Digital Commons Network^™

Introduction To The Special Series: Translating Behavioral Medicine Research To Prevent And Control The Spread Of Covid-19., A. M. Delamater, S. M. Miller, D. J. Bowen, M. A. Diefenbach, K. P. Tercyak

Journal Articles

No abstract provided.

Teaching Professional Formation In Response To The Covid-19 Pandemic., L. B. Mccullough, J. Coverdale, F. A. Chervenak

Journal Articles

In response to the COVID-19 pandemic, the Association of American Medical Colleges has called for a temporary suspension of clinical teaching activities for medical students. Planning for the continued involvement of learners in patient care during this pandemic should include teaching learners professional formation. The authors provide an ethical framework to guide such teaching, based on the ethical principle of beneficence and the professional virtues of courage and self-sacrifice from professional ethics in medicine. The authors show that these concepts support the conclusion that learners are ethically obligated to accept reasonable, but not unreasonable, risk. Based on this ethical framework, …

Latinx/@ Immigrant Inclusion Trajectories: Individual Agency, Structural Constraints, And The Role Of Community-Based Organizations In Immigrant Mobilities., Cirila Estela Vasquez Guzman, Julia Meredith Hess, Norma Casas, Dulce Medina, Margarita Galvis, Diana Anahi Torres, Alexis J. Handal, Annette Carreon-Fuentes, Alexandra Hernandez-Vallant, Mario J. Chavez, Felipe Rodriguez, Jessica R. Goodkind

Pediatrics Research and Scholarship

Immigration is at the forefront of national, state, and local policy struggles in the United States, and Latinx/@ immigrants have experienced increased deportations, detention, and individual threats. A mobilities perspective allows analysis to extend our view of migration beyond frameworks confined to pre- and postmigration, examining trajectories of social inclusion and exclusion that are influenced by multiple factors in the receiving country. The Immigrant Well-being Project, a community-based participatory research project involving university faculty, students, staff, and representatives from 4 community-based organizations (CBOs), was initiated in New Mexico in 2017 to better understand and promote Latinx/@ immigrant mental health and …

Building Capacity For Productive Indigenous Community-University Partnerships, Joel Gittelsohn, Annie Belcourt, Maya Magarati, Cathryn Booth-Laforce, Bonnie Duran, Shiraz I Mishra, Lorenda Belone, Valarie Blue Bird Jernigan

Pediatrics Research and Scholarship

This paper describes capacity development as a key aspect of community-based research with indigenous communities. University research engagement with indigenous communities includes extensive, and often negative, historical antecedents. We discuss strategies for developing effective, egalitarian, and balanced indigenous community-university relationships to build research capacity of these communities, and to create sustainable partnerships to improve health and wellness, and to reduce health disparities. We draw on the experience of eight investigators conducting research with indigenous communities to assess effective strategies for building and enhancing partnerships, including (1) supporting indigenous investigator development; (2) developing university policies and practices sensitive and responsive to …

Implementation Of The Hub And Spoke Model For Opioid Use Disorders In California: Rationale, Design And Anticipated Impact., Gloria M. Miele, Lauren Caton, Thomas E. Freese, Mark Mcgovern, Kendall Darfler, Valerie Pearce Antonini, Marlies Perez, Richard Rawson

Project ECHO Bibliography

As part of the State Targeted Response to the opioid epidemic, California has adopted the Hub and Spoke model to expand access to medications for opioid use disorder, particularly buprenorphine, throughout the state. By aligning opioid treatment programs as hubs with primary care, office-based practitioners, and other health care settings as spokes, a broader treatment model can reach more people with opioid use disorder, improve access to medications for opioid use disorders, and decrease overdose deaths. Expanding access requires expanding knowledge and intensive implementation support of new practices. This paper describes the rationale, specific activities and anticipated impact of the …

Digilego For Peripartum Depression: A Novel Patient-Facing Digital Health Instantiation, J Rodin, C Timko, S Harris

Faculty, Staff and Student Publications

Digital health technologies offer unique opportunities to improve health outcomes for mental health conditions such as peripartum depression (PPD), a disorder that affects approximately 10-15% of women in the U.S. every year. In this paper, we present the adaption of a digital technology development framework, Digilego, in the context of PPD. Methods include mapping of the Behavior Intervention Technology (BIT) model and the Patient Engagement Framework (PEF) to translate patient needs captured through focus groups. This informs formative development and implementation of digital health features for optimal patient engagement in PPD screening and management. Results show an array ofPPD-specific Digilego …

