Howard Eisenson - Academia.edu (original) (raw)

Papers by Howard Eisenson

NEJM Catalyst, Nov 6, 2019

Lincoln Community Health Center improved care quality by measuring and responding to upstream soc... more Lincoln Community Health Center improved care quality by measuring and responding to upstream social and economic risk factors disproportionately affecting low-income households.

Establishing sustainable and impactful partnerships to advance health equity and health dispariti... more Establishing sustainable and impactful partnerships to advance health equity and health disparities research requires a multipronged approach to assessing and aligning community and organizational priorities toward common goals and objectives. Partnerships to advance health equity and to ensure ongoing and meaningful health disparities research should ideally provide a win-win for community stakeholders and the health system. This often requires a cultural shift regarding how and to what extent academic/medical institutions value and fully engage diverse stakeholders as experts in the research process and delivery of care. At the Duke Cancer Institute, through the Office of Health Equity and Disparities, our intentional stakeholder engagement has led to robust partnerships with diverse community organizations and leaders capitalizing on each other's strengths and expertise. Through this process the DCI, together with the community, has built a sustainable platform to advance health equity through research, capacity building, and open communication. Citation Format: Nadine Barrett, Kearston Ingraham, Kevin Williams, Pao-Hwa Lin, Howard Eisenson, Maritza Chirinos, Demetrius Harvey, Steven Patierno. Developing effective community and health system partnerships to advance health equity and health disparities research [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA26.

Medicine and Science in Sports and Exercise, May 1, 2003

Frontiers in Public Health

IntroductionFew resources are available to train students to provide patients assistance for obta... more IntroductionFew resources are available to train students to provide patients assistance for obtaining needed community-based services. This toolkit outlines a curriculum to train student volunteers to become “community resource navigators” to serve patients via telephone at partner health sites.MethodsUniversity students co-designed the Help Desk navigator program and training for volunteer navigators as part of an academic-community partnership with a local Federally Qualified Health Center (FQHC). The multi-modal curricula consisted of five components: didactic instruction on social determinants of health and program logistics, mock patient calls and documentation, observation of experienced navigator interaction with patients, supervised calls with real patients, and homework assignments. In 2020, training materials were adapted for virtual delivery due to the COVID-19 pandemic. Trainees completed a survey after completion to provide qualitative feedback on the training and prep...

Frontiers in Public Health, Sep 2, 2022

Background: Implementation mapping (IM) is a promising five-step method for guiding planning, exe... more Background: Implementation mapping (IM) is a promising five-step method for guiding planning, execution, and maintenance of an innovation. Case examples are valuable for implementation practitioners to understand considerations for applying IM. This pilot study aimed to determine the feasibility of using IM within a federally qualified health center (FQHC) with limited funds and a-year timeline. Methods: An urban FQHC partnered with an academic team to employ IM for implementing a computerized strategy of tobacco cessation: the A's (Ask, Advise, Assess, Assist, Arrange). Each step of IM was supplemented with theory-driven methods and frameworks. Data collection included surveys and interviews with clinic sta , analyzed via rapid data analysis. Results: Medical assistants and clinicians were identified as primary implementers of the A's intervention. Salient determinants of change included the perceived compatibility and relative priority of A's. Performance objectives and change objectives were derived to address these determinants, along with a suite of implementation strategies. Despite indicators of adoptability and acceptability of the A's, reductions in willingness to adopt the implementation package occurred over time and the intervention was not adopted by the FQHC within the study timeframe. This is likely due to the strain of the COVID-pandemic altering health clinic priorities. Conclusions: Administratively, the five IM steps are feasible to conduct with FQHC sta within year. However, this study did not obtain its intended outcomes. Lessons learned include the importance of reassessing barriers over time and ensuring a longer timeframe to observe implementation outcomes.

