scholarly journals Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations

10.2196/16835 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e16835
Author(s):  
Alejandra Casillas ◽  
Anshu Abhat ◽  
Anish Mahajan ◽  
Gerardo Moreno ◽  
Arleen F Brown ◽  
...  
Keyword(s):  
Los Angeles ◽  
Health Care Disparities ◽  
Health Technology ◽  
Safety Net ◽  
The United States ◽  
Patient Portals ◽  
Department Of Health ◽  
Vulnerable Patients ◽  
English Speaking ◽  
Technology Tool

Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed.

scholarly journals Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations (Preprint)

2019 ◽  
Author(s):  
Alejandra Casillas ◽  
Anshu Abhat ◽  
Anish Mahajan ◽  
Gerardo Moreno ◽  
Arleen F Brown ◽  
...  
Keyword(s):  
Los Angeles ◽  
Health Care Disparities ◽  
Health Technology ◽  
Safety Net ◽  
The United States ◽  
Patient Portals ◽  
Department Of Health ◽  
Vulnerable Patients ◽  
English Speaking ◽  
Technology Tool

UNSTRUCTURED Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed.

Abstract 090: Armenian Ethnicity: An Independent Risk Factor for Positive Exercise Treadmill Tests

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Ara H Rostomian ◽  
Daniel Sanchez ◽  
Jonathan Soverow
Keyword(s):  
Risk Factors ◽  
Los Angeles ◽  
Multivariate Logistic Regression Analysis ◽  
Safety Net ◽  
The United States ◽  
World Health ◽  
Limited Information ◽  
Safety Net Hospital ◽  
Exercise Treadmill ◽  
History Of

Background: Several studies have examined the risk of cardiovascular disease (CVD) among larger racial and ethnic groups such as Hispanics and African-Americans in the United States, but limited information is available on smaller subgroups such as Armenians. According to the World Health Organization, Armenia ranks eighth in CVD rates among all countries however it is unclear if Armenian immigrants living in the US have the same high rates of disease. This study examined whether being of Armenian descent increased the risk of having a positive exercise treadmill test (ETT) among patients treated at a safety net hospital in Los Angeles County. Methods: Data on patients who received an ETT from 2008-2011 were used to conduct a retrospective analysis of the relationship between Armenian ethnicity and ETT result as a surrogate measure for CVD. A multivariate logistic regression analysis was used to estimate the odds ratios (OR) for having a positive ETT among Armenians relative to non-Armenians, adjusting for the following pre-specified covariates: gender, age, diabetes, hypertension, hyperlipidemia, smoking, family history of coronary artery disease (CAD), and patient history of CAD. Results: A total of 5,297 patients, ages 18 to 89, were included. Of these, 13% were Armenian and 46% were male, with an average age of 53 years. Armenians had higher odds of having a positive ETT than non-Armenians (Crude OR=1.30, p=0.037, CI:1.02,1.66). After adjusting for CV risk factors, Armenians were still significantly more likely to have a positive ETT than non-Armenians (OR=1.33, p=0.029, CI:1.03,1.71). CAD (OR 2.02, p<0.001, CI:1.38,2.96), and hyperlipidemia (OR=1.31, p=0.008, CI:1.07,1.60) were also significantly associated with a positive ETT. Conclusion: Armenians have a higher likelihood of having a positive ETT than non-Armenians. This relationship appears to be independent of traditional CV risk factors and suggests a role for cultural and/or genetic influences.

scholarly journals Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net

2019 ◽  
Vol 26 (12) ◽  
pp. 1525-1535 ◽  
Author(s):  
Alejandra Casillas ◽  
Giselle Perez-Aguilar ◽  
Anshu Abhat ◽  
Griselda Gutierrez ◽  
Tanya T Olmos-Ochoa ◽  
...  
Keyword(s):  
Los Angeles ◽  
Technology Acceptance ◽  
Health Systems ◽  
Safety Net ◽  
Patient Portal ◽  
Annual Household Income ◽  
Patient Centered ◽  
Spanish Speaking ◽  
English Speaking ◽  
Education Support

