Chenjuan Ma

Abstract

Transgender and gender-diverse (TGD) adults experience significant health disparities compared with their cisgender peers. Stigma functions as a fundamental cause of health disparity in TGD communities. Stigma can be tempered by gender-affirming care (GAC), in which TGD adults receive care that validates their gender identity. There is little evidence focusing on outcomes associated with integrated GAC as an approach to care delivery. This integrative review explores the extant evidence on the relationship between integrated GAC and health outcomes in TGD adults in the United States. A comprehensive search of 4 electronic databases was conducted in May 2022. Included studies were peer reviewed, conducted in the United States from 2013 to the present, and described integrated GAC delivery for TGD adults aged 18 and older. After screening 3328 records and reviewing 135 full-text articles, 15 articles were included in this review. Articles were critically appraised, and data extraction and analysis using constant comparison were used to identify themes and relationships across studies. Synthesis suggested that GAC relates to three distinct areas of TGD adult health: physical health, mental health, and health services outcomes. GAC was associated with better overall health and improvements in HIV-related outcomes; significant decreases in mental health symptoms and suicidality; and increases in utilization, engagement, and care retention. There is moderate evidence that GAC delivery is associated with positive health outcomes for TGD adults. This integrative review provides empirical and theoretical support for integrated GAC delivery as an approach to improve health and address stigma-related barriers to care.

Abstract

Objective: Despite being the fastest growing minority group in the USA, Asian Americans are among the least studied ones, particularly in the home and community-based services settings. This study aimed to review and synthesize extant evidence on Asian American’s access, utilization, and outcomes of home health care. Methods: This is a systematic review study. A comprehensive literature search was conducted in PubMed and CINAHL as well as hand search. Each study was screened, reviewed, and evaluated for quality by at least two reviewers independently. Results: Twelve articles were determined eligible and included for review. Asian Americans were less likely to be discharged to home health care following hospitalization. At admission to home health care, Asian Americans had a high rate of inappropriate medication issues (28%) and they also had poorer functional status compared to White Americans. Asian Americans were also reported with less improvement in functional status at the end of home health care; however, there were some inconsistencies in the evidence on Asian Americans’ utilization of formal/skilled home health care. Quality evaluation indicated that findings from some studies were limited by small sample size, single site/home health agency, analytic approaches, and other methodologic limitations. Conclusions: Asian Americans often experience inequities in home health care access, utilization, and outcomes. Multilevel factors may contribute to such inequities, including structural racism. Robust research using population-based data and advanced methodology is needed to better understand home health care to Asian Americans.

Abstract

Objectives: Home health care serves millions of Americans who are "Aging in Place," including the rapidly growing population of Medicare Advantage (MA) enrollees. This study systematically reviewed extant evidence illustrating home health care (HHC) services to MA enrollees. Methods: A comprehensive literature search was conducted in 6 electronic databases to identify eligible studies, which resulted in 386 articles. Following 2 rounds of screening, 30 eligible articles were identified. Each study was also assessed independently for study quality using a validated quality assessment checklist. Results: Of the 30 studies, nearly half (n=13) were recently published between January 1, 2017 - January 6, 2022. Among various issues related to HHC to MA enrollees examined, which were often compared with Traditional Medicare (TM) enrollees, the 2 most studied issues were HHC use rate (including access) and care dosage/intensity. Inconsistencies were common in findings across reviewed studies, with slight variations in the level of inconsistency by studied outcomes. Several critical issues, such as heterogeneity of MA plans, influence of MA-specific features, and program response to policy and quality improvement initiatives, were only examined by 1 or 2 studies. The depth and scope of scientific investigation were also limited by the scale and details available in MA data in addition to other methodological limits. Conclusions: Wild variations and conflicting findings on HHC to MA beneficiaries exist across studies. More research with rigorous designs and robust MA encounter data is warranted to determine home health care for MA enrollees and the relevant outcomes.

