Tackling the Dual Economic and Public Health Crises Caused by Covid-19 in Baltimore: Early Lessons from the Baltimore Health Corps Pilot

On March 12, 2020, the first case of Covid-19 was diagnosed in Baltimore City. Its infection rate increased rapidly through March and into April and May, proving to be 4 times higher among Latino residents and 1.5 times higher among Black residents than the city's White population. At the same time, the city's unemployment rate surged from 4.9 percent in March to a peak of 11.6 percent in April 2020. In June, The Rockefeller Foundation supported the Baltimore City government in launching the Baltimore Health Corps (BHC), a pilot program to recruit, train, and employ 275 new community health workers who were unemployed, furloughed, or underemployed, living in neighborhoods hardest hit by the health crisis and especially those residents unemployed as a result of Covid-19. BHC used equitable recruitment and hiring practices to employ contact tracers, care coordinators, and support staff, with a focus on good jobs, fair pay, training, skill-building, and support to improve career trajectories. This report, compiling data and interviews midway through the project, is a look at some of the early successes and the challenges ahead

‘Making it Meaningful’: Co-designing an intervention to improve medication safety for people from culturally and linguistically diverse backgrounds accessing cancer services.

This study reports on the process of using an adapted Experienced-Based Co-Design (EBCD) conducted with culturally and linguistically diverse (CALD) consumers and cancer service staff to co-design the novel ‘Making it Meaningful’(MiM) instrument at a cancer service in Australia. Multi-source experiential and contextual information was gathered in phase 1 of the co-design and this evidence, coupled with knowledge gathered via a feedback event was used to inform three co-design workshops in phase 2. A series of meetings were conducted prior to and in between the workshops. Theory was progressively integrated into the workshop content. Two Mandarin speaking CALD consumers and three cancer service staff participated as co-design members. Workshops were supported by a multilingual fieldworker, co-facilitated by researchers and a consumer co-facilitator, and conducted using a hybrid model (face-to-face or online participation). In the first workshop members democratically selected to focus on a strategy to enable CALD consumers to make non-emergency urgent contact with the cancer service for medication related communication. The second workshop resulted in consensus to develop an accessible instrument that would identify appropriate contacts and information sources for medication management between appointments. In the third workshop, the prototype MiM instrument was developed and refined. The MiM is a novel instrument designed with CALD consumers to enhance their knowledge of medication management and empower them to contact cancer service staff about medication safety concerns. Feasibility testing is the next step with successful implementation requiring senior health leadership support and involvement of co-design members as change agents. Experience Framework This article is associated with the Quality & Clinical Excellence lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

'When you have children, you're obliged to live': Motherhood, Chronic Illness and Biographical Disruption

Recent work on biographical disruption has emphasised the critical importance of timing and context to the understanding of the effects of illness on identity. This paper takes a different approach by examining the inter-relationship between illness and key sources of identity, in this instance HIV infection and motherhood. It is argued that, viewed in this light, biographical disruption remains a powerful analytic framework with which to explore the intense threat which may be posed to key identities by chronic, potentially fatal illnesses, and the fundamental re-working of such identities occasioned by such threats. With reference to the empirical study on which this paper draws, it is shown that, the respondents’ emphasis on their need to survive and to protect their children, represented a fundamental re-formulation of their identities as mothers and, therefore, a type of biographical disruption while paradoxically also containing elements of biographical reinforcement. It is further argued that the incorporation of such key identities into the analysis problematises work that suggests that biographical disruption is less relevant to those who have experienced difficult lives, while also highlighting the need to take greater account of gender and caring responsibilities in further work in this field

Availability and use of telehealth services among patients with ADRD enrolled in traditional Medicare vs. Medicare advantage during the COVID-19 pandemic

