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Introduction The COVID-19 pandemic led to a major transition for patients from routine ambulatory-care-based in-person primary care visits to telehealth visits to manage chronic diseases. However, it remains unclear the extent to which individuals access telehealth services and whether such utilization varies along neighborhood characteristics, especially among racial minorities. This study aims to examine the association of outpatient telehealth utilization with sociodemographic, clinical, and neighborhood characteristics among adults with ambulatory care sensitive conditions (ACSCs) during the COVID-19 pandemic. Methods We included adults treated for an ACSC between March 5, 2020, and December 31, 2020, at a single ambulatory-care-based healthcare system, which serves a large population of low-income patients in the South region of the United States (i.e., Memphis, TN, Metropolitan Statistical Area). Telehealth utilization was defined by outpatient procedural codes and providers’ notes on the type of visits. Generalized linear mixed models were used to examine the association of sociodemographic, clinical, and neighborhood factors with telehealth utilization in the overall cohort and the racial subpopulations. Results Among the 13,962 adults with ACSCs, 8583 (62.5%) used outpatient telehealth services. Patients who were older, female, with mental disorders, and who had more comorbidities had higher rates of telehealth services ( p < .05). Controlling for covariates, we observed 75.2% and 23.1% increased use of telehealth services among Hispanics and other race groups, respectively, compared to Whites. Patients who commuted more than 30 minutes to health facilities were slightly less likely to use telehealth services [OR: 0.994 (0.991,0.998)]. Racial minorities (Blacks and Hispanics) with mental disorders were more likely to use telehealth service when compared to Whites. Discussion We found that among patients being treated for ACSCs, the use of telehealth services was highly prevalent in Hispanic patients in general and were more pronounced among both Hispanics and Black patients who have mental disorders.

Introduction With the recent emergence of the Omicron variant, there has been a rapid and alarming increase in the number of COVID-19 cases among pediatric populations. Yet few US pediatric cohort studies have characterized the clinical features of children with severe COVID-19. The objective of this study was to identify those chronic comorbidities that increase the risk of hospitalization for pediatric populations with severe COVID-19. Methods A retrospective cohort study that utilized the Texas Inpatient Public Use Data file was conducted. The study included 1187 patients (ages 5 to 19) from 164 acute-care Texas hospitals with the primary or secondary ICD-10CM diagnosis code U07.1 (COVID-19, virus identified). The baseline comparison group included 38 838 pediatric patients who were hospitalized in 2020. Multivariable binary logistic regression, controlling for patient characteristics, sociodemographic factors, and health insurance, was used to estimate the adjusted risk of hospitalization for COVID-19. Results Obesity and type 1 diabetes increased the risk of hospitalization with COVID-19 among both children (5-12 years) and adolescents (13-19 years). Adolescents with morbid obesity were 10 times more likely to have severe COVID-19 (p Conclusion Pediatric providers and public health officials should consider the need to tailor clinical management and mitigation efforts for pediatric populations with identifiable risk factors for severe COVID-19. These findings can be used to improve risk communication with families of children with underlying medical conditions and to prioritize prevention measures, including vaccinations.

Summary We determined the effect of a multifaceted stroke telerehabilitation (STeleR) intervention on falls-related self-efficacy and satisfaction with care. We conducted a prospective, randomized, multisite, single-blinded trial in 52 veterans from three Veterans Affairs Medical Centers. Participants who experienced a stroke in the past 24 months were randomized to the STeleR intervention or usual care. Participants in the intervention arm were administered an exit interview to gather specific patient satisfaction data three months after their final outcome measure. The STeleR intervention consisted of three home visits, five telephone calls, and an in-home messaging device provided over three months to instruct patients in functionally based exercises and adaptive strategies. The outcome measures included Falls Efficacy Scale to measure fall-related self-efficacy and a Stroke-Specific Patient Satisfaction with Care (SSPSC) scale, a measure separated into two subscales (satisfaction with home care and satisfaction with hospital care) was employed to measure the participants’ satisfaction. At six months, compared with the usual care group, the STeleR group showed statistically significant improvements in one of the two SSPSC scales (satisfaction with hospital care, p = .029) and approached significance in the second SSPSC scale (satisfaction with home care, p = .077). There were no improvements in fall-related self-efficacy. Core concepts identified were: (a) beneficial impact of the trained assistant; (b) exercises helpful; (c) home use of technology. The STeleR intervention improved satisfaction with care, especially as it relates to care following their experience from the hospital. With the limited resources available for in-home rehabilitation for stroke survivors, STeleR (and especially its exercise components) can be a useful complement to traditional post-stroke rehabilitation.

