Underserved Urban Communities Research Articles

Participants' Experiences With a Community Based Participatory Research Produce Prescription Program: Findings From a Qualitative Study.

The purpose of this study was to explore a food-insecure, low income, predominantly African American community's experiences with a produce prescription program (PPP). Researchers conducted 3 focus groups and 4 individual interviews with Maywood Veggie Rx (VRxM) participants asking questions about the logistics of the program while also exploring ideas around health, food, and community. This produce prescription program took place in Maywood, Illinois which is an urban underserved community with 23.5K people, most of whom are Black/African American (61%) and Hispanic (32%). The 24 participants interviewed through focus groups and individual interviews were enrolled in the 2021-2022 VRxM program. Participants were mainly female, with only three participants being males. Ages ranged between 34 and 74 years of age with a mean age of 56.3. Qualitative data from transcripts were then coded via a grounded theory approach to identify common themes. A research team of seven including the two Co-PIs, three medical students and two dietetic interns identified 278 codes which were then condensed into 117 codes and then placed into 9 categories. Researchers identified three recurrent themes among the experiences of VRxM participants: (1) trust building, (2) culturally relevant and adaptive nutrition education, and (3) bidirectional feedback. These three themes mirror many of the principles of Community Based Participatory Research (CBPR). The study findings identify common themes among the experiences of VRxM which are in line with the collaborative approach of CBPR principles. Produce Prescription Programs should utilize CBPR principles in the creation and implementation of programming to improve the participant experience. Future research should include additional focus groups on new iterations of VRxM and should also include those people who chose not to participate in VRxM to explore barriers to participation.

Neurovascular Conditions and Associated Socio-Demographic and Behavioral Factors in an Urban Hospital in Northwest Indiana

Background: Brain health equity remains an underexplored research area despite high prevalence of neurovascular conditions and related health impacts. This study examined the associations between socio-demographic, behavioral factors, and hospital admissions for neurovascular-related morbidity in an urban underserved community. It is part of a multi-phased Community-Based Participatory Research (CBPR) partnership between Indiana University School of Medicine-Northwest and St. Mary Medical Center (SMMC) to examine the prevalence, distribution, and relationships between social determinants of health (SDOH), demographics, health behaviors, and health outcomes in Northwest Indiana.
 Methods: This retrospective study analyzed a limited dataset generated by SMMC from EPIC™ with SDOH, demographic, behavioral and health outcomes data for adult inpatient visits from January 2021 to March 2023. Neurovascular admission was determined by ICD-10 Codes I67-69. Data analysis was conducted in SPSS 29.0 using descriptive statistics (i.e., frequencies and central tendency), bivariate analysis (Chi-square; p<0.05), and multivariate analysis (binary logistic regression; p<0.05). This study received exemption from Indiana University Human Research Protection Program (IRB #14040).
 Results: There were 1,489 participants included in this study. The majority were white (77.7%), older adults (67 ± 21.5) and publicly insured (77.8%). The bivariate analysis demonstrated significant relationships between admission for neurovascular conditions and age group (p<0.001), veteran status (p<0.001), insurance type (p<0.037), and physical activity (p<0.001). After adjusting for these factors in multivariate analysis, age group (p< 0.003) and physical inactivity (p<0.008) were significantly associated with admission for neurovascular conditions.
 Conclusion: Understanding how SDOH and behavioral factors influence neurovascular admissions and inequities in urban settings will enhance collaborative efforts to develop, implement, and evaluate evidence-based interventions. The subsequent CBPR phases will utilize these findings to explore how socioeconomic status affects these patients’ ability to seek emergent and/or surgical care. This will enable implementation of strategies that better account for SDOH in patient care.

Enhancing Medical Students' Understanding of Team-Based Care to Address Social Determinants of Health: A Case-Based Experience.

