搜索结果：Rhode Island medical journal (2013)

The COVID-19 pandemic significantly impacted nursing homes in the United States. The Departments of Health within each state played a substantial role in providing guidance, issuing regulations, and supplying resources to help organizations respond to this health emergency. This research characterizes nursing home administrator perspectives on the role of Rhode Island's state agencies during the COVID-19 pandemic. This qualitative case study includes data from 19 repeated interviews with administrators of six nursing homes, conducted from July 2020-December 2021. In-depth, semi-structured interviews focused on their COVID-19 response, including infection control, vaccination, and interactions with state agencies, among other topics. Interview transcripts were qualitatively analyzed to determine overarching themes. Three themes emerged from analysis of interview transcripts: 1. Nursing home administrators described the regulatory guidance and communications from Rhode Island's Department of Health, which shaped their COVID-19 response. 2. Administrators discussed the tangible resources and support, such as personal protective equipment and staffing support, they received from the state. 3. Administrators identified the strengths and challenges in collaborating with state agencies and noted areas for improvement. Study findings have implications for how states help nursing homes respond during emergencies. While the vaccine has reduced the impact of COVID-19 on nursing home residents and staff, insights provided by administrators in this case study suggest best practices for improving future health emergency communications around guidance and regulations, and suggestions for necessary resources.

In 2021, the U.S. Surgeon General issued an advisory on youth mental health, stating that the challenges that youth are facing are unprecedented, hard to navigate, and significantly impacting their mental health.1 Through statewide quality improvement and collaborative learning models, the Care Transformation Collaborative of Rhode Island (CTC-RI) and PCMH-Kids have implemented innovative, pediatric integrated behavioral health (IBH) models to support pediatric medical homes in addressing youth mental health needs, reduce stigma, increase access, and improve care coordination. Early efforts focused on a traditional IBH model and practices were financially responsible for the IBH clinician; despite clinical successes, smaller practices could not sustain the model financially, so CTC-RI shifted its focus to an innovative model that removed financial risk from the practice. More recently, CTC-RI has launched initiatives to expand the pediatric team's capacity to manage the behavioral health needs of its patients and families by providing specialty skill building (e.g., sleep, anxiety, autism), and by adding community health workers to IBH teams. Results from these initiatives indicate that pediatric IBH models are an effective and essential element of advanced primary care.

Unhoused individuals have higher mortality from cancer than the overall population. We aimed to determine cancer screening uptake and the barriers to screening faced by unhoused individuals in Rhode Island. Surveys focused on cancer screenings. Logistic regressions were used to identify interactions between having undergone screening and demographic characteristics. Responses to open-ended questions were analyzed to inform the findings. Amongst 502 participants, the screening rates for breast, cervical and colorectal cancer were 27%, 58%, and 39%, all below the national averages. Cancer risk factors such as smoking and alcohol were highly prevalent. Not having a primary care provider (PCP), lack of transportation, fear and logistical issues were among the most self-identified barriers to cancer screening. There was a statistically significant interaction between sex and access to PCP (P=.03) with regards to having up to date colorectal cancer screening. Specifically, unhoused men with a PCP were significantly more likely to be screened for colorectal cancer than those without PCP (52% vs 18%, P<.0001). Improving cancer screening among unhoused communities is critical. Access to PCP and health insurance can be leveraged to improve uptake of screening recommendations.

This article (1) summarizes historical and present greening initiatives across Rhode Island, and (2) illustrates how Project Greenspace, Sleep Patterns, Activity Space, and Environment (G-SPACE) benefits from and builds upon this public health work.

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Childhood vaccination remains one of the most effective public health interventions, yet recent national declines in coverage and rising vaccine hesitancy threaten these achievements. Hepatitis B (HepB) birth dose administration is an early predictor of parental adherence to future immunization schedules. We examined recent trends in Rhode Island (RI) HepB birth dose coverage and their relationship to subsequent vaccine completion and school-entry compliance. We identified the immunization records of RI resident infants born in RI hospitals from 2019 through mid-2025 in the Rhode Island Child and Adult Immunization Registry (RICAIR), and categorized them by timing of initial HepB vaccination: birth dose prior to discharge; early well visit dose; or no dose by 3 months of age in order to compare combined 7-series completion by 24 months and kindergarten immunization. Recent trends were then used to model projected future coverage. HepB birth dose coverage declined abruptly to 84.2% by Q2 2025. Infants who received a HepB birth dose were more likely to meet kindergarten immunization requirements (91.1%) compared with those vaccinated later (81.8%) or not by 3 months (10.1%). Projections suggest statewide kindergarten compliance could decline from 88.8% to 85.3% if current trends persist. The accelerating decline in HepB birth dose administration in RI is an early warning sign of eroding vaccine confidence and adherence. Coordinated, cross-sector interventions linking public health, prenatal, and pediatric care are urgently needed to reverse this trend and sustain high early childhood immunization coverage.

