health disparities, which was approved by the Society. All discussions regarding the scientific statement content occurred via teleconference or written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement. Evidence: The primary sources of data on global disease prevalence are from the World Health Organization. A comprehensive literature search of PubMed identified U.S. population-ba...

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

Abstract: Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care The roadmap outlines a dynamic process in which individual interventions are just one part It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts Additionally, we summarize the major lessons learned through the Finding Answers program We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature Our research shows that promising interventions frequently are culturally tailored to meet patients’ needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient’s pathway of care Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care Electronic supplementary material The online version of this article (doi:101007/s11606-012-2082-9) contains supplementary material, which is available to authorized users

Patient-centered medical home characteristics and staff morale in safety net clinics.

Abstract: Background We sought to determine whether perceived patient-centered medical home (PCMH) characteristics are associated with staff morale, job satisfaction, and burnout in safety net clinics. Methods Self-administered survey among 391 providers and 382 clinical staff across 65 safety net clinics in 5 states in 2010. The following 5 subscales measured respondents' perceptions of PCMH characteristics on a scale of 0 to 100 (0 indicates worst and 100 indicates best): access to care and communication with patients, communication with other providers, tracking data, care management, and quality improvement. The PCMH subscale scores were averaged to create a total PCMH score. Results Six hundred three persons (78.0%) responded. In multivariate generalized estimating equation models, a 10% increase in the quality improvement subscale score was associated with higher morale (provider odds ratio [OR], 2.64; 95% CI, 1.47-4.75; staff OR, 3.62; 95% CI, 1.84-7.09), greater job satisfaction (provider OR, 2.45; 95% CI, 1.42-4.23; staff OR, 2.55; 95% CI 1.42-4.57), and freedom from burnout (staff OR, 2.32; 95% CI, 1.31-4.12). The total PCMH score was associated with higher staff morale (OR, 2.63; 95% CI, 1.47-4.71) and with lower provider freedom from burnout (OR, 0.48; 95% CI, 0.30-0.77). A separate work environment covariate correlated highly with the quality improvement subscale score and the total PCMH score, and PCMH characteristics had attenuated associations with morale and job satisfaction when included in models. Conclusions Providers and staff who perceived more PCMH characteristics in their clinics were more likely to have higher morale, but the providers had less freedom from burnout. Among the PCMH subscales, the quality improvement subscale score particularly correlated with higher morale, greater job satisfaction, and freedom from burnout.

Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes

Abstract: New translational strategies are needed to improve diabetes outcomes among low-income African-Americans. Our goal was to develop/pilot test a patient intervention combining culturally tailored diabetes education with shared decision-making training. This was an observational cohort study. Surveys and clinical data were collected at baseline, program completion, and 3 and 6 months. There were 21 participants; the mean age was 61 years. Eighty-six percent of participants attended >70 % of classes. There were improvements in diabetes self-efficacy, self-care behaviors (i.e., following a “healthful eating plan” (mean score at baseline 3.4 vs. 5.2 at program’s end; p = 0.002), self glucose monitoring (mean score at baseline 4.3 vs. 6.2 at program’s end; p = 0.04), and foot care (mean score at baseline 4.1 vs. 6.0 at program’s end; p = 0.001)), hemoglobin A1c (8.24 at baseline vs. 7.33 at 3-month follow-up, p = 0.02), and HDL cholesterol (51.2 at baseline vs. 61.8 at 6-month follow-up, p = 0.01). Combining tailored education with shared decision-making may be a promising strategy for empowering low-income African-Americans and improving health outcomes.

Association between patient-centered medical home rating and operating cost at federally funded health centers.