Does Knowing The Mental Health History Of A Mass Shooter Heighten Stigma And Negative Attitudes Toward Mental Illness?, Lianna Artessa

PCOM Psychology Dissertations

Mass-shooting incidents are an ongoing epidemic that continues to take countless lives. Despite the prevalence of gun-related mass-shooting events, the research on this phenomenon is scarce. Following these events, individuals often receive news from differing media outlets and programs. The current media portrayal of mass-shooting events often appears to support a widely accepted connection between mass shootings and mental illness. This portrayal may reflect an existing and perhaps growing misunderstanding and negative stigma toward individuals diagnosed with a psychiatric disorder. This experimental study sought to determine the degree to which individuals’ attitudes toward and opinions of a perpetrator of a …

Recommended Medical And Non-Medical Factors To Assess Military Preventable Deaths: Subject Matter Experts Provide Valuable Insights, Whitney Y. Harrison, Jana L. Wardian Phd, J.A. Sosnov, R.S. Kotwal, F.K. Butler, Z.T. Stockinger, S.A. Shackelford, J.M. Gurney, M.A. Spott, L.N. Finelli, E.L. Mazuchowski, D.J. Smith, J.C. Janak

Journal Articles: Hospital Medicine

INTRODUCTION: Historically, there has been variability in the methods for determining preventable death within the US Department of Defense. Differences in methodologies partially explain variable preventable death rates ranging from 3% to 51%. The lack of standard review process likely misses opportunities for improvement in combat casualty care. This project identified recommended medical and non-medical factors necessary to (1) establish a comprehensive preventable death review process and (2) identify opportunities for improvement throughout the entire continuum of care.

METHODS: This qualitative study used a modified rapid assessment process that includes the following steps: (1) identification and recruitment of US government …

Recommendations For Clinical Laboratory Testing For Antithrombin Deficiency; Communication From The Ssc Of The Isth, Elizabeth M. Van Cott, Christelle Orlando, Gary W. Moore, Peter C. Cooper, Piet Meijer, Richard Marlar, Subcommittee On Plasma Coagulation Inhibitors

Pathology Research and Scholarship

Hereditary deficiency of antithrombin, a natural anticoagulant, causes a thrombophilia with a high risk for venous thromboembolism. Guidance for laboratory testing to diagnose antithrombin deficiency include the use of an activity assay for initial testing, performing an antigen test and activity-to-antigen ratio when the activity level is low, using pediatric reference ranges until the age of 6 months, excluding acquired causes of low antithrombin (e.g. liver dysfunction, proteinuria, heparin, disseminated intravascular coagulation, thrombosis, surgery) or falsely normal/elevated results (e.g. argatroban, bivalirudin, dabigatran in factor IIa-based assays; rivaroxaban, apixaban, edoxaban, but not betrixaban in Xa-based assays). Molecular testing, if available, may …

Comparative Analysis Of Covid-19 Guidelines From Six Countries: A Qualitative Study On The Us, China, South Korea, The Uk, Brazil, And Haiti, Ji Youn Yoo, Samia Valeria Ozorio Dutra, Dany Fanfan, Sarah Sniffen, Hao Wang, Jamile Siddiqui, Hyo-Suk Song, Sung Hwan Bang, Dong Eun Kim, Shihoon Kim, Maureen Groer

All publications

Background: In late January, a worldwide crisis known as COVID-19 was declared a Public Health Emergency of International Concern by the WHO. Within only a few weeks, the outbreak took on pandemic proportions, affecting over 100 countries. It was a significant issue to prevent and control COVID-19 on both national and global scales due to the dramatic increase in confirmed cases worldwide. Government guidelines provide a fundamental resource for communities, as they guide citizens on how to protect themselves against COVID-19, however, they also provide critical guidance for policy makers and healthcare professionals on how to take action to decrease …

Using A Rapid Assessment Methodology To Identify And Address Immediate Needs Among Low-Income Households With Children During Covid-19, Shreela V. Sharma, Amier Haidar, Jacqueline Noyola, Jacqueline Tien, Melinda Rushing, Brittni M. Naylor, Ru-Jye Chuang, Christine Markham

All publications

Objective: Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and families. Due to COVID-19-related school closures, states were under "shelter in place" orders, and Brighter Bites administered a rapid assessment survey to identify social needs among their families. The purpose of this study is to demonstrate the methodology used to identify those with greatest social needs during this time ("high risk"), and to describe the response of Brighter Bites to these "high risk" families.

