Statewide System Research Articles

Evidence-Based Treatments in Community Mental Health Settings: Use and Congruence With Children’s Primary Diagnosis and Comorbidity

Many evidence-based treatments (EBTs) have been identified for specific child mental health disorders, but there is limited research on the use of EBTs in community-based settings. This study used administrative data from a statewide system of care to examine 1) the extent to which EBTs were provided congruent with the child's primary diagnosis, 2) whether there were differences in effectiveness of EBTs that were congruent or incongruent with the child's primary diagnosis, and 3) whether comorbidity moderated the effectiveness of EBTs for children based on congruence with their primary diagnosis. The sample consisted of 23,895 children ages 3-17 with at least one of the most common diagnoses (attention-deficit/hyperactivity disorder, conduct problems, depressive disorders, anxiety disorders, and post-traumatic stress disorder) who received outpatient psychotherapy. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity. Forty-two percent of children received an EBT congruent with their diagnosis, and these children showed greater improvement than the 35% of children who received no EBT (ES = 0.14-0.16) or the 23% who received an EBT incongruent with their diagnosis (ES = 0.06-0.15). For children with comorbid diagnoses, the use of EBTs congruent with the primary diagnosis was also associated with the greatest improvement, especially when compared to no EBT (ES = 0.22-0.24). Results of the current study support the use of EBTs in community-based settings, and suggest that clinicians should select EBTs that match the child's primary diagnosis to optimize treatment outcomes, especially for children with comorbidity.

Nomachi , Motoki Kiyosawa , Shiori Grammatika v obshchestve, obshchestvo v grammatike. Issledovaniia po normativnoi grammatike slavianskikh iazykov (review)

Slavonic and East European Review, 99, 4, 2021 Reviews Nomachi, Motoki and Kiyosawa, Shiori (eds). Grammatika v obshchestve, obshchestvo v grammatike. Issledovaniia po normativnoi grammatike slavianskikh iazykov. Studia Philologica. Izdatel´skii Dom IaSK, Moscow, 2021. 304 pp. Illustrations. Tables. Notes. Bibliographies. Price unknown. This useful Russian-language volume is edited by two scholars from the SlavicEurasian Research Center at Hokkaido University, Sapporo, Japan’s leading institutionintheinterdisciplinaryfieldofSlavicstudies.Interestingly,although this exquisitely manufactured book was typeset and published in Russia, it was actually printed in Japan. Its focus is on how historical and political processes conditioned the concepts and production of the grammars that standardized Slavic languages, which now function as official and national languages in independent nation-states. The authors of these grammars were the products of their times and social situations, and as such their publications reflected these conditions, thus contributing to the shaping and coalescing of standard languages in accordance with social, cultural and political requirements. Rewardingly, unlike in traditional linguistics that takes languages for granted andseesthemasproductsofnature(e.g.AugustSchleicher’sSprachorganismen), this collection approaches languages as artefacts of human ingenuity, choice and labour. The book’s chapters are grouped into three sections that correspond to the current tripartite classification of Slavic languages, which in itself is a political creation, given that areal linguists distinguish only two Slavic dialect continua: Northern and Southern. Oksana Aleksandrovna Ostapchuk and Shiori Kiyosawa open the volume with chapters devoted, respectively, to the two Ukrainian grammars by Olena Kurylo and Oleksa Syniavskyi, and the Belarusian grammar by Branisłav Taraškievič, conceived at the end of the Great War and published before the Soviet Union was founded in 1922. During the period of the Soviet policy of korenizatsiia, these works were instrumental in standardizing Ukrainian and Belarusian, and their use became widespread in Moscow’s official ‘struggle against Great Russian chauvinism’. With the first five-year plan this policy came to an end. The grammars were banned and replaced with ones that strove to bring Belarusian and Ukrainian ‘closer to Russian’, the aim being to Russify both languages. All three grammarians were repressed and lost their lives, either by execution or in Soviet concentration camps. This change in fortunes opened a clear career path for the ethnically Russian philologist Viktor Vinogradov, who worked on the standardization of Soviet Russian through authoritative dictionaries. Daisuke Adachi’s chapter is not devoted to any grammar but focuses on Vinogradov’s reflection on the contribution of the fiction of the ethnically Ukrainian writer Nikolai Gogol´ (Mykola Hohol’) to REVIEWS 743 the emergence of standard Russian in the first half of the nineteenth century, including Ukrainian linguistic loans. A rather brief second section on West Slavic omits Czech and Sorbian, instead focusing on late eighteenth-century grammars by the Catholic priests Onufry Kopczyński and Anton Bernolák, in chapters by Natalia Evgen´evna Anan´eva and Konstantin Vasil´evich Lifanov respectively. Kopczyński’s grammar became the primary school textbook of the first-ever state-wide educational system in Europe and facilitated both the standardization and spread of Polish. Bernolák’s gave rise to a Western standard of Slovak that was subsequently replaced by a Central standard in the mid-nineteenth century which forms the basis of today’s Slovak, since Bernolák’s standard was deemed too close to Czech. The book’s third section on South Slavic languages considers Ivan Bogorov’s early mid-nineteenth century standardizing grammar of Bulgarian, the standardizing grammars of Serbian of the nineteenth and twentieth centuries, and Valentin Vodnik’s early nineteenth-century school grammar of Slovenian, in chapters by Maria Nikolaevna Belova, Danko Šipka and Ol´ga Sergeevna Plotnikova respectively. However, no discussion is offered on grammars of Croatian or the post-Serbo-Croatian languages of Bosnian and Montenegrin. In a way, the section compensates for this absence with two final chapters by Elena Vladimirovna Verizhnikova and Motoki Nomachi devoted, respectively, to the early standardizing grammars of Macedonian by Krume Kepeski and the Soviet linguist Samuil Bernstein (Bernshtein). The 1944 decision to recognize and develop Macedonian as a language in its own right in post-war Yugoslavia was intended to offset the influence of Bulgaria’s wartime occupation. However, the...

