Faculty Bibliography

LEARNING OBJECTIVES 1: Describe a longitudinal curriculum to train internal medicine (IM) residents in point-of-care ultrasound (POCUS). LEARNING OBJECTIVES 2: Recognize the impact of decreased patient contact on residents' retention of POCUS skills. SETTINGAND PARTICIPANTS:Despite thewell-documented benefits of POCUS, internal medicine residents receive little formal training. We implemented a curriculumin the 2019 academic year to train 55 PGY-2 IMresidents in POCUS across four urban teaching hospitals and a method to evaluate its efficacy. As the COVID pandemic hit, we additionally sought to understand the impact of COVID on the efficacy of our curriculum and to ascertain from IM residents their barriers to using POCUS during the COVID pandemic. DESCRIPTION: The curriculum was composed of three workshops, consisting of lectures and hands-on practice covering lung, cardiac, abdominal, and lower extremity vascular views. Following the workshops, we sought to consolidate learners' knowledge with a subsequent year-long skill building phase. The skill-building phase was truncated due to the pandemic.A hands-on assessment was performed prior to the course and not repeated at course conclusion due to social distancing concerns. An online knowledge test was administered before the course, immediately following the course, and at one year. A survey assessing attitudes and barriers to POCUS was administered before the course and at one year. EVALUATION: No resident passed the pre-course hands-on assessment. Prior to the course, the average resident score was 54% on the online knowledge quiz; directly after the workshop series, the average rose to 78%. At one year, the average score on the online knowledge quiz was 74%, a statistically significant decrease (p=0.04). Ninety-one percent of residents reported performing POCUS at least once/month prior to the pandemic. During the pandemic, scanning activity decreased; 67% residents reported they scanned rarely or never. DISCUSSION/ REFLECTION / LESSONS LEARNED: Our course led to significant improvement of knowledge regarding ultrasound technology and image interpretation, however this decayed at one year, likely due to lack of skill reinforcement. Though POCUS was widely used prior to the pandemic, usage dropped at the pandemic's peak, despite its utility as both a diagnostic and therapeutic tool. The most commonly cited reason for lack of use was concern regarding contamination and infectious exposure. While the COVID pandemic disrupted our curriculum, it also highlighted opportunities to incorporate POCUS into clinical practice and reinforced the importance of continued longitudinal practice to retain learned skills

BACKGROUND: To justify nonprofit hospital organizations' tax exemption, the Affordable Care Act (ACA) requires these organizations to report on efforts to identify and invest in local health needs via Community Health Needs Assessments (CHNAs), Implementation Strategies (ISs), and Schedule H (990H) tax forms. However, there is no requirement that 990H spending aligns with topics raised on CHNAs or ISs, and recent reports have questioned whether 990H reporting categories adequately measure investments in social determinants of health. To assess the utility of ACA-mandated reporting for tracking spending on social health needs, this cross-sectional study aimed to describe how often a need identified in CHNAs is reflected in plans noted in ISs and in spending reported in 990Hs. Using housing as an example of a social health need, we focused on communities with the most homelessness to study organizations most likely to address housing.
METHOD(S): We identified nonprofit hospital organizations with facilities in the 5 metropolitan areas with highest per-capita homelessness using Department of Housing & Urban Development data and the Community Benefit Insight (CBI) database. We reviewed organizations' public reporting documents, obtained via internet search and from CBI, to determine whether they ever addressed housing on CHNAs, ISs, and 990Hs from 2015-2017. We excluded 3 organizations for which we could not obtain all 3 documents.
RESULT(S): Of 47 organizations sampled (representing 57 facilities in Washington, DC; Santa Cruz County; Boston; New York City; and San Francisco), housing was noted in 55% (n=26) of CHNAs, 36% (n=17) of ISs, and 26% (n=12) of 990Hs. Among the 26 organizations that recognized housing needs in CHNAs, 10 noted housing-related plans in ISs, and 7 reported spending on housing in 990Hs.
CONCLUSION(S): Although many nonprofit hospital organizations in areas with high homelessness recognize housing as a health need, public reporting documents provide limited evidence that an identified community need for housing was translated into related plans and spending. Further investigation should explore whether discrepancies among documented needs, strategies, and spending reflect inadequacy of the 990H for capturing housing-related spending versus hospitals' uncertainty in whether or how to invest in housing after identifying it as a health need. Regulatory reform to increase guidance for social investments and require greater concordance among CHNAs, ISs, and 990Hs could promote accountability and transparency in organizations' efforts to address housing and other health-related social needs. LEARNING OBJECTIVE #1: Quantify use of public reporting documents by nonprofit hospitals in communities with high rates of homelessness to show how they identify and invest in housing as a community health need (Patient Care) LEARNING OBJECTIVE #2: Appraise policy opportunities to enhance Affordable Care Act-mandated reporting requirements to hold nonprofit hospital organizations accountable to improving community health (SystemsBased Practice)

BACKGROUND:Statins are the mainstay of treatment for low-density lipoprotein cholesterol (LDL-C) lowering, however, some patients cannot tolerate statins because of adverse effects. Ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are alternative treatment options. The purpose of this meta-analysis was to compare LDL-C reduction with ezetimibe vs PCSK9i in patients not on statins. METHODS:PubMed and EMBASE were searched until 14th March 2020 for randomized clinical trials (RCTs) assessing the efficacy of ezetimibe vs PCSK9i in patients not on statins. The primary outcome was a reduction in LDL-C levels. A subgroup analysis of statin intolerant patients was also performed. RESULTS:=0]. CONCLUSION:Among patients who are statin intolerant or not receiving statins, PCSK9i use is associated with significantly lower LDL-C levels than after treatment with ezetimibe. PCSK9i might be useful in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD) in this subset of patients.