Madeline Brooks, MPH

Research Investigator

Publications

Mapping the Burden of Chronic Diseases in Delaware for Public Health Decision Making
Mapping the Burden of Chronic Diseases in Delaware for Public Health Decision Making
McIntire RK, Brooks M, Siegel SD, , Papas M

Dela J Public Health 2019 Feb;5(1):26-28

PMID: 34467011

Abstract

Public health decision-makers need to consider geographic differences in rates of chronic disease risk factors and outcomes in order to focus intervention efforts on populations exhibiting the greatest burden of disease. Increasingly, public health agencies are using geographic information systems (GIS) to analyze area-based variations and identify geographic priority areas for health promoting interventions. The articles in this issue are descriptive studies presenting the geographic distribution of select chronic disease risk factors and outcomes among Delaware communities. These studies emerged from a collaboration between the Christiana Care Value Institute and the Jefferson College of Population Health. These studies show that the burden of chronic diseases is not distributed evenly among communities in Delaware. The results of these studies add to the evidence base about public health in Delaware, and should inform public health practitioners working to improve the health of Delaware communities.
See more publications from Christiana Care experts
Malnourished adults' receipt of hospital discharge nutrition care instructions: a pilot study
Malnourished adults' receipt of hospital discharge nutrition care instructions: a pilot study
Brooks M, Vest MT, Shapero M, Papas M

J Hum Nutr Diet 2019 10;32(5):659-666

PMID: 31037779

Abstract

BACKGROUND">Malnutrition remains an important yet under-recognised problem among hospitalised adults. Although interventions exist aiming to improve nutritional status beyond hospitalisation, few studies examine how often and what type of nutrition care instructions are given at discharge. The present study sought to review nutrition-focused discharge care provided to malnourished adults.</Abstr: Malnutrition remains an important yet under-recognised problem among hospitalised adults. Although interventions exist aiming to improve nutritional status beyond hospitalisation, few studies examine how often and what type of nutrition care instructions are given at discharge. The present study sought to review nutrition-focused discharge care provided to malnourished adults.

METHODS">We reviewed the electronic medical record for discharge nutrition care instructions provided to adult patients identified by dietitians as malnourished over a 4-month period.</Abstr: We reviewed the electronic medical record for discharge nutrition care instructions provided to adult patients identified by dietitians as malnourished over a 4-month period.

RESULTS">Seventy-six eligible patients were identified during the study period. More than half of malnutrition cases (64.5%) were attributed to chronic illness. According to electronic medical record documentation, 6.6% received discharge instructions to consume oral nutrition supplements and 30.3% received new or changed prescriptions for vitamins/noncaloric supplements. Almost half of patients (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake.</Abstr: Seventy-six eligible patients were identified during the study period. More than half of malnutrition cases (64.5%) were attributed to chronic illness. According to electronic medical record documentation, 6.6% received discharge instructions to consume oral nutrition supplements and 30.3% received new or changed prescriptions for vitamins/noncaloric supplements. Almost half of patients (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake.

CONCLUSIONS">A majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. Clinician education and redesign of nutrition care options in the electronic medical record may improve the provision of post-discharge nutrition care instructions.© 2019 The British Dietetic Association Ltd.</CopyrightInfo: A majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. Clinician education and redesign of nutrition care options in the electronic medical record may improve the provision of post-discharge nutrition care instructions.

See more publications from Christiana Care experts
Using Geospatial Analyses of Linked Electronic Health Records and Tobacco Outlet Data to Address the Social Determinants of Smoking
Using Geospatial Analyses of Linked Electronic Health Records and Tobacco Outlet Data to Address the Social Determinants of Smoking
Siegel SD, Brooks MM, Gbadebo BM, Laughery JT

Prev Chronic Dis 2019 11;16():E152

PMID: 31726020

Abstract

No abstract available.
See more publications from Christiana Care experts
Social Determinants of Health, From Assessment to Action:: A Review of 3 Studies from the Value Institute at ChristianaCare
Social Determinants of Health, From Assessment to Action:: A Review of 3 Studies from the Value Institute at ChristianaCare
Harrison C, Brooks M, Goldstein JN

Dela J Public Health 2020 Jul;6(2):72-78

PMID: 34467115

Abstract

INTRODUCTION: The COVID-19 crisis highlights the importance of screening for and managing adverse social determinants of health (SDoH). Many of the same SDoH items that put individuals at increased risk of COVID-19 infection have increased dramatically due to the economic repercussions of slowing the viral spread.

