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Home care workers (HCWs) provide essential care in patients' homes but are often underappreciated and work in stressful and isolated environments with diverse and intersecting support needs. This paper describes a computer-mediated peer support program that centers around sharing circles: spaces for personal, narrative storytelling to encourage HCWs to collaboratively reflect on their home care experiences and build rapport and shared identity with their peers. We describe the design of this program and a 12-week deployment that we conducted to evaluate the program with 42 HCWs in New York City. Our findings show that participants engaged in multiple types of peer support including emotional validation, learning how to navigate the workplace and patient care, defining and enabling good home care praxis, and building understanding around purpose and identity as HCWs. We discuss how these findings inform the design of technology and use of holistic pedagogies, such as storytelling, to enable this support in computer-mediated peer support programs. Such programs can help researchers and practitioners interested in addressing diverse needs that occur in intersectional contexts, such as that of HCWs and other marginalized populations.

Home health aides are paid professionals who provide long-term care to an expanding population of adults who need it. However, aides' work is often unrecognized by the broader caregiving team despite being in demand and crucial to care---an invisibility reinforced by ill-suited technological tools. In order to understand the invisible work aides perform and its relationship to technology design, we interviewed 13 aides employed by home care agencies in New York City. These aides shared examples that demonstrated the intertwined nature of both types of invisible work (i.e., emotions- and systems-based) and expanded the sociological mechanisms of invisibility (i.e., sociocultural, sociolegal, sociospatial) to include the sociotechnical. Through these findings, we investigate the opportunities, tensions, and challenges that could inform the design of tools created for these important, but often overlooked, frontline caregivers.

Home health aides (HHAs) provide care to many adults with heart failure (HF) in the home. As the demand for HHAs increases, there is a need to promote HHAs’ job satisfaction and retention. In this cross-sectional community-partnered study, we examined whether mutuality (e.g., quality of the HHA-patient relationship), is associated with job satisfaction among HHAs caring for adults with HF. Mutuality was assessed with the Mutuality Scale, which measures overall mutuality and its four domains (reciprocity, love and affection, shared pleasurable activities, and shared values). Our final sample of 200 HHAs was primarily female. The mean overall mutuality score was 2.92 out of 4 (SD 0.79). In our final model, overall mutuality and each of the four domains were associated with increased job satisfaction; however, only the shared pleasurable activities domain was significant (aPR: 1.15 [1.03–1.32]). Overall, mutuality may play a role in promoting job satisfaction among HHAs.

Multisociety guidelines recommend a goal systolic blood pressure (BP)130 mm Hg and a hemoglobin A1c (HbA1c)8% in patients with heart failure (HF), regardless of ejection fraction. Few studies have described BP and glycemic control in ambulatory patients with HF and racial and ethnic disparities in this subset of the population.We evaluated prevalence of uncontrolled BP and HbA1c in non-Hispanic Black, non-Hispanic White, and Mexican American adults aged ≥20 years with self-reported HF (National Health and Nutrition Examination Surveys: 2001-2018). Prevalence ratios (95% CI) for uncontrolled BP and HbA1c were calculated by race and ethnicity and adjusted for sex, age, treatment, and socioeconomic status. In secondary analyses, we examined trends in the prevalence of uncontrolled BP and HbA1c.Uncontrolled BP was present in 48% (95% CI, 49%-56%) of adults with HF (representing 2.3 million people). Non-Hispanic Black participants had a higher prevalence of uncontrolled BP compared with non-Hispanic White participants (53% [48%-58%] compared with 47% [43%-51%],We document an unacceptably high prevalence of uncontrolled BP and HbA1c in a nationally representative, ambulatory HF sample with significant differences in BP control by race and ethnicity.

This presentation will use data from the 2014-2018 CDC's Behavioral Risk Factor Surveillance Survey to characterize the physical and mental health of home health care workers compared to other similar frontline, low-wage worker groups, before the COVID-19 pandemic. Next, using primary survey data collected in partnership with the 1199SEIU Training and Employment Fund, the health of the workforce during the COVID-19 pandemic will be presented, as well as the workforces' needs. The survey includes data from over 250 home health care workers employed in New York, NY who provided care during the pandemic. Finally, data from a pilot feasibility study of an intervention aimed at improving home care workers' well-being will be presented.