Abstract

An increasing body of evidence highlights the importance of an individual’s place of residence on their health and functional outcomes. This study is based on Outcome and Assessment Information Set data to assess the differences in emergency department visits among Medicare home health care patients by patients' residence location (rural/urban status and neighborhood socioeconomic status). Compared to urban patients, a disproportionately higher proportion of rural patients lived in more or most disadvantaged neighborhoods (83.9% vs. 41.3%). Using linear probability regression models, patients in rural areas (coefficient =.02, p <.001) and disadvantaged neighborhoods (less disadvantaged: coefficient =.02, p <.001; more disadvantaged: coefficient =.034, p <.001; most disadvantaged: coefficient =.042, p <.001) were more likely to experience emergency department visits. Policymakers should consider utilizing area-based target interventions to mitigate gaps in home health care. Also, given that the majority of rural patients reside in disadvantaged neighborhoods, neighborhood characteristics should be considered in addressing rural–urban disparities and improving home health care.

Abstract

Background: Nurses at the frontline faced high risks of the COVID-19 infection, undertook heavy workloads of patient care, and experienced tremendous stress that often led to compassion fatigue. Aim: This study was to explore the role of positive psychosocial resources (i.e., perceived social support and emotional regulation efficacy) in the relationship between role stress and compassion fatigue. Methods: A cross-sectional design was conducted in Hubei Province, China between May and September 2021. The Role Stress Questionnaire, the Perceived Social Support Scale, the Emotional Regulation Efficacy Scale, and the Professional Quality of Life Scale were used to measure key variables of interest. Nurse socio-demographic data were also collected. Structural equation modeling was used to explore the relationships, including potential mediating effect, among role stress, perceived social support, emotional regulation efficacy, and compassion fatigue. Results: A total of 542 nurses participated in this investigation, and 500 were eventually enrolled in the analysis. The incidence of compassion fatigue among nurses was 94.2%, including 65.8% of nurses reporting at least moderate compassion fatigue. Univariate analysis showed that educational level, marital status, hospital rank, sleep time were the factors affecting compassion fatigue of the nurses. The structural equation modeling revealed that: Role stress had a direct positive effect on compassion fatigue; Perceived social support and emotional regulation efficacy partially mediated the link between role stress and compassion fatigue respectively; And there was a chain mediating role of perceived social support and emotional regulation efficacy between role stress and compassion fatigue. Conclusion: The incidence of compassion fatigue was high during the COVID-19 pandemic among bedside nurses in China. Improving social support and enhancing the efficacy of emotion regulation may help alleviate compassion fatigue directly and/or via buffering the impact of role stress.

Abstract

Background: Language concordance between health care practitioners and patients have recently been shown to lower the risk of adverse health events. Continuity of care also been shown to have the same impact. Objective: The purpose of this paper is to examine the relative effectiveness of both continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. Design: A multivariable logistic regression model using rehospitalization as the dependent variable was built. The variable of interest was created to compare language concordance and continuity of care. Participants: The final sample included 22,103 patients from the New York City area between 2010 and 2015 who were non-English-speaking and admitted to their home health site following hospital discharge. Measures: The odds ratio (OR) average marginal effect (AME) of each included variable was calculated for model analysis. Results: When compared with low continuity of care and high language concordance, high continuity of care and high language concordance significantly decreased readmissions (OR=0.71, 95% CI: 0.62-0.80, P<0.001, AME=-4.95%), along with high continuity of care and low language concordance (OR=0.80, 95% CI: 0.74-0.86, P<0.001, AME=-3.26%). Low continuity of care and high language concordance did not significantly impact readmissions (OR=1.04, 95% CI: 0.86-1.26, P=0.672, AME=0.64%). Conclusion: In the US home health system, enhancing continuity of care for those with language barriers may be helpful to address disparities and reduce hospital readmission rates.