Methods: The rapid assessment survey was collected in April 2020 across Houston, Dallas, Washington DC, and …

Development And Validation Of A Model For Individualized Prediction Of Hospitalization Risk In 4,536 Patients With Covid-19, Lara Jehi, Xinge Ji, Alex Milinovich, Serpil Erzurum, Amy Merlino, Steve Gordon, James B. Young, Michael W. Kattan

All publications

Background: Coronavirus Disease 2019 is a pandemic that is straining healthcare resources, mainly hospital beds. Multiple risk factors of disease progression requiring hospitalization have been identified, but medical decision-making remains complex.

Objective: To characterize a large cohort of patients hospitalized with COVID-19, their outcomes, develop and validate a statistical model that allows individualized prediction of future hospitalization risk for a patient newly diagnosed with COVID-19.

Design: Retrospective cohort study of patients with COVID-19 applying a least absolute shrinkage and selection operator (LASSO) logistic regression algorithm to retain the most predictive features for hospitalization risk, followed by validation in a temporally …

Pharmacist-Led Chronic Care Management For Medically Underserved Rural Populations In Florida During The Covid-19 Pandemic, Madison Como, Chenita White Carter, Margareth Larose-Pierre, Kellie O'Dare, Cynthia R Hall, Jason Mobley, Gervin Robertson, Jason Leonard, Lindsey Tew

All publications

Medically underserved patients in rural areas are more vulnerable to poor health outcomes, including the risks associated with coronavirus disease 2019 (COVID-19). Pharmacists, student pharmacists, and other health care professionals are working together to implement new, innovative ways to deliver the same standard of care during the COVID-19 pandemic to these vulnerable patients. These services include telehealth with virtual and telephone medication therapy management sessions led by ambulatory care pharmacists and student pharmacists. Pharmacists, student pharmacists, and other health care professionals should continue to adapt to these new technologies to improve health outcomes for their patients during the pandemic.

Statewide Implementation Of Virtual Perinatal Home Visiting During Covid-19, Jennifer Marshall, Laura Kihlström, Acadia Buro, Vidya Chandran, Concha Prieto, Rafaella Stein-Elger, Keryden Koeut-Futch, Allison Parish, Katie Hood

All publications

Purpose: This evaluation describes efforts taken by MIECHV administrators and staff during the pandemic using data collected from 60 MIECHV staff surveys and nine statewide weekly focus groups.

Description: The Florida Maternal, Infant and Early Childhood Home Visiting (MIECHV) Initiative funds perinatal home visiting for pregnant women and families with infants throughout the state. Florida MIECHV has shown resilience to disasters and times of crises in the past, while generating a culture of adaptation and continuous quality improvement among local implementing agencies. Florida MIECHV responded to the COVID-19 pandemic crisis within the first few days of the first reported case …

The Impact Of Covid-19 On Hiv Treatment And Research: A Call To Action., Tiffany Chenneville, Kemesha Gabbidon, Patricia Hanson, Cashea Holyfield

All publications

The impact of the COVID-19 pandemic is far reaching, with devastating effects on individuals, communities, and societies across the world. People with chronic health conditions may be at greater risk of contracting or experiencing complications from COVID-19. In addition to illness or death for those who contract the virus, the physical distancing required to flatten the curve of new cases is having a negative impact on the economy, the effects of which intersect with mental health and other existing health concerns, thus affecting marginalized communities. Given that HIV also has a disproportionate impact on marginalized communities, COVID-19 is affecting people …

Real-Time Public Health Communication Of Local Sars-Cov-2 Genomic Epidemiology, Chaney C. Kalinich, Cole G. Jensen, Peter Neugebauer, Mary E. Petrone, Mario Peña-Hernández, Isabel M. Ott, Anne L. Wyllie, Tara Alpert, Chantal B. F. Vogels, Joseph R. Fauver, Nathan D. Grubaugh, Anderson F. Brito