Abstract Objectives Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets—health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems—including those who are limited English proficient (LEP). Materials and Methods The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. Results Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income &lt;$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants’ discussion centered around 3 major thematic narratives: (1) participants’ awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. Conclusions Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.

scholarly journals Communicating with Vulnerable Patient Populations: A Randomized Intervention to Teach Inpatients to Use the Electronic Patient Portal

2018 ◽  
Vol 09 (04) ◽  
pp. 875-883 ◽  
Author(s):  
Jacob Stein ◽  
Jared Klein ◽  
Thomas Payne ◽  
Sara Jackson ◽  
Sue Peacock ◽  
...  
Keyword(s):  
Usual Care ◽  
Safety Net ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Patient Portal ◽  
Patient Portals ◽  
Vulnerable Patients ◽  
Safety Net Hospital ◽  
Randomized Intervention ◽  
Vulnerable Patient

Background Patient portals are expanding as a means to engage patients and have evidence for benefit in the outpatient setting. However, few studies have evaluated their use in the inpatient setting, or with vulnerable patient populations. Objective This article assesses an intervention to teach hospitalized vulnerable patients to access their discharge summaries using electronic patient portals. Methods Patients at a safety net hospital were randomly assigned to portal use education or usual care. Surveys assessed perceptions of discharge paperwork and the electronic portal. Results Of the 202 prescreened eligible patients (e.g., deemed mentally competent, spoke English, and had a telephone), only 43% had working emails. Forty-four percent of participants did not remember receiving or reading discharge paperwork. Patients trained in portal use (n = 47) or receiving usual care (n = 23) preferred hospitals with online record access (85 and 83%, respectively), and felt that online access would increase their trust in doctors (85 and 87%) and satisfaction with care (91% each). Those who received training in portal use were more likely to register for the portal (48% vs. 11%; p < 0.01). Conclusion Patients had positive perceptions of portals, and education increased portal use. Lack of email access is a notable barrier to electronic communication with vulnerable patients.

scholarly journals Do Hispanic Patients Who Require a Medical Interpreter Understand the Severity of Their Glaucoma Diagnosis?

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Sophia Bertot ◽  
Louis Cantor
Keyword(s):  
United States ◽  
Los Angeles ◽  
The United States ◽  
Medical Encounter ◽  
Glaucoma Diagnosis ◽  
Hispanic Patients ◽  
Medical Interpreters ◽  
English Speaking ◽  
Medical Interpreter ◽  
Eye Clinic

Background and Hypothesis: Glaucoma is a group of progressive optic neuropathies characterized by a degeneration of retinal ganglion cells with characteristic changes in the visual field. The Los Angeles Latino Eye Study (LALES) is the largest and most recent study to determine the prevalence of open-angle glaucoma in Hispanics; reported at nearly 5%. Between 2010 – 2019, Hispanic patients accounted for more than half of the United States population growth, reaching a record of 60.6 million Hispanics living in the United States. With an influx of Hispanic’s migrating to the United States, there is an increased need for medical interpreters to assist medical professionals in encounters with Hispanic patients. The success of a medical encounter relies on a multitude of factors, but when a medical interpreter is involved, the stakes are even higher. We hypothesize that Hispanic speaking patients will have lower rates of understanding their glaucoma diagnosis and severity, in comparison to English speaking patients due to gaps in translation provided by medical interpreters.  Project Methods: Native Spanish and native English-speaking patients from the Eskenazi Health Eye Clinic were recruited via phone, reminding them of their upcoming eye appointment and their eligibility to participate in the study. Interested patients were provided with information regarding the study and consent materials at the start of the medical encounter. Participants who consented were administered the survey at the end of their medical encounter, in their preferred language, in person, at the clinic.  Results: This is an ongoing prospective study.  Potential Impact: This study will determine if medical interpreters successfully relay all the necessary information regarding a Hispanic patient’s glaucoma diagnosis. This study could also provide a partial explanation as to why there is a high no show rate and high medication noncompliance rate within the Eskenazi Health Eye Clinic Hispanic population. 

scholarly journals Predictors of SARS-CoV-2 Infection in Youth at a Large, Urban Healthcare Center in California, March–September 2020