Effect of COVID-19-related reductions in cancer screening in Native Hawaiians and across urban and rural communities in Hawaii.

109 Background: The COVID-19 pandemic has disrupted medical care in all areas of the US and had a profound impact on cancer screening, with a concern that this may lead to excess cancer-related deaths over the next decade. There are existing disparities in cancer mortality among rural US residents and Native Hawaiians (NHs) due to access issues, lower socioeconomic status and lack of a sufficient provider workforce. A reduction in cancer screening may therefore have an oversized impact on these populations. In this study, we examine the effects of the COVID-19 pandemic on cancer screening frequency among NHs and in urban and rural populations in Hawaii. Methods: De-identified data on the frequencies of breast cancer (BCS), cervical cancer (CCS) and colorectal cancer (CRCS) screenings for 2019 and 2020 were obtained for Hawaii residents from several sources, including Hawaii Medical Services Association, the largest private and Medicaid provider in Hawaii, and the two largest state-wide health systems, Queen’s Health Systems and Hawaii Pacific Health. Data was analyzed using Rural-Urban Continuum Codes (RUCC) and Rural-Urban Commuting Area (RUCA) codes to define rurality and, along with health system facility location, to ascertain whether there was a differential impact on cancer screening rates for rural populations due to the pandemic. Cancer screening data for NHs in comparison to other groups was analyzed separately. Results: Overall, reductions in cancer screening during the pandemic were seen, with the degree of reduction varying widely across regions of the state and among different ethnic populations. Annual reductions in BCS, CCS and CRCS ranged from 4.0-30.2%, 2.7-3.0% and 9.4-13.2%, respectively, depending on the data source. BCS reductions were greatest in rural areas (p = 0.09) and among NHs (p = 0.0005). The island of Kauai, which is rural but was minimally affected by COVID-19, saw no reduction in BCS. CCS reductions had a reverse urban vs. rural pattern, with reductions of 4.5% urban and 0.8% rural (p = 0.02). CRCS reductions were most profound in rural residents (17.1%; p = 0.0001); reductions in CRCS among NHs were 1.5x greater than other groups. The differential impact across urban and rural areas was consistent for both RUCC and RUCA analysis. The extent of reduction was most significant for CRCS and was directly proportional to the degree of rurality. Conclusions: BCS and CRCS were impacted more significantly by the COVID-19 pandemic than CCS. For BCS and CRCS, greater reductions were seen in rural compaed to urban populations and in NHs. The lack of correlation with rurality for CCS may be because this population is generally younger and screening is often provided as a component of primary care. The greater pandemic-related reduction in screening among rural residents and Native Hawaiians may exacerbate existing cancer mortality disparities in these vulnerable populations.

