Persistent Disparities Research Articles

Beyond Food Assistance: A Scoping Review Examining Associations of Nonfood Social Safety Net Programs in the United States With Food Insecurity and Nutrition Outcomes.

To conduct a scoping review to summarize the state of the evidence on associations between participation in nonfood social safety net programs (eg, income assistance, housing assistance) in the United States and food- and nutrition insecurity-related outcomes. Food and nutrition insecurity are persistent public health challenges in the United States that increase chronic disease risk and exacerbate health disparities. Several food assistance programs enhance food and nutrition security. Nonfood social safety net programs, however, may also improve these outcomes by relieving households' financial strain. Understanding the scope of research on nonfood social safety net programs' associations with not only food insecurity but also nutrition insecurity is needed to understand their potential to reduce the burden of diet-related chronic disease. Six databases were systematically searched for peer-reviewed articles. Articles were included if they were published between 1995 and 2023; conducted in the United States; available in English; included a dependent variable of food- and/or nutrition insecurity-related measures; and included an independent variable of participation in a federally funded, nonfood social safety net program. Included articles (n = 65) reported on studies that examined 10 unique social safety net programs; 8 studies examined program interactions. Twenty studies focused on COVID-19 pandemic-era programs. Fifty-eight studies used food insecurity, food insufficiency, or food hardship as outcomes, and 11 studies used nutrition insecurity-related outcomes. Overall, results suggest that participation in nonfood social safety net programs is associated with reductions in food insecurity. Current evidence for an association between program participation and nutrition insecurity-related outcomes is limited. Further research is warranted on the association between nonfood social safety net programs and nutrition insecurity; potential interactions between social safety net programs; associations between the expiration of pandemic-era programs and food and nutrition insecurity; and how program impacts might differ among populations with persistent disparities in food and nutrition insecurity.

Determining Sources of Air Pollution Exposure Inequity in New York City Through Land-Use Regression Modeling of PM2.5 Constituents

Differences in exposures and resources to manage personal health contribute to persistent inequities in air pollution burden despite vast air quality improvements over the past 2–3 decades in the United States. These factors are, partly, linked to historic racist practices, such as redlining, a discriminatory housing policy that was practiced legally between 1935 and 1968. Using 100 m × 100 m resolution land-use regression predicted surfaces of PM2.5 constituents (black carbon, nickel, vanadium, and copper) as pollution source indicators, we fit Bayesian generalized linear mixed-effects models to examine differences in source exposures over two study periods, 2008–2015 and 2016–2019, comparing (1) redlined to not redlined and (2) high-asthma to low-asthma neighborhoods. We examine redlining as an indicator of historical, and structural racism and asthma rates as an indicator of present-day community burden. Redlined areas saw near elimination of disparities in exposure to residual oil boilers and marine residual oil but persistent disparities in traffic. High-asthma neighborhoods continue to have disproportionately high exposures to both residual oil boilers and traffic, with no discernable disparities related to marine residual oil emissions. Overall exposure disparities are small, with PM2.5 disparities by both asthma morbidity and redlining amounting to less than 1 µg/m3 and NO2 disparities by asthma and redlining amounting to less than 2 ppb in the post-2016 period. For context, 2019 NYC average PM2.5 and NO2 were 8.5 µg/m3 and 20 ppb, respectively. Our findings suggest that local pollution policy should focus on reducing traffic and building boiler emissions in high-asthma neighborhoods to reduce exacerbations.

Gender and educational trends in lifetime risk, age at onset, expectancy, and survival with cardiovascular disease in Finland, 1996-2020.