2021 ◽  
Vol 9 ◽  
Author(s):  
Caitlin N. Newhouse ◽  
Tawny Saleh ◽  
Trevon Fuller ◽  
Tara Kerin ◽  
Mary C. Cambou ◽  
...  
Keyword(s):  
Viral Load ◽  
Los Angeles ◽  
Poverty Line ◽  
Safety Net ◽  
Academic Institution ◽  
Symptom Presentation ◽  
Median Viral Load ◽  
Older Youth ◽  
English Speaking ◽  
Positive Results

Objective: To understand which social, epidemiologic, and clinical risk factors are associated with SARS-CoV-2 infection in youth accessing care in a large, urban academic institution.Methods: We conducted a prospective cohort study with case–control analyses in youth who received testing for SARS-CoV-2 at our academic institution in Los Angeles during the first wave of the COVID-19 pandemic (March–September 2020).Results: A total of 27,976 SARS-CoV-2 assays among 11,922 youth aged 0–24 years were performed, including 475 youth with positive SARS-CoV-2 results. Positivity rate was higher among older, African American, and Hispanic/Latinx youth. Cases were more likely to be from non-English-speaking households and have safety-net insurance. Zip codes with higher proportion of Hispanic/Latinx and residents living under the poverty line were associated with increased SARS-CoV-2 cases. Youth were more likely to have positive results if tested for exposure (OR 21.5, 95% CI 14.6–32.1) or recent travel (OR 1.5, 95% CI 1.0–2.3). Students were less likely to have positive results than essential worker youth (OR 0.5, 95% CI 0.3–0.8). Patterns of symptom presentation varied significantly by age group; number of symptoms correlated significantly with age in SARS-CoV-2 cases (r = 0.030, p &lt; 0.001). SARS-CoV-2 viral load did not vary by symptom severity, but asymptomatic youth had lower median viral load than those with symptoms (21.5 vs. 26.7, p = 0.009).Conclusions: Socioeconomic factors are important drivers of SARS-CoV-2 infection in youth. Presence of symptoms, exposure, and travel can be used to drive testing in older youth. Policies for school reopening and infection prevention should be tailored differently for elementary schools and universities.

The Speech-Language Assessment of English Language Learning Students: A Non-Standardized Approach

2013 ◽  
Vol 14 (4) ◽  
pp. 95-101 ◽  
Author(s):  
Robert Kraemer ◽  
Allison Coltisor ◽  
Meesha Kalra ◽  
Megan Martinez ◽  
Bailey Savage ◽  
...  
Keyword(s):  
Language Learning ◽  
Language Impairment ◽  
Specific Language Impairment ◽  
English Language ◽  
Language Assessment ◽  
The United States ◽  
English Language Learning ◽  
Assessment Practices ◽  
Evidence Based ◽  
English Speaking

English language learning (ELL) children suspected of having specific-language impairment (SLI) should be assessed using the same methods as monolingual English-speaking children born and raised in the United States. In an effort to reduce over- and under-identification of ELL children as SLI, speech-language pathologists (SLP) must employ nonbiased assessment practices. This article presents several evidence-based, nonstandarized assessment practices SLPs can implement in place of standardized tools. As the number of ELL children SLPs come in contact with increases, the need for well-trained and knowledgeable SLPs grows. The goal of the authors is to present several well-establish, evidence-based assessment methods for assessing ELL children suspected of SLI.

The First Decade of Effort: Progress Toward a Hospital Information System at the UCLA Hospital, Los Angeles, California

1970 ◽  
Vol 09 (02) ◽  
pp. 75-80
Author(s):  
B. G. Lamson ◽  
W. S. Russell ◽  
J. Fullmore ◽  
W. E. Nix
Keyword(s):  
Los Angeles ◽  
Medical Record ◽  
Communication Systems ◽  
The United States ◽  
Computer Applications ◽  
Record Management ◽  
Successful Implementation ◽  
Accounting System ◽  
Accrual Accounting ◽  
Medical Specialties

