BACKGROUND:Nonattendance at new patient appointments leads to missed opportunities for engagement in care, lost revenue, and suboptimal resource utilization. OBJECTIVE:To assess the effectiveness of outreach calls to new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, on visit attendance. DESIGN:Rapid randomized quality improvement project. PARTICIPANTS:Patients with new patient appointments at an urban safety-net adult primary care clinic scheduled to occur between August 1, 2024 and September 30, 2024. INTERVENTION:Estimated probability of visit no-show for patients was calculated using a predictive algorithm embedded in the electronic health record and used to sort lists of patients with upcoming appointments. Every other patient received an outreach call from a trained volunteer within 3 business days of their appointment plus usual automated reminder messages versus usual automated reminder messages alone. MAIN MEASURES:New patient visit attendance compared between intervention and control groups. We conducted subgroup analyses of attendance by visit modality (in-person vs. telehealth), preferred language, and quartile of predicted no-show probability. KEY RESULTS:Patients in the intervention group (n = 281) had higher visit attendance than those in the control group (n = 280): 68.0% versus 54.1% (p < 0.01). There was a significant difference in attendance for in-person (70.7% vs. 51.7%; p < 0.01) but not telehealth (60.6% vs. 61.2%; p = 0.94) visits. Patients who preferred English had the biggest increase in attendance (17.2%; p < 0.01). Patients in the second and third quartiles of predicted no-show probability (31%-38% and 39%-45% predicted probability) had the biggest increases in attendance (22.2% [p = 0.01] and 15.4% [p = 0.05]). CONCLUSIONS:Outreach calls for new patients, prioritized by a no-show predictive algorithm and conducted by volunteers, can be a feasible and effective approach to improving visit attendance in a targeted fashion. Further investigation is needed to understand how to better support non-English preferring patients and patients with telehealth appointments.

Context: Over 200 000 people seeking asylum have arrived in New York City from 2022 to 2024. Program: As the safety net hospital system for our city, New York City (NYC) Health + Hospitals (H + H) has taken the lead in caring for newly arrived asylum seekers. We used electronic medical record data to gain early insights into utilization and needs among these patients. Implementation: We developed a hybrid definition to identify patients who are asylum seekers and examined their demographics, insurance, utilization, primary billing diagnoses, and immunizations from the Epic EMR. We included data on other patients as a point of comparison and analyzed data separately for adult and pediatric patients. Evaluation: In 2023, 15 233 or 1.4% of H + H patients were asylum seekers. Asylum seekers had fewer visits than other patients in 2023, and utilization was particularly driven by pregnancy and childbirth. Children seeking asylum were engaged in primary care at high rates. Documented childhood vaccinations were higher among asylum-seeking children engaged in primary care compared to those who were not. The majority of adults and children were insured. Adult primary care engagement was low, as were visits for those seeking care for behavioral health issues. Discussion: For adult asylum seekers, pregnancy and childbirth are key needs for adults. Increasing vaccination rates among children is critical and promoting engagement in primary care is a promising way to do so. Coordinated efforts are required to meet the varied needs of migrant arrivals, and safety net hospitals can play a key role in addressing their health care needs.

Background:In May 2022, mpox (formerly monkeypox) began spreading globally through LGBTQ+ sexual networks. By August 2022, New York City (NYC) became the global epicenter of the mpox outbreak, with the highest number of cases reported in the United States. Here, we quantify the mpox vaccination effort, focusing on flexible and community-responsive mobile vaccination. Methods:We describe an on-site mpox vaccination strategy at commercial sex venues, nightlife venues, and pride and health centers, during August 1-November 15, 2022. Data were collected on doses, demographics, and event size to determine and evaluate vaccine uptake. Results:The on-site vaccination strategy resulted in 3358 JYNNEOS doses administered at 363 events at 58 locations, including 22 events at 2 commercial sex venues. Commercial sex venues in New York City closed at the height of the mpox epidemic. We show high uptake of the JYNNEOS vaccine at commercial sex venues, with as many as 60% of attendees of 1 event receiving a JYNNEOS vaccine dose on site. This was possible after New York City health agencies responded to community demand for second doses. Messaging about the importance and availability of vaccination at these parties was community-led. JYNNEOS vaccination via mobile clinics demonstrated less racial and geographic disparity compared with nonmobile vaccinations. We show no increase in mpox cases as commercial sex venues reopened with vaccination on site. Conclusions:These results demonstrate the success of a community-led rapid response to an emergent mpox outbreak, including at places where people meet for sex.