COVID-19 mRNA vaccination, reactogenicity, work-related absences and the impact on operating room staffing: A cross-sectional study

BackgroundThe COVID-19 pandemic has caused disruption to healthcare delivery worldwide including in the delivery of surgical services. The introduction of mRNA COVID vaccines and the significant reactogenicity seen with vaccination has caused an unanticipated impact on the operating room workforce via unanticipated paid time off after employee vaccination. MethodsA retrospective cross-sectional survey was made available to approximately 33,000 front-line healthcare workers, students and volunteers who were offered voluntary vaccination in a state-wide healthcare system during phase one of the state's vaccine roll-out. The primary study aim was to determine the frequency of unanticipated paid time off, and the secondary study aim was to identify any demographic determinants influencing the need for unanticipated time off work secondary to adverse effects. Results4009 responses were received, a 12.15% response rate. When looking specifically at individuals who did not proactively schedule themselves for time off after vaccination, we determined that unanticipated paid administrative leave was required for 4.9% and 19.79% of individuals after the first and second doses of vaccine, respectively. The average lengths of absence were 1.66 days and 1.39 days for the first and second doses, respectively. There were no statistically significant differences found in the need for unanticipated leave when compared by vaccine manufacturer, gender, age, ethnicity, or job description. However, individuals with a bachelor's degree demonstrated a significantly higher unanticipated leave requirement than respondents who reported other educational backgrounds. ConclusionsThe ability to staff operating rooms and other critical healthcare services may be negatively affected as a result of COVID-19 mRNA vaccination reactogenicity and subsequent unanticipated paid administrative leave. For future COVID-19 boosters or during other pandemics in which mRNA vaccination is recommended, employees should proactively schedule their vaccination(s) in conjunction with their work schedules to minimize the impact of reactogenicity and unanticipated time off on the operating room schedule and patient care.

Defined Benefit Public Pension Funding Determinants and Consequences: A Review of the Literature

Public employee pension funding in the United States continues to be a topic of interest to both practitioners and researchers. Early works in this area date back to Mumy (1978). However, it wasn't until the mid-1990s that the stream of research on public pension funding resurfaced. the objective of this essay is to provide an overview of the literature on defined benefit pension funding in the public employee pensions sector in the United States over the approximately past 20 years and to highlight research areas where there may be gaps. Empirical research on defined benefit pension funding has predominantly focused on the antecedents or determinants of the pension funded status, motivated in large part by the magnitude of underfunding. These studies are often concentrated on a subset of (typically) larger, state-wide systems, given existing data limitations. Thus, this essay outlines how research has evolved and aggregates the works on determinants of defined benefit pension funding at three levels: states’ plan level, local level across states, and local and/or specific state level. It also presents the research available on the consequences of defined benefit pension funding. This review reveals limited research on the consequences of pension funding and highlights opportunities for related future empirical research in this domain.

"Doing What I can, but I got no Magic Wand:" A Snapshot of Early Childhood Educator Experiences and Efforts to Ensure Quality During the COVID-19 Pandemic.

The COVID-19 pandemic impacted early childhood programs serving infants, toddlers, and preschoolers in dramatic ways. After temporarily closing, many educators quickly adapted their procedures to ensure children’s safety as they reopened to provide childcare for essential workers and then the community at large. This manuscript reports on statewide efforts to continue quality improvement initiatives for early childhood programs amidst the COVID-19 pandemic. We first describe the impacts of the COVID-19 pandemic for over 2000 educators—teachers, administrators, and specialists—who completed surveys in the Spring and Fall of 2020. These survey data come from a statewide system called the Texas Early Childhood Professional Development System (TECPDS), designed to track the professional development needs/progress of early childhood educators. Second, we describe an example of how a statewide professional development and quality improvement program shifted to remote delivery during the pandemic. As an increasing number of educators turn to virtual training resources, we explain lessons learned from these response efforts and how they can inform future virtual professional development efforts, even amidst crisis, to ensure that a focus on quality improvement continues while supporting teachers’ individual needs.

