2019 NCEAS Conference Poster Abstracts

Cis-Gender women with sexual health complaints in an Urban Emergency Department, do patients understand what cervical swabs are for?

Presenting author: Alvie Bender, LCSW

Co-authors:  Nora Friedman, PhD;  Jessica Schmitt, LCSW; Andrew Richardson, DNP;  Aniruddha Hazra, MD; Jessica Ridgway, MS, MD

Background: Emergency Departments (ED) often serve as primary care for the uninsured. Even with the expansion of Medicaid through the Affordable Care Act many people still utilize ED’s for a range of non-emergency medical issues, including for sexual health issues.  We found that women accessing the ED for sexually transmitted disease testing and treatment were confused as to the exact procedures and testing being done, despite engagement with healthcare staff and patient navigators, and the presence of after visit summaries. In our urban ED we found that cis-gender women often misinterpreted cervical swabs and the pelvic exam performed during their ED visit for a Papanicolaou test (pap smear).

Gender disparities in the outpatient management of post-laminectomy syndrome

Presenting Author: Ryan G. Chiu, B.S.

Co-authors: Amy Zhu, B.S. Jeffrey Zhao, B.S. , Ankit I. Mehta, M.D.

Introduction: Post-laminectomy syndrome (PLS), also known as failed back surgery syndrome, is a major cause of chronic back pain in patients having undergone one or more spinal surgeries. Management of this often-debilitating pain can involve pharmacological (i.e. opioid narcotics, non-steroidal anti-inflammatory drugs [NSAIDs], intraspinal injections) as well as surgical interventions (e.g. spinal cord stimulation [SCS]). In recent years, the opioid epidemic has become an increasingly concerning public crisis with increasing overdose, abuse, and death rates. Despite increased research on factors contributing to this issue, current literature often neglects gender differences in opioid prescriptions.2 Many health experts have even stated that current efforts have neglected to understand how women fit into this epidemic. This study investigates gender disparities in the ambulatory management of PLS.


Preparing Students for Careers in Underserved Settings: An Educational Model

Presenting Author: Amie Duford, PA-C

Co-author: Oksana Matvienko, Ph.D.

Abstract: Southern Nevada has one of the highest rates of homelessness in the nation. The mission of the Physician Assistant (PA) program at Touro University Nevada (TUN) is to address healthcare needs of underserved populations with compassion, professionalism and competency while creating hands-on learning experiences for students. The PA program has partnered with 12 community organizations to provide coordinated services to those in need. Its outreach encompasses four components. The TUN Mobile Health Clinic goes out into the community to treat the underserved regardless of their insurance coverage. The Stallman Touro clinic is housed in a shelter for homeless and battered women and children. The Touro student clinic provides health care for low-income families not qualified for Medicaid yet too poor to afford health coverage. The forth component targets individuals living in the storm drainage/tunnel system under Las Vegas. Tunnel-dwellers tend to be more service-resistant and challenging to treat compared with other subgroups. Through these four community outreach components PA students learn to care for the underserved and understand their needs.

Using Social Determinants of Health and Other Screening Tools to Improve Care in Two Integrated Behavioral Health Primary Care Clinics

Presenting Author: Gail Marion, PA-C, PhD

Co-authors: Brittany H. Swain, BS, Maribel E. Moscoso, Med, Stephen W. Davis, MA, Aubry N. Koehler, PhD, Edward Ip, PhD, Julienne K. Kirk, PharmD

Background: An integrated approach allows for identification and treatment of behavioral health and social health needs in conjunction with physical health needs. Compared to other industrialized nations, the United States spends disproportionately less on social services compared to health care. Over the first 3 years of a 5-year Health Resources and Services Administration (HRSA) Grant, Behavioral Health Providers (BHPs) and a care manager provide care in a Family Practice Clinic (FPC) and a Federally Qualified Health Clinic (FQHC). Our goal is to utilize and assess screening tools that are brief and easy to administer in these integrated behavioral health care sites.

Skin Risk Behaviors of Youth Racial & Sexual Minorities 

Presenting Author: Morgan Nguyen, BA

Co-authors: Jeffrey Zhao BA, Kyle Tegtmeyer BSNolan Maloney BS, Peter A Lio MD

Introduction: Previous studies have found a high prevalence rate of skin cancer in sexual minority males, and have reported an association with increased indoor tanning and sexual minority men. The existing literature is limited in its examination of skin health practices of youth and sexual minority women, and no prior analysis has been performed for sunburn as a skin cancer risk factor in this cohort.  Given the established association between skin cancer and sexual minority status, there is a need to better understand high-risk behaviors in this population. There is also limited data on race and skin health behaviors.


