Faculty Bibliography

OBJECTIVE:Estimate the seroprevalence of SARS-CoV-2 antibodies among New York City Health and Hospitals (NYC H+H) healthcare workers during the first wave of the COVID-19 pandemic, and describe demographic and occupational factors associated with SARS-CoV-2 antibodies among healthcare workers. DESIGN:Descriptive, observational, cross-sectional study using a convenience sample of data from SARS-CoV-2 serological tests accompanied by a demographic and occupational survey administered to healthcare workers. SETTING:A large, urban public healthcare system in NYC. PARTICIPANTS:Participants were employed by NYC H+H and either completed serological testing at NYC H+H between 30 April 2020 and 30 June 2020, or completed SARS-CoV-2 antibody testing outside of NYC H+H and were able to self-report results from the same time period. PRIMARY OUTCOME MEASURE:SARS-CoV-2 serostatus, stratified by key demographic and occupational characteristics reported through the demographic and occupational survey. RESULTS:Seven hundred and twenty-seven survey respondents were included in analysis. Participants had a mean age of 46 years (SD=12.19) and 543 (75%) were women. Two hundred and fourteen (29%) participants tested positive or reported testing positive for the presence of SARS-CoV-2 antibodies (IgG+). Characteristics associated with positive SARS-CoV-2 serostatus were Black race (25% IgG +vs 15% IgG-, p=0.001), having someone in the household with COVID-19 symptoms (49% IgG +vs 21% IgG-, p<0.001), or having a confirmed COVID-19 case in the household (25% IgG +vs 5% IgG-, p<0.001). Characteristics associated with negative SARS-CoV-2 serostatus included working on a COVID-19 patient floor (27% IgG +vs 36% IgG-, p=0.02), working in the intensive care unit (20% IgG +vs 28% IgG-, p=0.03), being employed in a clinical occupation (64% IgG +vs 78% IgG-, p<0.001) or having close contact with a patient with COVID-19 (51% IgG +vs 62% IgG-, p=0.03). CONCLUSIONS:Results underscore the significance that community factors and inequities might have on SARS-CoV-2 exposure for healthcare workers.

Background: Self-efficacy to manage chronic conditions affects patients' health-related behaviors and interactions with the healthcare system and therefore influences health outcomes. Few studies have explored the complex relationships between mental health, self-efficacy, and management of chronic disease. A greater understanding of these interactions could inform successful community programming for marginalized populations such as public housing residents. Harlem Health Advocacy Partners is a community health worker (CHW) program designed to close health and social outcomes gaps in residents living in New York City Housing Authority (NYCHA). This study uses survey data collected for this initiative to explore the relationship between mental health and self-efficacy to manage chronic conditions among NYCHA residents with asthma, diabetes, and/or hypertension, and assess whether key variables such as connectedness to health care, social isolation and general health influence this relationship.
Method(s): Five NYCHA housing developments were selected for the CHW intervention with five matched developments for comparison. Four-hundred adult residents with a chronic disease were recruited. Baseline intake interviews were conducted in person. Self-efficacy for managing chronic disease was measured with a 6-question scale. Depression was assessed using PHQ9 scores, a screen for the presence and severity of depression. Difficulty with mental health was assessed with questions on how difficult mental health problems made it to do work, take care of things at home, or get along with others. Bivariate analyses were conducted to assess the relationship between mental health and self-efficacy. A hierarchical linear regression model was run with mental health and other relevant variables (selected based on availability in the dataset and theoretical significance) as independent variables and self-efficacy as the outcome variable.
Result(s): Self-rated general health predicted the greatest amount of variance in self-efficacy (15.7%, p < 0.001). Mental health also contributed significantly; difficulty with mental health contributed 4.0% (p< 0.001) and depressive symptoms contributed 1.1% (p=0.03) to the variance in self-efficacy. Other variables, including demographics, type of insurance, connectedness to a primary care provider, and social isolation, were not associated with self-efficacy. Overall, the full model explained 22.5% of the variance in self-efficacy to manage chronic conditions.
Conclusion(s): NYCHA residents with mental health difficulty or depression represent a uniquely marginalized subpopulation of public housing residents, and were found to have lower self-efficacy than other residents, which may mean decreased ability to self-manage chronic medical conditions. Future research should explore relationships among mental health, self-management, and health care outcomes with the goal of augmenting targeted CHW interventions

