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Article: The Evolving Role of Nurse Leadership in the Fight for Health Equity.

Azar, Kristen M J

2021 Volume 19, Issue 6, Page(s) 571–575

Abstract: Devastating disparities in COVID-19 infection and outcomes among socioeconomically marginalized groups have resulted in a public outcry to address longstanding societal inequities that have contributed to the present situation. Nurse leaders have an ... ...

Abstract	Devastating disparities in COVID-19 infection and outcomes among socioeconomically marginalized groups have resulted in a public outcry to address longstanding societal inequities that have contributed to the present situation. Nurse leaders have an opportunity and an obligation in this moment to lend their skills as scientists, innovators, advocates, and educators to lead in these efforts, advancing health equity for all.
Language	English
Publishing date	2021-09-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2150320-5
ISSN	1541-4620 ; 1541-4612
ISSN (online)	1541-4620
ISSN	1541-4612
DOI	10.1016/j.mnl.2021.08.006
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Changes in Healthcare Utilization After Lifestyle Intervention for Weight Loss.

Sudat, Sylvia E K / Huang, Qiwen / Szwerinski, Nina / Romanelli, Robert J / Azar, Kristen M J

American journal of preventive medicine

2023 Volume 66, Issue 4, Page(s) 619–626

Abstract: Introduction: This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system.: Methods: Using electronic health record data from a large health system in northern California, U.S., ... ...

Abstract	Introduction: This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system. Methods: Using electronic health record data from a large health system in northern California, U.S., LCP participant and propensity-score-matched nonparticipant outcomes were compared in the second year post-participation: (1) overall healthcare utilization and (2) utilization and medications related to cardiometabolic conditions and obesity. Adult LCP participants between 2010 and 2017 were identified and matched 1:1 with replacement to comparable nonparticipants. Participants without electronic health record activity in the 12-36 months before baseline, or with conditions or procedures associated with substantial weight change, were excluded. Statistical analysis and modeling were performed in 2021-22. Results: Compared to matched nonparticipants, LCP participants in the 12-24 months post-baseline were more likely to have specialty-care visits (+4.7%, 95% CI +1.8%, +7.6%), electronic communications (8.6%, 95% CI +5.6%, +11.7%), and urgent-care visits (+6.5%, 95% CI +3.0%, 10.0%). Participants also had more office visits for cardiometabolic conditions and obesity (+1.72 visits/patient, 95% CI +1.05, +2.39). Conclusions: Compared with matched nonparticipants, LCP participation was associated with higher utilization of outpatient services post-participation. Additional research could assess whether this indicates an increase in preventive care that could lead to improved future outcomes.
MeSH term(s)	Adult ; Humans ; Life Style ; Obesity/prevention & control ; Patient Acceptance of Health Care ; Weight Loss ; Cardiovascular Diseases
Language	English
Publishing date	2023-10-29
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2023.10.018
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Article ; Online: Measuring and Promoting SARS-CoV-2 Vaccine Equity: Development of a COVID-19 Vaccine Equity Index.

Pressman, Alice R / Lockhart, Stephen H / Shen, Zijun / Azar, Kristen M J

Health equity

2021 Volume 5, Issue 1, Page(s) 476–483

Abstract: Purpose: ...

Abstract	Purpose:
Language	English
Publishing date	2021-07-13
Publishing country	United States
Document type	Journal Article
ISSN	2473-1242
ISSN (online)	2473-1242
DOI	10.1089/heq.2021.0047
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Article ; Online: Learning health system, positive deviance analysis, and electronic health records

Kristen M.J. Azar / Mark J. Pletcher / Sarah M. Greene / Alice R. Pressman

Learning Health Systems, Vol 7, Iss 3, Pp n/a-n/a (2023)

Synergy for a learning health system

2023

Abstract: Abstract Introduction Over the past decade, numerous efforts have encouraged the realization of the learning health system (LHS) in the United States. Despite these efforts, and promising aims of the LHS, the full potential and value of research ... ...