Evolution of a sundown town and racial caste system: Norman, Oklahoma from 1889 to 1967

Sundown regions were post-Reconstruction localities that deliberately excluded African Americans, often well into the 20th century. While former states of the Confederacy instituted state-wide racial caste systems denying African Americans basic political and economic privileges and opportunities, what of localities outside the Deep South? This case study concludes that Norman, Oklahoma, located outside of the Deep South, was a sundown town from 1889 to 1967 or for 78 years. Sundown implementation practices resulting in ongoing racial cleansing and exclusion include a variety of extra-legal actions including violent racial expulsion in the beginning; Ku Klux Klan terror in the 1920s; ongoing freeze-out of local services such as hotel services; denial of home ownership; denial of employment; curtailment of political rights including voting and freedom of movement; an ominous reputation as a sundown town; continuing violence; and threats. The widespread act of systematically excluding African Americans after dark from Norman, in tandem with state legislation that outlawed interracial marriage and intimate relationships until 1967 and maintaining all white public colleges until 1948, contributed to a racial caste system based on unequal opportunities and privileges afforded to whites. Sundown practices were not only ongoing geographic and racist Jim Crow segregation issues as is sometimes stated, but also, a key approach to enforce a rigid racial caste system in the midst of a society with democratic ideals.

Groundwater Recharge for a Regional Water Bank

The Kern Water Bank is a semi-private groundwater bank operated by the Kern Water Bank Authority in Kern County, CA. The bank stores water from the State Water Project (SWP), Central Valley Project (CVP), and the Kern River. It is massive in scale, covering over 20,000 acres, with approximately 2.5 million acre feet diverted to the bank since 1995. The bank stores water on behalf of its member water agencies, which include both public and private water entities mainly focusing on agricultural use, along with a small number of municipal and residential customers. Water is withdrawn by the member agencies during droughts when surface water supplies from the SWP, CVP, and Kern River are insufficient to meet local demand or when member agencies elect to sell their stored water to outside third parties. In addition, the overlying land and infiltration ponds serve as habitat for some endangered and threatened species. Legal and political controversy surrounded the bank’s creation, but its unique suite of physical assets, creative enabling agreements, and clear operational rules and incentives have enabled it to use managed aquifer recharge to make significant contributions to the flexibility of regional and statewide water systems over decades of operations.

P0163 / #572: DEVELOPMENT OF THE ESCALATION SYSTEM IN WESTERN AUSTRALIA

Aims & Objectives: Western Australia is vast, isolated and sparsely populated and significant variation exists in the paediatric population, healthcare services with no standardised approach in recognition and response to clinical deterioration. This project aimed to develop an evidence based state-wide system for recognising and responding to paediatric clinical deterioration. Methods: ESCALATION was a prospective mixed methods implementation study conducted in 2019, guided by a key Stakeholder Steering Group. Literature review, benchmarking, and stakeholder consultation informed an evidence based early warning tool incorporating human factor principles and family involvement. The PARROT consists of five track and trigger age-specific charts, ten weighted variables, a targeted communication model and escalation pathway. The PARROT was trialled for feasibility and acceptability in paediatric wards and Emergency Departments at six purposively selected metropolitan and country sites. Evaluation data collected were site characteristics, chart utilisation audits, escalation of care audits, staff surveys, staff focus groups and interviews with parents whose children had been inpatients. Results: The PARROT underwent extensive iterative review and modelling using case-based scenarios providing strong face and content validity. Refinements required include; reorientation of the chart format, removal of some redundant prompts, extra detail for use of the family/clinician concern variable. Conclusions: The PARROT is the first early warning tool to incorporate clinical assessment, clinician and family concern, an escalation pathway and a clinical communication model for timely action. The trial demonstrated that it is feasible to use and acceptable to all stakeholders

Intrinsic hospital factors: overlooked cause for variations in delay to transfer for endovascular thrombectomy

BackgroundIntrinsic hospital factors leading to time delay to inter-hospital transfer for endovascular thrombectomy (EVT) have not been adequately investigated, leading to uncertainty in generalizability of hub and spoke EVT services....