Social determinants contribute to disparities in incident CHD but it is not known if they have an additive effect. We hypothesized that having more socially determined vulnerabilities to health disparities is associated with increased risk of incident CHD in the REGARDS study, a large biracial prospective cohort with physiological and survey measures. Experts adjudicated incident fatal and nonfatal CHD over 10 years of follow-up. Vulnerabilities included black race, low education, low income, and Southeastern US residence. The risks for CHD outcomes associated with 1, 2, and 3+ vs 0 vulnerabilities were calculated with Cox proportional hazards models adjusted for medical conditions, functional status, health behaviors, and physiologic variables. Of the 19,645 participants free of CHD at baseline (mean age 64 years, 57% women), 16% had 0 vulnerabilities, 36% had 1, 29% had 2, and 18% had 3+. Increasing numbers of vulnerabilities were associated with higher incidence (Figure) and risk of CHD that attenuated somewhat after multivariable adjustment (Table). These findings may provide a method of risk stratification useful for population health management.

Introduction: Post-discharge medical follow-up among geriatric patients admitted with heart failure (HF) is especially important given high rates of multimorbidity and polypharmacy. Hypothesis: Patients admitted with HF aged ≥65 years will have a high rate of follow-up appointments (FUA) scheduled upon discharge from the hospital. Methods: We studied patients discharged home from a medicine service with principal diagnosis of HF at an academic hospital in NYC during 2013-2014. Patients discharged to hospice were excluded. We collected demographics, hospitalization characteristics, clinical indices, and FUA data by chart review. Results: . 796 unique patients were hospitalized with HF, among whom 443 (56%) had an FUA scheduled prior to discharge. Patients who did not have an FUA were older, more commonly white, and less likely to have Medicaid (Table). They had higher LVEF and higher rates of HFpEF (LVEF≥50%) compared to those with an FUA. Patients with and without an FUA were similar with respect to rates of coronary artery disease (CAD), RV dysfunction, valvular disease, atrial fibrillation/flutter (AF), and ventricular tachycardia. Patients also had similar rates of non-cardiac comorbidities irrespective of having an FUA, with the exception of COPD, which was more common among those with an FUA. Despite increased rates of CAD, AF, COPD, gastrointestinal bleeding, cancer, and cerebrovascular accidents, patients aged ≥65 years were less likely to have an FUA (52% vs. 65%, p=0.001). In multivariate analysis controlling for race, insurance, COPD, and HFpEF, age ≥65 remained independently associated with not having a scheduled FUA upon hospital discharge (OR 1.45, [1.02 to 2.05], p=0.03). Conclusions: Despite higher burden of both cardiac and non-cardiac disease, patients aged ≥65 years admitted with HF were less likely to have a follow-up appointment upon discharge. This highlights an important disparity in care of the geriatric population that must be addressed.

The Institute of Medicine highlighted shared decision-making (SDM) over a decade ago.1 Since then, more than 80 randomized trials have been published, many demonstrating that involving the patient in decisions and improving provider communication are associated with positive healthcare quality markers and overall morbidity and mortality outcomes.2 Few have involved multi-disciplinary practitioners; the trial by Hoffman et al.3 evaluated the effectiveness of a brief intervention on facilitating shared decision making (SDM) among student clinicians (of medicine, physiotherapy and occupational therapy) from two Australian universities. Based on valid, objective measures of video recorded interactions with simulated patient encounters, they found that their intervention improved performance of student healthcare providers in several important outcomes, including SDM communication skills, self-confidence in SDM skills, SDM attitudes and involving patients in decision making. An important limitation of this study is that it is based on simulated patients rather than live patients and the impact of the intervention was measured shortly after the intervention. However, its rigorous methods and robust evaluations suggest that modest interventions can yield significant improvement in learner SDM skills. A very important finding is that participants had high confidence at baseline in their SDM skills; a confidence that was not borne when objectively measured. This has been seen in other studies, whereby learners express overconfidence in their own communication skills—which begs the question: do residents and physicians do the same? One of the core competencies for US residencies is interpersonal and communication skills. This study highlights tools that are available for measuring learner competencies in shared decision making (OPTION scale4) and in eliciting patient preferences (ACEPP5). The authors are willing to share their training materials for programs that want to adopt formal curricula in shared decision making. There are a number of potential research questions that could be asked, such as the impact of health literacy (and numeracy), language/culture concordance between the provider and the patient and whether or not training in SDM persists over time, and whether knowledge gained from artificial simulated encounters transfers to inpatient and outpatient settings.