Journal Articles: Epidemiology

Genomic epidemiology can provide a unique, real-time understanding of SARS-CoV-2 transmission patterns. Yet the potential for genomic analyses to guide local policy and community-based behavioral decisions is limited because they are often oriented towards specially trained scientists and conducted on a national or global scale. Here, we propose a new paradigm: Phylogenetic analyses performed on a local level (municipal, county, or state), with results communicated in a clear, timely, and actionable manner to strengthen public health responses. We believe that presenting results rapidly, and tailored to a non-expert audience, can serve as a template for effective public health response to …

Rev-Erb Agonism Improves Liver Pathology In A Mouse Model Of Nash, Kristine Griffett, Gonzalo Bedia-Diaz, Bahaa Elgendy, Thomas P. Burris

Open Access Publications

Non-alcoholic fatty liver disease (NAFLD) affects a significant number of people worldwide and currently there are no pharmacological treatments. NAFLD often presents with obesity, insulin resistance, and in some cases cardiovascular diseases. There is a clear need for treatment options to alleviate this disease since it often progresses to much more the much more severe non-alcoholic steatohepatitis (NASH). The REV-ERB nuclear receptor is a transcriptional repressor that regulates physiological processes involved in the development of NAFLD including lipogenesis and inflammation. We hypothesized that pharmacologically activating REV-ERB would suppress the progression of fatty liver in a mouse model of NASH. Using …

The Baby Bridge Program: A Sustainable Program That Can Improve Therapy Service Delivery For Preterm Infants Following Nicu Discharge, Roberta Pineda, Elizabeth Heiny, Patricia Nellis, Joan Smith, Jaqueline M. Mcgrath, Margaux Collins, Abigail Barker

Open Access Publications

OBJECTIVE: The aim of this project was to determine revenues and costs over time to assess the sustainability of the Baby Bridge program.

METHODS: The Baby Bridge program was developed to promote timely, consistent and high quality early therapy services for high-risk infants following neonatal intensive care unit (NICU) discharge. Key features of the Baby Bridge program were defined as: 1) having the therapist establish rapport with the family while in the NICU, 2) scheduling the first home visit within one week of discharge and continuing weekly visits until other services commence, 3) conducting comprehensive assessments to inform targeted interventions …

Nonmicrobial Activation Of Tlrs Controls Intestinal Growth, Wound Repair, And Radioprotection, William F Stenson, Matthew A Ciorba

Open Access Publications

TLRs, key components of the innate immune system, recognize microbial molecules. However, TLRs also recognize some nonmicrobial molecules. In particular, TLR2 and TLR4 recognize hyaluronic acid, a glycosaminoglycan in the extracellular matrix. In neonatal mice endogenous hyaluronic acid binding to TLR4 drives normal intestinal growth. Hyaluronic acid binding to TLR4 in pericryptal macrophages results in cyclooxygenase2- dependent PGE

Advances In Modeling The Immune Microenvironment Of Colorectal Cancer, Paul Sukwoo Yoon, Nuala Del Piccolo, Venktesh S Shirure, Yushuan Peng, Amanda Kirane, Robert J Canter, Ryan C Fields, Steven C George, Sepideh Gholami

Open Access Publications

Colorectal cancer (CRC) is the third most common cancer and second leading cause of cancer-related death in the US. CRC frequently metastasizes to the liver and these patients have a particularly poor prognosis. The infiltration of immune cells into CRC tumors and liver metastases accurately predicts disease progression and patient survival. Despite the evident influence of immune cells in the CRC tumor microenvironment (TME), efforts to identify immunotherapies for CRC patients have been limited. Here, we argue that preclinical model systems that recapitulate key features of the tumor microenvironment-including tumor, stromal, and immune cells; the extracellular matrix; and the vasculature-are …

Dementia Research In The Caribbean Hispanic Islands: Present Findings And Future Trends, Daisy Acosta, Jorge J Llibre-Guerra, Ivonne Z Jiménez-Velázquez, Juan J Llibre-Rodríguez