New York City has been the epicenter of multiple recent infectious disease outbreaks, including COVID-19 and mpox, due to its position as one of the largest international travel hubs in the United States. In response to the imperative need to transport patients to specialized biocontainment units during high-consequence infectious disease outbreaks, the Health and Human Services Region 2 Regional Emerging Special Pathogen Treatment Center at New York City Health + Hospitals/Bellevue and the NYC Department of Health and Mental Hygiene spearheaded a comprehensive patient transport system. Informed by real-world experiences, quarterly drills, and regional partner engagement, the updated Region 2 patient transport concept of operations (CONOPS) ensures safe and seamless patient transfers. This article elucidates key components of the patient transport CONOPS, the multifaceted partner engagement approach used to develop it, and the collaborative workshop that fine-tuned the plan. Organizational skills, partner engagement, and adaptability were all necessary for refining and operationalizing a robust patient transport CONOPS. The finalization of this plan speaks to the collaborative spirit and commitment of regional leaders to ensure the effective management of high-consequence infectious disease outbreaks and the safeguarding of public health within Region 2 and beyond.

During infectious disease epidemics, accurate diagnostic testing is key to rapidly identify and treat cases, and mitigate transmission. When a novel pathogen is involved, building testing capacity and scaling testing services at the local level can present major challenges to healthcare systems, public health agencies, and laboratories. This mixed methods study examined lessons learned from the scale-up of SARS-CoV-2 testing services in New York City (NYC), as a core part of NYC’s Test Trace program. Using quantitative and geospatial analyses, the authors assessed program success at maximizing reach, equity, and timeliness of SARS-CoV-2 diagnostic testing services across NYC neighborhoods. Qualitative analysis of key informant interviews elucidated key decisions, facilitators, and barriers involved in the scale-up of SARS-CoV-2 testing services. A major early facilitator was the ability to establish working relationships with private sector vendors and contractors to rapidly procure and manufacture necessary supplies locally. NYC residents were, on average, less than 25 min away from free SARS-CoV-2 diagnostic testing services by public transport, and services were successfully directed to most neighborhoods with the highest transmission rates, with only one notable exception. A key feature was to direct mobile testing vans and rapid antigen testing services to areas based on real-time neighborhood transmission data. Municipal leaders should prioritize fortifying supply chains, establish cross-sectoral partnerships to support and extend testing services, plan for continuous testing and validation of assays, ensure open communication feedback loops with CBO partners, and maintain infrastructure to support mobile services during infectious disease emergencies.

NYC Health + Hospitals stood up the largest-scale testing and tracing operation in the country. With 5000 workers and a 24/7 operation, T2 was instrumental in keeping people healthy and safe, and getting New York City back to normal operations. T2 started a massive undertaking of community engagement, reaching out to New Yorkers to provide COVID-19 assistance in all forms and facets, from mobile testing units to isolation hotels for those unable to safely isolate at home, to wraparound services and connection to healthcare services, and much more. Taking into account the unique makeup of NYC, the immigrant population, the disproportionate impact on people of color, and the significant burden of disease and death, T2 rose to the challenge to encompass every aspect of this daunting situation.

Chronic diseases are the leading cause of death and disability in the United States, and much of this burden can be attributed to lifestyle and behavioral risk factors. Lifestyle medicine is an approach to preventing and treating lifestyle-related chronic disease using evidence-based lifestyle modification as a primary modality. NYC Health + Hospitals, the largest municipal public health care system in the United States, is a national pioneer in incorporating lifestyle medicine systemwide. In 2019, a pilot lifestyle medicine program was launched at NYC Health + Hospitals/Bellevue to improve cardiometabolic health in high-risk patients through intensive support for evidence-based lifestyle changes. Analyses of program data collected from January 29, 2019 to February 26, 2020 demonstrated feasibility, high demand for services, high patient satisfaction, and clinically and statistically significant improvements in cardiometabolic risk factors. This pilot is being expanded to 6 new NYC Health + Hospitals sites spanning all 5 NYC boroughs. As part of the expansion, many changes have been implemented to enhance the original pilot model, scale services effectively, and generate more interest and incentives in lifestyle medicine for staff and patients across the health care system, including a plant-based default meal program for inpatients. This narrative review describes the pilot model and outcomes, the expansion process, and lessons learned to serve as a guide for other health systems.

