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: Background: Intimate partner violence (IPV) and reproductive coercion (RC) can result in serious psychological, social and physical harm. Screening patients for IPV/RC has the potential to identify and assist patients who may not otherwise discuss this with a health practitioner. Targeted screening for those with a range of specific presentations including many sexual and reproductive health issues has been recommended, but universal screening has not. Methods: The implementation and evaluation of a screening program for IPV and RC in an urban sexual and reproductive health clinic is described. Results: The program enabled patients who had been exposed to IPV and/or RC to receive assistance and support. Screening was highly acceptable to patients, and the reception and clinical staff became both highly supportive of screening and increasingly confident to assist patients who were exposed to IPV and/or RC. Conclusion and implications for public health: This program could be adapted for use in a number of healthcare settings and lead to positive health outcomes., Typically, only one‐third of women experiencing intimate partner abuse disclose this to their general practitioner.[sup.1] Intimate partner violence encompasses a range of types of abuse, including emotional, physical, financial, sexual, [...]

In Canada, more than 11% of the country's gross domestic product (GDP) and almost 50% of provincial budgets are spent on health care expenditures, (1) yet the high spending is [...], Background: Wait times for many elective orthopedic surgical procedures in Ontario have become unacceptably long and substantially exceed the recommended guidelines. As a consequence, many patients experience chronic pain, disability and other poor health outcomes. The purpose of this study was to test a novel, resource-saving redesign of outpatient operating room (OR) services, based on tiered grouping of surgical cases, to maximize health benefits for patients while improving efficiency and decreasing wait times. Methods: This prospective cohort study enrolled adult patients scheduled to undergo unilateral lower limb procedures that had a low requirement for surgical resources and did not require admission to the hospital (ambulatory surgical services) at an academic hospital. Patients were randomly assigned to a conventional OR group or a high-efficiency (tiered) OR group, in which the intensity of surgical, anesthesia and nursing resources was matched to the procedure and the patient's health status. The tiered OR made use of local anesthesia and a block room rather than general anesthesia. Primary outcomes were costs of surgical services provided and patient health outcomes; secondary outcomes were patient and staff satisfaction with each OR setup. Results: The costs associated with the high-efficiency OR were 60% lower than those associated with the conventional OR (this was primarily due to the streamlining of OR care and elimination of the need to use a postanesthetic care unit), with the same or equivalent patient health outcomes. No differences in patient and staff satisfaction were found between the 2 setups. Conclusion: The use of tiered, ambulatory services for elective orthopedic surgery does not compromise health outcomes and patient satisfaction, and it is associated with substantial cost savings. Contexte : En Ontario, les temps d'attentes de plusieurs interventions en chirurgie orthopédique non urgentes s'allongent déraisonnablement et excèdent large-ment ceux des lignes directrices. Par conséquent, plusieurs patients doivent vivre avec de la douleur chronique, une invalidité ou d'autres problèmes de santé. Le but de cette étude était de mettre à l'essai une nouvelle configuration des services en salle d'opération pour les patients ambulatoires qui permettrait d'économiser les ressources et qui se fonderait sur un regroupement des cas chirurgicaux en échelons afin de maximiser les bienfaits pour la santé des patients tout en améliorant l'efficacité et en diminuant les temps d'attente. Méthodes : Dans cette étude de cohorte prospective, les patients adultes participants ont subi dans un hôpital universitaire une intervention chirurgicale unilaté-rale à un membre inférieur demandant peu de ressources et ne nécessitant pas d'hospitalisation (services de chirurgie ambulatoire). Les patients étaient répartis aléatoirement en 2 groupes : 1 groupe était assigné à une salle d'opération clas-sique, et l'autre à une salle à rendement élevé (interventions échelonnées), où l'intensité des ressources allouées à l'intervention, à l'anesthésie et au personnel infirmier correspondait au type d'intervention et à l'état de santé du patient. La salle d'opération par échelons avait la possibilité d'utiliser l'anesthésie locale dans une salle d'anesthésie locorégionale plutôt qu'une anesthésie générale. Les paramètres principaux de l'étude étaient le coût des services chirurgicaux fournis et les résultats cliniques des patients; le paramètre secondaire était la satisfaction des patients et du personnel de chaque configuration de la salle d'opération. Résultats : Les coûts associés aux salles d'opération à rendement élevé étaient inférieurs de 60% à ceux associés aux salles d'opération classiques (cette différence s'expliquerait par la simplification des soins en salle d'opération et l'élimination du besoin d'une salle de réveil), pour des résultats cliniques similaires ou équivalents. Aucune différence dans la satisfaction des patients et du personnel n'a été observée entre les 2 configurations. Conclusion : Le recours à l'échelonnage des services ambulatoires pour l'exécution des interventions en chirurgie orthopédique non urgentes ne compromet ni les résultats cliniques ni la satisfaction des patients et s'accompagne d'une réduction substan tielle des coûts.

