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PurposeTo conduct a post-Americans with Disabilities Act Amendments Act of 2008 multisite, multicohort study called the Pathways Project to assess the performance and trajectory of medical students with disabilities (SWDs).MethodFrom June to December 2020, the authors conducted a matched cohort study of SWDs and nondisabled controls from 2 graduating cohorts (2018 and 2019) across 11 U.S. MD-granting medical schools. Each SWD was matched with 2 controls, one from their institution and, whenever possible, one from their cohort for Medical College Admission Test score and self-reported gender. Outcome measures included final attempt Step 1 and Step 2 Clinical Knowledge scores, time to graduation, leave of absence, matching on first attempt, and matching to primary care.ResultsA total of 171 SWDs and 341 controls were included; the majority of SWDs had cognitive/learning disabilities (118/171, 69.0%). Compared with controls, SWDs with physical/sensory disabilities had similar times to graduation (88.6%, 95% confidence interval [CI]: 77.0, 100.0 vs 95.1%, 95% CI: 90.3, 99.8; P = .20), Step 1 scores (229.6 vs 233.4; P = .118), and match on first attempt (93.9%, 95% CI: 86.9, 100.0 vs 94.6%, 95% CI: 91.8, 97.4; P = .842), while SWDs with cognitive/learning disabilities had lower Step 1 scores (219.4; P < .001) and were less likely to graduate on time (81.2%, 95% CI: 69.2, 93.2; P = .003) and match on first attempt (85.3%, 95% CI: 78.0, 92.7; P = .009). Accommodated SWDs had Step 1 scores that were 5.9 points higher than nonaccommodated SWDs (95% CI: -0.7, 12.5; P = .08).ConclusionsStructural barriers remain for SWDs with cognitive/learning disabilities, which could be partially mitigated by accommodations on high-stakes exams.

This cohort study examines the association between Medical College Admission Test (MCAT) scores, disability status and category, and performance on US Medical Licensing Examination (USMLE) Step 1 and Step 2 CK scores.

PURPOSE Hearing loss (HL) is underdiagnosed and often unaddressed. A recent study of screening for HL using an electronic prompt showed efficacy in increasing appropriate referrals for subsequent testing. We build on the results of this study using a qualitative lens to explore implementation processes through the perspectives of family medicine clinicians. METHODS We collected clinic observations and semistructured interviews of family medicine clinicians and residents who interacted with the HL prompt. All data were analyzed using thematic, framework, and mixed methods integration strategies. RESULTS We interviewed 27 clinicians and conducted 10 observations. Thematic analysis resulted in 6 themes: (1) the prompt was overwhelmingly viewed as easy, simple to use, accurate; (2) clinicians considered prompt as an effective way to increase awareness and conversations with patients about HL; (3) clinician and staff buy-in played a vital role in implementation; (4) clinicians prioritized prompt during annual visits; (5) medical assistant involvement in prompt workflow varied by health system, clinic, and clinician; (6) prompt resulted in more conversations about HL, but uncertain impact on patient outcomes. Themes are presented alongside constructs of normalization process theory and intervention outcomes. CONCLUSION Integration of a HL screening prompt into clinical practice varied by clinician buy-in and beliefs about the impact on patient outcomes, involvement of medical assistants, and prioritization during clinical visits. Further research is needed to understand how to leverage clinician and staff buy-in and whether implementation of a new clinical prompt has sustained impact on HL screening and patient outcomes. Key words: hearing loss; deaf health; deaf and hard of hearing; primary care; hearing loss screening, INTRODUCTION Over 50 million adults aged 50 years and older in the United States have hearing loss (HL). (1) Hearing loss can negatively impact physical and mental health outcomes, (2-7) [...]