We developed a User-Testing Database to be able to process a greater amount of user data, from multiple sources of data, at a much finer level of granularity, and to be able to aid in a more sophisticated analysis, including specific queries of usability data than a typical “manual”-based usability analysis. In this paper, we demonstrate our User-Testing Database as applied to a usability assessment of the Veterans Affairs (VA) My HealtheVet personal health record. The usability test included 24 Veterans who completed a series of scenarios in the usability lab at a Midwest Veterans Affairs Medical Center (VAMC). The User-Testing Database facilitated reduction of data gathered from video review, facilitator notes, and debrief notes into 1160 observations that were sorted into conceptual bins and summarized for the designers of the personal health record. From creation of the database to completion of the reports took four months and did not require extensive knowledge of qualitative analysis techniques. We argue a User-Testing Database can allow other usability studies to increase the number of participants and the granularity of the data without prohibitively increasing the amount of time and experience required to process the data gathered.

We examined the cost-effectiveness of a care coordination/home telehealth (CCHT) programme for veterans with diabetes. We conducted a retrospective, pre-post study which compared data for a cohort of veterans ( n=370) before and after the introduction of the CCHT programme for two periods of 12 months. To assess the cost-effectiveness, we converted the patients' health-related quality of life data into Quality Adjusted Life Year (QALY) utility scores and used costs to construct incremental cost-effectiveness ratios (ICERs). The overall mean ICER for the programme at one-year was &dollar;60,941, a value within the commonly-cited range of cost-effectiveness of &dollar;50,000–100,000. The programme was cost-effective for one-third of the participants. Characteristics that contributed to cost-effectiveness were marital status, location and clinically relevant co-morbidities. By targeting the intervention differently in future work, it may become cost-effective for a greater proportion of patients.

Objectives: To assess the effect of one-on-one peer support at enhancing self-efficacy and decreasing depression in older men treated by radical prostatectomy for prostate cancer. Methods: Six weeks after surgery, 72 men ( Mage = 60) were randomly assigned to a treatment ( n = 37) or control group ( n = 35). Treatment group participants were paired to form dyads with a trained support partner who had similar treatment and related side effects; control group participants received usual health care. Dyads met 8 times over 8 weeks to discuss concerns and coping strategies. Results: At posttest, the treatment group had significantly higher self-efficacy than the controls ( M = 328.89 and M = 304.54, respectively) and significantly less depression ( M = 0.92 and M = 2.49, respectively). Depression outcomes remained significant when controlling baseline self-efficacy and social support ( F = 4.845, p = .032). Discussion: Findings confirm pilot study results and are theoretically consistent with the self-efficacy enhancing nature of vicarious experience described by Bandura in self-efficacy theory.

We examined the feasibility of a Cancer Care Dialogues Model, with daily telehealth interactions between patients at home and their care coordinator, who acted as an adjunct to the oncologist. The patient and the care coordinator used a home messaging device, connected via the ordinary telephone network. Thirty-four patients with a new diagnosis of cancer and whose treatment plan included chemotherapy taken at a single clinic were enrolled and followed for six months. The home messaging device collected information daily on common symptoms associated with chemotherapy. On average, the patients had the home messaging device for 120 days (range 30–180). The mean cooperation rate was 84% (range 4–100). No variables were significantly associated with patient cooperation in the dialogues over time. The health-related quality of life (HRQL) mean score at baseline was 73.9 (SD 15.4), and the mean score at six months was 78.4 (SD 14.5). After adjusting for demographic and clinical factors, there was a 6.5-point increase in HRQL score between the baseline and end of treatment, which represented an important clinical difference. Management of nervousness/worry over time through cancer care dialogues is important in maintaining HRQL and can be assisted by remote home messaging.

We evaluated a Veterans Health Administration (VHA) care coordination/ hometelehealth (CC/HT) programon the utilization of health care services and health-related quality of life (HRQL) in veterans with diabetes. Administrative records of 445 veterans with diabetes were reviewed to compare health care service utilization in the 1-year period before and 1-year period postenrollment and also examined self-reported HRQL at enrollment and 1 year later. Multivariate analyses indicated a statistically significant reduction in the proportion of patients who were hospitalized (50% reduction), emergency room use (11% reduction), reduction in the average number of bed days of care (decreased an average of 3.0 days), and improvement in the HRQL role-physical functioning, bodily pain, and social functioning. The results need to be interpreted with caution because we used a single-group study design that may be influenced by regression to the mean. Ideally, future research should use a randomized controlled trial design.