Incorporating Student Hotspotting into Graduate Medical Education

Presenting Author: Sangrok Oh, DO

The USA has subpar health outcomes despite its high healthcare spending. One main contributor to increased costs is “super-utilizer” patients. These patients tend to have Social Determinants of Health (SDOH) which adversely impacts their overall health and access to adequate, organized care. Due, in part, to these reasons, these patients utilize the hospital and the ED as their main source of healthcare. This in turn increases healthcare spending. To address this, a better understanding of SDOH and interprofessional teamwork are important. Moreover, Increased interprofessional teamwork has been shown to improve patient outcomes as well as provider satisfaction.

Rheumatic Fever in an Israeli Child of Ultra Orthodox Faith

Presenting author: Hayley Sparks, M.D. Candidate 2019 Northwestern University

Introduction: Acute rheumatic fever (ARF) has been virtually eradicated from high income countries over previous decades due to improved detection and treatment of Group A Streptococcal (GAS) pharyngitis.1 However, low income communities within high income countries may be vulnerable to ARF2 attributable to risk factors including poverty, overcrowding and reduced access to care.Bnei Brak, a densely populated, impoverished city in Israel has multiple risk factors for ARF. However, to our knowledge no cases of ARF in the community have been reported.

Promoting Health Equity through Public Health Workforce Education and Development

Presenting Author: Anna Yankelev, MPH(C), MBA(C)

Background: Health inequity is defined as differences in health that are unnecessary, avoidable, unjust, and unfair. Structural Determinants of Health Inequity (SDOHI), including power structures and social, political, and economic policies, greatly influence the health of a population.


Housing is Health

Presenting author: Christine Haley

Abstract: Cook County Health (CCH) is an integrated health care delivery system working to develop a Flexible Housing Spending Pool to create new housing resources in the County. CCH is working to partner with the Housing Sector to identify individuals who are multiple system users who could benefit from housing to connect to this resource.

Structural Equation Model Analysis of Students’ Intention to Provide Healthcare to the Homeless

Presenting author: Amie Duford, PA-C

Co-authors: Oksana Matvienko, Ph.D., Cheryl Vanier, Ph.D.

Purpose: Homeless population faces enormous health inequalities. Limited access to healthcare services is one serious challenge. Increasing access to services is only part of the solution. It is equally important to have enough providers who are trained and willing to treat homeless patients. Students in healthcare fields have shown a decline in attitude toward underserved groups as they progress through their programs of study. Fortunately, pertinent learning opportunities may improve students’ attitude. However, it is unclear whether improvements in attitude translate into the intention to treat this population. According to literature, the intention to provide healthcare to the homeless is determined by the provider’s attitude, self-efficacy, volunteerism, and relevant experiences. This study examined the relationships between the intent and its determinants including frequency and type of volunteering, personal and professional experience with homelessness, self-efficacy related to healthcare services for the homeless, and two components of attitude – one’s perspective on homelessness as a societal issue and one’s personal stand or sense of responsibility towards homeless patients.

An Interactive Game for Cultural Proficiency Training Featuring Virtual Reality Immersion

Presenting Author: Paul J. Hershberger Ph.D

Co-authors: Blaine A. Klingler, Matt Davis, Sankalp Mishra, Miteshkumar Vasoya, Dixit Patel, Aishwarya Bositty, Tanuja Addanki, Frank A. Allen, Suneesh Menon, Sabrina Neeley, Angie Castle, Todd Pavlak, Yong Pei, Thomas Wischgoll

Imagine that your next patient is a Syrian refugee with limited English proficiency, or a young woman with a history of opioid use disorder who is now pregnant. What biases may be present that could impact care for these patients, and what might help minimize the impact of such biases?

The Life Course game is an interactive training tool for health professionals designed to engage players in an experience of the impact of social determinants of health. It was developed and produced by CityMatCH in 2008, funded by the Centers for Disease Control and Prevention (CDC). In 2017, Wright State University received permission from CityMatCH to adapt the game to a digital and online version, which we are now using for teaching social determinants of health to medical students/residents and other health professions students at WSU. There are numerous advantages of the digital version over the physical board game. These include the fact that numerous individuals can play at the same time, that feature changes to the game can be easily made, and that game completion can be easily tracked.