Social and structural factors play a critical role in driving inequitable health outcomes, resulting in the need for undergraduate medical education to include important care components such as team-based care to address social determinants of health. Research shows that learning strategies such as case-based initiatives are valuable opportunities to impact knowledge of population health, health disparities, and social determinants that impact care. The purpose of this study was to assess the impact of a clinical case-based experience on medical students' self-efficacy and future intent to use the team-based care necessary to address social determinants of health. We used a retrospective analysis of program data from 640 third-year medical students who engaged in a case-based experience and small-group debriefing around the impact of team-based care and social determinants of health on patient care during their family medicine clerkship between July 2020 and April 2022. We found a statistically significant improvement in students' reported self-efficacy and intent to collaborate with other health care workers (team-based care) to address patient care needs in rural and urban underserved community settings. Our students reported that a case-based experience coupled with a small-group debriefing was an effective method for teaching them how to use a team-based approach to address social determinants of health.

Intervention to increase physical activity and healthy eating among under-represented adolescents: GOAL trial protocol

IntroductionTo reduce obesity-related disparities, reaching economically disadvantaged and/or minority status adolescents to assist them in meeting physical activity (PA) and nutrition recommendations is important. To address the problem, a 16-week...

Latent Class Groups of Concurrent Substance Use Among Adolescents in an Urban Community: Correlates With Mental Health, Access to Drugs and Alcohol, and Risk Perception.

Concurrent substance use among adolescents has been associated with an increase in physical and mental health problems. These outcomes tend to be exacerbated among adolescents of color in underserved urban settings. The purpose of this study was to understand alcohol and concurrent drug use patterns among adolescents in an underserved urban community to provide targeted prevention and treatment recommendations. This study examined data among adolescents in an underserved urban community (N = 1789; 56.90% female; 70.86% Hispanic/Latino/a; meanage = 15.96 ± 1.56). Using latent class analysis (LCA) and multinomial logistic regression modeling, analyses identified independent correlates of latent class membership. Five latent classes (LC) were identified including LC group 1: Predominant alcohol use and limited to no concurrent-drug use (n = 213; 11.9%); LC group 2: Concurrent drug and alcohol use including methamphetamine, marijuana and synthetic marijuana use, and alcohol use (n = 74; 4.2%); LC group 3: Concurrent drug and alcohol use, with no marijuana use (n = 204; 11.39%); LC group 4: High Concurrent drug use and alcohol use (n = 204; 11.40%); and LC group 5: Concurrent drug use without alcohol use (n = 1101; 61.52%). Significant between group differences were noted between latent class groups and sociodemographic characteristics. Multinomial logistic regression models identified the associations between sociodemographic characteristics and corollary clinical features of substance use on latent class groupings of alcohol and concurrent drug use. Understanding concurrent substance use LC groups among adolescents is essential to providing targeted interventions and treatment programs, as well as early intervention programs that may help reduce substance use during adolescence.

Low-dose buprenorphine initiation and treatment continuation among hospitalized patients with opioid dependence: A retrospective cohort study

BackgroundBuprenorphine is an effective treatment for both opioid use disorder (OUD) and chronic pain, but buprenorphine's pharmacology complicates treatment initiation for some patients. Low-dose buprenorphine initiation is a novel strategy that may reduce precipitated withdrawal. Few studies describe what patient populations benefit most from low-dose initiations and the clinical parameters that impact treatment continuation. This study aimed to 1) describe experiences with low-dose buprenorphine initiation, including both successes and failures among hospitalized patients in an urban underserved community; 2) identify patient- and treatment-related characteristics associated with unsuccessful initiation and treatment discontinuation; and 3) assess buprenorphine treatment continuation after discharge. MethodsThis is a retrospective cohort study with opioid-dependent (meaning OUD or receiving long-term opioid therapy for chronic pain) patients who underwent low-dose buprenorphine initiation during hospital admission from October 2021 through April 2022. The primary outcome was successful completion of low-dose initiation. Bivariate analysis identified patient- and treatment-related factors associated with unsuccessful initiation. Secondary outcomes were buprenorphine treatment discontinuation at post-discharge follow-up, 30- and 90-days. ResultsOf 28 patients who underwent low-dose buprenorphine initiation, 68 % successfully completed initiation. Unsuccessful initiation was associated with receipt of methadone during admission and higher morphine milligram equivalents (MME) of supplemental opioids. Of 22 patients with OUD, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 46 %, 36 %, and 36 %. Of 6 patients with chronic pain, the percent receiving a buprenorphine prescription at a follow-up visit, 30 days, and 90 days, respectively, was 100 %, 100 %, and 83 %. ConclusionLow-dose buprenorphine initiation can be successful in opioid-dependent hospitalized patients. Patients taking methadone or requiring higher MME of supplemental opioids may have more difficulty with the low-dose buprenorphine initiation approach, but these findings should be replicated in larger studies. This study suggests patient- and treatment-related factors that clinicians could consider when determining the optimal treatment strategy for patients wishing to transition to buprenorphine.