The Journal of the American Board of Family Medicine

Introduction: Many primary care clinics screen patients for their unmet social needs, such as foo... more Introduction: Many primary care clinics screen patients for their unmet social needs, such as food insecurity and housing instability, and refer them to community-based organizations (CBOs). However, the ability for patients to have their needs met is difficult to evaluate and address. This study explores patient-reported barriers to accessing referred resources using a conceptual framework that identifies opportunities for intervening to optimize success. Methods: Patients who participated in a social needs screening and referral intervention at a Federally Qualified Health Center (FQHC) were called 2 weeks after the clinic encounter. We conducted a directed content analysis across 6 domains of access to examine responses from patients who reported barriers. Results: Of the 462 patients that were reached for follow-up, 366 patients reported 537 total barriers. The most frequent challenges related to resource availability (24.6%, eg, patients waiting for submitted application to process) and approachability (23.8%, eg, patients lacking information needed to contact or access resources). Barriers in the domains of acceptability (21.6%, eg, competing life priorities such as medical issues, major life events, or caretaking responsibilities) and appropriateness (17.9%, eg, resource no longer needed) largely represented patient constraints expressed only after the clinical encounter. It was less common for patients to identify accommodation (eg, physical limitations, language barriers, transportation barriers, administrative complexity) or affordability of community resources as barriers (11.2% and 0.9%, respectively). Conclusion: Findings suggest opportunities for improvement across the access continuum, from initial referrals from primary care staff during the clinical encounter to patients' attempts to accessing services in the community. Future efforts should consider increased collaboration between health and social service organizations, and advocacy for structural changes that mitigate system-level barriers related to resource availability and administrative complexity.

International Journal of Integrated Care

BACKGROUND Healthcare providers are increasingly screening patients for unmet social needs (e.g.,... more BACKGROUND Healthcare providers are increasingly screening patients for unmet social needs (e.g., food, housing, transportation, social isolation) and referring patients to relevant community-based resources and social services. Patients’ connection to referred services is often low, however, suggesting the need for additional support to facilitate engagement with resources. Short message service (SMS) text messaging presents an opportunity to address barriers related to contacting resources in an accessible, scalable, and low-cost manner. OBJECTIVE In this multi-methods pilot study, we aim to develop an automated SMS-based intervention to promote patient connection to referred social needs resources within two weeks of the initial referral, as well as evaluate its feasibility and patient acceptability. This protocol describes the intervention, conceptual underpinnings, study design, and evaluation plan to provide a detailed illustration of how SMS technology can complement current ...

Supplemental material, sj-docx-1-jpc-10.1177_21501327211024390 for Factors Associated with Patien... more Supplemental material, sj-docx-1-jpc-10.1177_21501327211024390 for Factors Associated with Patients' Connection to Referred Social Needs Resources at a Federally Qualified Health Center by Tyler Lian, Kate Kutzer, Diwas Gautam, Howard Eisenson, Jane C. Crowder, Emily Esmaili, Sahil Sandhu, Lawrence Trachtman, Janet Prvu Bettger and Connor Drake in Journal of Primary Care & Community Health

Additional file 2. Clinician Focus Group Guide. Questions were designed to identify areas of cons... more Additional file 2. Clinician Focus Group Guide. Questions were designed to identify areas of consensus and disagreement across the HEIF domains.

Additional file 1. Comparison across LASSO logistic regressions across the three clinical outcome... more Additional file 1. Comparison across LASSO logistic regressions across the three clinical outcomes. Models and c-statistics for cross-validation, minimum-AIC, minimum-BIC, and adaptive LASSO models.

Additional file 1. Patient Semi-Structured Interview Guide. Questions were designed to evaluate p... more Additional file 1. Patient Semi-Structured Interview Guide. Questions were designed to evaluate patient-reported barriers and facilitators across the HEIF domains.