Cardiovascular disease (CVD) is the leading cause of mortality globally. Examining trends in CVD burden and associated sociodemographic disparities can contribute to tailoring policies that promote cardiovascular health and narrow health disparities. However, existing studies predominantly focus only on mortality. Therefore, we provide a more comprehensive understanding of CVD trends by studying the diverse aspects of CVD burden: lifetime risk, onset age, CVD-free and CVD life expectancy, and survival with CVD. We focus on the overall Finnish population in 1996-2020, as well as gender and educational disparities. We use sociodemographic information from individual-level population registers, which are linked to hospital discharge and Death Registers, on the entire Finnish population aged 40-100 years in five five-year periods in 1996-2020 (N=2,796,732-3,273,232). We employed multistate models to derive the study metrics. Overall, CVD's lifetime risk stabilizes at 72% following a rise, with onset age and CVD-free life expectancy increased by 3 years. Although men bear a higher CVD burden, they experience a greater increase in onset age and CVD-free expectancy than women. Educational disparities in CVD-free expectancy persist, exceeding 3.5 years for men and women. Furthermore, survival with CVD has extended by 2.8 years but educational disparities widen. Despite the encouraging CVD trends in the overall population and progress in narrowing gender disparities, there remains considerable room for further improvement. Persistent educational disparities in CVD burden underscore the need for more effective interventions to address enduring inequalities.

A Narrative Review of Cardiometabolic Profiles among U.S. Adults: Temporal Trends and Implications.

To provide a narrative overview of trends and disparities in the cardiometabolic profiles of U.S. adults by synthesizing findings from nationally representative studies conducted between 1999 and 2020. During the study period, the cardiometabolic profiles of U.S. adults displayed a complex mix of trends. While there were notable improvements in specific risk factors, such as reductions in total cholesterol, triglycerides, and low-density lipoprotein cholesterol levels, other aspects of cardiometabolic health worsened. The mean body mass index and hemoglobin A1c levels increased, accompanied by significant rises in the prevalence of obesity, type 2 diabetes, and metabolic syndrome. Despite some progress in blood pressure and lipid profiles, the overall cardiometabolic health of the population declined, with only a small percentage of adults maintaining optimal health by 2018. Furthermore, significant disparities persisted across racial and socioeconomic groups, with non-Hispanic Black participants and those with lower education and income facing higher cardiometabolic risks compared to their counterparts. Despite improvements in certain aspects of cardiometabolic profiles among U.S. adults, significant challenges remain, particularly with the rising rates of obesity, type 2 diabetes, and metabolic syndrome. Persistent disparities in cardiometabolic health across sociodemographic groups emphasize the need for comprehensive public health strategies that address medical care, lifestyle factors, and social determinants of health. Future efforts should prioritize reducing these disparities and enhancing health equity to mitigate the overall burden of cardiometabolic disease.

The Impact of Gender Wage Differentials on Economic Growth in Kenya

Purpose: This study investigates the impact of gender wage differentials on Kenya's economic growth. Methodology: The study utilized a correlation research design and time-series data spanning 2012 to 2023. Econometric modeling was applied to evaluate the relationship, with economic growth as the dependent variable and gender wage differentials as the independent variable. Findings: Descriptive statistics revealed that the gender wage gap, measured by the gender wage gap index, exhibited significant variations over the study period, with an average index of 0.531. Regression analysis demonstrated a statistically significant negative relationship (β = -0.249, p < 0.01) between gender wage differentials and economic growth, with a moderate explanatory power (R² = 0.269). The findings suggest that persistent wage disparities undermine economic productivity by constraining female labor participation and limiting household investment in education and health. Unique contribution to theory, practice and policy: These results underline the urgency of addressing occupational segregation, pay inequity, and structural barriers through targeted economic policies, affirmative action, and enforcement by the National Gender and Equality Commission (NGEC). This study contributes to the literature on gender economics and highlights the importance of equitable wage structures in achieving sustainable development goals, particularly SDG 5 (Gender Equality) and SDG 8 (Decent Work and Economic Growth). Future research could explore sector-specific effects to refine policy interventions.

