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IMPORTANCEAdults who belong to racial/ethnic minority groups are more likely than White adults to receive a diagnosis of chronic disease in the United States. OBJECTIVE To evaluate which health indicators have improved or become worse among Black and Hispanic middle-aged and older adults since the Minority Health and Health Disparities Research and Education Act of 2000. DESIGN, SETTING, AND PARTICIPANTS In this repeated cross-sectional study, a total of 4 856 326 records were extracted from the Behavioral Risk Factor Surveillance System from January 1999 through December 2018 of persons who self-identified as Black (non-Hispanic), Hispanic (non-White), or White and who were 45 years or older. EXPOSUREThe 1999 legislation to reduce racial/ethnic health disparities. MAIN OUTCOMES AND MEASURESPoor health indicators and disparities including major chronic diseases, physical inactivity, uninsured status, and overall poor health. RESULTS Among the 4 856 326 participants (2 958 041 [60.9%] women; mean [SD] age, 60.4 [11.8] years), Black adults showed an overall decrease indicating improvement in uninsured status (β = −0.40%; P < .001) and physical inactivity (β = −0.29%; P < .001), while they showed an overall increase indicating deterioration in hypertension (β = 0.88%; P < .001), diabetes (β = 0.52%; P < .001), asthma (β = 0.25%; P < .001), and stroke (β = 0.15%; P < .001) during the last 20 years.The Black-White gap (ie, the change in β between groups) showed improvement (2 trend lines converging) in uninsured status (−0.20%; P < .001) and physical inactivity (−0.29%; P < .001), while the Black-White gap worsened (2 trend lines diverging) in diabetes (0.14%; P < .001), hypertension (0.15%; P < .001), coronary heart disease (0.07%; P < .001), stroke (0.07%; P < .001), and asthma (0.11%; P < .001). Hispanic adults showed improvement in physical inactivity (β = −0.28%; P = .02) and perceived poor health (β = −0.22%; P = .001), while they showed overall deterioration in hypertension (β = 0.79%; P < .001) and diabetes (β = 0.50%; P < .001). The Hispanic-White gap showed improvement in coronary heart disease (−0.15%; P < .001), stroke (−0.04%; P < .001), kidney disease (−0.06%; P < .001), asthma (−0.06%; P = .02), arthritis (−0.26%; P < .001), depression (−0.23%; P < .001), and physical inactivity (−0.10%; P = .001), while the Hispanic-White gap worsened in diabetes (0.15%; P < .001), hypertension (0.05%; P = .03), and uninsured status (0.09%; P < .001).

Purpose To describe the processes and outcomes of developing and implementing a Continuity of Care Document (CCD), My Health Profile, as personal health record for persons living with HIV (PLWH) in an HIV/AIDS Special Needs Plan (SNP) in New York City. Methods Multiple qualitative and quantitative data sources were used to describe the processes and outcomes of implementing My Health Profile including focus groups, Audio Computer Assisted Self Interview (ACASI) surveys, administrative databases, chart abstraction, usage logs, and project management records. Qualitative data were thematically analyzed. Quantitative data analytic methods included descriptive and multivariate statistics. Data were triangulated and synthesized using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework. Results Reach SNP members are predominantly African American or Hispanic/Latino and about one third are female. A larger proportion of African Americans and smaller proportions of Hispanics/Latinos and Whites were trained to use My Health Profile. Efficacy/Effectiveness CCDs were produced for 8,249 unique members and updated on a monthly basis, 509 members were trained to use My Health Profile. Total number of member logins for 112 active users was 1,808 and the longest duration of use was 1,008 days. There were no significant differences between users and non-users of My Health Profile in clinical outcomes, perceptions of the quality of medical care, or health service utilization. Adoption My Health Profile was well-matched to organizational mission, values, and priorities related to coordination of care for a high-risk population of PLWH. Implementation Pre-implementation focus group participants identified potential barriers to use of My Health Profile including functional and computer literacy, privacy and confidentiality concerns, potential reluctance to use technology, and cognitive challenges. Key strategies for addressing barriers included a dedicated bilingual coach for recruitment, training, and support; basic computer and My Health Profile training; transparent audit trail revealing clinician and case manager access of My Health Profile, time-limited passwords for sharing My Health Profile with others at the point of need, and emergency access mechanism. Maintenance My Health Profile was integrated into routine operational activities and its sustainability is facilitated by its foundation on standards for Health Information Exchange (HIE). Conclusions Although potential barriers exist to the use of PHRs such as My Health Profile, PLWH with complex medical needs, low socioeconomic status, and limited computer experience will use such tools when a sufficient level of user support is provided and privacy and confidentiality concerns are addressed.