Abstract: Context Little is known about the cost associated with a health center's rating as a patient-centered medical home (PCMH). Objective To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. Design, Setting, and Participants Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. Main Outcome Measures Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. Results Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD, 12; range, 21-90). For the average health center, a 10-point higher total PCMH score was associated with a $2.26 (4.6%) higher operating cost per patient per month (95% CI, $0.86-$4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent ($27 300; 95% CI, $3047-$57 804) and higher operating cost per patient per month ($1.06; 95% CI, $0.29-$1.98). A 10-point higher score for quality improvement was also associated with higher operating cost per physician full-time equivalent ($32 731; 95% CI, $1571-$73 670) and higher operating cost per patient per month ($1.86; 95% CI, $0.54-$3.61). A 10-point higher PCMH subscale score for access/communication was associated with lower operating cost per physician full-time equivalent ($39 809; 95% CI, $1893-$63 169). Conclusions According to a survey of health center administrators, higher scores on a scale that assessed 6 aspects of the PCMH were associated with higher health center operating costs. Two subscales of the medical home were associated with higher cost and 1 with lower cost.

Early lessons from an initiative on Chicago's South Side to reduce disparities in diabetes care and outcomes.

Abstract: Interventions to improve health outcomes among patients with diabetes, especially racial or ethnic minorities, must address the multiple factors that make this disease so pernicious. We describe an intervention on the South Side of Chicago-a largely low-income, African American community-that integrates the strengths of health systems, patients, and communities to reduce disparities in diabetes care and outcomes. We report preliminary findings, such as improved diabetes care and diabetes control, and we discuss lessons learned to date. Our initiative neatly aligns with, and can inform the implementation of, the accountable care organization-a delivery system reform in which groups of providers take responsibility for improving the health of a defined population.

Using mobile health to support the chronic care model: developing an institutional initiative

Abstract: Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a "human face" to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time. Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral. Conclusion. Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.

"One Can Learn From Other People's Experiences": Latino adults' preferences for peer-based diabetes interventions.

Abstract: PurposeTo assess Latino adults’ preferences for peer-based diabetes self-management interventions and the acceptability of the church setting for these interventions.MethodsThe authors partnered wi...

Post-tonsillectomy pain in 24 children - utilising short message service (SMS) to assess postoperative outcomes.

Abstract: Tonsillectomy is a common paediatric surgical procedure, now predominantly performed as a dayor overnight-stay procedure. It is widely regarded as a painful operation, whereupon inadequate analgesia can lead to decreased oral intake, reduced sleep and longer time off school. Many studies have looked into strategies for reducing post-tonsillectomy pain, including preoperative behavioural interventions, peritonsillar infiltration of local anaesthetics and the use of non-steroidal antiinflammatory drugs or steroids perioperatively. Most of these interventions have focused on minimising pain in the immediate postoperative period, without exploring the management of post-tonsillectomy pain at home where parents often use non-standardised regimens of analgesia. Our experiences of pain after tonsillectomy in children show that it often persists beyond 1 week. There are limited data describing the nature or trend of the patient’s pain at home, which makes the assessment of pain and analgesia requirements difficult. Studies that have attempted to investigate post-tonsillectomy pain at home have often required parents to fill out daily forms or answer daily phone calls which can be intrusive. This pilot study prospectively evaluates the use of a novel means of data collection – short message service (SMS) – as a minimally intrusive means of obtaining almost real-time feedback of pain severity in children for 14 days following tonsillectomy. We sought to define the trend and time course of post-tonsillectomy pain persisting beyond the immediate postoperative period, with the ultimate clinical objective of developing strategies for effective, long-lasting and individualised pain management. Materials and methods

Lessons for reducing disparities in regional quality improvement efforts.

Abstract: Regional efforts to improve quality of care face particular challenges when addressing racial and ethnic disparities in health. Diverse populations have different needs and barriers, and the same quality improvement (QI) intervention can affect them variably. Thus, different approaches may be necessary to deliver high-quality healthcare to different populations.

Large-scale 2D electronics based on single-layer MoS[subscript 2] grown by chemical vapor deposition

Abstract: 2D nanoelectronics based on single-layer MoS2 offers great advantages for both conventional and ubiquitous applications. This paper discusses the large-scale CVD growth of single-layer MoS2 and fabrication of devices and circuits for the first time. Both digital and analog circuits are fabricated to demonstrate its capability for mixed-signal applications.