BACKGROUND: Ineffective transitions of care continue to be a source of risk for patients. Although there has been widespread implementation of electronic medical record (EMR) systems, little is currently known about hospitalists' and primary care providers' (PCPs) direct communication preferences at discharge using messaging capabilities in a shared EMR system. OBJECTIVE: We examined how hospitalists and PCPs with a shared EMR prefer to directly communicate at the time of hospital discharge by identifying preferred modes, information prioritization, challenges, facilitators, and proposed solutions. DESIGN: A sequential, explanatory mixed methods study with surveys and semi-structured interviews. PARTICIPANTS: Thirty-eight academic hospitalists and 63 PCPs working in outpatient clinics in a single safety net hospital system with a shared EMR. MAIN APPROACH: Descriptive statistics were used to analyze survey responses. Interviews were analyzed using immersion/crystallization and a mixture of inductive and deductive thematic analysis. KEY RESULTS: PCPs preferred direct communication at discharge through a message within the EMR while hospitalists preferred a message within the EMR and email. Qualitative results identified key themes related to patient care and direct communication: value of direct communication, safety, social determinants of health, and clinical judgment. Both groups prioritized direct communication for high-risk medications, pending and follow-up studies, and high-risk patients that hospitalists were concerned about. Overall, both hospitalists and PCPs reported that ensuring patient safety, flagging patients with social challenges, and expressing concerns about patients based on clinical judgment were key communication priorities.CONCLUSIONS: Hospitalists and primary care providers report considerable overlap in preferences for direct communication at the time of hospital discharge through a shared EMR. Specifically, both groups reported similar concerns regarding patient safety and continuity during transitions. Direct messaging within the EMR could enable "closed loop" communication that helps ensure safe transitions of care for high-risk patients.
Psychological theories of identity concealment locate the ultimate source of concealment decisions within the social environment, yet most studies have not explicitly assessed stigmatizing environments beyond the immediate situation. We advanced the identity-concealment literature by objectively measuring structural forms of stigma related to sexual orientation (e.g., social policies) at proximal and distal geographic levels. We linked these measures to a new, population-based data set of 502 gay and bisexual men (residing in 44 states and Washington, DC; 269 counties; and 354 cities) who completed survey items about stigma, including identity-concealment motivation. Among gay men, the association between structural stigma and concealment motivation was (a) observed across three levels (city, county, and state), (b) conditional on one’s exposure at another geographic level (participants reported the least motivations to conceal their identity if they resided in both cities and states that were lowest in structural stigma), and (c) mediated by subjective perceptions of greater structural stigma.
Objective: This study evaluated the degree to which recommendations for demographic data standardization improve patient matching accuracy using real-world datasets. Methods: We used four manually reviewed datasets, containing a random selection of matches and non-matches. Matching datasets included Health Information Exchange (HIE) records, public health registry records, Social Security Death Master records, and newborn screening records. Standardized fields including last name (LN), telephone number (TEL), social security number (SSN), date of birth (DOB), and address (ADDR). Matching performance was evaluated using four metrics: sensitivity, specificity, positive predictive value, and accuracy. Results: Standardizing address was independently associated with improved matching sensitivities for both the public health and HIE datasets of approximately 0.6% and 4.5%. Overall accuracy was unchanged for both datasets due to reduced match specificity. We observed no similar impact for address standardization in the death master file dataset. Standardizing last name yielded improved matching sensitivity of 0.6% for the HIE dataset, while overall accuracy remained the same due to a decrease in match specificity. We noted no similar impact for other datasets. Standardizing other individual fields (telephone, DOB, or SSN) showed no matching improvements. Since standardizing address and last name improved matching sensitivity, we examined the combined effect of address and last name standardization, which showed that standardization improved sensitivity from 81.3% to 91.6% for the HIE dataset. Conclusion: Data standardization can improve match rates, thus ensuring that patients and clinicians have better data on which to make decisions to enhance care quality and safety.
Bisexual men are disproportionately affected by negative mental health outcomes compared to heterosexual and gay men. These disparities are related to the unique stressors that they experience, and emerging evidence suggests that their experiences of these stressors can be different depending on the gender of their partner. However, previous studies have largely focused on bisexual women and little is known about the role of partner gender in bisexual men's experiences and mental health. We examined the associations between relationship type and outness, stigma-related experiences, and mental health using data from Wave 1 of the National Study of Stigma and Sexual Health, a probability-based sample of 502 gay and bisexual men in the U.S. Analyses focused on the subset of 128 men who identified as bisexual (44.53% in relationships with women, 14.84% in relationships with men, 40.63% not in relationships). Bisexual men in relationships with men reported being more out than those in relationships with women and those who were not in relationships; furthermore, bisexual men in relationships with men reported more discrimination and family stress than those in relationships with women. Bisexual men who were not in relationships reported more anticipated and internalized stigma than those in relationships with men; additionally, bisexual men who were not in relationships reported more anticipated stigma and depression than those in relationships with women. Partner gender plays a role in bisexual men's stigma-related experiences and mental health, and efforts to improve bisexual men's health should attend to sexual orientation, relationship status, and partner gender.
Background: Although gay and bisexual men (GBM) represent the largest group of HIV-infected individuals in the United States, nearly all evidence on their HIV risk and prevention outcomes derive from nonprobability samples. Setting: A probability-based cohort of GBM (N = 502) from 45 states and Washington, DC. Methods: Cross-sectional survey. Results: Among HIV-negative/unknown/untested GBM, only 6.7% reported using pre-exposure prophylaxis (PrEP) in the past 6 months. Two-thirds (63.3%) of PrEP users reported daily adherence in the past week. Over half (54.2%) of GBM reported not using a condom during anal sex with their most recent male partner; of these men, 93.8% were not on PrEP. Most GBM had been tested for HIV (80.7%) and other sexually transmitted infections (67.1%) in their lifetime, with 45.2% having tested for HIV during the past year. Among those ever tested, 14.1% reported being HIV infected, whereas an additional 8.9% reported testing positive for at least one other sexually transmitted infection after their most recent test. All HIV-positive GBM reported being currently on antiretroviral treatment, and 94.7% reported an undetectable viral load, but nearly one-third (30.4%) reported not taking their medication every day during the past month. A majority of HIV-negative/unknown/untested GBM (64.3%) reported that they had never discussed HIV prevention with their primary health care provider. Conclusions: Our findings present a decidedly mixed picture regarding the success of the US National HIV/AIDS Strategy in meeting its stated goals of addressing HIV risk among the general population of GBM.
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