Similar to the early phases of the COVID-19 pandemic, New York City was the national epicenter of the ongoing 2022 mpox (formerly monkeypox) outbreak. Cases quickly began to rise in July 2022, primarily in gay, bisexual, or other men who have sex with men. Tools in the form of a reliable diagnostic test, an effective vaccine, and a viable treatment option have been available from the onset, although logistically complex to roll out. The special pathogens program at NYC Health + Hospitals/Bellevue, the flagship facility for the largest public hospital system in the United States, collaborated with multiple departments within Bellevue, the hospital system, and the NYC Department of Health and Mental Hygiene, to swiftly establish ambulatory testing, immunizations, patient-centered inpatient care, and outpatient therapeutics. With the ongoing mpox outbreak, hospitals and local health departments must prepare a systemwide response to identify and isolate patients and provide high-quality care. Findings from our experience can help guide institutions in developing a multipronged, comprehensive response to the ongoing mpox outbreak.

In the spring of 2022, mpox spread to non-endemic countries, including the United States. In New York City (NYC), vaccine demand grew as quickly as case counts. With the leadership of the Regional Emerging Special Pathogens Treatment Center (RESPTC) at NYC Health and Hospitals/Bellevue (NYC H+H)—part of the largest public hospital system in the United States—an innovative vaccination model was established that overcame challenges involving health inequities, inadequate access, and lack of vaccine uptake, to successfully administer JYNNEOS vaccines to over 12,000 patients. Transmission has slowed since its peak in August 2022, which has been attributed to successful vaccination campaigns, infection-induced immunity, and behavioral changes among those at highest risk; however, a Centers for Disease Control and Prevention (CDC) assessment released on 4 April 2023 suggests jurisdictions with low vaccination levels (<35%) remain at risk for an mpox resurgence. Here, we summarize the critical aspects of our mpox vaccination model in NYC, which include integration into routine clinical care, prioritization of health equity, and reutilization of COVID-19 vaccination systems, to provide valuable insights for healthcare institutions as we move into the next stage of this ongoing outbreak.

Importance Financial incentives for weight management may increase use of evidence-based strategies while addressing obesity-related economic disparities in low-income populations. Objective To examine the effects of 2 financial incentive strategies developed using behavioral economic theory when added to provision of weight management resources. Design, Setting, and Participants Three-group, randomized clinical trial conducted from November 2017 to May 2021 at 3 hospital-based clinics in New York City, New York, and Los Angeles, California. A total of 1280 adults with obesity living in low-income neighborhoods were invited to participate, and 668 were enrolled. Interventions Participants were randomly assigned to goal-directed incentives, outcome-based incentives, or a resources-only group. The resources-only group participants were given a 1-year commercial weight-loss program membership, self-monitoring tools (digital scale, food journal, and physical activity monitor), health education, and monthly one-on-one check-in visits. The goal-directed group included resources and linked financial incentives to evidence-based weight-loss behaviors. The outcome-based arm included resources and linked financial incentives to percentage of weight loss. Participants in the incentive groups could earn up to $750. Main Outcomes and Measures Proportion of patients achieving 5% or greater weight loss at 6 months. Results The mean (SD) age of the 668 participants enrolled was 47.7 (12.4) years; 541 (81.0%) were women, 485 (72.6%) were Hispanic, and 99 (14.8%) were Black. The mean (SD) weight at enrollment was 98.96 (20.54) kg, and the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 37.95 (6.55). At 6 months, the adjusted proportion of patients who lost at least 5% of baseline weight was 22.1% in the resources-only group, 39.0% in the goal-directed group, and 49.1% in the outcome-based incentive group (difference, 10.08 percentage points [95% CI, 1.31-18.85] for outcome based vs goal directed; difference, 27.03 percentage points [95% CI, 18.20-35.86] and 16.95 percentage points [95% CI, 8.18-25.72] for outcome based or goal directed vs resources only, respectively). However, mean percentage of weight loss was similar in the incentive arms. Mean earned incentives was $440.44 in the goal-directed group and $303.56 in the outcome-based group, but incentives did not improve financial well-being. Conclusions and Relevance In this randomized clinical trial, outcome-based and goal-directed financial incentives were similarly effective, and both strategies were more effective than providing resources only for clinically significant weight loss in low-income populations with obesity. Future studies should evaluate cost-effectiveness and long-term outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT03157713