METHODS: This is a review of 3 studies conducted by the Health Services Research Core in the Value Institute at ChristianaCare. The studies had 3 overarching goals: 1) to conduct a survey of primary care providers in Delaware to determine their current methods for collection of social determinants data, 2) to validate a 2-item screening tool for food insecurity, and 3) to assess the geographic distribution of patients with food insecurity.

RESULTS: Our studies have demonstrated the importance of screening for SDoH by highlighting the inconsistent data collection of SDoH items, examining the prevalence of food insecurity and validating a standardized instrument for rapid data collection, as well as displaying geospatial differences in food insecurity prevalence across New Castle County, DE.

PUBLIC HEALTH IMPLICATIONS: The COVID-19 pandemic has increased the prevalence of these social determinants in our communities. Therefore, it is imperative to employ screening and geospatial strategies to address the SDoH implications of the novel coronavirus.

See more publications from Christiana Care experts
Mapping the ChristianaCare response to COVID-19:: Clinical insights from the Value Institute's Geospatial Analytics Core
Mapping the ChristianaCare response to COVID-19:: Clinical insights from the Value Institute's Geospatial Analytics Core
Brooks M, Brown C, , Liu W, Siegel SD,

Dela J Public Health 2020 Jul;6(2):66-70

PMID: 34467114

Abstract

INTRODUCTION: COVID-19 exemplifies the spatial nature of infectious disease in both its mechanism of transmission and the community-level conditions that facilitate its spread. With a long history of use for infectious disease applications, maps and geographic information systems (GIS) have been widely used in recent months for surveillance and risk prediction mapping. The Value Institute's Geospatial Analytics Core applied spatial methodologies to inform ChristianaCare's pandemic response around telehealth, testing disparities, and test site prioritization.

METHODS: Descriptive data related to disparities in telehealth utilization were mapped to identify areas in which intervention is needed to increase telehealth access. Cluster detection methodology was used to identify "hot" and "cold" spots for COVID-19 testing by place and race across New Castle County, DE. A composite risk score was created to prioritize communities for testing sites. All analyses took place in Delaware from March-June 2020, with particular emphasis on New Castle County.

RESULTS: Parts of northeastern New Castle County and western Sussex County were highlighted for intervention to increase broadband internet access for telehealth utilization. "Cold" spots for COVID-19 testing were found in New Castle County, indicating neighborhoods in which testing levels were significantly lower than expected. Data for testing levels, disease positivity, and socioeconomic risk factors were used to identify communities in northeastern New Castle County that warranted new test sites to mitigate disease spread.

PUBLIC HEALTH IMPLICATIONS: Geospatial methodologies can be used to combine electronic health record data and population-level spatial data for pandemic response efforts. This allows health systems to confidently identify areas of need while mitigating disparities in resource allocation.

See more publications from Christiana Care experts
Examining the relationship between food environment and gestational diabetes
Examining the relationship between food environment and gestational diabetes
Fonge YN, Jain VD, Harrison C, Brooks M, Sciscione AC

Am J Obstet Gynecol MFM 2020 11;2(4):100204

PMID: 33345920

Abstract

BACKGROUND">Studies have shown an association between the incidence of gestational diabetes and living in neighborhoods oversaturated with unhealthy foods.</Abstr: Studies have shown an association between the incidence of gestational diabetes and living in neighborhoods oversaturated with unhealthy foods.

OBJECTIVE">This study sought to determine if the food environment also affects the management of gestational diabetes. We hypothesized that living in areas with a higher quality of food decreased the risk of requiring medication to treat gestational diabetes.</Abstr: This study sought to determine if the food environment also affects the management of gestational diabetes. We hypothesized that living in areas with a higher quality of food decreased the risk of requiring medication to treat gestational diabetes.