Abstract

Background: Hospitalized older adult medication-related falls are common and understudied. Local Problem: There were organizational educational gaps identified in assisting nurses to recognize and mitigate medication associated side effects that may predispose hospitalized older adults to fall. Methods: A quality improvement project that utilized pre and post-test design. An eLearning module was developed and distributed to registered nurses in a medical unit. Interventions: Eighty registered nurses participated in an eLearning module that included patient and family centered evidence-based guidelines and teach-back guides related to medication fall safety. Results: An increase in overall (2.2%) medication patient satisfaction scores and decrease (8%) in falls for patients > 65 years old over a 4-month period. Conclusions: There is benefit of implementing a structured medication fall risk education program for nurses on a medical unit. Patient satisfaction related to communication about medications and a reduction in falls was impacted by this interdisciplinary intervention.

Abstract

Objective: The purpose of this study was to understand the limited English proficiency patient experience with health care services in an urban setting in the United States. Methods: Through a narrative analysis approach, 71 individuals who spoke either Spanish, Russian, Cantonese, Mandarin, or Korean shared their experiences through semi-structured interviews between 2016 and 2018. Analyses used monolingual and multilingual open coding approaches to generate themes. Results: Six themes illustrated patient experiences and identified sources of structural inequities perpetuating language barriers at the point of care. An important thread throughout all interviews was the sense that the language barrier with clinicians posed a threat to their safety when receiving healthcare, citing an acute awareness of additional risk for harm they might experience. Participants also consistently identified factors they felt would improve their sense of security that were specific to clinician interactions. Differences in experiences were specific to culture and heritage. Conclusions: The findings highlight the ongoing challenges spoken language barriers pose across multiple points of care in the United States' health care system. Innovation: The multi-language nature of this study and its methodological insights are innovative as most studies have focused on clinicians or patient experiences in a single language.

Abstract

Patients with chronic obstructive pulmonary disease (COPD) experience a high risk for psychological distress. Understanding what factors contributing to this risk is vital for developing effective interventions to address COPD-related psychological distress. To examine psychological distress and its associated factors in COPD patients in China. This is a cross-sectional study. Using cluster random sampling, 351 COPD patients participated in and completed a questionnaire survey from June 2021 to January 2022. Instruments used in this research included a self-designed social-demographic questionnaire, the Kessler Psychological Distress Scale (K10), the COPD Knowledge Question, the Type D Personality Scale (DS-14), the COPD Assessment Test (CAT), and modified Medical Research Council Dyspnea Score (mMRC). Multivariate linear regressions were used in the final analysis. Among 351 COPD patients, 307 (or 87.5%) had psychological distress. Our univariate analysis indicated that psychological distress scores were significantly associated with monthly household income (F = 2.861, P < 0.05), exercise frequency (F = 4.039, P < 0.01), type D personality (t = 5.843, P < 0.01), years with COPD (rs = 0.156, P < 0.01), frequency of acute exacerbation (rs = 0.114, P < 0.05), mMRC score (rs = 0.301, P < 0.01), and CAT score (rs = 0.415, P < 0.01). Our final multivariate linear regression showed that exercise frequency (coefficient = −1.012, P < 0.01) was an independent protective factor of psychological distress in COPD patients, while type D personality (coefficient = 3.463, P < 0.001), mMRC score (coefficient = 1.034, P < 0.001) and CAT score were independent risk factors (coefficient =.288, P < 0.001). No relationship was observed between psychological distress and knowledge of COPD. Psychological distress is commonly presented among COPD patients in China. Findings from this study suggest promoting and increasing frequency of exercise will be beneficial in reducing psychological distress among COPD patients. This study also highlights the importance of assessing personality type, dyspnea, and impact of COPD on daily living for preventing and managing psychological distress due to COPD. In addition, Given the high rate of psychological distress among COPD patients, policymakers should consider making mental health resources easily available and accessible to this vulnerable population.