Flooding in the urban fringes: Analysis of flood inundation and hazard levels within the informal settlement of Kibera in Nairobi, Kenya

Overlapping conditions of rapid urbanisation and climate change across developing countries are threatening the capacity of cities to manage climate risks, especially in the flood-exposed low-income peripheral areas. Limited studies have applied hydrodynamic flood models in ascertaining flooding conditions, supportive of risk-informed decisions in such urban fringes. Against this backdrop, we assessed plausible flooding and hazard conditions in the low-lying villages of Lindi and Silanga in Kibera informal settlement. The coupled one-dimensional and two-dimensional hydrodynamic model, customised from the Hydrological Engineering Centre's River Analysis System (HEC-RAS) was parameterised for flood simulation under different hydrological regimes and scenarios associated with flooding in Kibera. Volumetric flow estimates and a computed energy slope were used to define the upstream and downstream modelling boundary conditions respectively. Trial-and-error adjustment of the flow resistance coefficients from land-use features was applied in model calibration, and the results compared to the surveyed flood of 23rd April 2019. Results show that proximal areas to the Ngong River and Nairobi dam face high flood risks. A flood volume of 11.7×105m3 from a 2.5h, 50 mm rainfall could potentially inundate about 2.0% and 8.3% of areas in Lindi and Silanga respectively, while a volume of 48.9×105m3 from a 100-year storm of 172 mm could inundate about 10.6% of Lindi and 29.1% of Silanga. Upstream steeply sloping topographies of the villages increase flood velocities and risk of drowning, while the lower reaches at relatively flatter topographies, experience attenuated flow and rapid accumulation of flood waters, hence, higher flood depths. These results can support policy interventions for integrated flood risk management in Kibera, as a way of mainstreaming the underserved urban communities in climate risk management.

Geographic access to dermatologic care in urban underserved communities

Geographic access to dermatologic care in urban underserved communities

Preliminary Workforce Outcomes of an Urban Longitudinal Integrated Clerkship.

The authors examined whether students participating in an urban longitudinal integrated clerkship (LIC) with a curriculum focused on care for underserved populations have a sustained commitment to urban underserved care through residency training and into practice. This mixed-methods study collected data from medical student application essays to the Denver Health LIC (DH-LIC), end-of-course surveys, residency match outcomes, and postgraduation surveys annually for academic years 2014 to 2022. The authors analyzed students' responses to the surveys on interest in working with underserved patients, understanding the rewards and challenges of working in safety net institutions, working in the community to improve health, and working at DH. The authors qualitatively coded the 70 application essays of all selected students using summative content analysis. Seventy DH-LIC students were compared with 1,450 medical students between 2014 and 2022. Qualitative analysis of LIC application essays revealed 3 themes: interest in working with underserved populations, work experience with underserved populations, and personal experience with medical vulnerability. Fifty-seven DH-LIC participants (81.4%) expressed high levels of career interest in working with underserved populations, 45 (64.3%) had high levels of work experience with underserved populations, and 18 (25.7%) expressed high levels of personal experience. Graduates of the DH-LIC program demonstrated a high degree of continuing interest in practicing in urban underserved settings throughout medical school and postgraduate training. Ten graduates (71.4%) in practice work in urban underserved settings. Participants reported a high or very high level of interest and commitment to working with underserved populations (96.7%-100%), understanding the safety net health care system (91.7%-98.6%), and working in communities (95.0%-100%) at all time points studied. Early data indicate high rates of graduates working in urban underserved settings. These preliminary outcomes suggest the LIC may support the development of a committed workforce for urban underserved communities.

