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BackgroundSepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention.MethodsOur aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis.DiscussionThis study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.

Connectedness is vital for health and well-being. Families with lower socioeconomic status and of racial and ethnic minority groups experience inequities in social connections compared to families with higher income and of White race in the United States. We aimed to understand how families in lower-income neighborhoods experienced social connectedness and isolation during the COVID-19 pandemic and if and how political, economic, and other societal factors influenced social connectedness. We conducted in-depth interviews with nineteen caregivers of young children in Cincinnati, Ohio. Participants had a decreased sense of social connectedness to family and friends but also across all aspects of their lives. The current crisis has exacerbated preexisting societal conditions within the United States. We can learn from these caregivers how best to bolster social connectedness and disrupt social isolation. Keywords: COVID-19, isolation, loneliness, pandemic, qualitative study, racism, social connectedness, social quality, According to Debra Umberson and Jennifer Karas Montez (2010), 'social connectedness' concerns the number, strength, and types of relationships that people possess and their perceived sense of belonging within their [...]

Background: Although the benefits of eConsults in increasing access and lowering unnecessary utilization have been well described, the development of a successful program can be challenging. Objective: We sought to share the experiences of a large academic health system in implementing and evaluating a high-volume electronic consultation (eConsult) program across 34 adult and pediatric medical and surgical specialties. Methods: Using a multi-method approach, we collected qualitative and quantitative data on operational and process outcomes to describe adoption of eConsults, and survey data to capture satisfaction and experience among referring and specialist clinicians. Results and conclusions: Data evaluating this eConsult program demonstrated robust uptake of the eConsult workflow as well as high satisfaction amongst primary care and specialty clinicians. Effective implementation strategies included engaging leadership, building a dedicated team, and developing quality assurance mechanisms. These experiences and findings may inform implementation at health systems interested in eConsult programs. [ABSTRACT FROM AUTHOR]