Piloting and Validating A School Health and Wellness Policy Implementation Survey

Presenting Author: Rachael Dombrowski, PhD, MPH

Co-authors: Heide Cygan, Jamie Tully, Kimberly Kin, E. Whitney Moore

Background: Evidence that school health and wellness policies can positively influence the health and academic outcomes of young people has led to a national call for the implementation of comprehensive, evidence-based school health and wellness policies. Several studies report on validation of evaluative tools for policy language; however, few focus on measures of policy implementation for effectively determining policy adoption within individual schools. The purpose of this study was to pilot and validate a school health and wellness policy implementation (HWPI) survey in a large urban school district.


Address the Needs of Complex Patients and the Resident Physicians Who Care for Them: A Qualitative Study

Presenting Author: Emily Manlove, MD

Co-authors: Elizabeth Ablah, PhD, MPH, Kari M. Nilsen, PhD, MA, Ruth Nutting, PhD, LCMFT, Tara J. Neil, MD, Ashley Crowl, PharmD, Josh Schafer, BS

Introduction: There is a growing focus of improving quality in healthcare in the United States.  However, it is unknown how standard quality measures apply to the most complex patients in the healthcare system and take into account the social determinants of health. Additionally, burnout is an increasingly significant problem among physicians, and it is partly due to the burden of attempting to care for the most complex patients in the fractured healthcare system.  Resident physicians can be particularly prone to burnout in caring for complex patients as they have more time constraints and less experience. The Collaborative Care Team (CCT) was developed at the Via Christi Family Medicine Residency Program to address the burdens of caring for complex patients and to explore their patients’ social determinants of health. The overall objective of this study was to understand family medicine residents’ perspectives in caring for socially and medically complex patients. The three aims of the study were 1) to describe complex patients through the eyes of resident family physicians, 2) to explore how residents feel about caring for complex patients, 3) to understand residents’ experiences with the CCT.


Perspectives of homeless service providers on their work, their clients, and the healthcare system

Presenting Author: Cindy Wu, M.D. Candidate Class of 2021 Northwestern University

While there is growing recognition of homelessness as a public health problem, few studies have explored the perspectives of specifically those who provide services to persons experiencing homelessness (PEHs), also referred to in literature as homeless service providers (HSPs). The goal of this study was to describe the perspectives of HSPs who work for organizations that primarily target their services toward PEHs in the city of Chicago and consider them in the context of sociological theories of systemic injustice. We explored themes in HSP’s thoughts and attitudes toward their work, their clients, and the healthcare system using a qualitative methodology. This cross-sectional study consisted of a half-hour semi-structured interview and a validated attitudinal scale, the Attitudes Toward the Homeless Inventory (ATHI) (Buchanan et al. 2004) given to current HSPs (n=17) at five Chicago non-profit organizations that predominantly serve PEHs. Interviews were transcribed verbatim and analyzed for themes and patterns. Preliminary results showed 6 categories of themes describing HSP perspectives: HSPs’ motivations and challenges in their work, HSP expressions of empathy toward PEH, HSP understanding and respect of PEH, diversity and multifactorial factors of homelessness, public perception of homelessness, and perception of hospitals and their role in homeless healthcare. Through a richer understanding of the perspectives of HSPs toward their work, their clients, and the healthcare system, this study may serve as guidance in recruitment and retention of workers and volunteers in this area and offer insight into caring for PEH in hospital settings.


Initial Outcomes of a Social Determinants of Health Curriculum for Primary Care Fellows

Presenting Author: Rebekah Moore, MPAS, PA-C

Co-authors: Megan Rich, MD and Daniel Hargraves, MSW

Rationale: Primary care providers have the privilege of caring for medically, socially and psychiatrically complex patients, who are often the most vulnerable in our society. To address the needs of area providers, teach healthcare transformation, and step closer to the quadruple aim (better health outcomes and care experiences, a lower price, with less provider burnout1), we created a faculty development fellowship focused on 6 key content areas, including the social determinants of health (SDH). The SDH were deemed relevant to healthcare transformation because of their contribution to the health status of individuals and communities – perhaps even more influential than medical treatment plans2. Yet attending level physicians avoid asking about SDH because they are unsure how to proceed once a SDH has been identified3. In our curriculum we have focused on three aspects of SDH: identifying and connecting with local resources, advocating for changes in local public policy, and partnering with communities and across disciplines for innovative solutions.