Jail-based competency treatment comes of age: Multi-site outcomes and challenges to the implementation of an evidence-based forensic continuum.

The jail‐based competency treatment (JBCT) model has become an established forensic practice across the country. From the perspective of implementation science and the three core elements of the Promoting Action on Research Implementation in Health Service (PARiHS) framework, the JBCT model is a remarkable example of how context (an unrelenting and overwhelmingly strong demand for forensic beds) has driven multiple state governments to facilitate implementation of a methodology in the absence of empirical evidence supporting its efficacy. This 7‐year study of outcomes from four JBCT program sites provides this much‐needed evidence by showing that JBCT restored 56% of 1553 male and 336 female patients over an average of 48.7 days. At the same time, the study highlights how variations in JBCT models, methods, and preadmission stabilization time present challenges to planned and effective implementation of evidence‐based practice at the statewide system level. By identifying differential responsiveness to JBCT treatment by diagnosis and other factors, the study suggests preliminary implementation ideas for what types of patients are well served by the JBCT model as part of a continuum of restoration options that includes inpatient, outpatient and diversion. Significant findings showed that JBCT patients were restored at a higher rate and in a shorter time if they were female, < 20 years old (highest restoration rate; those < 60 years old also significantly better rates), free of co‐occurring intellectual and cognitive deficits, and malingering. Of the major diagnoses, schizoaffective disorder required a significantly longer length of JBCT treatment for restoration, and lower restoration rates than schizophrenia and bipolar disorder, although this was moderated by a significant interaction with abuse of amphetamines.

Opening the "black box": Four common implementation strategies for expanding the use of medications for opioid use disorder in primary care.

Despite the persistent increase in overdose deaths, access to medications for opioid use disorders remains limited. Recent federal funding aimed at increasing access prompts a need to understand if implementation strategies improve access. This is an analysis of data from 174 primary care clinics enrolled in a state-wide medications for opioid use disorders (MOUD) implementation effort in California. We examined clinic use of one of four implementation strategies: learning collaboratives, Project Extension for Community Health care Outcomes (ECHO), didactic webinars, and clinical skills trainings. The primary implementation outcome was categorical change in new patients prescribed buprenorphine. Univariate and multivariate logistic regressions were used to determine the impact of clinic attendance in all or individual implementation strategies, respectively, on patient growth. Clinics attending learning collaboratives, Project ECHO, and clinical skills trainings had significantly higher odds of patient growth (odds ratio [OR] = 3.56; 95% confidence interval [CI] = 1.78, 7.10, p < .001), (OR = 3.39; 95% CI = 1.59, 7.24, p < .01), (OR = 3.90, 95% CI = 1.64, 9.23, p < .01) than non-attending clinics. The impact of attendance at learning collaboratives (OR = 5.81, 95% CI = 1.89, 17.85; p < .01), didactic webinars (OR = 3.59; 95% CI = 1.04, 12.35; p < .05), and clinical skills trainings (OR = 3.53, 95% CI = 1.06, 11.78, p < .05) on patient growth was greater for Federally Qualified Health Centers. When comparing strategies in multivariate models, only the relationship between learning collaborative attendance and new patients prescribed buprenorphine remained significant (OR = 2.57; 95% CI = 1.12, 5.88; p < .05). This study reported on a large, statewide, implementation-as-usual project offering four typical implementation strategies. Clinic attendance at learning collaboratives, a multi-component strategy, had the most consistent impact on new patients prescribed buprenorphine. These results suggest that while a broad array of strategies was initially reasonable, optimizing the selection of implementation strategies could be more effective. Access to life-saving medications for opioid use disorder, such as buprenorphine, remains limited despite strong evidence of effectiveness. Systems and organizations often select from a variety of implementation strategies aimed at expanding access to these medications. However, scant research exists to enable these organizations to select the most effective and efficient strategies. Our study-within a large state-wide system of care-examined the impact of primary care clinic attendance in four common implementation strategies on new patients prescribed buprenorphine. Learning collaboratives were the strategy that most consistently improved outcomes. These results highlight the challenges to strategy selection inherent in implementation-as-usual systems-level approaches. The field needs evidence-based information on which implementation strategies are most likely to yield desired implementation outcomes.