Statement of Problem Or Question (One Sentence): Is enrollment in a Care Transitions Program (CTP) associated with decrease in 90-day hospital admissions compared to standard discharge care for high utilizers in a large safety-net city hospital? Objectives of Program/Intervention (No More Than Three Objectives): 1. Implement a team to follow high-utilizers for 30 days post-discharge; 2. Assess patient needs with a home visit or other face-to-face visit and coordinate care based on needs, and 3. Decrease hospital admissions of high utilizers Description of Program/Intervention, Including Organizational Context (E.G. Inpatient Vs. Outpatient, Practice or Community Characteristics): In a large safety-net hospital, high utilizers were Medicaid-insured or uninsured patients who had four or more admissions in the prior year. Inpatient medical teams made referrals to CTP. In CTP, a multidisciplinary team of a social worker, nurse, community liaison and, at times, a medicine resident followed the patient for 30 days post-discharge. Interventions included medication reconciliation, weekly phone calls, and either a home visit or face-to-face visit at a preferred location for the patient. Eligible high utilizers not referred to CTP received standard discharge follow-up and served as controls in this quasi-experimental study. Measures of Success (Discuss Qualitative And/Or Quantitative Metrics Which Will Be Used To Evaluate Program/Intervention): We identified all admissions of high-utilizers eligible for CTP enrollment between 4/1/17 and 9/30/17. Patients were categorized as enrolled in CTP, with or without a home or face-to-face visit, or not enrolled in CTP. Changes in 90-day admission rates before and after the eligible admission were compared in the CTP and control groups, with the eligible admission included in the pre-intervention period. Subgroup comparisons were also performed. The decrease in 90-day admission rates across groups were compared using ANOVA. Findings To Date (It Is Not Sufficient To State Findings Will Be Discussed): Of the 358 admissions of eligible high-utilizers, 31% (112) were enrolled in CTP. Of those in CTP, 54% had either a home visit (28) or a face-to-face visit (32). Within control patients, 90-day admission rates fell from 2.90 to 1.26, a decrease of 50.6% (95% CI 39.0%-62.3%). Within CTP patients, admission rates fell from 2.53 to 1.02, a decrease of 54.6% (95% CI 41.0%-67.6%). The difference in 90-day admission reductions between CTP and control groups, 3.7% (95% CI-22.8%-30.2%), was not significant. Per-protocol analysis of the CTP subgroups who had either a home visit or a face-to-face visit showed decreases in 90-day admissions of 68.7% (95% CI 51.2%-86.2%) and 64.0% (95% CI 46.9%-81.1%) respectively. The differences in 90-day admission reductions between CTP patients with home or face-to-face visit vs. controls, 18% (95% CI-13%-49%, p=0.59) and 13.3% (95% CI-17.8%-44.5%, p=0.84) respectively, were not significant. Key Lessons For Dissemination (What Can Others Take Away For Implementation To Their Practice Or Community?): The trend towards greater decrease in 90-day admissions for high utilizers that had a home or face-to-face visit suggests that assessing high utilizers in their community environment may improve care for these patients. Given the small sample size and non-randomized allocation, interpretation of the Results is preliminary, and subsequent, randomized, adequately powered study with criteria-based high-utilizer referral to these high-intensity resources is warranted

BACKGROUND:Many medical schools have adopted the longitudinal integrated clerkship (LIC) model in response to calls for increased continuity in clinical learning environments. However, because of implementation challenges, such programs are not feasible at some institutions or are limited to a small number of students. OBJECTIVE:In January 2014, Columbia University College of Physicians and Surgeons (P&S) recognized the need to explore different LIC formats and began offering four, 12-week amalgamative clerkships (AC). Students within this curricular track experienced primary care, internal medicine 'away', orthopedic surgery, urology, and an elective in an integrated format. DESIGN/METHODS:P&S developed the AC in partnership with the James J. Peters VA Medical Center in Bronx, NY (BVA). All patient care and educational conferences took place at the BVA during the 12-week experience. The learning objectives of the AC were aligned to the learning objectives of a 52-week20 LIC also offered at Columbia. An evaluation process was developed to determine studentlearning experiences and preliminary outcomes, including how well the LIC-related objectivescould be achieved in a shorter period of time. RESULTS:In 2015, P&S collected AC evaluation data through three student feedback sessions. Students reported that the AC provided opportunity for patient continuity, patient-centered care approaches, meaningful roles for students, career development opportunities, and health systems awareness. CONCLUSIONS:Early outcomes indicate that the BVA AC provides a degree of longitudinality that can influence student perceptions of patient care, career development, and health systems, consistent with the larger LIC. The team continues to gather additional data on students' experiences and investigate additional sites that have potential to serve as future AC learning environments.