Enhancing Patient Care and Outcomes Related to Social Determinants of Health at the Sentara Ambulatory Care Center 

Presenting author:Tolu Akinola, MPH Student, Eastern Virginia Medical School

Co-authors: Carmen Ingram-Thorpe, MPH; Jennifer Ryal, MD; Kaethe Ferguson, EdD, MS; Bruce Britton, MD.

Introduction: Structural determinants and conditions of daily life such as transportation, family support and housing conditions, constitute the Social Determinants of Health (SDOH) and cause much of the health inequity between and within countries. To address these determinants and hopefully see an improvement on health inequities, An interdisciplinary quality improvement initiative has been developed and implemented at the Sentara Ambulatory Care Center (ACC) where uninsured patients who have been recently discharged from the Sentara hospital network and referred for follow-up care are given a brief SDOH screening, then based on the information collected, they are provided with basic interventions, education and connected with beneficial resources in the community. Using a mixed methods study design, past survey data going back to the opening of the clinic was analyzed to understand the three main concerns for the clinics patients and ensure it is being addressed effectively.

Improving Medical Student Behavior and Skills Towards Addressing Social Determinants of Health

Presenting Author: Haeyeon Hong – 4th year medical student, Boston University School of Medicine

Co-authors: Sylvester, L.Hollander, M. Parunyan, J. Deshpande, S. Losi, M. Stack, M. Eyllon, A. Garg, N. R. Kressin, P. S. Garg, J. Abbott, L. B. Demers, T. James, P. Buitron de la Vega*

INTRODUCTION: Addressing our patient’s social determinants of health (SDOH) is critical to providing high-quality care. Because SDOH are usually taught as immutable realities rather than actionable circumstances addressable with specific tools, medical students are underprepared to address them. The Boston Medical Center (BMC) primary care department recently implemented a SDOH screening and referral model called THRIVE, adapted from the WECARE model, and established the THRIVE Directory, a web-based resource platform to help clinicians connect patients with social services. We developed a quality improvement initiative for third-year medical students (MS3’s) at the Boston University School of Medicine with the goal of familiarizing students with THRIVE and improving students’ behaviors and skills in addressing SDOH.


Potential Restored: Changing the Developmental Trajectory of Lead-Exposed Children Through Early Intervention

Presenting Author: Amy Zimmerman JD

Co-authors: Nicole Hamp MD and Johan Lee

Background: Lead poisoning remains a prevalent, yet preventable, environmental health hazard affecting children. Low-level lead exposure has been proven to significantly increase the risk of learning disabilities, behavioral problems, and developmental delay. This has substantial social implications as lead poisoning disproportionately affects children from low-income, minority households. Early Intervention (EI) is a federal program established to enhance the development of children who are at risk of or who have known developmental delays and allows states to include “disorders secondary to exposure to toxic substances” as a medical condition automatically qualifying children for services. Recognizing EI services have the potential to improve child outcomes, a workgroup was assembled to determine the capacity of EI to serve Illinois (IL) children who have been lead-poisoned and action steps for statewide adoption.


Bringing Social Determinants of Health to Life:  From the Classroom to the Underserved Neighborhoods of Miami

Presenting author: Julia Bisschops MD, MSc

Co-authors: Gregory Schneider MD, Nana Aisha Garba MD Phd, Onelia Lage MD, David Brown MD, and Pedro Greer MD

Founded in 2006, the Florida International University’s (FIU’s) Herbert Wertheim College of Medicine (HWCOM) emphasizes the social determinants of health (SDOH) both in didactic experiences and in its distinctive longitudinal service-learning courses for all medical students.   This combination of course work and community work in the SDOH helps make the college’s mission of creating socially accountable physicians come alive.  The Association of American Medical Colleges (AAMC) strongly recommends service-learning experiences for medical students (AAMC).  Seifer (1998) defines service learning as “a structured learning experience that combines community service with specific learning objectives, preparation and reflection.”  To set the stage for such experiences at HWCOM, first-year medical students participate in a course entitled “Foundations for the Community Engaged Physician.” The course introduces students to the SDOH, health equity, cultural humility, social and cultural influences on health, interprofessional communication team work and population health. The course culminates in orientations to FIU’s Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP).

As part of NeighborhoodHELP, each medical student, together with a social work and nursing student, is assigned to a household in an underserved area of Miami-Dade County.  FIU’s network of more than 150 community partners identifies these households and refers them to the NeighboorhoodHELP.  Via regular phone contact and nine required home visits, the medical student cares for their household during their second, third and fourth years.   Under the umbrella of the Community Engaged Physician (CEP) course series, student teams complete their visits and complete health education activities in the household.  They present their households during required interprofessional rounds with nursing and social work students and reflect on their experiences with their medical faculty.