This article investigates the independent additive and the interactive effects of being an informal caregiver of an elderly parent and three role commitments (being married, having a child or grandchild coreside, and being employed) on depressive symptomatology. For the respondents with a living mother, being a caregiver to their mother was not associated with the level of depressive symptoms. For the respondents with a living father, being a caregiver to their father was associated with higher levels of depressive symptoms. Respondents who were caregivers to their father reported lower depressive symptom scores due to being married and due to being employed. Being married and being employed may provide an alternative source of integration and thus buffer the detrimental effects that caregiving for a father has on depressive symptomatology. The findings are discussed in the context of role strain and role enhancement perspectives.

Objective: The purpose of this research was to determine whether geographic access influences service utilization in a community-based sample of older adults with cognitive impairment. Methods: A telephone screener for cognitive impairment was administered to 9,100 elderly Arkansans with caregivers, resulting in a sample with 317 elder/caregiver dyads. Self-reported service utilization was collected for three sectors: home health, physical health, and mental health. Geographic access was measured from (a) self-reported awareness of services in each sector and (b) the travel time to the closest provider in each sector calculated using a Geographic Information System. Results: Travel time significantly predicted home health service utilization while perceived awareness significantly predicted mental health service utilization. Neither measure of geographic access predicted use of physical health services. Discussion: Because rural elders with less geographic access receive fewer home/mental health services, they may be at greater risk for hospitalization or nursing home placement.

The degree of clinical decision making and clinical productivity among nurse practitioners (NPs) is of great interest to policy makers and planners involved in providing appropriate outpatient primary care services. The authors performed a statewide mailed survey of all NPs practicing either full-time or part-time in Wisconsin (response rate of 72.1%) to address the following research questions: Do the demographic characteristics, practice attributes, and primary practice settings of NPs impact their level of clinical decision making (e.g., the autonomy to order laboratory and radiological tests or to refer a patient to a physician specialist other than their collaborating physician)? Do NPs’ levels of clinical decision making correlate with their outpatient clinical productivity, adjusting for demographic characteristics, practice attributes, and primary practice settings? The multiple linear regression results indicated that having more years in practice as an NP, practicing in the family specialty area (vs. a combined other category, which included pediatrics, acute care, geriatrics, neonatal, and school), treating patients according to clinical guidelines, practicing in settings with a fewer number of physicians, and practicing in a multispecialty group practice versus a single-specialty group practice were associated with greater levels of clinical decision making. However, NPs who primarily practiced in a hospital/facility-based practice, as compared with a single-specialty group practice, had lower levels of clinical decision making. After adjusting for demographic characteristics, practice attributes, and primary practice settings, NPs with greater clinical decision-making authority had greater outpatient clinical productivity. The conclusions discuss the policy implications of the findings.

This research examined whether older adults'ethnicity (African American vs. White) and type of rural residence were associated with nurse case managers' determinations of eligibility for in-home respite care service use, after adjusting for sociodemographic as well as physical and cognitive status characteristics. This study reports the results of a program evaluation of a state Medicaid waiver program for support services. The study sample consisted of 775 older adults residing in the rural counties (63) of Arkansas and enrolled in a Medicaid waiver program for support services. Logistic regression analyses revealed that the combination of being African American and residing in rural counties of smaller population sizes combined with nonadjacency to metropolitan statistical areas were associated with a lower likelihood of being eligible for in-home respite care. The article ends with a discussion on programplanning, policy, and practice initiatives in light of the findings.

Although podiatrists treat a large number of older adults, few studies have examined podiatry students' attitudes to treating them. Using data from a nationally representative random sample of podiatry students (n = 528), a theoretical model was tested that examined the impact on the level of expected satisfaction from treating older adults in terms of: students' perceptions of the effectiveness of podiatry for treating older adults (i.e. the belief that the students can have a meaningful impact on the health outcomes); the extent to which students enter podiatry for intrinsic rewards; the amount of exposure to instruction on geriatric health issues students receive in podiatry school; and the amount of clinical contact students have with older adult patients. Consistent with the hypothesized model, the findings indicated that respondents who believe that podiatrists can have a meaningful impact on the health outcomes of older adults reported a higher level of expected satisfaction with treating them. In addition, intrinsic motivation exhibited a positive indirect effect on satisfaction via its direct effect on perceptions of the effectiveness of treating older adults.