Impact Over 3 Years of a Family Medicine-led Addiction Medicine Curriculum for Medical Students.

Innovations in medical school training are essential for family physicians to enter practice confident in addressing the opioid epidemic and substance use disorders. The objective of this study was to evaluate the effectiveness of a distance-learning addiction medicine curriculum led by family medicine physicians for third-year medical students. Our prospective cohort study of third-year medical students compared our educational model to a traditional curriculum. Our distance-learning collaboration employed videoconferencing and community experts to engage students across Minnesota in an addiction medicine curriculum. Students in a family medicine-focused 9-month longitudinal integrated curriculum (LIC)participated in this 16-session curriculum while embedded in a rural or urban underserved community for their core third-year clerkships. We evaluated program effectiveness through a knowledge and attitude self-assessment survey of student participants before and after the program compared to students in a traditional curriculum. The pre- and postsurvey response rates, respectively, were 22.8% for the control group and 98.4% for the ECHO (Extension for Community Healthcare Outcomes) group. Compared to classmates in a traditional curriculum, program participants reported significantly higher self-perceived ability managing addiction concerns upon completing this curriculum (mean score of 3.2 vs 2.2 on a 5-point Likert scale, P<.001). Data from our LIC showed promise that the model can be effective in building confidence in students' abilities to practice addiction medicine. Because of its broad reach and low cost, this form of medical education may be a key model for medical schools to respond to the opioid epidemic and better serve our patients.

No Isolate, No Problem: Using a Novel Insertion Sequence PCR to Link Rats to Human Shigellosis Cases in an Underserved Urban Community.

During an investigation into a cluster of Shigella flexneri serotype 2a cases in an underserved community, we assessed the relatedness of human and rat S. flexneri isolates utilizing a novel PCR targeting insertion sites (IS-PCR) of mobile elements in the Shigella genome characteristic of the cluster strain. Whole-genome sequences of S. flexneri (n = 50) associated with the cluster were analyzed. De novo genome assemblies were analyzed by a Geneious V10.2.6 motif search, and two unique IS were identified in all human Shigella sequences of the local cluster. Hydrolysis probe PCR assays were designed to detect these sequences consisting of forward and reverse primers to amplify across each insertion site and a hydrolysis probe spanning the insertion site. IS-PCR was performed for three Shigella PCR-positive culture-negative rat intestine specimens from this community. Both insertion sites were detected in the de novo genome assemblies of all clinical S. flexneri isolates (n = 50). Two of the three PCR-positive culture-negative rat samples were positive for both unique ISs identified in the human S. flexneri isolates, suggesting that the rat Shigella species strains were closely related to the human strains in the cluster. The cycle threshold (Ct) values were >35, indicating that the bacterial load was very low in the rat samples. Two unique IS were identified in clinical isolates from a community S. flexneri cluster. Both IS targets were identified in PCR-positive (Shigella spp.), culture-negative rat tissue and clinical isolates from humans, indicating relatedness. IMPORTANCE This article describes a novel molecular method to show relatedness between bacterial infections, which may not be able to grow in the laboratory due to treatment with antibiotics or for bacteria requiring unique conditions to grow well. Uniquely, we applied this technique to Shigella isolates from human cases associated with a local cluster in an underserved community, as well as rat samples from the same community. We believe that this novel approach can serve as a complementary method to support outbreak/cluster investigation for Shigella spp.