The influencing factors and regional heterogeneity of county-level public services quality in China

ABSTRACT Enhancing the equity of public services is a strategic objective for China's socio-economic development during the 14th Five-Year Plan. However, existing research primarily focuses on urban areas, neglecting peripheral regions like counties. This article aims to address this research gap by exploring the development level and influencing factors of public services in county areas. Using the entropy weight TOPSIS method and Dagum's Gini coefficient, this article assesses the quality and equity of public services in 632 counties across four regions of China and employs spatial models to identify influencing factors. The findings indicate a general improvement in public service quality across counties, with persistent regional disparities. The eastern region demonstrates the highest quality, followed by the western, northeastern, and central regions. Per capita GDP, per capita deposits, and the tertiary industry employment ratio positively influence public services and exhibit spatial spillover effects. Conversely, the financial self-sufficiency rate negatively impacts public services. This article recommends increasing financial support for underdeveloped counties, promoting industrialization and upgrading, and strategically formulating fiscal expenditure structures. The theoretical contribution lies in integrating theories of welfare distribution, equalization, and spatial equity to deepen the understanding of regional disparities in public services. Highlights Assessed public service quality in 632 counties using entropy TOPSIS and Dagum’s Gini coefficient. Found persistent regional disparities, with eastern counties having the highest service quality. Identified spatial spillover effects of GDP, deposits, and tertiary industry employment rates. Revealed negative impacts of financial self-sufficiency rates on public service quality. Recommended fiscal support and industrial upgrading for underdeveloped counties.

The persistent global disparities in environmental and climate communication scholarship

IntroductionAs the climate crisis progresses, it is clear that environmental catastrophes are unequally distributed and unequally caused. The Global South is disproportionately affected by the consequences of climate change despite being less responsible for some of its anthropogenic causes, compared to the Global North.MethodsTo understand whether environmental and climate communication scholarship reflect the global nature of these crises, we conducted a publication review of 505 articles published in the top-producing journals of climate communication between 2020 and 2022, along with an authorship survey and keyword network analysis. We investigate who conducts environmental and climate communication research, the geographic focus and contextualization of the research, and the thematic focus of the research.ResultsThe Global North dominates in authorship (93%) and research focus (67%), while the Global South affiliated authors make up a fraction of the sample (7%) and of the research focus (12%), revealing a gap in scholarship based in and about the Global South. While articles across the Global North and the Global South focused on climate change and adaptation, articles about the Global South more prominently focused on disasters, vulnerability, and risk management.ConclusionThe review highlights the need for greater diversity in environmental and climate communication publishing and suggests consistent geographic naming practices in titles to achieve a more inclusive academy.

Digital transformation in Cambodian higher education: Current trends and future directions

This paper delves into stakeholder perspectives on the current state and future of digital transformation in higher education institutions (HEIs) in Cambodia. Through online surveys, data were collected from academic staff, management, support personnel, and students across both private and public HEIs. The findings reveal generally positive assessments of the extent and effectiveness of digital transformations in Cambodian higher education. Respondents expressed a collective aspiration for enhanced digital infrastructure, training, and leadership support, while also highlighting persistent disparities in access and digital competence among students. The study underscores the need for a coherent, socially responsive digital strategy that addresses Cambodia’s unique socio-economic factors. Participants recognize the transformative potential of technologies such as AI, gamification, and blended learning in enhancing educational experiences. However, concerns regarding equity must be prioritized to prevent exacerbating existing divides. The findings emphasize the importance of ongoing stakeholder collaboration and strategic leadership from governmental and educational authorities to foster a comprehensive digital ecosystem that promotes equitable access to education. Ultimately, this research offers critical insights for policy-making, institutional planning, and educational practices. It advocates for a balanced approach between technological integration and maintaining essential human elements in learning environments. Further research is recommended to capture a wider range of voices and experiences from diverse educational contexts within Cambodia, enabling a more nuanced understanding of the challenges and prospects of digital transformation in higher education.

Impact of Social Determinants of Health on Pre-exposure Prophylaxis Care for HIV Prevention.