BackgroundThe objective of this study was to examine differences in availability and use of telehealth services among Medicare enrollees according to Alzheimer’s disease and related dementias (ADRD) status and enrollment in Medicare Advantage (MA) versus Traditional Medicare (TM) during the period surrounding the COVID-19 pandemic.MethodsThis was a retrospective cross-sectional analysis of data from community-dwelling MA and TM enrollees with and without ADRD from the Medicare Current Beneficiary Survey (MCBS) Fall 2020 and Winter 2021 COVID-19 Supplement Public Use Files. We examined self-reported availability of telehealth service before and during the COVID-19 pandemic and use of telehealth services during COVID-19. We analyzed marginal effects under multivariable logistic regression.ResultsThere were 13,700 beneficiaries with full-year enrollment in MA (6,046) or TM (7,724), 518 with ADRD and 13,252 without ADRD. Telehealth availability during COVID-19 was positively associated with having a higher income (2.81 pp. [percentage points]; 95% CI: 0.57, 5.06), having internet access (7.81 pp.; 95% CI: 4.96, 10.66), and owning telehealth-related technology (3.86; 95% CI: 1.36, 6.37); it was negatively associated with being of Black Non-Hispanic ethnicity (−8.51 pp.; 95% CI: −12.31, −4.71) and living in a non-metro area (−8.94 pp.; 95% CI: −13.29, −4.59). Telehealth availability before COVID-19 was positively associated with being of Black Non-Hispanic ethnicity (9.34 pp.; 95% CI: 3.74, 14.94) and with enrollment in MA (4.72 pp.; 95% CI: 1.63, 7.82); it was negatively associated having dual-eligibility (−5.59 pp.; 95% CI: −9.91, −1.26). Telehealth use was positively associated with being of Black Non-Hispanic ethnicity (6.47 pp.; 95% CI: 2.92, 10.01); it was negatively associated with falling into the age group of 75+ years (−4.98 pp.; 95% CI: −7.27, −2.69) and with being female (−4.98 pp.; 95% CI: −7.27, −2.69).ConclusionTelehealth services were available to and used by Medicare enrollees with ADRD to a similar extent compared to their non-ADRD counterparts. Telehealth services were available to MA enrollees to a greater extent before COVID-19 but not during COVID-19, and this group did not use telehealth services more than TM enrollees during COVID-19

Table_1_Availability and use of telehealth services among patients with ADRD enrolled in traditional Medicare vs. Medicare advantage during the COVID-19 pandemic.DOCX

BackgroundThe objective of this study was to examine differences in availability and use of telehealth services among Medicare enrollees according to Alzheimer’s disease and related dementias (ADRD) status and enrollment in Medicare Advantage (MA) versus Traditional Medicare (TM) during the period surrounding the COVID-19 pandemic.MethodsThis was a retrospective cross-sectional analysis of data from community-dwelling MA and TM enrollees with and without ADRD from the Medicare Current Beneficiary Survey (MCBS) Fall 2020 and Winter 2021 COVID-19 Supplement Public Use Files. We examined self-reported availability of telehealth service before and during the COVID-19 pandemic and use of telehealth services during COVID-19. We analyzed marginal effects under multivariable logistic regression.ResultsThere were 13,700 beneficiaries with full-year enrollment in MA (6,046) or TM (7,724), 518 with ADRD and 13,252 without ADRD. Telehealth availability during COVID-19 was positively associated with having a higher income (2.81 pp. [percentage points]; 95% CI: 0.57, 5.06), having internet access (7.81 pp.; 95% CI: 4.96, 10.66), and owning telehealth-related technology (3.86; 95% CI: 1.36, 6.37); it was negatively associated with being of Black Non-Hispanic ethnicity (−8.51 pp.; 95% CI: −12.31, −4.71) and living in a non-metro area (−8.94 pp.; 95% CI: −13.29, −4.59). Telehealth availability before COVID-19 was positively associated with being of Black Non-Hispanic ethnicity (9.34 pp.; 95% CI: 3.74, 14.94) and with enrollment in MA (4.72 pp.; 95% CI: 1.63, 7.82); it was negatively associated having dual-eligibility (−5.59 pp.; 95% CI: −9.91, −1.26). Telehealth use was positively associated with being of Black Non-Hispanic ethnicity (6.47 pp.; 95% CI: 2.92, 10.01); it was negatively associated with falling into the age group of 75+ years (−4.98 pp.; 95% CI: −7.27, −2.69) and with being female (−4.98 pp.; 95% CI: −7.27, −2.69).ConclusionTelehealth services were available to and used by Medicare enrollees with ADRD to a similar extent compared to their non-ADRD counterparts. Telehealth services were available to MA enrollees to a greater extent before COVID-19 but not during COVID-19, and this group did not use telehealth services more than TM enrollees during COVID-19.</p