Open Access Publications

During the last decade, the Caribbean Hispanic islands experienced accelerated demographic aging, representing the fastest aging region within Latin America. Age-related non-communicable diseases, including dementia, are now reported at high prevalence. The Caribbean islands share similar genetic ancestry, culture, migration patterns, and risk profiles, providing a unique setting to understand dementia in the Caribbean-Hispanics. This perspective article aimed to describe the impact of dementia in the Caribbean, at a local and regional level and reflect on research strategies to address dementia. We report on 10/66 project findings, described research projects and regional plans for the region. According to our results, …

An Evaluation Of Florida’S Zika Response Using The Who Health Systems Framework: Can We Apply These Lessons To Covid-19?, Jennifer Marshall, Blake Scott, Jennifer Delva, Cedrick Ade, Santiago Hernandez, Jaladhikumar Patel, Mantero Moreno-Cheek, Dogeli Rojas, Jean-Paul Tanner, Russell S. Kirby

All publications

Objectives: From 2016 to 2018 Florida documented 1471 cases of Zika virus, 299 of which were pregnant women (Florida Department of Health, https://www.floridahealth.gov/diseases-and-conditions/mosquito-bornediseases/surveillance.html , 2019a). Florida's response required unprecedented rapid and continuous cross-sector communication, adaptation, and coordination. Zika tested public health systems in new ways, particularly for maternal child health populations. The systems are now being challenged again, as the Coronavirus COVID-19 pandemic spreads throughout Florida. This qualitative journey mapping evaluation of Florida's response focused on care for pregnant women and families with infants exposed to Zika virus.

Methods: Fifteen focus groups and interviews were conducted with 33 public health …

Diagnostic Accuracy Of Chest Computed Tomography Scans For Suspected Patients With Covid-19: Receiver Operating Characteristic Curve Analysis, Lianpin Wu, Qike Jin, Jie Chen, Jiawei He, David Brett-Major, Jianghu James Dong

Journal Articles: Epidemiology

BACKGROUND: Computed tomography (CT) scans are increasingly available in clinical care globally. They enable a rapid and detailed assessment of tissue and organ involvement in disease processes that are relevant to diagnosis and management, particularly in the context of the COVID-19 pandemic.

OBJECTIVE: The aim of this paper is to identify differences in the CT scan findings of patients who were COVID-19 positive (confirmed via nucleic acid testing) to patients who were confirmed COVID-19 negative.

METHODS: A retrospective cohort study was proposed to compare patient clinical characteristics and CT scan findings in suspected COVID-19 cases. A multivariable logistic model with …

Colorectal Cancer Screening Uptake: Differences Between Rural And Urban Privately-Insured Population, Mesnad Alyabsi, Jane L. Meza, K. M. Monirul Islam, Amr Soliman, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

Earlier studies investigated rural-urban colorectal cancer (CRC) screening disparities among older adults or used surveys. The objective was to compare screening uptake between rural and urban individuals 50-64 years of age using private health insurance. Data were analyzed from 58,774 Blue Cross Blue Shield of Nebraska beneficiaries. Logistic regression was used to assess the association between rural-urban and CRC screening use. Results indicate that rural individuals were 56% more likely to use the Fecal Occult Blood Test (FOBT) compared with urban residents, but rural females were 68% less likely to use FOBT. Individuals with few Primary Care Physician (PCP) visits …

Defining Current Gaps In Quality Measures For Cancer Immunotherapy: Consensus Report From The Society For Immunotherapy Of Cancer (Sitc) 2019 Quality Summit, Sara Pai, David Blaisdell, Rachel Brodie, Robert G. Carlson, Heidi Finnes, Michele Galioto, Roxanne E. Jensen, Tom Valuck, Antonia R. Sepulveda, Howard L. Kaufman

Population and Public Health Sciences Faculty Publications

Background Quality measures are important because they can help improve and standardize the delivery of cancer care among healthcare providers and across tumor types. In an environment characterized by a rapidly shifting immunotherapeutic landscape and lack of associated long-term outcome data, defining quality measures for cancer immunotherapy is a high priority yet fraught with many challenges. Methods Thus, the Society for Immunotherapy of Cancer convened a multistakeholder expert panel to, first, identify the current gaps in measures of quality cancer care delivery as it relates to immunotherapy and to, second, advance priority concepts surrounding quality measures that could be developed …

Online Availability Of Fish Antibiotics And Documented Intent For Self-Medication, Weiwei Zhang, Austin Williams, Nicole Griffith, Jessica Gaskins, P Brandon Bookstaver