HIV continues to disproportionately impact men who have sex with men (MSM) in the United States (US). Pre-exposure prophylaxis (PrEP) is effective, but disparities persist. Limited studies have conducted systematic evaluations of social determinants of health (SDOH) and their effects on PrEP persistence among MSM. We enrolled MSM into a prospective observational cohort to assess progression through the PrEP care continuum. We enrolled patients from three diverse US settings from 2018-2022. We explored the impact of SDOH on PrEP persistence (defined as successfully obtaining PrEP prescriptions and/or clinical documentation of retention in PrEP care) at 6- and 12-months using multilevel, mixed-effects logistic models. A total of N=300 MSM were enrolled. Median age was 28 years; 40% were Black/African American (B/AA), and 11% were Hispanic/Latino (H/L). PrEP persistence was 84.7% and 49.3% at 6- and 12-months, respectively. In the unadjusted analysis, B/AA and H/L individuals were 56% and 54%, respectively, less likely to demonstrate PrEP persistence at 6- and 12-months compared to white/non-H/L individuals. Findings were no longer significant after adjusting for economic stability and educational attainment. Individuals with higher levels of internalized homophobia were less likely to persist on PrEP. Every 1-unit increase on a validated measure of internalized homophobia was independently and negatively associated with PrEP persistence (adjusted odds ratio = 0.95, 95% CI: 0.93-0.98). SDOH are important predictors of racial and ethnic disparities in PrEP persistence among MSM. Addressing these factors could help mitigate racial disparities in PrEP persistence in the US.

Trends and cross-country inequalities in global burns burden among children and adolescents: A population-based study from 1990 to 2021.

Burns among children and adolescents represent a significant global health burden, leading to substantial morbidity and disability. This study aimed to analyze the trends in burn incidence, prevalence, and years lived with disability (YLDs) from 1990 to 2021, and to project future trends to 2035, highlighting global and regional disparities. We utilized data from the Global Burden of Disease (GBD) database covering 204 countries and territories. Burn data were extracted from multiple sources including hospital records, health surveys, and national health databases. Trend analysis was projected using the Bayesian age-period-cohort (BAPC) model. Health inequality was assessed using the slope index of inequality (SII) and the concentration index (CI). In 2021, the global incidence of burns among children and adolescents was 8,484,254 cases, with an age-standardized incidence rate (ASIR) of 1315.94 per 100,000 population, showing an annual reduction of 1.33 % from 1990. The prevalence and YLDs also showed significant annual declines. Males had higher incidence rates than females. Younger children (0-4 years) experienced the highest incidence rates, while adolescents (15-19 years) had the highest prevalence. Regional disparities were evident, with Central Asia and Central Europe having the highest ASIRs. The SII and CI indicated persistent socio-economic health disparities, with lower socio-demographic index (SDI) countries bearing a disproportionate burden. Predictive analysis suggests a continued decline in burn incidence, prevalence, and YLDs through 2035. Additionally, burns among adolescents and young adults result in significant loss of labor force, exacerbating socio-economic challenges in affected regions. The global burden of burns in children and adolescents has decreased significantly, yet substantial disparities persist across different regions and socio-economic strata. Continued efforts in improving burn prevention, treatment, and rehabilitation are essential to further reduce the burden and address health inequalities.

Equity-Focused Evaluation of a Medicaid-Funded Statewide Diabetes Quality Improvement Project Collaborative.

To evaluate the Ohio Diabetes Quality Improvement Project (QIP) equity aim to reduce the percentage of Non-Hispanic Black (NHB) and Hispanic patients with A1C >9% by ≥20% over 2 years. The Ohio Department of Medicaid, Ohio Colleges of Medicine Government Resource Center, Ohio Medicaid managed care plans, and seven medical schools in Ohio formed the Diabetes QIP collaborative using the collective impact model to improve diabetes outcomes and equity in 20 practices across 11 health systems. The quality improvement (QI) strategies included data audit and feedback, peer-to-peer learning, QI coaching/practice facilitation, and subject matter expert consultation through coaching calls, monthly webinars, and annual virtual learning sessions. Electronic health record data were collected for preintervention (2019-2020) and intervention (2020-2022) periods. Assessments of improvements in A1C were based on prevalence of A1C >9% from preintervention, year 1, and year 2 with stratification by race and ethnicity. The Diabetes QIP included 7,689 (54% female) sociodemographically diverse patients, self-identifying as non-Hispanic White (NHW) (42%), NHB (43%), Hispanic (8%), non-Hispanic Asian (4%), or other (3%). In year 2 compared with baseline, there were decreases in the proportion of patients with A1C >9% among NHW, NHB, and Hispanic patients (NHW from 19% to 12% [37% reduction], NHB 23% to 18% [22% reduction], and Hispanic 29% to 23% [20% reduction]). The Ohio Diabetes QIP, focused on multisector collaborative approaches, reduced the percentage of patients with A1C >9% by ≥20% among NHW, NHB, and Hispanic populations. Given the persistence of disparities, further equity-focused refinements are warranted to address disparities in diabetes control.