Highlights Three themes emerged from the data: Risk assessment and planning, innovative evolution of roles and responsibilities, and pandemic response and capacity. In a rapidly changing landscape of practice protocols and discipline-specific responsibilities, it is key to secure capacity-building resources early on. Hierarchies seemed to compress during the pandemic, with a leveling of the traditional roles played by different professions. Clear, concise and consistent information must be accessible to all staff.

Background Despite their integral role, Home Health Aides (HHAs) are largely unrecognized as essential to implementing effective infection prevention and control practices in the home healthcare setting. We sought to understand the infection prevention and control needs and challenges associated with caring for patients during the pandemic from the perspective of HHAs. Methods From June to August 2020, data were collected from HHAs in the New York metropolitan area using semi-structured qualitative interviews by telephone; 12 HHAs were interviewed in Spanish. Audio-recorded interviews were transcribed, translated and analyzed using conventional content analysis. Results In total, 25 HHAs employed by 4 unique home care agencies participated. HHAs had a mean age of 49.8 (±9.1), 24 (97%) female, 11 (44%) Black, 12 (48%) Hispanic. Three major themes related to the experience of HHA's working during the COVID-19 pandemic emerged: (a) all alone, (b) limited access to information and resources, and (c) dilemmas related to enhanced COVID-19 precautions. Hispanic HHAs with limited English proficiency faced additional difficulties related to communication. Conclusion We found that HHA communication with nursing staff, plays a key role in infection control efforts in home care. Efforts to manage COVID-19 in home care should include improving communication between HHAs and nursing staff.

This study examines healthcare utilization over time in Bronx, New York schoolchildren with asthma who were previously identified via parent surveys in six elementary schools. Four of the schools have on-site school-based health centers (SBHCs), and two do not have on-site health services (control schools). At baseline, we reported an asthma prevalence of 20%, and high rates of emergency department (ED) use (46%) in the previous year. To determine if asthma morbidity (specifically, ED use, community provider use, and hospitalizations for asthma) could be reduced by incorporating an aggressive intervention at two schools with SBHCs, we prospectively followed children for up to 3 years. Parents were scheduled for interviews every 6 months, and were queried about their children's use of health services for asthma in the prior 6 months. In multivariate models, children in the two intervention SBHC schools were less likely to have visited a community provider for asthma (relative rate ratio, 0.52; 95% confidence interval (CI), 0.30-0.88) or an emergency department for asthma (odds ratio, 0.44; 95% CI, 0.14-1.38; P = 0.059) in the prior 6 months compared to children attending control schools. There was no difference in community provider use or emergency department use for asthma between children attending nonintervention SBHCs and control schools. However, school type did not affect asthma hospitalization rates, which declined in all groups. Our findings support the effectiveness of aggressive school-based asthma services provided by SBHCs to reduce asthma morbidity and complement community health services.

Introduction. For effective public communication during major disease outbreaks like the 2014-2016 Ebola epidemic, health information needs of the population must be adequately assessed. Through content analysis of social media data, like tweets, public health information needs can be effectively assessed and in turn provide appropriate health information to effectively address such needs. The aim of the current study was to assess health information needs about Ebola, at distinct epidemic time points, through longitudinal tracking.

Introduction:For effective public communication during major disease outbreaks like the 2014-2016 Ebola epidemic, health information needs of the population must be adequately assessed. Through content analysis of social media data, like tweets, public health information needs can be effectively assessed and in turn provide appropriate health information to address such needs. The aim of the current study was to assess health information needs about Ebola, at distinct epidemic time points, through longitudinal tracking.Methods:Natural language processing was applied to explore public response to Ebola over time from July 2014 to March 2015. A total 155,647 tweets (unique 68,736, retweet 86,911) mentioning Ebola were analyzed and visualized with infographics.Results:Public fear, frustration, and health information seeking regarding Ebola-related global priorities were observed across time. Our longitudinal content analysis revealed that due to ongoing health information deficiencies, resulting in fear and frustration, social media was at times an impediment and not a vehicle to support health information needs. Discussion:Content analysis of tweets effectively assessed Ebola information needs. Our study also demonstrates the use of Twitter as a method for capturing real-time data to assess ongoing information needs, fear, and frustration over time.