Total information and communication systems within hospitals have been designed, but successful complete implementation, to date, has not been achieved. Limited applications with both patient medical data, notably in the clinical laboratories, and in the hospital accounting offices have been numerous. Although total programs are not yet a reality, it is apparent that the computer will serve ultimately many communication requirements, both medical and financial, within the hospital.Sound hospital management requires that costs of all component operations be known in order that value judgments concerning worth and efficiency may be made. Accrual accounting systems which match revenue and expense over the same time period are a prerequisite. Cash and modified cash hospital accounting cannot provide current reliable data for sound decision making.Costs of hospital operations cannot be evaluated unless related to the characteristics of the patient service load. Average per diem costs mean little except when large similar populations of patients are being compared. A modern hospital accrual accounting system should be able to provide information concerning the costs of caring for specific diseases in patients with known age and sex and disease severity characteristics. Without information of this type, it will not be possible to objectively evaluate alternative systems of financing and organizing patient care.Medical record management offers the promise of prospective use of patient disease information in the planning and scheduling of facilities. The prose content of medical record summaries, such as diagnostic statements in tissue pathology, radiology, and admission and discharge diagnoses, may be susceptible to non-coded, full prose input into computer controlled diagnostic files. Thesauri in the several medical specialties will be necessary for this achievement.There is little immediate prospect for complete hospital communication systems that can be made available as a package to any hospital without substantial local alteration. Pilot projects in teaching centers should be viewed for the time being as opportunities to define objectives, evaluate feasibility, and determine degree of risk and expense.A brief survey of applications in the United States which have been successfully implemented or which appear suitable for successful implementation is recorded.Eleven general principles which have been associated with successful implementation of computer applications within the UCLA Hospital are enumerated.

Community Outreach Partnership Center (COPC)

2003 ◽  
Vol 1 (2) ◽  
pp. 44-51
Author(s):  
Kristine Brown ◽  
James Sturges
Keyword(s):  
Health Promotion ◽  
Los Angeles ◽  
Mexican Immigrants ◽  
Community Outreach ◽  
Well Being ◽  
Integrated Services ◽  
The United States ◽  
Primary Objective ◽  
Health Promotion Program ◽  
Federal Grant

With the continued influx of Mexican immigrants to the United States, especially to Southern California, health concerns and needs have increased among this population over the last several years. California State Polytechnic University, Pomona (Cal Poly Pomona) obtained a federal grant that provided resources to establish the Community Outreach Partnership Center (COPC). COPC consists of comprehensive efforts to improve the overall well-being of the Angela Chanslor area within the City of Pomona in East Los Angeles. Focus areas of the project include 1) Education and Integrated Services, 2) Community Planning and Capacity Building for Neighborhood Revitalization and Safety, and 3) Job Development and Training. The focus of this paper is health promotion activities within Education and Integrated Services. The primary objective of this portion of the program was to provide residents with physical examinations and health screenings, health education, and medical and social service referrals. Topics discussed are the target community, general overview of COPC, Family Services Information and Referral Program (i.e. health promotion program within Education and Integrated Services), program impact and results, and suggestions for continued implementation and future efforts. / Con la influencia continua de inmigrantes Mexicanos a los Estados Unidos, especialmente al sur de California, ciertas necesidades con respecto a la salud han incrementado en esta poblacion en los ultimos anos. California State Polytechnic University, Pomona (Cal Poly Pomona). Obtuvo ayuda Federal para establecer El Community Outreach Partnership Center (COPC). El centro COPC consiste de esfuerzos conprensivos para mejorar el bienestar del area Angela Chanslor que esta ubicado en la Ciudad de Pomona en la parte Este de Los Angeles. Las partes enfocadas del proyecto incluyen, 1) Educacion y servicios Integrados, 2) Plan para la Comunidad y un Edificio de Capacitacion para la comunidad que dara revitalizacion y seguridad, 3) Y habrira trabajos y entrenamientos. El enfoque de este proyecto es de actividades en Promocion de Salud aliadas con educacion y Servicios Integrados. El objetivo principal de esta porcion del programa era de proveer a los residentes con examinaciones fisicas, educacion para la salud, y eran referidas a servicios medicos y sociales. Los topicos que son tratados son: La comunidad que sera ayudada, El enfoque general de COPC, informacion del programa para referir a servicios familiares, el impacto del programa y resultados, y sugerencias para implementar futuros esfuerzos.

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