Increasing screening for breast cancer using a randomized evaluation of electronic health record nudges: Design and rationale of the I-screen clinical trial.

Routine mammogram screening is critical for early detection of breast cancer. However, screening rates are below national targets, with persistent disparities among sub-populations. The purpose of this trial is to examine the effectiveness of a multi-component nudge intervention to increase breast cancer screening among eligible primary care patients. This is a two-phase, multisite, pragmatic cluster randomized clinical trial. In the first phase, two concurrent trials (trial A, B) will test the effectiveness of a multi-component nudge intervention that leverages the electronic health record (EHR) for increasing mammogram screening. The second phase includes a replication trial at an additional site. In Trial A, primary care clinics (n=30) will be randomized 2:1 to a nudge intervention or usual care. Eligible clinicians and patients within the intervention clinics will receive the intervention. Patients identified as high-risk for mammogram non-completion in the intervention arm will be further randomized 1:1 to receive an intensification nudge. In Trial B, primary care clinicians (n=82) will be randomized 1:1 to a nudge intervention or usual care. The primary outcome is mammogram completion within three months of the eligible visit. Outcomes will be evaluated using generalized estimating equations (GEE) to address clinic-level clustering. GEE models will also be fit to evaluate the impact of the intensification nudge on mammogram completion. If successful, this trial provides a blueprint for leveraging scalable multi-component nudge interventions for clinicians and patients to improve cancer screening rates.

“Because you love us as much as we love you”: The role of community relationships in facilitating Indigenous engagement in healthcare

Grounded in relational worldviews and ways of being, Indigenous health on Turtle Island once thrived. However, colonization disrupted and sought to delegitimize Indigenous relationships, having devastating impacts on Indigenous health and contributing to persistent Indigenous health disparities. Making matters worse, Indigenous Peoples face barriers to engagement in mainstream Canadian healthcare, including racism and the marginalization of Indigenous relational conceptions of health and ways of caring. Using an Indigenous methodology, we explored Kanyen’kehá:ka (Mohawk) relationality between community members and community-based healthcare providers (n=25), and how these ways of relating shaped engagement in community-based care. Our analysis identified three key themes: in Kenhté:ke (Tyendinaga) the concept of health goes beyond western definition and is broadly defined and relational; connectedness and shared experiences are foundational to Kenhté:ke identity and ways of caring; and relationships that reflect community connection foster more engagement in healthcare than otherwise in western care settings. These findings have critical implications for western norms of healthcare professional training and practice and the need to include Indigenous relational ways of caring and conceptions of health.

A Nationwide Exploration of Social Inequalities in Cancer Mortality Amidst the COVID-19 Pandemic in Belgium.

The COVID-19 pandemic disrupted global health systems, impacting cancer care and potentially increasing cancer mortality, especially among socioeconomically disadvantaged individuals. We aimed to assess changes in cancer mortality from March 1 to December 31, 2020 relative to the same period in 2019, and to examine potential shifts in cancer mortality's social disparities during the same time frame. We used nationwide individually linked cancer mortality data from the Belgian National Register, the Census 2011, and the tax register. Analyses were stratified by age group (45-59 years, 60-74 years, 75+ years) and sex across all cancer types, including breast, colorectal, lung, pancreatic, and prostate. Direct age-standardized mortality rates were calculated in 2019 and 2020 to calculate absolute and relative changes in cancer mortality by social indicators. Relative inequalities in cancer mortality by social groups were calculated for both time frames using Poisson regression. Sensitivity analysis considered any mention of specified cancer groups on the Belgian death certificate. For both overall and site-specific cancers, our study found decreases in cancer mortality during the pandemic's early stages, particularly among individuals aged 75 and older. These changes did not significantly alter established socioeconomic patterns in cancer mortality. Reductions in reported cancer deaths in 2020 may reflect COVID-19 prioritization in cause-of-death coding and its role as a competing risk, rather than true declines. Persistent educational disparities emphasize the need for continued policy and healthcare collaboration, with future research focused on the pandemic's long-term effects on cancer mortality and social inequalities.