Abstract	Abstract Introduction Over the past decade, numerous efforts have encouraged the realization of the learning health system (LHS) in the United States. Despite these efforts, and promising aims of the LHS, the full potential and value of research conducted within LHSs have yet to be realized. New technology coupled with a catalyzing global pandemic have spurred momentum. In addition, the LHS has lacked a consistent framework within which “best evidence” can be identified. Positive deviance analysis, itself reinvigorated by recent advances in health information technology (IT) and ubiquitous adoption of electronic health records (EHRs), may finally provide a framework through which LHSs can be operationalized and optimized. Methods We describe the synergy between positive deviance and the LHS and how they may be integrated to achieve a continuous cycle of health system improvement. Results As we describe below, the positive deviance approach focuses on learning from high‐performing teams and organizations. Conclusion Such learning can be enabled by EHRs and health IT, providing a lens into how digital clinical interventions are successfully developed and deployed.
Keywords	comparative effectiveness ; learning health system ; positive deviance ; quality improvement ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	027
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	Wiley
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Learning health system, positive deviance analysis, and electronic health records: Synergy for a learning health system.

Azar, Kristen M J / Pletcher, Mark J / Greene, Sarah M / Pressman, Alice R

Learning health systems

2022 Volume 7, Issue 3, Page(s) e10348

Abstract: Introduction: Over the past decade, numerous efforts have encouraged the realization of the learning health system (LHS) in the United States. Despite these efforts, and promising aims of the LHS, the full potential and value of research conducted ... ...

Abstract	Introduction: Over the past decade, numerous efforts have encouraged the realization of the learning health system (LHS) in the United States. Despite these efforts, and promising aims of the LHS, the full potential and value of research conducted within LHSs have yet to be realized. New technology coupled with a catalyzing global pandemic have spurred momentum. In addition, the LHS has lacked a consistent framework within which "best evidence" can be identified. Positive deviance analysis, itself reinvigorated by recent advances in health information technology (IT) and ubiquitous adoption of electronic health records (EHRs), may finally provide a framework through which LHSs can be operationalized and optimized. Methods: We describe the synergy between positive deviance and the LHS and how they may be integrated to achieve a continuous cycle of health system improvement. Results: As we describe below, the positive deviance approach focuses on learning from high-performing teams and organizations. Conclusion: Such learning can be enabled by EHRs and health IT, providing a lens into how digital clinical interventions are successfully developed and deployed.
Language	English
Publishing date	2022-10-11
Publishing country	United States
Document type	Journal Article
ISSN	2379-6146
ISSN (online)	2379-6146
DOI	10.1002/lrh2.10348
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Article ; Online: Homelessness Among Acute Care Patients Within a Large Health Care System in Northern California.

Mudiganti, Satish / Nasrallah, Catherine / Brown, Stephanie / Pressman, Alice / Kiger, Anna / Casey, Joan A / LaMori, Joyce C / Pesa, Jacqueline / Azar, Kristen M J

Population health management

2024 Volume 27, Issue 1, Page(s) 13–25

Abstract: The impacts of homelessness on health and health care access are detrimental. Intervention and efforts to improve outcomes and increase availability of affordable housing have mainly originated from the public health sector and government. The role that ... ...

Abstract	The impacts of homelessness on health and health care access are detrimental. Intervention and efforts to improve outcomes and increase availability of affordable housing have mainly originated from the public health sector and government. The role that large community-based health systems may play has yet to be established. This study characterizes patients self-identified as homeless in acute care facilities in a large integrated health care system in Northern California to inform the development of collaborative interventions addressing unmet needs of this vulnerable population. The authors compared sociodemographic characteristics, clinical conditions, and health care utilization of individuals who did and did not self-identify as homeless and characterized their geographical distribution in relation to Sutter hospitals and homeless resources. Between July 1, 2019 and June 30, 2020, 5% (
MeSH term(s)	Male ; Humans ; Middle Aged ; Female ; Ill-Housed Persons ; Mental Disorders ; Housing ; Health Services Accessibility ; California
Language	English
Publishing date	2024-01-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2454546-6
ISSN	1942-7905 ; 1942-7891
ISSN (online)	1942-7905
ISSN	1942-7891
DOI	10.1089/pop.2023.0190
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Article ; Online: Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis.

Huang, Hsiao-Ching / Szwerinski, Nina K / Nasrallah, Catherine / Huang, Qiwen / Chopra, Vidita / Venditti, Elizabeth M / Azar, Kristen M J / Romanelli, Robert J

Translational behavioral medicine

2023 Volume 13, Issue 3, Page(s) 168–182

Abstract: Participant engagement in structured lifestyle change programs (LCPs) is essential for adopting behaviors that promote weight loss; however, the challenges to, and facilitators that promote, engagement with such programs are not well understood. We ... ...

