Sean Treacy-Abarca's research while affiliated with University of California, Los Angeles and other places

Background Effective healthcare disparities curricula seek to train physicians who are well equipped to address the health needs of an increasingly diverse society. Current literature on healthcare disparities curricula and implementation focuses on courses created independent of existing educational materials. Our aim was to develop and implement a novel resource-conserving healthcare disparities curriculum to enhance existing medical school lectures without the need for additional lectures. Methods This non-randomized intervention was conducted at the University of California Los Angeles. The curriculum was offered to all first-year medical students in the class of 2021 (n=188). With institutional approval, a new healthcare disparities curriculum was created based on the Society of General Internal Medicine’s core learning objectives for effective healthcare disparities curricula (J General Internal Med 25:S160–163, 2010). Implementation of the curriculum made use of “teachable moments” within existing medical school lectures. Teachable moments were broad lecture topics identified by the research team as suitable for introducing relevant healthcare disparities content. The new lecture-enhancing healthcare disparities curriculum was delivered with the related lecture via integrated PDF documents uploaded to an online learning management system. Students were encouraged to complete pre- and post- course assessments to examine changes in disparities knowledge and self-rated confidence in addressing disparities. Matched χ2 tests were used for statistical analysis. Results Participating students (n=92) completed both pre- and post-course assessments and were retrospectively stratified, based on self-reported use of the new lecture enhancing curriculum, into the “high utilizer” group (use of materials “sometimes” or “very often,” n=52) and the comparison “low utilizer” group (use of the materials “rarely” or “very rarely,” n=40). Students who self-identified as underrepresented racial and ethnic minorities in medicine were more likely to utilize the material (41% of the high utilizers vs. 17% of the low utilizer group, p<.01). Post-course knowledge assessment scores and self-reported confidence in addressing healthcare disparities improved only in the high utilizer group. Conclusions Integrating new guideline based curricula content simultaneously into pre-existing lectures by identifying and harnessing teachable moments may be an effective and resource-conserving strategy for enhancing healthcare disparities education among first year medical students.

Background: Effective healthcare disparities curricula are essential to improve care of minority patients. Methods: A cost-neutral, evidence-based curriculum was created by enhancing established medical school lectures at the UCLA David Geffen School of Medicine class of 2021 (n=188). Lectures within an 8-week course were evaluated for “teachable moments” or broad topics suitable to introduce specific healthcare disparities content. A lecture-enhancing curriculum based on Society of General Internal Medicine learning objectives was introduced into the DGSOM learning management system via supplemental PDF documents. Results: A total of 92 of 188 students completed curricular assessments and were stratified into intervention group (“utilized materials” n=52) and comparison (“did not utilize the material” n=40) groups based on self-reported use of materials. Minorities were more likely to utilize the material (41% of the intervention group vs 17% of the comparison group, p<.01). Post-course 16-item knowledge composite scores, and confidence in addressing healthcare disparities improved only in the intervention group (p=0.001), and 96% of respondents described the health disparities curriculum as a valuable learning resource. Conclusions: Enhancing pre-existing lectures by identifying and harnessing “teachable moments” is a cost-neutral and effective strategy to integrate a healthcare disparities curriculum.

Background: Safety-net emergency departments often serve as the primary entry point for medical care for low income predominantly minority patient populations. Herein, we sought to provide insight into the feasibility, technological proficiencies, engagement characteristics, and practical considerations for a mHealth intervention at a safety-net emergency department. Objective: We aimed to analyze patient technological proficiency to understand the feasibility of and draw practical considerations for mobile phone technology (mHealth) solutions for patients with chronic disease served by safety-net emergency departments. Methods: We analyzed data from a previous diabetes randomized clinical mHealth trial for a diabetes social support intervention. Patients from a safety-net emergency department with preexisting diabetes who used SMS text messages, owned a mobile phone, and with hemoglobin A1c levels >8.5% were enrolled. A text message-based mHealth program to improve disease self-management was provided to all patients. Supporters of patients were randomized to receive a mailed copy or mHealth-based curriculum designed to improve diabetes support. Among enrolled patients, we surveyed mobile technological capacity and frequency of use. We performed latent class analysis to identify classes of patients by level of technological proficiency and compared demographic characteristics between the latent classes to identify demographic subgroups that may require more training or tailoring of the mHealth approach. Study engagement between classes was assessed by comparing the mean number of text messages exchanged, loss to follow-up, and early termination. Results: Of 1876 patients who were approached, 44.2% (n=829) of patients had a stable mobile phone and were able to use text messages. Among them 166 met the trial inclusion and enrolled, 90% (149/166) of the cohort were ethnically diverse. Significant variance was found in technology capacity and frequency of use. Our latent class analysis classified 75% (124/166) of patients as highly technologically proficient and 25% (42/166) patients as minimally technologically proficient. Age (P<.001) and level of education (P<.001) were associated with class membership. Highly technologically proficient patients were younger and had higher levels of education (45.74 years old; high school or more: 90%) than minimally technologically proficient patients (53.64 years old; high school or more: 18%). Highly technologically proficient participants exchanged a mean of 40 text messages with the system coordinators compared to a mean of 10 text messages by minimally technologically proficient patients (P<.001). Conclusions: This study found that nearly half of the patients screened at the safety-net emergency department were equipped for an SMS text message-based mHealth intervention. In the small sample of patients who were enrolled, the majority were classified as highly technologically proficient. These highly proficient patients had greater study engagement. mHealth use in emergency departments may be an opportunity to improve health of ethnically diverse populations by pairing sophisticated chronic disease self-management program with SMS text message-based and traditional in-person interventions to reach patients through the method that is most familiar and comfortable. International registered report identifier (irrid): RR2-10.1016/j.cct.2019.03.003.

UNSTRUCTURED Purpose: To understand feasibility and practical considerations for mobile phone technology (mHealth) at safety-net emergency departments (EDs) via analysis of patient technological proficiency and its effect on mHealth engagement. Methods: We analyzed the 2017 TExT-MED + FANS social support intervention for diabetes randomized clinical mHealth trial. From a safety-net ED 166 patients who used SMS text messages, owned a mobile phone, and had a Hemoglobin A1C (Hba1c) >8.5% were enrolled. A text message based mHealth platform was provided all patients. Supporters of patients were randomized to receive a mailed copy or a mHealth based curriculum designed to improve diabetes support. We surveyed patient technological capacity and frequency of use at initiation. Latent class analysis (LCA) was used to identify two classes of patients with higher or lower technological proficiency. We compared demographic characteristics between classes to identify predictors of class membership. Study engagement between classes was assessed via comparison of mean text-messages exchanged, loss to follow-up rates, and early termination were used to. Results: A 90% minority cohort was recruited. Significant variance was found in technology capacity and frequency of use. LCA classified 75% of patients as “highly technologically proficient” and 25% as “minimally technologically proficient”. Age (p<0.0001) and educational attainment (p<0.05) correlated with class membership. Highly technologically proficient patients were younger and had higher educational attainment than the minimally technologically proficient patients (45.74 years old with 90% high school or more compared to 53.64 years old and 18% high school or more for minimally technologically proficient patients). Highly technologically proficient participants exchanged a mean of 40 text-messages compared to 10 text-messages by minimally technologically proficient patients (p<.0001) with the system coordinators. Conclusions: Technology capacity varies for different communication modalities, but the majority of patients classified as highly technologically proficient; these highly proficient patients had greater engagement. Diverse safety-net ED patients are equipped and ready for text message based mHealth solutions. INTERNATIONAL REGISTERED REPORT RR2-10.1016/j.cct.2019.03.003