Trauma Symptoms and Relationship With Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care.

Systems of care (SOCs) are comprehensive, community-based services for youth with emotional and behavioral disorders. For these youth, little is known about how trauma symptoms influence participation in SOC care coordination through the Child and Family Team (CFT) meeting. The current study assessed the extent to which exposure to potentially traumatic events (PTEs) and trauma symptoms were associated with participation in CFTs and youth and family outcomes. Participants were 464 youth (M age = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-month follow-up. Care coordinators completed surveys assessing CFT characteristics following each meeting and assessments of youth functioning. Moderated multiple regression analyses tested the conditional effects of youth trauma symptoms on the relationships between CFT characteristics and youth and caregiver outcomes. Trauma symptoms moderated the relationship between the number of days to the first CFT meeting and youth impairment and the relationship between CFT meeting duration and youth impairment. Results suggest the presence of trauma and other contextual factors contributed to difficulty in initiating services and to changes in youth impairment. Implications for the provision of trauma-informed SOC services are discussed.

Shaw and Legacy: Introduction

Shaw and Legacy: Introduction

COVID-19 Needs Assessment and Support for Primary Care Practices in Western North Carolina.

It is critical to ensure that Primary Care Providers (PCPs) have adequate personal protective equipment (PPE), supplies, training, staffing, and contingency planning during pandemics, particularly in rural areas. In March 2020, during the onset of the COVID-19 pandemic, the Mountain Area Health Education Center (MAHEC), in collaboration with the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, rapidly created and conducted a needs assessment of PCPs in western North Carolina (WNC). A group of twenty volunteers conducted a telephone survey of PCPs in a 16 county region of WNC. Practices were asked about their COVID-19 testing and telehealth offerings, PPE adequacy, and capacity to continue serving patients. The survey's emergency alert feature linked practices to immediate support. Descriptive data were generated to identify regional needs. Out of 110 practices, 48 (43.6%) offered COVID-19 testing, with testing more common in rural counties (56.3% vs 33.9%). Telehealth services, including phone-only visits, were offered by almost all practices (91.8%). PPE needs included N-95 respirators (49.1%), face shields (45.5%), and staff gowns (38.2%). Rural practices were more likely to report the need for PPE. Assistance was requested for staff member childcare (34.5%) and providing or billing for telehealth (31.8%). The most urgent practice requests were related to finances, PPE, and telehealth. MAHEC's Practice Support team linked practices to virtual coaching, tip sheets, case-based video didactics and communication forums, and newsletters. During a pandemic, it is crucial to ensure that PCPs can continue to serve their patients. A rapid needs assessment of PCPs can allow for immediate and ongoing support that matches regional and practice-specific needs. Rural practices may require more assistance than their urban counterparts. Our rapid survey process jumpstarted a statewide system for enhanced communications with PCPs to better prepare for future emergencies.

Outcomes, evidence-based treatments, and disparities in a statewide outpatient children’s behavioral health system

Abstract Purpose Many questions remain about the effectiveness of behavioral health treatments for children in large systems of care, including the use of evidence-based treatments (EBTs). The goals of this study were to 1) describe outcomes of children receiving treatment in a statewide system, overall and separately for demographic groups; 2) describe penetration rates of EBTs and examine outcomes by treatment type and 3) examine moderation of treatment type by demographic group. Methods Participants were 46,399 children receiving behavioral health services at one of 25 outpatient clinics in a state system between 2013 and 2017. Administrative data included child demographic characteristics, treatment type, and problem severity based on the Ohio Scales. Propensity score methods were used to analyze EBT effects compared to no EBT conditions, and interactions with demographic groups. Results The overall pre- to post-treatment effect size across all treatment types was medium (Cohen’s d = 0.49 to 0.51) and similar to prior research. White children showed greater improvements than Black or Hispanic children, 7 to 12-year olds improved more than younger and older children, and females improved more than males. Almost half (47%) of children received cognitive behavioral therapy, and an additional 12.4% received another EBT. Children receiving EBTs showed greater improvement than those not receiving an EBT. The relative benefits of EBTs were mostly consistent across sex, age, and race/ethnicity, but EBTs were associated with some reductions in disparities by race/ethnicity (particularly for Hispanic youth and more modestly for Black youth) and age. Conclusions Outcomes for children receiving behavioral health treatment in a statewide system were modest. EBTs can be disseminated within large systems and have potential for improving overall outcomes for children from diverse backgrounds.