Barriers and Facilitators to Telehealth Timed Up and Go (TUG) Assessment in an Underserved Urban Stroke Population (P6-5.013)

<h3>Objective:</h3> To eliminate barriers and facilitate remote assessment of a standardized mobility outcome measure for stroke patients in a telehealth-based study to facilitate physical activity and rehabilitation at home through fitness monitoring and feedback. <h3>Background:</h3> Telehealth for assessment &amp; intervention for individuals with neurological conditions has grown since the CoVid-19 pandemic. Our stroke patients are from an underserved urban community with social, personal, and environmental barriers that would impact success of a telehealth program. <h3>Design/Methods:</h3> Patients (n= 6 to date) with minor stroke discharged home from acute hospitalization were recruited. Evaluation by the interdisciplinary team determined patient safety for discharge home (6Clicks Mobility Score=46.15(9.12)). A neurologist evaluated the patient through telehealth and information from 1 month monitoring period was reviewed with an infographic guided discussion to enhance self-efficacy. Physical therapy team members executed two TUG trials and determined real-time reliability. The assessors followed a standardized script including a flowsheet with video demonstrations of camera set-up, testing materials and TUG demonstration. Patients provided feedback regarding instruction mode and suggested improvements. The Theoretical Domains Framework (TDF) mapped identified barriers/facilitators, analyzed, and interpreted the results. Intertester reliability for TUG and TUG/physical mobility measure correlation were performed. <h3>Results:</h3> The flowsheet, video demonstration, and client feedback eliminated patient barriers in knowledge, environmental context and resources domains. Memory, attention, and decision process barriers were facilitated by flexible patient scheduling and phone call reminders. Professional role/identity barriers were eliminated by optimizing each interprofessional team member’s skill set. Patient selection criteria during hospitalization eliminated the barrier to beliefs about consequences. Beliefs about capability barriers were mitigated by intertester reliability (r²=0.98) during telehealth TUG assessment and correlation with remote monitored average daily step counts (r²=−0.52). <h3>Conclusions:</h3> TDF identified facilitators to telehealth TUG assessment in an urban underserved stroke community with resource and environmental constraints and should be utilized to promote equity in health care. <b>Disclosure:</b> Clare Bassile has nothing to disclose. Ms. McIntyre has nothing to disclose. Miss Powell has nothing to disclose. Ms. Sareen has nothing to disclose. Ms. Karsos has nothing to disclose. Dr. Naqvi has nothing to disclose.

Differences in Anorectal Manometry Values Among Women With Fecal Incontinence in a Racially, Ethnically, and Socioeconomically Diverse Population.

Anorectal manometry (ARM) is a valuable diagnostic and therapeutic tool that can both aid in identifying mechanisms contributing to fecal incontinence (FI) and inform management strategies. Consensus on standard reference range values has not been established, and women of varying racial and ethnic backgrounds are not well-represented in the current literature. We aimed to compare ARM values between women of different racial and ethnic groups with FI. We conducted a retrospective cross-sectional study of women with FI who underwent ARM at a tertiary health system in an urban underserved community between 2016 and 2021. Demographic information and ARM values were collected from the medical record. Socioeconomic status (SES) was represented by the percent of the population living below the poverty line according to zip code using U.S. census data. Anorectal manometry values were compared between racial and ethnic groups, and multivariable logistic regression was conducted to control for patient characteristics. Fifty-eight women were included in the analysis: 33% Hispanic, 22% Black, and 45% White. Hispanic and Black women had higher body mass index and higher rates of diabetes and loose stools and were of significantly lower SES compared with White women. Black and Hispanic women had significantly lower thresholds for volume at first sensation and higher mean anal squeeze pressure. Differences were maintained after controlling for body mass index, diabetes, SES, and diarrhea (P = 0.03 and P = 0.01, respectively). Other ARM values were not significantly different between groups. Racial and ethnic differences in ARM values among women with FI exist. Further studies are needed to determine whether these differences have an impact on symptom severity, treatment selection and outcomes, and patient satisfaction.

Positive yet problematic: Lived experiences of racial and ethnic minority medical students during rural and urban underserved clinical rotations.