Faculty Publications

Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of …

Healthcare Practitioners’ Views Of Social Media As An Educational Resource, Adam G. Pizzuti, Karan H. Patel, Erin K. Mccreary, Emily Heil, Christopher M. Bland, Eric Chinaeke, Bryan L. Love, P Brandon Bookstaver

Faculty Publications

Social media is increasingly utilized as a resource in healthcare. We sought to identify perceptions of using social media as an educational tool among healthcare practitioners. An electronic survey was distributed to healthcare administrators, nurses, nurse practitioners, pharmacists, physicians, and physician assistants f hospital systems and affiliated health science schools in Georgia, Maryland, South Carolina, and Wisconsin. Survey questions evaluated respondents' use and views of social media for educational purposes and workplace accessibility using a Likert scale (1 = strongly disagree, 5 = strongly agree). Nurses (75%), pharmacists (11%), and administrators (7%) were the most frequent respondents. Facebook® (27%), Pinterest® …

The Impact Of A Wireless Audio System On Communication In Robotic-Assisted Laparoscopic Surgery: A Prospective Controlled Trial, Ziv Tsafrir, Kirsten Janosek-Albright, Joelle Aoun, Mireya Diaz-Insua, Abd-El-Rahman Abd-El-Barr, Lauren Schiff, Shobhana Talukdar, Mani Menon, Adnan R. Munkarah, Evan Theoharis, David Eisenstein

Obstetrics, Gynecology and Women's Health Services Articles

BACKGROUND: Robotic surgery presents a challenge to effective teamwork and communication in the operating theatre (OR). Our objective was to evaluate the effect of using a wireless audio headset device on communication, efficiency and patient outcome in robotic surgery.

METHODS AND FINDINGS: A prospective controlled trial of team members participating in gynecologic and urologic robotic procedures between January and March 2015. In the first phase, all surgeries were performed without headsets (control), followed by the intervention phase where all team members used the wireless headsets. Noise levels were measured during both phases. After each case, all team members evaluated the …

Identification And Evaluation Of Epidemic Prediction And Forecasting Reporting Guidelines: A Systematic Review And A Call For Action, Simon Pollett, Michael Johansson, Matthew Biggerstaff, Lindsay C. Morton, Sara L. Bazaco, David Brett-Major, Anna M. Stewart-Ibarra, Julie A. Pavlin, Suzanne Mate, Rachel Sippy, Laurie J. Hartman, Nicholas G. Reich, Irina Maljkovic Berry, Jean-Paul Chretien, Benjamin M. Althouse, Diane Myer, Cecile Viboud, Caitlin Rivers

Journal Articles: Epidemiology

INTRODUCTION: High quality epidemic forecasting and prediction are critical to support response to local, regional and global infectious disease threats. Other fields of biomedical research use consensus reporting guidelines to ensure standardization and quality of research practice among researchers, and to provide a framework for end-users to interpret the validity of study results. The purpose of this study was to determine whether guidelines exist specifically for epidemic forecast and prediction publications.

METHODS: We undertook a formal systematic review to identify and evaluate any published infectious disease epidemic forecasting and prediction reporting guidelines. This review leveraged a team of 18 investigators …

Echo Care: Providing Multidisciplinary Specialty Expertise To Support The Care Of Complex Patients, Miriam Komaromy, Judy Bartlett, Andrea Zurawski, Sarah R. Gonzales-Van Horn, Summers G. Kalishman, Venice Ceballos, Xi Sun, Martin Jurado, Sanjeev Arora

Project ECHO Bibliography

BACKGROUND: Programs for high-need, high-cost (HNHC) patients can improve care and reduce costs. However, it may be challenging to implement these programs in rural and underserved areas, in part due to limited access to specialty consultation.

AIM: Evaluate the feasibility of using the Extension for Community Health Outcomes (ECHO) model to provide specialist input to outpatient intensivist teams (OITs) dedicated to caring for HNHC patients.

SETTING: Weekly group videoconferencing sessions that connect multidisciplinary specialists with OITs.

PARTICIPANTS: Six OITs across New Mexico, typically consisting of a nurse practitioner or physician assistant, a registered nurse, a counselor or social worker, and …