Brian Reed

Mobile health units (MHUs) can reach populations facing barriers to traditional primary care, but information about factors associated with their utilization is limited. The objective of this ecological study was to evaluate whether MHU encounter density is increased in census tracts designated as Primary Care Health Professional Shortage Areas (HPSAs) and explore whether associations varied by socioeconomic vulnerability. We analyzed Wayne State University/Wayne Health MHU encounters with adult patients from July 2021 to September 2025. Negative binomial regression models with a log link and log(population) offset tested the a priori hypothesis that encounter density was increased in designated versus undesignated HPSA census tracts. Sensitivity analyses assessed variation by social vulnerability index score quartiles established by the US Centers for Disease Control and Prevention. One quarter of the five-county metropolitan Detroit, Michigan, catchment area census tracts were designated healthcare shortage areas. Overall, 13,852 encounters with 10,924 unique patients occurred across 924 of 1305 census tracts. Encounter rate per adult population was significantly increased by severalfold comparing designated versus undesignated shortage areas, with stronger associations at lower socioeconomic vulnerability index score quartiles (interaction p = 0.0006). These findings support continued efforts to scale and evaluate MHUs to address projected healthcare shortages, particularly in socioeconomically vulnerable areas.

Mobile health units (MHUs) offer an attractive means to reach people facing barriers that limit engagement with traditional primary care providers, but evidence on utilization as-sociated factors is sparse. This ecological study leveraged data from Wayne State University/Wayne Health MHU encounters with adult patients from 07/2021-09/2025 to address the knowledge gap. We fit negative binomial regression models with a log link and log(population) offset to test the a priori hypothesis that the density of MHU encounters is increased in designated versus undesignated Primary Care Health Professional Shortage Area census tracts established by the U.S. Health Resources and Services Administration. Sensitivity analyses examined whether the association varied by socioeconomic status vulnerability index score quartiles established by the US Centers for Disease Control and Prevention. One quarter of the five-county metropolitan Detroit, Michigan, catchment area census tracts were designated healthcare shortage areas. There were 13,852 encounters with 10,924 unique patients living in 924 of the total 1,305 census tracts in the catchment. The MHU encounter rate per adult population was significantly increased by severalfold comparing designated versus undesignated healthcare shortage areas; the estimated magnitude of association strengthened with increasing socioeconomic vulnerability index score quartile (interaction p-value, 0.0006). Continued efforts to scale and evaluate the capacity for mobile health units to help address projected healthcare shortages appears warranted, particularly in areas with heightened socioeconomic vulnerability.

Aim: The Cass Clinic is a student-run free clinic in Detroit, Michigan that treats chronic diseases including hypertension (HTN), diabetes mellitus (DM), and obesity. Our study aims to quantify the effectiveness of our clinic in managing chronic diseases. Subject and methods: This study assessed selected health outcomes for 137 patients who visited our clinic between September 1, 2017 and August 31, 2018 based on initial and most recent surrogate markers including manual blood pressure, hemoglobin A1c (HbA1c), and body mass index (BMI) recorded in the clinic’s medical record system dating back to 2012. Results: Patients were divided into two groups: occasionally seen patients (OSP) and frequently seen patients (FSP). FSP with HTN had systolic blood pressure (SBP) decreased by an average of 14.1 mmHg and diastolic blood pressure (DBP) decreased by 9.8 mmHg, which were statistically associated with the number of clinic visits. Additionally, all patients treated at Cass Clinic saw a decrease in their HbA1c and BMI. HbA1c in OSP decreased by 0.50%. HbA1c in the FSP decreased by 1.7%. Patients with at least two recorded BMIs (n=73) saw a decrease of 0.13 kg/m². Conclusion: The data from our analysis support that a student-run free clinic model like Cass Clinic provides long-term value for patients who frequently utilize the clinic. These clinics also act as an important resource for the community by making positive strides toward better health in multiple measurable outcomes, including HTN and DM management.

Introduction One of the most challenging aspects of Emergency Medicine (EM) residency is mastering the leadership skills required during a resuscitation. Use of resuscitation video recording for debriefing is gaining popularity in graduate medical education. However, there are limited studies of how video technology can be used to improve leadership skills in the emergency department. We aim to evaluate the utility of video-assisted self-reflection, compared with self-reflection alone, in the setting of resuscitation leadership. Methods This was a prospective, randomized, controlled pilot study conducted in 2018 at an urban level 1 trauma center with a three-year EM residency program. The trial included postgraduate year (PGY) 2 and 3 residents (n = 10). Each resident acted as an individual team leader for a live real-time resuscitation in the emergency department. The authors classified a patient as a resuscitation if there was an immediate life- or limb-threatening disease process or an abnormal vital sign with an indication of hypoperfusion. Each resident was recorded as the team leader twice. Both control and intervention groups produced written self-reflection after their first recording.

The objective of the present study was to evaluate the relationship between speckle-tracking-derived parameters left ventricular (LV) mechanical dispersion index (MDI), defined as the standard deviation of the time-to-peak longitudinal strain of all segments analyzed of the LV, and global longitudinal strain (GLS) and 30-day post-discharge outcomes (death and readmission to the hospital) in patients with acute heart failure (AHF). We performed a prospective observational study of selected emergency department patients with a primary diagnosis of AHF. Point-of-care echocardiograms were performed at baseline (prior to, or concurrent with the initiation of treatment) and 23 h post-enrollment. Offline speckle-tracking analysis was utilized to calculate GLS and MDI. The primary outcome was 30-day readmissions. A total of 31 patients were included, 13 of whom were readmitted within 30 days. Patients who were not readmitted to the hospital experienced an average relative improvement in MDI of 24% from baseline to 23 h (84 ms to 64 ms), while patients who were readmitted experienced an average relative worsening in MDI of 6% (66 ms to 70 ms) from baseline to 23 h. MDI has promise as a treatment response variable in admitted patients with AHF; however, further study is needed.