This study examined the relationships between five dimensions of religious involvement (i.e., participation, divine interaction, existential certainty, spiritual gifts, and divine power or authority), two forms of secular social involvement (i.e., social activity and social affiliation), six social background covariates (i.e., marital status, gender, race, age, social class, and traumatic life events), and individual life satisfaction. Following specific theories of life satisfaction previously delineated by Ellison (Ellison, 1991; Ellison, Gay, & Glass, 1989), the study employed nested regression models to analyze data from a convenience sample of 163 adolescents and adults derived from a university (n = 68) and a nondenominational protestant church (n = 95) in the Southeast. In general, findings indicated that individuals with strong religious faith report higher levels of life satisfaction. Specifically, two of the five dimensions of religious involvement, divine power and existential certainty, had relatively strong relationships with life satisfaction, when controlling for social background covariates and secular social involvement. In addition, both forms of secular social involvement have small but persistent positive relationships with life satisfaction when social background variables and religiosity are held constant. Also discussed are the implications of the findings for psychologists interested in personality/developmental theory, social psychology, and counseling.

Ability to predict discharge destination would be a useful way of optimizing posthospital care. We conducted a cross-sectional, multiple state study of inpatient services to assess the likelihood of home discharges in 2009 among Medicaid enrollees who were discharged following general hospitalizations. Analyses were conducted using hospitalization data from the states of California, Georgia, Michigan, and Mississippi. A total of 33 160 patients were included in the study among which 13 948 (42%) were discharged to their own homes and 19 212 (58%) were discharged to continue with institutional-based treatment. A multiple logistic regression model showed that gender, age, race, and having ambulatory care-sensitive conditions upon admission were significant predictors of home-based discharges. Females were at higher odds of home discharges in the sample (odds ratio [OR] = 1.631; 95% confidence interval [CI], 1.520-1.751), while patients with ambulatory care-sensitive conditions were less likely to get home discharges (OR = 0.739; 95% CI, 0.684-0.798). As the nation engages in the continued effort to improve the effectiveness of the health care system, cost savings are possible if providers and systems of care are able to identify admission factors with greater prospects for in-home services after discharge.

This article examines the extent to which older adult patients’ perceptions of inpatient dimensions of care experiences are associated with their overall satisfaction. A secondary objective is to determine if these specific care experiences differed between elderly female and male patients. Patient satisfaction data from 6,021 older patients (65 years of age and older) were collected by using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey through telephone interviews of older patients who were recently discharged. Multiple linear regression analyses with older patients’ HCAHPS dimensions (Communication With Nurses, Communication With Doctors, Responsiveness of Hospital Staff, Communication About Medicines, Cleanliness of the Hospital Environment, and Quietness of Hospital Environment) and gender were conducted while controlling for self-rated health status, age, race, and education. Multiple linear regression analysis showed that all of the HCAHPS dimensions were significantly associated with overall satisfaction. Older female patients reported substantially more positive global evaluations than their male counterparts. However, for older male patients, Communication With Doctors was more influential in their ratings of overall satisfaction than for older female patients. For older female patients, Communication With Nurses was more influential in their ratings of overall satisfaction than for older male patients.

This article investigates whether discharge planning procedures and discharge planners' perceptions of the availability of paid home care services vary according to the metropolitan or nonmetropolitan location of hospitals. Resource dependency theory suggests that hospital and community environments are likely to affect the discharge planning process through discharge planners'perceptions of the adequacy of resources in those environments. A stratified random sample of discharge planning coordinators in 60 metropolitan and 59 nonmetropolitan acute care hospitals in Ohio were sent questionnaires on the discharge and referral process of elderly patients. Findings indicate that discharge personnel of nonmetropolitan and large inner-city metropolitan hospitals are less likely than those of moderate-sized metropolitan hospitals to feel that an adequate amount of paid home care services is available in the community. Moreover, discharge departments of nonmetropolitan and large inner-city metropolitan hospitals are more likely to rely on patient financial information and informal care availability in discharge planning. Discharge departments in these hospitals also are more likely to train informal caregivers and maintain postdischarge contact.

Adolescent pregnancy is often described as a major concern in public health and is associated with negative outcomes for educational and career attainment. Our objective was to compare the future aspirations of pregnant and parenting adolescents and identify social or structural barriers that they experience in their daily lives using journal entries from pregnant and parenting adolescents. The journals, which served as primary data sources, were completed by 52 multi-ethnic pregnant and parenting adolescents aged 15 to 19 in Indiana. Both pregnant and parenting adolescents aspired to provide a “better life” for their children that included finishing school and obtaining a career. An emergent theme is that the experience of pregnancy and parenting is transformative and may invoke a positive refocusing of life aspirations for educational and career attainment. However, social stigma and barriers exist that make achieving educational and employment opportunities difficult. The study findings indicate that pregnant and parenting adolescents need strong social support networks and practical tools to help harness their motivation and transcend social and material barriers to achieve their goals and aspirations.