STUDY DESIGN">This was a retrospective cohort study of singleton births at the Christiana Care Health System between 2015 and 2018. Patients with gestational diabetes who live in Delaware (N=1327) were geocoded and classified according to their census tract food environment. The food environment was assessed using the modified Retail Food Environment Index, which measures the percentage of healthy food retailers among all food retailers within a half-mile radius of the census tract boundaries. The modified Retail Food Environment Index scores were divided into 3 categories: poor (modified Retail Food Environment Index score, 0-3), average (modified Retail Food Environment Index score, 4-10), and good or above average (modified Retail Food Environment Index score, ≥11) food environments. The primary outcome was the prevalence of A2 gestational diabetes mellitus. Several neonatal and obstetrical outcomes were also examined including type II diabetes mellitus (defined as a 2-hour glucose tolerance test with at least 1 value above the threshold), cesarean delivery, shoulder dystocia, admission to the neonatal intensive care unit, neonatal hypoglycemia, neonatal hyperbilirubinemia, neonatal respiratory distress syndrome, and macrosomia.</Abstr: This was a retrospective cohort study of singleton births at the Christiana Care Health System between 2015 and 2018. Patients with gestational diabetes who live in Delaware (N=1327) were geocoded and classified according to their census tract food environment. The food environment was assessed using the modified Retail Food Environment Index, which measures the percentage of healthy food retailers among all food retailers within a half-mile radius of the census tract boundaries. The modified Retail Food Environment Index scores were divided into 3 categories: poor (modified Retail Food Environment Index score, 0-3), average (modified Retail Food Environment Index score, 4-10), and good or above average (modified Retail Food Environment Index score, ≥11) food environments. The primary outcome was the prevalence of A2 gestational diabetes mellitus. Several neonatal and obstetrical outcomes were also examined including type II diabetes mellitus (defined as a 2-hour glucose tolerance test with at least 1 value above the threshold), cesarean delivery, shoulder dystocia, admission to the neonatal intensive care unit, neonatal hypoglycemia, neonatal hyperbilirubinemia, neonatal respiratory distress syndrome, and macrosomia.

RESULTS">A total of 689 (52%) women were diagnosed as having A2 gestational diabetes mellitus. Women in the average or good or above average food environment groups had a lower prevalence of A2 gestational diabetes mellitus than women in the poor food environment group (modified Retail Food Environment Index score, 4-10 [adjusted odds ratio, 0.58; 95% confidence interval, 0.37-0.92] and modified Retail Food Environment Index score, ≥11 [adjusted odds ratio, 0.56; 95% confidence interval, 0.40-0.82]). They also had a lower prevalence of type II diabetes mellitus (modified Retail Food Environment Index score, 4-10 [adjusted odds ratio, 0.25; 95% confidence interval, 0.09-0.72] and modified Retail Food Environment Index score, ≥11 [adjusted odds ratio, 0.48; 95% confidence interval, 0.27-0.86]). There were no differences in the other secondary outcomes of interest.</Abstr: A total of 689 (52%) women were diagnosed as having A2 gestational diabetes mellitus. Women in the average or good or above average food environment groups had a lower prevalence of A2 gestational diabetes mellitus than women in the poor food environment group (modified Retail Food Environment Index score, 4-10 [adjusted odds ratio, 0.58; 95% confidence interval, 0.37-0.92] and modified Retail Food Environment Index score, ≥11 [adjusted odds ratio, 0.56; 95% confidence interval, 0.40-0.82]). They also had a lower prevalence of type II diabetes mellitus (modified Retail Food Environment Index score, 4-10 [adjusted odds ratio, 0.25; 95% confidence interval, 0.09-0.72] and modified Retail Food Environment Index score, ≥11 [adjusted odds ratio, 0.48; 95% confidence interval, 0.27-0.86]). There were no differences in the other secondary outcomes of interest.

CONCLUSION">The food environment affects the requirement for medication to obtain glycemic levels that are within the target range for those with gestational diabetes.Copyright © 2020 Elsevier Inc. All rights reserved.</CopyrightInfo: The food environment affects the requirement for medication to obtain glycemic levels that are within the target range for those with gestational diabetes.