Since 2015, the Long-Term Care Quality & Innovation (Q&I) Lab at the Brown University School of Public Health has advanced pragmatic, partner-engaged research to improve care for older adults and chronically ill individuals receiving post-acute and long-term care. Rather than evaluating interventions under controlled conditions, Q&I researchers conduct embedded studies in real-world care settings, working with clinicians and frontline staff to implement interventions and assess their effectiveness and feasibility in routine practice. In parallel, researchers also collaborate with health systems and public agencies to generate practice-relevant evidence on operational priorities, positioning the lab as a translational research platform. This article presents two nursing home case studies: a pragmatic trial of a personalized music intervention for residents living with dementia and a portfolio of COVID-19-related partnered research. Together, these examples demonstrate how embedded, partner-engaged approaches generate actionable evidence, inform practice and policy, and position Rhode Island health system partners as contributors to evidence generation at scale in aging care.

Long wait times for autism spectrum disorder diagnostic evaluations delay access to early intervention and disproportionately affect Hispanic families and families who speak a primary language other than English. Integrated behavioral health models in pediatric primary care offer an opportunity to improve early identification, streamline referrals, and reduce inequities in access to specialty care. We describe the implementation of a tiered, integrated autism screening and diagnostic pathway within Hasbro Children's Pediatric Primary Care Clinic in Providence, Rhode Island. The pathway embeds behavioral health consultation and secondary autism screening into routine well-child visits for children ages 0-3. Children identified as at risk for autism receive expedited referral to specialty diagnostic evaluation using gold-standard assessment tools available in English and Spanish. Program evaluation includes comparison with two historical control groups (2018 pre-COVID and 2022 post-COVID) on wait times to specialty contact and diagnostic evaluation, as well as referral completion and connection to services. Patient experience is assessed using quantitative satisfaction measures and qualitative interviews within a quality improvement framework. The clinical pathway is currently active, and data collection is underway. Outcome data are not yet available. Early implementation demonstrates the feasibility of embedding secondary autism screening and care coordination within pediatric primary care and highlights the role of behavioral health integration in addressing delays in access to specialty services. A tiered, integrated autism evaluation pathway within pediatric primary care has the potential to reduce diagnostic delays, improve equity, and enhance family-centered care. Findings from ongoing evaluation will inform refinement and replication of this model in other primary care settings.

Sleep disorders are prevalent in children yet significantly underdiagnosed and undertreated in primary care. The Extension for Community Healthcare Outcomes ("Project ECHO&#xa9;") is a telementoring model that connects healthcare specialists with generalists, combining brief didactic presentations and case-based learning. In this one-year project, the ECHO&#xa9; model was employed to train primary care pediatricians in Rhode Island in behavioral sleep management strategies. Monthly teleconference sessions included a didactic presentation by a pediatric behavioral sleep expert, followed by a case presentation and discussion. Practices also designed and completed a Quality Improvement project, supported by monthly meetings with a facilitator. Six practices enrolled; 10 clinicians completed both pre- and post-program evaluations. Providers reported increased knowledge about pediatric sleep, particularly in the areas of sleep training in infants, and addressing sleep in patients with Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Improvements in overall confidence and comfort to address sleep in primary care were reported. After the project, providers reported an increase in systematic tracking of sleep concerns, and an increase in frequency of follow-up visits to address sleep. Project ECHO&#xa9; is a promising model for diffusion of practice-based behavioral sleep knowledge to primary care pediatricians. An expanded clinical skillset helps primary care pediatricians feel empowered to identify and address sleep problems in their practices, which has the potential to improve sleep care and preserve healthcare resources.

Occupational injuries of the hand are a major cause of disability. This study analyzes crush injury fractures of the hand and resultant time off work at a Level I Trauma Center in Providence, Rhode Island. Adult patients presenting to the emergency department with acute fractures to the metacarpals or phalanges following occupational hand crush injuries between July 2011 and June 2023 were retrospectively identified. Patients were evaluated for demographic variables, injury patterns, treatment, and time to return to work (RTW). Bivariate and multivariate regression analyses assessed RTW in relation to covariates with a significance level set at <0.05. One hundred and thirty-five (135) patients met study criteria, of which the mean age of presentation was 42.4. Almost all patients were engaged in manual labor (n = 123, 91.1%); 78.5% of injuries were open fractures (n = 106), 20.0% were intra-articular (n = 27) and 54.8% were comminuted (n = 74). Amputation injury occurred in 30.4% (n = 41) of cases. One-third, (n = 45, 33.3%) required surgery. The median RTW was 67.5 days post- injury. Regression analysis demonstrated that Hispanic/ Latino ethnicity, increased age, intra-articular fractures and middle phalanx and metacarpal fractures were significantly associated with longer RTW. Occupational hand crush fractures are associated with considerable time off work, with a median of 67.5 days demonstrated in our cohort. Several factors may be associated with prolonged RTW, including older age and more complex injury patterns. These findings underscore the importance of providing equitable care to facilitate timely RTW.

Over the past decade, the Center for Health Promotion and Health Equity (CHPHE) at the Brown University School of Public Health has emerged as a national leader in equity-centered research, education, and community engagement. The Center's story began decades earlier, built on pioneering work in community-based health interventions that would shape the field of public health in Rhode Island and beyond.