Abstract 16719: Impact of Underlying Cardiovascular Disease for the Hospitalized Covid-19 Patients in Delaware

Background: Patients with cardiovascular disease (CVD) are especially vulnerable to respiratory infections caused by the coronavirus. The underlying effect of cardiovascular comorbidities on patients with COVID-19, however, remains to be sufficiently understood. Methods: Hospitalized COVID-19 patients from a state-wide large health care system with completed historical clinical conditions during March - June of 2020 were included in this study. The impact of CVD on the mortality, resources utility including the uses of intensive care unit (ICU) and ventilator, length of stay (LOS) and financial burden of COVID-19 inpatients were examined. Logistic analysis was applied to analyze the relationship between CVD and mortality, and non-parametric methods were used to evaluate the impact of CVD on resources utility. Random forest method was used to rank the importance of risk factors. Results: Among 811 hospitalized COVID-19 patients, 228 (28.11%) were placed in ICU, 105 (12.95%) spent on ventilators, and there were 94 deaths (11.59%). The mean LOS was 11.93 ± 11.26 (SD, standard deviation), mean time a patient in an ICU was 2.41 ± 5.49 days, and mean ventilator time was 1.29 ± 4.62 days. The mean charge of a patient was $55242 ± 71742) with inter-quarter range of $44124. Age, gender, and race were the top 3 factors of mortality and utilities. Patients who present with heart failure vs. those who do not, have increased mortality (21.47% vs 8.97%; odds ratio [OR], 2.00 (95% CI: 1.25-3.21; P=0.004), longer LOS (12.97 ±10.09 vs. 11.61±11.46), p=0.18), higher ICU usage ( 3.32 ± 6.04 vs. 2.14 ±5.26, p=0.02) and ICU requiring ventilator (1.86 ± 4.90 vs. 1.15 ± 4.56, p=0.09), and significant higher charge ($ 66175 ± 68773 vs $ 50736 ±64142, mean difference $15439± 65193 with 95% CI: $4537-26340, p=0.01). Similar results were shown for patients with coronary artery disease or arrhythmia. Patients with hypertension vs those who do not, have increased mortality (14.81% vs. 4.92%; OR=3.22 (95% CI: 1.76-5.90, p=0.01), but the impact was not significant after adjusted by age, race and gender. Conclusions: Among COVID-19 hospitalized patients with established cardiovascular disease, there was a worse survival and adverse utility outcomes in hospital resources and financial charges.

Real-time suicide mortality data from police reports in Queensland, Australia, during the COVID-19 pandemic: an interrupted time-series analysis