BACKGROUND COVID-19 has caused over 45,000 deaths in New York City, with a disproportional impact on certain communities. As part of the COVID-19 response, the city has directly administered over six million COVID-19 tests (not including millions of indirectly administered tests not covered in this analysis), at no cost to the individual, resulting in nearly half a million positive results. Given that testing throughout the pandemic has tended to be higher in more affluent areas, these tests were targeted to areas with fewer resources. OBJECTIVE This study aims to evaluate the impact of this program; specifically, to review its ability to provide equitable testing in economically, geographically, and demographically diverse populations. Of note, in addition to the brick-and-mortar testing sites evaluated here, this program additionally conducted 2.1 million tests through mobile units, to further address testing inequity. METHODS Testing data was collected from the in-house Microsoft SQL Server Management Studio 18 Clarity database, representing 6,347,533 total tests and 449,721 positive tests. These tests were conducted at 48 hospital system locations. Per capita testing rates by zip code tabulation area (ZCTA) and COVID-19 positivity rates by ZCTA were used as dependent variables in separate regressions. Median income, median age, percent English speaking, and percent People of Color were used as independent demographic variables, to analyze testing patterns across several intersecting identities. Negative binomial regressions were run in a Juypter Notebook using Python. RESULTS Per capita testing was inversely correlated with median income geographically. The overall pseudo r-squared value when comparing hospital system tests by ZCTA against the selected variables was 0.1101. The number of tests significantly increased as median income fell (SE= 1.00000155, P CONCLUSIONS This program was able to improve equity through the provision of no-cost testing focused in areas of the city that were disproportionately impacted and had fewer resources. By finding higher numbers of positive tests in resource-poor neighborhoods, New York City was able to deploy additional resources such as contact tracing and isolation/quarantine support including free food delivery and free hotel stays early in the course of the COVID-19 pandemic. Equitable deployment of testing is feasible and should be considered early on in future epidemics or pandemics. CLINICALTRIAL Biomedical Research Alliance of New York (BRANY) Study: 23-15-564, Sponsor ID: RH2023-814, Category: 15-Not Human Subject Research.

The 2022 mpox outbreak in New York City posed challenges to rapidly scaling up treatment capacity. We describe a telehealth treatment model launched during this outbreak that facilitated healthcare provider treatment capacity, and was able to adhere to a Centers for Disease Control and Prevention (CDC)-sponsored expanded access investigational new drug (EA-IND) protocol for tecovirimat. Sixty-nine patients were evaluated and prescribed tecovirimat for mpox through telehealth visits at NYC Health + Hospitals/Bellevue and NYU Langone Health from June to August 2022. Thirty-two (46.4%) were previously diagnosed with HIV. Forty-four (63.8%) reported full recovery, with the remainder lost to follow-up. Most patients (n = 60, 87.0%) attended at least one follow-up visit (either in person or through telehealth) after starting treatment. We observed favorable treatment outcomes, with no serious adverse events, hospitalizations, or deaths related to mpox. While equitable access to telehealth remains a limitation that needs to be addressed, this telehealth model enabled a rapid scale-up of tecovirimat prescription during the mpox outbreak, and should be considered as an important tool used to respond to future infectious disease outbreaks.

Abstract The coronavirus disease 2019 (COVID-19) pandemic has caused more than 675 million confirmed cases and nearly 7 million deaths worldwide [1]. While testing for COVID-19 was initially centered in health care facilities, with required reporting to health departments, it is increasingly being performed in the home with rapid antigen testing [2]. Most at-home tests are self-interpreted and not reported to a provider or health department, which could lead to delayed reporting or underreporting of cases [3]. As such, there is a strong possibility that reported cases may become a less reliable indicator of transmission over time.

The objective of this study was to compare unannounced standardized patient (USP) and patient reports of care. Patient satisfaction surveys and USP checklist results collected at an urban, public hospital were compared to identify items included in both surveys. Qualitative commentary was reviewed to better understand USP and patient satisfaction survey data. Analyses included χ 2 and Mann-Whitney U test. Patients provided significantly higher ratings on 10 of the 11 items when compared to USPs. USPs may provide a more objective perspective on a clinical encounter than a real patient, reinforcing the notion that real patients skew overly positive or negative.