Delaware journal of public health最新文献

Objective: To describe the use, activities, and human interactions of cobots as a delivery system for medications, supplies, and equipment within a complex and multi-level 900-bed hospital setting. Integrating collaborative robots (cobots) into existing hospital workflows as a secure delivery transportation system is an early innovation and emerging area to explore.

Methods: Guided by the Diffusion of Innovations theory, a qualitative descriptive design was used to build the foundational knowledge required to better understand and describe cobot implementation in the acute care hospital setting. The cobots were observed on all shifts, on different days of the week as they interacted with staff members, clinicians, and visitors while they traveled throughout the hospital completing deliveries. Data were analyzed among the study team members using an inductive coding approach followed by a qualitative content analysis level of interpretation.

Results: For seven weeks from November 2022 - December 2022, 33 hours were collected from 23 individual cobot observation sessions. These observations included 89 end-to-end cobot deliveries. After analysis, four major themes emerged: 1) humanization of robots, 2) usability of robots, 3) cobots' autonomy, and 4) cobots' functionality within a dynamic hospital environment.

Conclusions: Implementing cobots as a semi-autonomous delivery transporter is still in the early innovation phase. The cobots used in this study required human support to function adequately in a complicated and unpredictable environment. To sustainably augment current and future workflows exclusively performed by human, the cobots will need to transition toward greater model of autonomy and less human assistance.

Objective: In the wake of COVID-19, the use of virtual modalities to provide healthcare has increased significantly. While virtual care services, particularly for behavioral health encounters, have become commonplace in many healthcare systems, there is limited data describing to what extent access to virtual care is affected by social determinants of health. The present study aims to characterize the utilization of virtual (video, phone) and non-virtual (in-person office visits) behavioral health care encounters among differing socioeconomic and demographic populations in two campuses served by a tertiary care center in Delaware to identify trends and potential barriers to these services.

Methods: A dataset of 19500 behavioral health visits among 3420 patients in the Christiana-Care health network at sites in Newark, DE and Wilmington, DE was analyzed using Kruskal-Wallis test results for continuous variables and chi-squared tests for categorical variables.

Results: Patients utilizing virtual (video, phone) visits tended to be younger and have a lighter burden of economic inequality than patients seen in-person. Metrics such as access to a computer, internet connection, and median income were directly correlated with increased use of virtual modalities.

Conclusion: The findings indicate that access to and utilization of virtual care may be a social determinant of health. Future research should assess access to telehealth and its impact on health outcomes.

COVID-19 and related challenges to patient access necessitated the development of new models of care to ensure a healthy patient population. This paper describes the outcomes of a pilot virtual primary care program at a large independent academic health center in Delaware. The preliminary results are encouraging from the perspective of provider and patient satisfaction, as well as the utility of the operational model. A complete cost-benefit analysis was beyond the scope of the paper; thus, future operational research should focus on the metrics of cost and quality as key indicators of model sustainability.

Objective: To investigate if a telehealth option as the initial postpartum visit would increase postpartum visit attendance.

Methods: This was a retrospective cohort study of women receiving prenatal care through a federally qualified health center, Westside Family Health in Delaware, comparing attendance at a postpartum visit before telehealth was an option (2018) versus after the onset of the pandemic (2021). Representative random samples were taken from one year of deliveries pre- and post-implementation of the telehealth visit option. The primary outcome of this study was attendance of any postpartum visit before and after the option of a telehealth visit.

Results: A total of 700 subjects were enrolled, with 349 subjects pre-telehealth and 351 subjects post-telehealth implementation. Our population was >50% Hispanic/Latina and >40% Spanish- speaking. The post-implementation group had a significantly higher attendance of the postpartum visit (83.95% vs. 90.60%, p-value 0.0092, OR 1.887, 95% CI 1.171-3.043).

Conclusion: There was a significant increase in the rate of postpartum visit attendance with the addition of a telehealth visit option. Postpartum depression screening was negatively impacted by the introduction of the telehealth visit.

Public health implications: The recommendation for all women post-delivery is to see their obstetric provider within the first 3 weeks postpartum. This includes assessing for complications, postpartum wellness and interconception care planning before 12 weeks post-delivery. We found that there was a significant increase in the rate of postpartum visit attendance with the addition of a telehealth visit option. Telemedicine has increased dramatically with the COVID-19 pandemic, and patients are satisfied with telehealth as an option for care. Telemedicine offers the convenience of portable health care. However, those in underserved populations may or may not be able to access care through telemedicine, as telehealth requires reliable internet service, a smartphone or computer, and digital literacy. Lack of access to any of these may create health care disparities, especially in disadvantaged or vulnerable populations.