Persistent Gender Disparity in Authorship of Arthroscopic Surgery Research

Persistent Gender Disparity in Authorship of Arthroscopic Surgery Research

The Global, Regional, and National Burden of Paralytic Ileus and Intestinal Obstruction, 1990 to 2021: a Cross-sectional Analysis From the 2021 Global Burden of Disease Study.

Paralytic ileus and intestinal obstruction (PIAIO) pose significant public health concerns, given the notable scarcity of current research on their disease burden and trends. This study evaluated the global burden of PIAIO from 1990 to 2021 and forecastsed their future burden over the next decade. Using the latest data from Global Burden of Disease Study (GBD) 2021, we obtained the prevalence, incidence, mortality and disability adjusted life years (DALYs) data for these conditions, along with their corresponding age-standardized rate (ASR) indicators. Data were stratified by time, location, age and socio-demographic index (SDI). This study employed comprehensive analyses over 32years (1990-2021) to reveal trends in PIAIO, using advanced statistical methods including estimated Annual percentage change (EAPC), Joinpoint regression, health inequity analysis (slope index and concentration index), decomposition analysis, frontier analysis and predictive modeling (Nordpred mehod). In 2021, the global age-standardized rates for prevalence (ASPR), incidence (ASIR), mortality (ASMR), and DALYs (ASDR) were 7.38 (95%UI: 7.12~7.65), 191.92 (95%UI: 185.41~198.80), 2.88 (95%UI: 2.52~3.22), and 84.49 (95%UI: 72.58~94.16), respectively. High SDI regions exhibited high ASPR, high ASIR, but low ASDR and ASMR. Males generally exhibited higher prevalence and incidence rates across most age groups, while females showed higher mortality and DALY rates in specific age brackets. The epidemiological indicators of the age group under 5years old and the elderly are relatively high. The joinpoint regression analysis indicated fluctuating increases in ASPR and ASIR, and nearly linear declines in ASMR and ASDR over the past 32years. Health inequity analyses of the slope indices of ASPR and ASIR suggested an exacerbation of inequality in certain health indicators over the past 32years, while those of ASMR and ASDR indicate potential improvements in inequality in certain health outcomes. Concentration index analysis confirms a significant reduction in inequality for ASPR and ASIR, with marginal changes for ASMR and ASDR, highlighting persistent health disparities in certain areas despite overall improvements. The decomposition analysis of global and across SDI regions indicated that population and aging have increased the DALYs burden, while epidemiological changes have reduced the disease burden. The frontier analysis suggested greater potential for improvement in low SDI regions. Nordpred predictive analysis forecasts a slight increase in ASPR and ASIR by 2050, with a significant in ASMR. PIAIO represent substantial global health and economic challenges. Anticipated population growth and aging will exacerbate burdens, highlighting the urgency of addressing critical need for targeted prevention and control strategies. Health system managers should develop robust plans to mitigate these escalating health challenges.

Utilization and regional disparities of radiotherapy in cancer treatment in Japan: a longitudinal study using NDB open data.