International Journal of Integrated Care, 2021

Introduction: While unmet social needs are major drivers of health outcomes, most health systems ... more Introduction: While unmet social needs are major drivers of health outcomes, most health systems are not fully integrated with the social care sector to address them. In this case study, we describe the development and implementation of a model utilizing student volunteer community resource navigators to help patients connect with community-based organizations (CBOs). We then detail initial implementation outcomes and practical considerations for future work. Methods: We used the Ten Essential Public Health Services Framework to guide program planning of a student "Help Desk" model for a community health center. Planning included a literature review, observation of exemplar programs, development of a CBO directory, and evaluation of the center's patient population, clinical workflows, and data infrastructure. We piloted the model for two months. After pilot completion, we reviewed patient data to understand the feasibility of the student "Help Desk" model. We utilized planning and pilot execution materials, as well as pilot data, to develop and discuss practical considerations. Results: Design and implementation complemented ongoing social needs screening and referral to CBOs by center case managers. Patients were asked if they would accept telephone follow-up by volunteers two and four weeks after the clinic visit. Of 61 patients screened, 29 patients were referred for follow-up. Ninety percent were reached at least once during the follow-up period, and 48% of patients referred reported connecting to at least one CBO. Only 27% of patients required escalation back to case managers, and no emergency escalation was needed for any patients. Students, faculty advisors, and community health center frontline staff and leadership supported the scale up and continuation of the "Help Desk" model at the community health center. Discussion: Successful implementation required multi-sectoral collaboration, welldefined scope of practice, and data interoperability. Student volunteers are untapped resources to support integrated health and social care.

American Journal of Preventive Medicine, 2020

Introduction: Severe hypertension (≥180 mmHg systolic or ≥110 mmHg diastolic) is associated with ... more Introduction: Severe hypertension (≥180 mmHg systolic or ≥110 mmHg diastolic) is associated with a twofold increase in the relative risk of death. At the authors' Federally Qualified Health Center in the Southeast, 39% of adults (n=8,695) had hypertension, and 3% (n=235) were severe. The purpose of this project was to lower blood pressure and improve the proportion of patients achieving the Agency for Healthcare Research and Quality goal for blood pressure. Methods: This quality improvement project was performed in 2017 in three 3-month Plan, Do, Study, Act cycles using a multidisciplinary outreach model in a community-based primary care setting. A clinical team including physicians, nurses, patient navigators, behavioral health counselors, and pharmacists contacted adult patients with severe hypertension (≥180/110 mmHg), scheduled visits, and established blood pressure and medication management goals. The data review and analysis concluded in 2019. Results: Among patients with blood pressure ≥180/110 mmHg (n=235), the average age was 57 years (SD=12 years), 37% (n=87) were male, 82% (n=193) were Black, and 46% (n=108) were uninsured. The majority of those contacted attended a follow-up appointment within the 9-month project (77%, n=181) and achieved an improved systolic blood pressure (87%, n=167) and diastolic blood pressure (76%, n=146). Target blood pressure of <140/90 mmHg was achieved in 29% of patients (n=53). Medication possession ratio improved from 23% to 40% among patients reached by pharmacists (n=30). Fewer deaths occurred in those reached by the intervention than in those not reached (n=1 vs n=3). Conclusions: Multidisciplinary outreach and use of evidence-based guidelines (Eighth Joint National Committee) were associated with lower blood pressure in patients with severe hypertension.

Circulation, 2020

Introduction: Racial and socioeconomic disparities in hypertension prevalence and treatment have ... more Introduction: Racial and socioeconomic disparities in hypertension prevalence and treatment have been observed over numerous decades. There is opportunity to close racial disparities by focusing resources on patient education, skill-building, and self-management. Methods: A hypertension-reduction program was established between an academic-affiliated FQHC in the southeast, the American Heart Association, the Centers for Disease Control, and the American College of Preventive Medicine using a multidisciplinary outreach model in the community setting. Participants included 265 high-risk patients from the FQHC with severe hypertension (>160/90 mm HG). Program activities included a weekly class where participants learned about hypertension, were trained to take their blood pressure (BP), and received cuffs to use at home. A prospective pre-post cohort design was used to evaluate this portion of the program. Participants’ attendance at the self-management classes was tracked along wit...

NEJM Catalyst, 2020

NEJM Catalyst Insights Council members believe in the efficacy of SDOH data to improve outcomes a... more NEJM Catalyst Insights Council members believe in the efficacy of SDOH data to improve outcomes and the ability of health care organizations to scale up programs.