Abstract	Participant engagement in structured lifestyle change programs (LCPs) is essential for adopting behaviors that promote weight loss; however, the challenges to, and facilitators that promote, engagement with such programs are not well understood. We conducted a mixed-methods study among real-world LCP participants to assess factors associated with program engagement and to examine the reasons for withdrawal. Using electronic health records (EHR), we identified LCP eligible participants between 2010 and 2017. Multivariable logistic regression was used to assess associations between program engagement and baseline characteristics. Semi-structured interviews with LCP participants were conducted and thematically analyzed to examine reasons for withdrawal. A total of 1,813 LCP participants were included. The median number of sessions attended was 10 of 21-25 sessions. Highest LCP engagement was associated with factors potentially related to self-efficacy/motivation, such as older age, higher baseline weight, prior healthcare utilization and an absence of a history of smoking or depression. Engagement was also negatively associated with being Non-Hispanic Black versus White. The qualitative analysis of the interviews revealed four general themes pertaining to participants' withdrawal: competing priorities, perceived program effectiveness, characteristics of the program, and facilitator-related factors. Taken together, results from this mixed-methods study suggest that motivation and self-efficacy are important for program engagement; future LCP enhancements should incorporate flexible formats that may help participants manage competing priorities and maximize personal and cultural relevance for all racial/ethnic groups, especially those who have not benefitted fully. Furthermore, participants should be encouraged to set realistic goals to manage expectations.
MeSH term(s)	Humans ; Life Style ; Motivation ; Patient Acceptance of Health Care ; Body Weight ; Weight Loss
Language	English
Publishing date	2023-01-24
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2586893-7
ISSN	1613-9860 ; 1869-6716
ISSN (online)	1613-9860
ISSN	1869-6716
DOI	10.1093/tbm/ibac098
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Article ; Online: Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention.

Azar, Kristen M J / Sudat, Sylvia / Huang, Qiwen / Pressman, Alice P / Szwerinski, Nina K / Nasrallah, Catherine / Venditti, Elizabeth M / Romanelli, Robert J

Obesity science & practice

2023 Volume 9, Issue 6, Page(s) 641–652

Abstract: Objective: Evaluations of lifestyle modification interventions (LMIs), modeled after the Diabetes Prevention Program, have repeatedly shown a dose-response relationship between session attendance and weight loss. Despite this, not all participants had " ... ...

Abstract	Objective: Evaluations of lifestyle modification interventions (LMIs), modeled after the Diabetes Prevention Program, have repeatedly shown a dose-response relationship between session attendance and weight loss. Despite this, not all participants had "average" weight loss experiences. Nearly one-third of LMI participants experienced unexpected, paradoxical outcomes (i.e., high attendance with little weight loss, and low attendance with clinically significant weight loss). Paradoxical weight-loss outcomes were characterized based on session attendance among participants in a group-based LMI in a real-world healthcare setting. This group-based LMI was delivered over 1 year to participants with the possibility of attending up to 25 sessions total. Methods: LMI participants identified in 2010-2017 from electronic health records were characterized as having low (<75%) or high (≥75%) session attendance. Weight-loss outcomes were defined as expected (≥5%, high-attendance; <5%, low-attendance) or paradoxical (≥5%, low-attendance; <5%, high-attendance). Paradoxical-outcome-associated characteristics were identified using logistic regression. Results: Among 1813 LMI participants, 1498 (82.6%) had low and 315 (17.4%) high session attendance; 555 (30.6%) had paradoxical outcomes, comprising 415 (74.8%) responders (≥5% weight-loss) and 140 (25.2%) non-responders (<5% weight-loss). Among participants with high session attendance, paradoxical non-responders were more likely to be female (odds ratio [OR]: 2.76; 95% confidence interval [CI]: 1.32, 5.77) and have type 2 diabetes (OR: 3.32; 95% CI: 1.01, 10.95). Among low-attendance participants, paradoxical responders were more likely to be non-Hispanic White and less likely to be non-Hispanic Black (OR: 0.35; 95% CI: 0.18, 0.69), non-Hispanic Asian (OR: 0.40; 95% CI: 0.22, 0.73), or Hispanic (OR: 0.53; 95% CI: 0.35, 0.80). Conclusions: In a healthcare setting, nearly one-third of LMI participants experienced paradoxical outcomes. More research is needed to understand the facilitators and barriers to weight loss above and beyond session attendance.
Language	English
Publishing date	2023-07-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2836381-4
ISSN	2055-2238 ; 2055-2238
ISSN (online)	2055-2238
ISSN	2055-2238
DOI	10.1002/osp4.696
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Article ; Online: Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course.