Applying a Model of Culturally-Adapted Motivational Interviewing to the South Asian Healthy Lifestyle Initiative

Presenting author: Melissa Palma, MD

Co-authors: Namratha Kandula, MD

Abstract: The South Asian population in the United States is known to have increased risk and have higher proportional mortality rates from cardiovascular disease (CVD) compared to other Asian groups and non-Hispanic whites.1 In the absence of robust longitudinal epidemiologic studies of this population, the American College of Cardiology ASCVD Risk Estimator may, in fact, underestimate the 10-year and lifetime risk for people in this racial/ethnic group. For this population of mostly first generation immigrants, the multifactorial CVD risk for South Asians stems from an increased rate of type II diabetes and hypertension and a lower rate of exercise and dietary modifications.1 However, little is known how to reduce risk in this high-need population.

The South Asian Heart Lifestyle Intervention (SAHELI) Study aims to determine if a culturally-targeted, primary prevention lifestyle intervention provided to South Asian immigrants in a community-based setting will improve physical activity, dietary behaviors, psychosocial outcomes, and other clinical CVD risk factors.2 This descriptive study is a secondary analysis of audio recordings of the SAHELI intervention group education sessions. Structured coding and review of several cohorts of the study are used to investigate how the SAHELI intervention targets deeper culturally-specific factors as a part of motivational interviewing to promote lifestyle modifications and sustained behavior change.

This study applies the Culturally Adapted Motivational Interviewing (CAMI) model3 to describe how culturally-adapted motivational interviewing may address the social context and culturally-specific stressors that participants at high risk for CVD may experience, particularly in relation to the role of food, physical activity, and stress in South Asian culture. Additionally, this study will describe how evidence-based lifestyle interventions and motivational interviewing may be culturally-targeted to address cultural knowledge (language, customs, rituals) and provide cultural empathy (empowerment of group identity, code-switching) in order to reduce CVD risk in the South Asian population.

“Introspection, Discussion, and Reflection”: An innovative curriculum for resident education on social determinants of health.

Presenting Author: Pranav Shah, MD

Co-authors: Abubaker Hassan MD, Leslie Kao MD, Chyrisha Rucker, Jennifer Mendez PhD, Ijeoma Nnodim MD

Social Determinants of Health (SDH) account for a large proportion of disease burden, impacting a significant portion of health outcomes and contributing to health disparities and inequities. Physician awareness of SDH is a key factor in providing equitable care, yet traditional medical training often does not address these issues and falls short in educating resident physicians on how to identify and navigate patients’ social, economic, and environmental needs.

Our Internal Medicine residents work in an urban underserved minority community with high poverty rates and significant health disparities. However, most of our residents express limited knowledge of SDH and their role in clinical decision making and health outcomes. To further explore, we surveyed a sample of residents attending a noon conference: 60 residents completed the survey. Within this cohort, 88% believed that education in SDH would help them develop humanistic qualities and 87% believed it would help them become better physicians.

To fill this educational gap, we developed an innovative multi-modal interactive SDH curriculum utilizing critical reflection. Our aim was to introduce residents to SDH and equip them with the following tools: better understanding of the social (historical, cultural, economic, structural, and environmental) contexts of their patients’ health; knowledge regarding the impact of SDH on health outcomes; and insight into appropriate referrals to community resources and social services. Residents participated in weekly facilitated interactive small group discussions informed by case studies and articles on SDH and regularly posted reflective blogs. A pre-designed resident-managed secure website allowed for discussion of their experiences while addressing SDH with their patients. Residents were also encouraged to comment on colleagues’ posts to build a collaborative digital community of practice on SDH.

Qualitative analysis of blog posts (83) highlighted common themes including enhanced understanding, confidence, and comfort in dealing with SDH. Of these, 92% also commented on actionable changes residents wished to incorporate into their own medical practices. Over the course of 10 weeks, we have found an increase in both self-reflection and a deepened understanding of SDH amongst our residents through this innovative use of blogging and group critical reflection.

Detroit is a city with high rates of health disparities. Physicians who practice clinical care in the context of SDH are essential in providing compassionate, culturally competent, patient-centered, high value care which will transform the health landscape in terms of health equity. Also, by improving resident knowledge, skills, and attitudes around SDH, our curriculum serves as an example of effectively incorporating these competencies into busy graduate medical training programs.

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