Active Research Projects
MOLAR
The MOLAR Study (Mapping Oral Health and Local Area Resources) is a randomized controlled trial of an adverse social determinants of health (aSDoH) screening and resource linkage intervention for Emergency Department (ED) patients. The aim of the study is to screen ED patients to identify unmet oral health needs or aSDoH risks/needs and provide geographically targeted resources to address them. Participants will be randomized into one of three intervention arms 1) standard care aSDoH and dental resources 2) geographically specific aSDoH and dental resources 3) geographically specific aSDoH and dental resources with navigational assistance. Participants will be followed for 12 months with the primary outcome being successful linkage to care and healthcare utilization.
Primary Publication:
Mapping Oral health and Local Area Resources (MOLAR): protocol for a randomised controlled trial connecting emergency department patients with social and dental resources. Simon L, Marsh R, Sanchez LD, Camargo CA, Donoff RB, Cardenas V, Manning W, Loo S, Cash RE, Samuels-Kalow M.
aSDoH
Adverse social determinants of health (aSDoH), such as housing and food insecurity, are strongly associated with healthcare utilization and health outcomes. The goal of our work is to identify and address aSDoH in an efficient and scalable way to address social needs, reduce disparities in care, and improve health outcomes. We have ongoing additional work around understanding neighborhood and spatial risk, evaluating and developing directories of community resources, and identification of social risk and social need.
Various projects are aimed at (1) determining the utility of the ED as a screening site for patients who are missed by existing screening pathways within an integrated health system, (2) establishing the prevalence of screening for aSDoH in a nationally representative sample, and (3) identifying barriers and facilitators among EDs that are successfully screening for aSDoH.
MEDS 2
While the Medication Education for Dosing Safety (MEDS) intervention is efficacious when delivered by a research assistant, we lack data on its effectiveness in routine clinical practice. The goals of MEDS 2 are to establish the effectiveness of the MEDS intervention as delivered by ED staff and determine the factors associated with successful implementation of the intervention.
Role of Individual and Hospital Factors in Quality of Care for Children in EDs
Although most children receive emergency care in general emergency departments (EDs), national studies have shown that pediatric readiness is low and that the lack of readiness has consequences for clinical quality and outcomes. Presentation to a highly prepared hospital, one with a high pediatric readiness score, is associated with decreased in-hospital mortality. Presence of a pediatric emergency care coordinator (PECC) is associated with increased readiness, but limited data are available to directly assess the association between PECC status and quality of care for children. Previous work has focused primarily on quality variation among specialty pediatric centers which account for a minority of care provided to pediatric patients and have very different staffing and resources as compared to general EDs. Our long-term goal is to develop systems to improve care for children presenting to general EDs. The goal of this R01 project is to define the hospital-level characteristics associated with quality of care provided to children in general EDs. We will use a slate of recently developed process and outcome quality measures across geographically diverse states with high- quality pediatric data available. Our primary hypothesis is that more intensive pediatric-focused staffing (e.g. more robust PECC implementation) is associated with higher-quality care and better clinical outcomes for children. The specific aims are to (1) Identify PECC implementation factors that are associated with variation in quality of emergency care for children (2) Establish if PECC status is associated with higher quality of care for children treated in general EDs and (3) Determine if disparities in quality of care by race/ethnicity and insurance vary by PECC status.