Sudat, Sylvia E K / Wesson, Paul / Rhoads, Kim F / Brown, Stephanie / Aboelata, Noha / Pressman, Alice R / Mani, Aravind / Azar, Kristen M J

American journal of epidemiology

2022 Volume 192, Issue 5, Page(s) 703–713

Abstract: Arterial blood oxygen saturation as measured by pulse oximetry (peripheral oxygen saturation (SpO2)) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect the course of coronavirus disease 2019 ( ... ...

Abstract	Arterial blood oxygen saturation as measured by pulse oximetry (peripheral oxygen saturation (SpO2)) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect the course of coronavirus disease 2019 (COVID-19) treatment. We analyzed pulse oximeter accuracy and its association with COVID-19 treatment outcomes using electronic health record data from Sutter Health, a large, mixed-payer, integrated health-care delivery system in Northern California. We analyzed 2 cohorts: 1) 43,753 non-Hispanic White (NHW) or non-Hispanic Black/African-American (NHB) adults with concurrent arterial blood gas oxygen saturation/SpO2 measurements taken between January 2020 and February 2021; and 2) 8,735 adults who went to a hospital emergency department with COVID-19 between July 2020 and February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (-3.1 percentage points), dexamethasone treatment (-3.1 percentage points), and supplemental oxygen treatment (-4.5 percentage points), as well as increased time to treatment: 37.2 minutes before dexamethasone initiation and 278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.
MeSH term(s)	Adult ; Humans ; COVID-19/therapy ; COVID-19 Drug Treatment ; Dexamethasone/therapeutic use ; Oximetry/methods ; Oxygen/therapeutic use ; Healthcare Disparities ; Electronic Health Records ; Health Equity
Chemical Substances	Dexamethasone (7S5I7G3JQL) ; Oxygen (S88TT14065)
Language	English
Publishing date	2022-09-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwac164
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Article ; Online: Racial and sociodemographic predictors of COVID-19 compared with influenza, appendicitis, and all-cause hospitalization: retrospective cohort analysis.

Raphael, Eva / Azar, Kristen M J / Gu, Dian / Shen, Zijun / Rubinsky, Anna / Wang, Michael / Pantell, Matthew / Lyles, Courtney R / Fernandez, Alicia / Bibbins-Domingo, Kirsten / Pressman, Alice / Nasrallah, Catherine / Hamad, Rita

Ethnicity & health

2023 Volume 28, Issue 6, Page(s) 836–852

Abstract: Objective: To determine whether inequities in COVID-19 infection and hospitalization differ from those for common medical conditions: influenza, appendicitis, and all-cause hospitalization.: Design: Retrospective study based on electronic health ... ...

Abstract	Objective: To determine whether inequities in COVID-19 infection and hospitalization differ from those for common medical conditions: influenza, appendicitis, and all-cause hospitalization. Design: Retrospective study based on electronic health records of three healthcare systems in San Francisco (university, public, and community) examining (1) racial/ethnic distribution in cases and hospitalization among patients with diagnosed COVID-19 (March-August 2020) and patients with diagnosed influenza, diagnosed appendicitis, or all-cause hospitalization (August 2017-March 2020), and (2) sociodemographic predictors of hospitalization among those with diagnosed COVID-19 and influenza. Results: Patients 18 years or older with diagnosed COVID-19 ( Conclusions: Racial/ethnic and sociodemographic inequities in diagnosed COVID-19 and hospitalization differed from those for diagnosed influenza and other medical conditions, with consistently higher odds among Latine and Spanish-speaking patients. This work highlights the need for disease-specific public health efforts in at-risk communities in addition to structural upstream interventions.
MeSH term(s)	Humans ; Male ; Appendicitis/epidemiology ; Black or African American/statistics & numerical data ; Cohort Studies ; COVID-19/epidemiology ; Hospitalization/statistics & numerical data ; Influenza, Human/epidemiology ; Obesity/epidemiology ; Retrospective Studies ; White People/statistics & numerical data ; San Francisco/epidemiology ; Female ; Adolescent ; Young Adult ; Adult ; Asian American Native Hawaiian and Pacific Islander/statistics & numerical data ; Hispanic or Latino/statistics & numerical data
Language	English
Publishing date	2023-03-12
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1497968-8
ISSN	1465-3419 ; 1355-7858
ISSN (online)	1465-3419
ISSN	1355-7858
DOI	10.1080/13557858.2023.2179021
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