Bandaging amputee

Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers

Expect Delays: Poor Connections Between Rural and Urban Health Systems Challenge Multidisciplinary Care for Rural Americans With Diabetic Foot Ulcers

Over 30 million people in the United States have diabetes, and up to 25% of them will develop a diabetic foot ulcer (DFU). Specific to DFUs, rural patients face 50% higher odds of major (above-ankle) amputation and 40% higher odds of death compared to their urban counterparts. A group of authors including HIP Investigators, Dr. Meghan Brennan and Dr. Christie Bartels sought to understand what health system factors contribute to the rural disparity in diabetic foot ulcer outcomes.

The authors concluded that future interventions focusing on mitigating the poor connections across rural and urban healthcare systems could reduce the rural disparity in major amputations.

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Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition

Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy, Third Edition

The third edition of the Practice Guidelines for Ocular Telehealth-Diabetic Retinopathy includes fundamental requirements to be followed when providing medical and other health care services using telecommunication technologies, and any other electronic communications between patients, practitioners, and other health care providers, as well as “best practice” recommendations. These guidelines were co-authored by HIP Investigator, Dr. Yao Liu and aim to assist providers in pursuing a sound course of action in providing safe and effective medical care using telehealth tools based on current scientific knowledge, technological requirements, and patient needs.

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Health System Research Priorities for Children and Youth With Special Health Care Needs

Health System Research Priorities for Children and Youth With Special Health Care Needs

Children and youth with special health care needs (CYSHCN) have, or are at an increased risk for, chronic physical, developmental, behavioral, or emotional conditions and also require health and related services of a type or amount beyond that required by children generally.

HIP Investigator, Dr. Ryan Coller et al. synthesized the opinions of a national multidisciplinary group of CYSHCN experts, including family caregivers, to prioritize research topics facing CYSHCN. Authors sought to take a foundational step toward developing a national research agenda for CYSHCN systems of care.

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Association of Cardiovascular and Alzheimer’s Disease Risk Factors with Intracranial Arterial Blood Flow in Whites and African Americans

Association of Cardiovascular and Alzheimer’s Disease Risk Factors with Intracranial Arterial Blood Flow in Whites and African Americans

Alzheimer’s disease (AD) is the most common cause of dementia among older adults (≥60 years old), affecting more than 5.3 million people in the United States. AD has a higher prevalence among African Americans. Targeting cardiovascular and metabolic risk factors may be potential mechanisms to modify AD risk and address racial/ethnic disparities in AD dementia. HIP Investigator, Dr. Heather Johnson et al. investigated relationships among cardiovascular and metabolic risk factors, APOE genotype, AD biomarkers, and intracranial arterial blood flow in Whites and African Americans enriched for AD risk.

Authors found that elevated fasting glucose and triglycerides were associated with lower intracranial arterial flow; these relationships were more prominent in African Americans. Targeting metabolic risk factors may impact intracranial arterial health. Additional research is needed to determine if this will impact disparities in dementia prevalence.

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Investigating lupus retention in care to inform interventions for disparities reduction: an observational cohort study

Investigating lupus retention in care to inform interventions for disparities reduction: an observational cohort study

Systemic lupus erythematosus (SLE) is an autoimmune disease that disproportionately impacts young women, patients of color, and the socioeconomically disadvantaged, making SLE an important target for health disparity measurement and research. HIP Investigator, Dr. Christie Bartels et al. applied WHO-endorsed metrics that helped reduce similar disparities in HIV to investigate relationships between race, disadvantage, and retention in care in an urban lupus cohort. The authors examined predictors of lupus retention in care, developed an SLE Care Continuum, and informed interventions to reduce disparities. Key findings include 40% of patients not being retained at one year, and neighborhood disadvantage was the leading predictor of retention gaps.

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Eye doctor

Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program

Diabetic Retinopathy Assessment Variability Among Eye Care Providers in an Urban Teleophthalmology Program

Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability. While teleophthalmology has become increasingly accepted for diabetic eye screening in primary care settings, the availability of adequately trained, qualified readers may limit its widespread implementation. HIP Investigator, Dr. Yao Liu et al. assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program.

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Eye exam

Factors influencing patient adherence with diabetic eye screening in rural communities: A qualitative study

Factors influencing patient adherence with diabetic eye screening in rural communities: A qualitative study

Diabetic retinopathy remains the leading cause of blindness among working-age U.S. adults largely due to low screening rates. Rural populations face particularly greater challenges to screening because they are older, poorer, less insured, and less likely to receive guideline-concordant care than those in urban areas. Current patient education efforts may not fully address multiple barriers to screening faced by rural patients. HIP Investigator, Dr. Yao Liu et al. sought to characterize contextual factors affecting rural patient adherence with diabetic eye screening guidelines.

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Asset-Based Community Development as a Strategy for Developing Local Global Health Curricula.

Asset-Based Community Development as a Strategy for Developing Local Global Health Curricula.

A significant and growing proportion of US children have immigrant parents, an issue of increasing importance to pediatricians. Training globally minded pediatric residents to address health inequities related to globalization is an important reason to expand educational strategies around local global health (LGH). HIP Investigator, Dr. Ryan Coller et al. developed a curriculum in the pediatric global health residency track at UW to address gaps in LGH education and to increase resident knowledge about local health disparities for global community members.

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Longitudinal trends and predictors of statin use among patients with diabetes.

Longitudinal trends and predictors of statin use among patients with diabetes.

Patients with diabetes have a well-established elevated risk of cardiovascular disease. Statins reduce morbidity and mortality among patients with diabetes, but their use remains suboptimal. In this study, HIP Investigator Dr. Meghan Brennan et al. sought to understand trends in statin use to inform strategies for improvement. They found that Statin use is slowly increasing among patients with diabetes, and at varying rates within subgroups of this population. Policies that prioritize these subgroups for statin promotion may help guide future, intervention-based research to increase compliance with current guidelines.

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Sociodemographics and hypertension control among young adults

Sociodemographics and hypertension control among young adults

Young adults ages 18-39 have low hypertension control rates compared to young adults. Using electronic health record data, Dr. Heather Johnson et al. evaluated the role of sociodemographic factors in hypertension control among young adults with primary care access and incident hypertension. They found that young men had a 39% lower rate of hypertension control compared to young women, and that people for whom English was not their primary language and unmarried people also had lower control rates.

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