BackgroundDeaths by suicide can increase during infectious disease outbreaks. This study analysed suspected suicide rates in 2020 relative to 2015–19 to assess any early effects of the COVID-19 pandemic in Queensland, Australia.MethodsWe analysed data from the interim Queensland Suicide Register (iQSR), a state-wide real-time suicide surveillance system, using an interrupted time-series design. The data source for the iQSR is the Form 1 police report of a death to a coroner. Two QSR staff independently classed the probability of a death by suicide as possible, probable, or beyond reasonable doubt. The analysis included the probable or beyond reasonable doubt categories as suspected suicides. The primary outcome was the monthly suspected suicide rate. We applied Poisson and negative binomial regressions to assess whether Queensland's Public Health Emergency Declaration on Jan 29, 2020, affected suspected suicides from Feb 1 to Aug 31, 2020. Secondary outcomes included absolute or relative changes in police-reported motives of recent unemployment, financial problems, domestic violence, and relationship breakdown.Findings3793 suspected suicides were recorded with an unadjusted monthly rate of 14·85 deaths per 100 000 people (from Jan 1, 2015, to Jan 31, 2020) before the declaration, and 443 suspected suicides were recorded with an unadjusted monthly rate of 14·07 deaths per 100 000 people (Feb 1, 2020, onwards) after the declaration. An interrupted time-series Poisson regression model unadjusted (rate ratio [RR] 0·94, 95% CI 0·82–1·06) and adjusted for overdispersion, seasonality, and pre-exposure trends (RR 1·02, 95% CI 0·83–1·25) indicated no evidence of a change in suspected suicide rates. We found no absolute or relative increases in the motives for suspected suicides, including recent unemployment, financial problems, relationship breakdown, or domestic violence from February to August, 2020, compared with the pre-exposure period.InterpretationThere does not yet appear to be an overall change in the suspected suicide rate in the 7 months since Queensland declared a public health emergency. Despite this, COVID-19 has contributed to some suspected suicides in Queensland. Ongoing community spread and increasing death rates of COVID-19, and its impact on national economies and mental health, reinforces the need for governments to maintain the monitoring and reporting of suicide mortality in real time.FundingNone.

A Unique Model for Developing Continuing Education Resources for Health Professionals in Geographically Dispersed Health Organizations.

The provision of high quality, equitable, and accessible education resources is a key to supporting continuing professional development (CPD) in health organizations. The Health Education and Training Institute (HETI) and its operational model for districts (District HETI Operational Model), is a novel approach that supports this imperative for over 155,000 staff working across the state of New South Wales (NSW), Australia. The model uses three principles in education and training development. These include collaborative partnerships, rapid resource development, and effective leadership within virtual teams. A state-wide learning management system has been implemented to support this initiative. Over 451 standardized, education, and training online modules have been developed for medical, nursing and midwifery, dental, allied health, and nonclinical NSW Health employees since 2013. These educational resources are accessible 24 hours a day. Cost-effective online programs have enabled more than 13.6 million learner completions. Program evaluations highlight the value of these resources in providing a positive learning experience. Furthermore, the District HETI Operational Model has been recognized by multiple national and international excellence awards in learning and development. The principles of the District HETI Operational Model apply to other health organizations that may choose to adopt a similar model. Such a model may support equity of access to contemporary, standardized, evidence-based education resources for health professionals working across geographically and clinically diverse environments. Implementation of a similar model for future CPD interventions warrants consideration by practitioners, researchers, and policymakers.

Accuracy of Self-Reported Vaccination Status in a Cohort of Patients with Inflammatory Bowel Disease.

Background and AimsPrevention of vaccine-preventable diseases is important in the care of patients with inflammatory bowel disease (IBD). Thus, accurate immunization histories are critical. Many providers rely on patient self-report when assessing immunization status. The primary aim of our study was to determine the accuracy of self-reported influenza vaccination status in a cohort of patients with IBD.MethodsWe conducted a prospective study of patients with IBD who answered a vaccination status questionnaire and compared their responses to the Wisconsin Immunization Registry, a state-wide electronic immunization information system. The primary outcome was the sensitivity and specificity of self-reported influenza vaccination status. A secondary outcome evaluated the sensitivity and specificity of pneumococcal vaccination status.ResultsA total of 200 patients with IBD were included in the study. Documented immunization rates were 74.5% for influenza vaccinations and 79.9% for pneumococcal vaccinations. Influenza vaccination self-report had a sensitivity of 98.7%, a specificity of 90.2%, a positive predictive value (PPV) of 96.7% and a negative predictive value (NPV) of 95.8%. In comparison, the sensitivity for pneumococcal vaccination was 83.5% with a specificity of 86.2%, PPV of 96.4%, and NPV of 54.3%.ConclusionsSelf-reported influenza immunization status is sensitive and specific in patients with IBD. Accuracy for pneumococcal vaccination is slightly lower, but responses were notable for a high PPV. Self-report is an effective way to determine influenza immunization status and provides useful information for receipt of pneumococcal vaccine in patients with IBD.