INTRODUCTION Addressing patients' health-related social needs is integral to patient care, (1-6) and several state and national agencies incentivize social needs screening innovations. (7,8) Incentives include national initiatives to establish [...], PURPOSE Federally qualified health centers (FQHCs) are leaders in screening for and addressing patient's health-related social needs but variation exists in screening practices. This variation is relatively unexplored, particularly the influences of organizational and state policies. We employed a qualitative descriptive approach to study social needs screening practices at Michigan FQHCs to characterize screening processes and identify drivers of variation in screening implementation. METHODS Site visits and semistructured interviews were conducted from October 2016 through March 2017, to explore implementation of social needs screening in clinical practice. Five FQHCs were selected through maximum variation sampling. Within each site, snowball sampling identified care team members highly knowledgeable about social needs screening. We conducted 4 to 5 interviews per site. Transcripts were analyzed using a thematic approach. RESULTS We interviewed 23 participants from 5 sites; these sites varied by geography, age distribution, and race/ethnicity. We identified 4 themes: (1) statewide initiatives and local leadership drove variation in screening practices; (2) as community health workers (CHWs) played an integral role in identifying patients' needs, their roles often shifted from that of screener to implementer; (3) social needs screening data was variably integrated into electronic health records and infrequently used for population health management; and (4) sites experienced barriers to social needs screening that limited the perceived impact and sustainability. CONCLUSIONS FQHCs placed value on the role of CHWs, on sustainable initiatives, and on funding to support continued social needs screening in primary care settings. Key words: community health centers; community health workers; primary health care; social determinants of health

Author(s): Mary Jane Rotheram-Borus 1,*, Karl W. le Roux 2,3,4,5, Peter Norwood 1, Linnea Stansert Katzen 2, Andre Snyman 5, Ingrid le Roux 6, Elaine Dippenaar 5, Mark Tomlinson 2,7 [...], Background Community health workers (CHWs) can supplement professional medical providers, especially in rural settings where resources are particularly scarce. Yet, outcomes of studies evaluating CHWs effectiveness have been highly variable and lack impact when scaled nationally. This study examines if child and maternal outcomes are better when existing government CHWs, who are perinatal home visitors, receive ongoing enhanced supervision and monitoring, compared to standard care. Methods and findings A cluster randomized controlled effectiveness trial was conducted comparing outcomes over 2 years when different supervision and support are provided. Primary health clinics were randomized by clinic to receive monitoring and supervision from either (1) existing supervisors (Standard Care (SC); n = 4 clinics, 23 CHWs, 392 mothers); or (2) supervisors from a nongovernmental organization that provided enhanced monitoring and supervision (Accountable Care [AC]; n = 4 clinic areas, 20 CHWs, 423 mothers). Assessments were conducted during pregnancy and at 3, 6, 15, and 24 months post-birth with high retention rates (76% to 86%). The primary outcome was the number of statistically significant intervention effects among 13 outcomes of interest; this approach allowed us to evaluate the intervention holistically while accounting for correlation among the 13 outcomes and considering multiple comparisons. The observed benefits were not statistically significant and did not show the AC&apos;s efficacy over the SC. Only the antiretroviral (ARV) adherence effect met the significance threshold established a priori (SC mean 2.3, AC mean 2.9, p < 0.025; 95% CI = [0.157, 1.576]). However, for 11 of the 13 outcomes, we observed an improvement in the AC compared to the SC. While the observed outcomes were not statistically significant, benefits were observed for 4 outcomes: increasing breastfeeding for 6 months, reducing malnutrition, increasing ARV adherence, and improving developmental milestones. The major study limitation was utilizing existing CHWs and being limited to a sample of 8 clinics. There were no major study-related adverse events. Conclusions Supervision and monitoring were insufficient to improve CHWs&apos; impact on maternal and child outcomes. Alternative strategies for staff recruitment and narrowing the intervention outcomes to the specific local community problems are needed for consistently high impact. Trial registration Clinicaltrials.gov, NCT02957799.