The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) is a database that stores anonymized information on medical receipts and health checkups in Japan. The NDB Open Data is a publicly accessible summary table of the NDB database. To reveal annual trends and regional disparities in radiotherapy utilization in Japan, we analyzed the NDB Open Data tables for a 9-year period from 2014 to 2022. We extracted medical cost codes for radiotherapy management fees and specific types of radiotherapy, such as stereotactic irradiation (STI) and intensity-modulated radiotherapy (IMRT), to analyze nationwide changes over time. To investigate regional disparities, we counted the three subitems representing 3-dimensional conformal radiotherapy (3D-CRT), IMRT, and STI for each prefecture per year. The utilization of advanced radiotherapy techniques, such as IMRT (199% increase), increased, while the use of simpler forms of irradiation, such as 1 or 2-opposite fields irradiation (40% decrease), decreased in the period from 2014 to 2022. Regarding regional disparities, the coefficients of variation in 47 prefectures for 3D-CRT remained relatively stable at 0.17 in 2014 and 0.18 in 2022, while the coefficients of variation for IMRT and STI decreased from 0.64 and 0.39 in 2014 to 0.31 and 0.36 in 2022, respectively. The popularization of IMRT was correlated with the number of certified radiation oncologists in the prefecture. In conclusion, although the utilization of high-precision radiotherapy in Japan has been increasing and regional differences have been diminishing, there are still persistent disparities.

New indices to track interoperability among US hospitals.

To develop indices of US hospital interoperability to capture the current state and assess progress over time. A Technical Expert Panel (TEP) informed selection of items from the American Hospital Association Health IT Supplement survey, which were aggregated into interoperability concepts (components) and then further combined into indices. Indices were refined through psychometric analysis and additional TEP input. Final indices included a "Core Index" measuring adoption of foundational interoperability capabilities, a "Pathfinder Index" representing adoption of advanced interoperability technologies and auxiliary exchange activities, and a "Friction Index" quantifying barriers. The first 2 indices were scored from 0 (no interoperability) to 100 (full interoperability); the Friction Index was scored 0 (no friction) to 100 (maximum friction). We calculated indices annually from 2021 to 2023, stratifying by hospital characteristics. Items within components created reliable and meaningful measures, and associations between components within indices followed the TEP's expectations. Weighted mean scores for the Core (2023), Pathfinder (2022), and Friction (2023) Indices were 61, 57, and 30, respectively. Hospitals with 500+ beds (large), not designated as critical access, in metropolitan areas, and using market leading electronic health records had statistically significant higher mean scores on all indices. Index values also improved modestly over time. Hospitals performed best on the Core Index. Given recent policy and programmatic initiatives, we anticipate continued improvement across all indices. Ongoing index tracking can inform policy impact evaluations and highlight persistent interoperability disparities across hospitals.

Race disparities in dental care use from adolescence to middle adulthood in the USA

BackgroundThis study examines the longitudinal patterns of dental care use from adolescence to middle adulthood (ages 11–43) and investigates racial and ethnic disparities in these patterns.MethodsData from Waves I through...

Investing in a New Role to Increase Timely Morning Discharges in the Inpatient Setting

OBJECTIVE Delays in discharges have a downstream effect on emergency department admissions, wait times, intensive care unit transfers, and elective admissions. This quality improvement project’s aim was to increase the percentage of discharges before noon from a hospital medicine service from 19% to 30% over a 6-month period and sustain the increase for 6 months. METHODS Interventions included introduction of a dedicated patient flow provider (PFP), optimization of workflow, technology assistance with discharge tasks, and multidisciplinary education on patient flow. The primary outcome was percentage of discharges before noon, and secondary outcome was length of stay (LOS). The process measure compared discharges before noon with and without the PFP. Additional equity and regression analyses were completed. The balancing measure was 7-day readmissions. RESULTS Discharges before noon rose from baseline 19% to 34%. On days the PFP was present, discharges before noon were 43% vs 22% when not present. Rational subgrouping showed an initial and persistent disparity in discharges before noon for racial and ethnic minority patients and patients who use a language other than English (LOE). LOS remained stable from baseline 2.74 to 2.54 days. There was no change in 7-day readmission rate. CONCLUSION Discharges before noon significantly increased after the addition of a staff member dedicated to discharge tasks. Additional staffing represents a large investment, and additional studies are needed to quantify the financial impact of this intervention. Future targeted work to address persistent disparities in discharges before noon for racial and ethnic minority patients and those who use an LOE is also needed.