Medical students who identify as Black, Indigenous, and People of Color (BIPOC) regularly experience mistreatment and discrimination. This study sought to understand these student experiences during rotations in rural and urban underserved community teaching sites. Self-identified BIPOC medical students who completed the University of Washington School of Medicine's Rural Underserved Opportunities Program from 2019 through 2021 were invited to participate in a 60- to 90-minute focus group discussion via Zoom. From August to September 2021, 4 focus groups and 1 individual interview were conducted with a total of 12 participants. A current BIPOC medical student facilitated the sessions utilizing questions developed by the research team. Four study team members coded transcripts for key themes related to experiences of microaggressions. All participants reported having an overall positive experience, but everyone also witnessed and/or experienced at least 1 microaggression. Unlike those in urban placements, participants placed in rural sites expressed anxiety about being in predominantly White communities and experienced feelings of racial and/or ethnic isolation during the rotation. Participants recommended that rural preceptors identify themselves as trusted advocates and the program should prioritize placing BIPOC students at diverse clinical sites. Medical schools must take action to address the mistreatment of BIPOC medical students in the clinical environment.Schools and rural training sites need to consider how to best support students to create an equitable learning environment and recruit more BIPOC physicians to rural practice.

Analysis of school-based asthma screenings and need for care coordination in underserved urban communities

BackgroundAsthma is one of the most common chronic childhood disease states in the United States and continues to become more prevalent. Data suggest the incidence, morbidity, and mortality of asthma are higher among minority children of lower socioeconomic status living in urban settings. There is a lack of data evaluating the impact of mass school-based asthma screenings and care coordination in underserved communities. ObjectiveThis study aimed to determine whether a school-based asthma screening program is effective in identifying children who are at risk of undiagnosed and uncontrolled asthma and whether there is a need for care coordination. MethodsThis study is a retrospective review describing the outcomes of the 2021 school-based asthma screening program. Asthma screening data from 6 participating school districts (prekindergarten to twelfth grade) in the greater Pittsburgh area were included in this review. An asthma screening questionnaire was distributed school-wide and included questions about demographics, previous asthma diagnosis, repeated episodes of asthma, and frequency of symptoms. Based on caregiver-reported answers, children who screened positive for previously diagnosed asthma, uncontrolled asthma, or undiagnosed asthma received care coordination for follow-up care. ResultsThis study included asthma screening results for 561 participants. Approximately 13% of participants (n = 73) displayed asthma symptoms but did not have a diagnosis of asthma. Of those 73 participants, 9.6% (n = 54) were at risk of uncontrolled asthma. The screening tool also identified 5.6% of participants (n = 32) who had a diagnosis of asthma and were at risk of uncontrolled asthma. ConclusionsThe school-based asthma screening program was effective in identifying children at risk of undiagnosed and uncontrolled asthma. Pharmacists are well positioned to implement asthma screening programs in schools and throughout the community.

PA educational outreach to underserved urban communities.

PA educational outreach to underserved urban communities.

High Burden of Undiagnosed Hepatitis B and Liver Disease in an Urban Emergency Department—Baltimore, 2020

Hepatitis B virus (HBV) is the world’s leading cause of liver disease and complicates infection for those living with HIV and/or hepatitis C virus (HCV).1 In the United States, HBV is concentrated among certain populations, including people who inject drugs.2 The estimated prevalence of HBV surface antigen (HBsAg) is 1.59 million adult Americans, or 0.65% (95% confidence interval, 0.51%–1.0%) in the United States. However, evidence suggests that HBV, and HIV/HCV coinfection, may be underdiagnosed in underserved urban communities.

Ocular syphilis resurgence in an urban underserved community in the United States.