Presenters Ambar Kulshreshtha, MD, PhD, Julianne Kubes, MPH, Saria Hassan, MD, MPH, Zanthia [...], Importance: The COVID-19 pandemic has led to increased utilization of telemedicine. Patients with diabetes are a vulnerable population that require regular treatment and monitoring. Little is known about the impact visit modality on diabetes outcomes in an ambulatory setting. Objective: Compare proportions of patients with diabetes with uncontrolled diabetes among those with telemedicine versus in-person only ambulatory visits and examine differences by age, race, gender, ethnicity, and insurance. Design: A retrospective cohort study. Setting: The largest academic healthcare system in the state of Georgia with ambulatory clinics in urban, suburban and rural settings. Participants: Adults with diabetes scheduled for an ambulatory primary or specialty clinic visit between May 2020 and May 2021 were included. Patients were compared among three visit groups: those with all in-person visits, those with one telemedicine visit, and those with 2+ telemedicine visits. Demographics including age, race, ethnicity, gender, insurance status, and comorbidities were extracted from the electronic medical record. Main Outcomes and Measures: The primary clinical outcome was uncontrolled diabetes, defined as HbA1c [greater than or equal to] 9.0%. Chi-square test was used to determine crude differences in uncontrolled diabetes between visit groups. Multivariable logistic regression was used to assess differences in uncontrolled diabetes between visit groups following risk adjustment. Results: A total of 18,148 ambulatory clinic visits for patients with diabetes were scheduled during the study period, and 11.6% had uncontrolled diabetes. There was no difference in proportion of patients with uncontrolled diabetes between all in-person visits (834 (11.6%)), one telemedicine visit (558 (11.8%)), or 2+ telemedicine visits (709 (11.4%)) (p = 0.80). Patients with 2+ telemedicine visits had significantly lower odds of uncontrolled diabetes compared to all in- person visits after adjusting for age, gender, race, ethnicity, insurance status, and comorbidities (OR: 0.88; 95% CI: 0.79-0.99, p = 0.03). Conclusions and Relevance: Telemedicine visits were associated with a lower odds of uncontrolled diabetes. Further work is warranted to explore the relationship between telemedicine visits, equitable access to care, and diabetes outcomes.

Author(s): L. Adriana Matiz [sup.1] [sup.2] , Laura Robbins-Milne [sup.1] [sup.2] , John A. Rausch [sup.1] [sup.2] Author Affiliations: (Aff1) 0000 0001 2285 2675, grid.239585.0, Department of Pediatrics, Columbia University [...], Introduction Children with special health care needs (CSHCN) are a high risk population with complex medical issues and needs. It is challenging to care for them in a busy, pediatric practice without understanding how many exist and how best to allocate resources. EMRs can be adapted to develop registries and stratify patients to promote population health management. Methods Adaptations were made to the EMR in September 2013 to capture CSHCN and the associated risk level during well-child visits prospectively. All physicians were trained on the definition of CSHCN and on risk stratification levels 1, 2, 3A and 3B. An analysis using one-way ANOVA for children ages 0-21, seen between September 1, 2011 and August 31, 2015, who were identified and stratified after September 2013, was conducted to determine utilization patterns on hospital admissions, emergency department (ED), subspecialty, and primary care visits. Results A total of 4687 CSHCN were identified during the study period. Of the CSHCN, 45% were Level 1, 41% Level 2, 7% 3A and 7% 3B. There were significant differences in utilization across the tiers of CSHCN with the highest level of stratification (3B) demonstrating the most hospital admissions and primary care visits. Level 3B and level 3A (unstable) had significantly more ED visits. Additionally, as tiers increased from level 1 to 3B there was an increase in subspecialty provider utilization (p < 0.0001). Discussion The EMR adaptations developed for CSHCN identified the expected number of CSHCN and predicted utilization patterns across primary, subspecialty, ED and in-patient care.

THE INNOVATION Many people experiencing homelessness own animals that provide emotional support and other health benefits. We created the One Health Clinic (OHC) to provide primary health care and veterinary [...]