CONTEXT: Tobacco, alcohol and drug use are among the top 10 causes of preventable death in the United States, but unhealthy substance use is often under-recognized and under-treated. In primary care, screening, brief intervention, and referral to treatment (SBIRT) contributes to improved patient outcomes. While many barriers exist to implementing SBIRT, the annual or new patient visit is often a critical touchpoint for many patients. OBJECTIVE: The purpose of this study was to assess, at the population level, our department's rates of screening, risk identification and intervention for tobacco, alcohol and other substance use. STUDY DESIGN/SETTING/POPULATION: Monocentric multisite retrospective chart review over the calendar year 2019. We conducted secondary data analysis of 18,420 patients (Mean age = 43 years, SD = 13; range: 18-65 years old), with a health maintenance exam in this 12 month period who received care at six Family Medicine clinics. PROCESS AND OUTCOME MEASURES: The primary process measures examined screening rates for tobacco, alcohol, and other substance use. The primary outcome measures examined evidence of intervention (dx, medication prescription, referral) among those with and without positive screen. RESULTS: The percent of patients identified at risk for unhealthy use: 9.4% tobacco, 7.3% alcohol, and 6.15% other substance use. Of those who screened positive for tobacco use, 54.7% with evidence of intervention (50% associated diagnosis code; 17% CPT code cessation counseling; less than 2%, with a referral; 14% medication prescription). Of those who screened positive for unhealthy alcohol use, 7.2% with evidence of intervention (7% associated diagnosis code; 1% referral; 0.3% medication prescription). Of those who screened positive for substance use, 7.4% with evidence of intervention (7.4% associated diagnosis code; 0.1% referral). Few statistically significant differences identified by patient or provider demographics or care site. CONCLUSIONS: Overall, patients who were screened and were positive were more likely to have evidence of intervention, supporting efforts to complete at least annual screens. The department is strongest at identifying and intervening on tobacco use. Brief assessment and intervention with alcohol and substance use are areas in need of additional focus. The use of validated tools, systematic survey implementation, and population level data storage provide avenues for improvement., Presenters Meredith Baumgartner, MD, MPH, MD MPH, Golfo Tzilos Wernette, PhD, Melissa Plegue, [...]

PURPOSE Hearing loss, the second most common disability in the United States, is under-diagnosed and under-treated. Identifying it in early stages could prevent its known substantial adverse outcomes. METHODS A multiple baseline design was implemented to assess a screening paradigm for identifying and referring patients aged [greater than or equal to] 55 years with hearing loss at 10 family medicine clinics in 2 health systems. Patients completed a consent form and the Hearing Handicap Inventory for the Elderly (HHI). An electronic alert prompted clinicians to screen for hearing loss during visits. RESULTS The 14,877 eligible patients during the study period had 36,701 encounters. Referral rates in the family medicine clinics increased from a baseline rate of 3.2% to 14.4% in 1 health system and from a baseline rate of 0.7% to 4.7% in the other. A general medicine comparison group showed referral rate increase from the 3.0% baseline rate to 3.3%. Of the 5,883 study patients who completed the HHI 25.2% (n = 1,484) had HHI scores suggestive of hearing loss; those patients had higher referral rates, 28% vs 9.2% (P CONCLUSION An electronic alert used to remind clinicians to ask patients aged [greater than or equal to] 55 years about hearing loss significantly increased audiology referrals for at-risk patients. Audiologic and audiogram data support the effectiveness of the prompt. Clinicians should consider adopting this method to identify patients with hearing loss to reduce its known and adverse sequelae., INTRODUCTION Hearing loss affects over 30% of those aged >55 years, with over one-half suffering morbidity that includes reduced quality of life. (1-14) Untreated hearing loss is a major risk [...]

BackgroundHypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. ObjectiveWe sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. MethodsWe conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. ResultsA total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P

BackgroundHypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach. ObjectiveOur goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support. MethodsWe conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined. ResultsA total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change –12.6, SD 24.0 vs mean change –11.3, SD 25.5 mm Hg, P=.78), and DBP (mean change –4.9, SD 13.1 mm Hg vs mean change –3.3, SD 14.3 mm Hg, P=.54). Control and BPMED participants had slight improvements to medication adherence self-efficacy (mean change 0.8, SD 9.8 vs mean change 0.7, SD 7.0) with no significant differences found between groups (P=.92). On linear regression analysis, baseline SBP was the only predictor of SBP change; participants with higher SBP at enrollment exhibited significantly greater improvements at one-month follow-up (β=–0.63, P