See more publications from Christiana Care experts
Operationalizing the Population Health Framework: Clinical Characteristics, Social Context, and the Built Environment
Operationalizing the Population Health Framework: Clinical Characteristics, Social Context, and the Built Environment
Siegel SD, Brooks M, Curriero FC

Popul Health Manag 2021 08;24(4):454-462

PMID: 34406088

Abstract

As a framework, population health emphasizes health outcomes for entire populations, the broad range of determinants of these outcomes, and the comparative effectiveness of medical and public health interventions. In practice, however, many contemporary population health programs instead focus on small subsets of patients who account for a disproportionate share of health care utilization, often with disappointing results. The authors proposed a new approach to operationalize population health in clinical settings, with the example of tobacco use. Electronic health record (EHR) data from a mid-Atlantic health system were used to: (1) define and describe a hospital-based population of current smokers, (2) analyze the demographic characteristics of the population to consider how the social context may impact treatment, and (3) join EHR data with public licensing data on tobacco retail locations to assess the relationship between the built environment and smoking status. Out of a total of 20,310 unique adult admissions to the health system, 3749 (18.5%) were current smokers. Compared to never smokers, current smokers were significantly younger, more likely to be male, more likely to be Black/African American, less likely to be Hispanic/Latino/a, and more likely to be on Medicaid or be self-pay. Current vs. former smokers had significantly higher exposure to tobacco retail locations, even after adjusting for demographic and other covariates. By defining populations around leading modifiable medical determinants of health, and accounting for the larger context of sociodemographic factors and the built environment, health systems can invest in comprehensive programs designed to produce the greatest population health returns.
See more publications from Christiana Care experts
Characterizing the spatial relationship between smoking status and tobacco retail exposure: Implications for policy development and evaluation
Characterizing the spatial relationship between smoking status and tobacco retail exposure: Implications for policy development and evaluation
Brooks MM, Siegel SD, Curriero FC

Health Place 2021 03;68():102530

PMID: 33609995

Abstract

Tobacco retail density and smoking prevalence remain elevated in marginalized communities, underscoring the need for strategies to address these place-based disparities. The spatial variation of smokers and tobacco retailers is often measured by aggregating them to area-level units (e.g., census tracts), but spatial statistical methods that use point-level data, such as spatial intensity and K-functions, can better describe their geographic patterns. We applied these methods to a case study in New Castle County, DE to characterize the cross-sectional spatial relationship between tobacco retailers and smokers, finding that current smokers experience greater tobacco retail exposure and clustering relative to former smokers. We discuss how analysis at different geographic scales can provide complementary insights for tobacco control policy.
See more publications from Christiana Care experts
The co-occurrence of smoking and alcohol use disorder in a hospital-based population: Applying a multimorbidity framework using geographic information system methods
The co-occurrence of smoking and alcohol use disorder in a hospital-based population: Applying a multimorbidity framework using geographic information system methods
Siegel SD, Brooks M, Ragozine-Bush HE, Schnoll RA, Curriero FC

Addict Behav 2021 07;118():106883

PMID: 33714034

Abstract

Tobacco and alcohol use are leading causes of premature mortality in the US and concurrent use is associated with even greater health risks. A cross-sectional study of 20,310 patients admitted to a Mid-Atlantic acute health care system between July 1, 2018 and June 30, 2019 were categorized according to smoking and alcohol use disorder (AUD) status. Of the total admissions, 1464 (7.2%) were current smokers with an AUD. These patients were younger (52.4 vs. 63.9), more likely to be male (64.1% vs. 38.0%) and covered by Medicaid (46.9% vs. 11.6%), and resided in proximity to higher counts of tobacco (10.3 vs. 4.72) and alcohol (2.24 vs. 1.14) retailers than never smokers without an AUD. Clinically, these patients had higher rates of other substance use disorders (60.4% vs. 6.1%), depression (64.6% vs. 34.8%), HIV/AIDS (3.3% vs. 0.6%), and liver disease (40.7% vs. 13.2%) than never smokers without an AUD. Patients who concurrently smoke and have an AUD face unique and serious health risks. A multimorbidity framework can guide clinical and community-based interventions for individuals with concurrent psychiatric and chronic medical conditions, complex social needs, and adverse environmental exposures.
See more publications from Christiana Care experts
Food Insecurity in Delaware: A Triangulation of Spatial Data Sources
Food Insecurity in Delaware: A Triangulation of Spatial Data Sources
Harrison C, Brooks M, Goldstein JN, Papas M

Prev Chronic Dis 2021 08;18():E81

PMID: 34410907

Abstract

No abstract available.
See more publications from Christiana Care experts