In Canada, men who have sex with men (MSM) account for a large proportion of incident HIV and sexually transmitted infections (STIs). (1,2) In Ottawa, in 2010 (most recent published [...], OBJECTIVES: To 1) create a space where men who have sex with men (MSM) feel comfortable accessing sexually transmitted infection/human immunodeficiency virus (STI/HIV) testing, and 2) reduce STI/HIV incidence. PARTICIPANTS: Gay men in Ottawa and its surrounding regions. SETTING: A preponderance of diagnoses of sexually transmitted infections and HIV continue to occur among MSM. Meanwhile, other literature identifies that many MSM are reluctant to access STI/HIV testing services or to disclose their sexual practices to primary care practitioners. INTERVENTION: In Ottawa, in an effort to surmount these issues and decrease STI/HIV incidence among MSM, the local public health unit in collaboration with community partners created "GayZone", a three-hour-per-week STI/HIV testing and STI treatment clinic for gay men. In this paper, we report on the uptake and STI/HIV diagnosis outcomes for this clinic from January 2010 through December 2013. OUTCOMES: GayZone is a well-utilized clinic that yields a number of STI/HIV diagnoses per year. Overall, the positivity rates of the STI/HIV tests at this clinic are above-average, although lower than what might be expected by local epidemiological data. While the results of this clinic validate anonymous HIV testing, they bring into question the utility of pharyngeal swabs to test for gonorrhea and chlamydia. CONCLUSION: The results of our study demonstrate the utility of a gay men&apos;s STI/HIV testing clinic and highlight some areas for improvement. Public health practitioners, frontline clinicians, and community workers in other regions who wish to implement such an STI/HIV clinic would do well to consider our results beforehand. KEY WORDS: Clinical services; gay men; HIV; MSM; public health; sexually transmitted infections OBJECTIFS : 1) Offrir un endroit ou les hommes ayant des relations sexuelles avec d&apos;autres hommes (HARSAH) n&apos;hesitent pas a se rendre pour obtenir des services de depistage des infections transmises sexuellement (ITS) et du virus d&apos;immunodeficience humaine (VIH); et 2) reduire l&apos;incidence des ITS et du VIH. PARTICIPANTS : Hommes gais d&apos;Ottawa et des environs. CONTEXTE : Alors meme que les diagnostics d&apos;ITS et de VIH demeurent nombreux pour les HARSAH, il y a differentes indications a l&apos;effet que ces hommes sont reticents a recourir aux services de depistage ou a divulguer leurs pratiques sexuelles aux pourvoyeurs de soins primaires. INTERVENTION : Dans le but de surmonter ces difficultes pour parvenir a diminuer la prevalence des ITS et du VIH chez les HARSAH, les services de sante publique de la ville d&apos;Ottawa ont mis sur pied, en collaboration avec des partenaires communautaires, la Zone gaie, une clinique specialisee ou les hommes gais ont acces trois heures par semaine a des services de depistage des ITS et du VIH et de traitement des ITS. Le present rapport traite du taux de frequentation de cette clinique et des diagnostics d&apos;ITS et de VIH qui ont pu y etre etablis entre janvier 2010 et decembre 2013. RESULTATS : La Zone gaie est une clinique abondamment utilisee qui etablit chaque annee un bon nombre de diagnostics d&apos;ITS et de VIH. La proportion de tests de depistage positifs y est au-dessus de la moyenne, bien qu&apos;inferieure a ce que l&apos;on pourrait attendre selon les donnees epidemiologiques locales. Le travail de la clinique a mis en lumiere l&apos;importance du depistage anonyme du VIH, mais nous amene par ailleurs a nous interroger sur la pertinence des prelevements pharynges pour depister la gonorrhee et la chlamydia. CONCLUSION : Non seulement les resultats obtenus temoignent-ils de l&apos;utilite d&apos;une clinique semblable, mais ils font egalement ressortir quelques points a ameliorer. Les praticiens en sante publique, les cliniciens de premiere ligne et les travailleurs communautaires qui envisagent l&apos;etablissement d&apos;une telle clinique specialisee dans leur region seraient bien avises de prendre d&apos;abord connaissance des resultats de notre travail. MOTS CLES : services cliniques; homes gais; VIH; HARSAH; sante publique; infections transmissibles sexuellement

In this paper a stochastic overbooking model is formulated and an appointment scheduling policy is developed for outpatient clinics. The schedule is constructed for a single service period partitioned into time slots of equal length. A clinic scheduler assigns patients to slots through a sequential patient call-in process where the scheduler must provide each calling patient with an appointment time before the patient's call terminates. Once an appointment is added to the schedule, it cannot be changed. Each calling patient has a no-show probability, and overbooking is used to compensate for patient no-shows. The scheduling objective captures patient waiting time, staff overtime and patient revenue. Conditions under which the objective evolution is unimodal are derived and the behavior of the scheduling policy is investigated under a variety of conditions. Practical observations on the performance of the policy are presented. Keywords: Open access, appointment scheduling, patient no-shows, outpatient clinic operations, 1. Introduction Healthcare currently consumes 15% of the US Gross Domestic Product and is expected to reach 19% within the coming decade (Centers for Medicare and Office of the Actuary [...]