To evaluate the clinical characteristics, demographics, and visual outcomes of patients with ocular syphilis at an urban hospital to increase awareness and assist in earlier diagnosis and treatment of the resurgent disease. A retrospective chart review was performed on patients with ICD-9 and ICD-10 diagnosis codes correlating with syphilis or syphilis-related ocular diseases between 2010 and 2019. Variables evaluated included age, gender, race, vision, ocular findings, human immunodeficiency virus (HIV) status and men who have sex with men status, recreational drug and alcohol use. Ocular syphilis was diagnosed in 40 patients (53 eyes) of a total of 229 patients who tested positive for syphilis via serum and/or cerebrospinal fluid treponemal testing from 2010-2019. Among patients with ocular syphilis, most patients were males, aged 45 or above and Black, and had no diagnosed HIV infection. Approximately 50% patients had 20/40 vision or better. Nearly 50% had non-granulomatous anterior uveitis as their initial presentation, and 49% of patients had involvement of the posterior segment. Neovascular glaucoma (5.7%), papillitis (7.5%), vasculitis (5.7%), and retinal detachment (5.7%) were rarer presentations of the disease and were associated with a poorer visual prognosis. Given the increased prevalence and protean manifestations of syphilis, early diagnosis and treatment are paramount. More studies on ocular syphilis are warranted to understand this resurging disease.

A comparison of the COVID-19 response for urban underserved patients experiencing healthcare transitions in three Canadian cities

ObjectivesThe COVID-19 pandemic and response has highlighted existing strengths within the system of care for urban underserved populations, but also many fault lines, in particular during care transitions. The objectives of this study were to describe COVID-19 response policies for urban underserved populations in three Canadian cities; examine how these policies impact continuity of care for urban underserved populations; determine whether and how urban underserved community members were engaged in policy processes; and develop policy and operational recommendations for optimizing continuity of care for urban underserved populations during public health crises.MethodsUsing Walt & Gilson’s Policy Triangle framework as a conceptual guide, 237 policy and media documents were retrieved. Five complementary virtual group interview sessions were held with 22 front-line and lived-experience key informants to capture less well-documented policy responses and experiences. Documents and interview transcripts were analyzed inductively for policy content, context, actors, and processes involved in the pandemic response.ResultsAvailable documents suggest little focus on care continuity for urban underserved populations during the pandemic, despite public health measures having disproportionately negative impacts on their care. Policy responses were largely reactive and temporary, and community members were rarely involved. However, a number of community-based initiatives were developed in response to policy gaps. Promising practices emerged, including examples of new multi-level and multi-sector collaboration.ConclusionThe pandemic response has exposed inequities for urban underserved populations experiencing care transitions; however, it has also exposed system strengths and opportunities for improvement to inform future policy direction.

The Cost-Effectiveness of a Telemedicine Screening Program for Diabetic Retinopathy in New York City.

BackgroundA telemedicine screening initiative was implemented by the Montefiore Health System to improve access to eyecare for a multi-ethnic, at-risk population of diabetic patients in a largely underserved urban community in the Bronx, New York. This retrospective, cross-sectional analysis evaluates the societal benefit and financial sustainability of this program by analyzing both cost and revenue generation based on current standard Medicare reimbursement rates.MethodsNon-mydriatic fundus cameras were placed in collaboration with a vendor in eight outpatient primary care sites throughout the Montefiore Health Care System, and data was collected between June 2014 and July 2016. Fundus photos were electronically transmitted to a central reading center to be systematically reviewed and coded by faculty ophthalmologists, and patients were subsequently scheduled for ophthalmic evaluation based upon a predetermined treatment algorithm. A retrospective chart review of 2251 patients was performed utilizing our electronic medical record system (Epic Systems, Verona WI). Revenue was projected utilizing standard Medicare rates for our region while societal benefit was calculated using quality adjusted life years (QALY).ResultsOf the 2251 patient charts reviewed, 791 patients (35.1%) were seen by Montefiore ophthalmologists within a year of the original screening date. Estimated revenue generated by these visits was $276,800, with the majority from the treatment of retinal disease ($208,535), and the remainder from other ophthalmic conditions detected in the fundus photos ($68,265). There was a societal benefit of 14.66 quality adjusted life years (QALYs) with an estimated value of $35,471/QALY.ConclusionThis telemedicine initiative was successful in identifying many patients with diabetic retinopathy and other ophthalmic conditions who may otherwise not have been formally evaluated. Our analysis demonstrates the program to generate a downstream revenue of nearly $280K with a cost benefit below <50% of the threshold of $100,000/QALY, and therefore cost-effective in marginalized communities.