Pub Date : 2026-01-10DOI: 10.1016/j.hjdsi.2025.100775
Brian D'Anza , Tayana Williams , Stacy Porter , Robert Eardley , Jeff Sunshine
{"title":"Knocking down silos and herding apps: Digital health governance at a large health system","authors":"Brian D'Anza , Tayana Williams , Stacy Porter , Robert Eardley , Jeff Sunshine","doi":"10.1016/j.hjdsi.2025.100775","DOIUrl":"10.1016/j.hjdsi.2025.100775","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100775"},"PeriodicalIF":2.1,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-07DOI: 10.1016/j.hjdsi.2025.100776
Adam C. Powell , Ronald C. Whiting
{"title":"Addressing rural hospital challenges through integration","authors":"Adam C. Powell , Ronald C. Whiting","doi":"10.1016/j.hjdsi.2025.100776","DOIUrl":"10.1016/j.hjdsi.2025.100776","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100776"},"PeriodicalIF":2.1,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145927698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.hjdsi.2025.100774
Dinah Foer , Jorge Alberto Sulca Flores , Jessica L. Sousa , Anuj K. Dalal , Savanna Plombon , David W. Bates , Robert S. Rudin
Symptom checkers are tools designed to aid self-triage and used in various contexts including acute disease exposures. However, their utility within mobile health (mHealth) applications, particularly those used for long-term disease management, is unclear. This study evaluates the integration of a COVID-19 symptom checker into an asthma-focused mHealth application. Among users of the application, over 75 % engaged with the symptom checker at least once. Notably, patients prompted by the application with a nudge to use the symptom checker—triggered due to problematic scores on their weekly asthma questionnaires—were significantly more likely to complete it compared to those with non-problematic scores who did not receive the nudge. Qualitative analysis of semi-structured patient interviews explained reasons underlying patient symptom checker use which included reassurance that symptoms were not suggestive of COVID-19. Findings support the integration of symptom checkers into mHealth apps that offer continuous monitoring between clinical visits, especially for patients with chronic conditions vulnerable to acute disease triggers. Symptom checker integration can also facilitate timely dissemination of public health information.
{"title":"Evaluating the integration of a COVID-19 symptom checker into an asthma-focused mHealth application","authors":"Dinah Foer , Jorge Alberto Sulca Flores , Jessica L. Sousa , Anuj K. Dalal , Savanna Plombon , David W. Bates , Robert S. Rudin","doi":"10.1016/j.hjdsi.2025.100774","DOIUrl":"10.1016/j.hjdsi.2025.100774","url":null,"abstract":"<div><div>Symptom checkers are tools designed to aid self-triage and used in various contexts including acute disease exposures. However, their utility within mobile health (mHealth) applications, particularly those used for long-term disease management, is unclear. This study evaluates the integration of a COVID-19 symptom checker into an asthma-focused mHealth application. Among users of the application, over 75 % engaged with the symptom checker at least once. Notably, patients prompted by the application with a nudge to use the symptom checker—triggered due to problematic scores on their weekly asthma questionnaires—were significantly more likely to complete it compared to those with non-problematic scores who did not receive the nudge. Qualitative analysis of semi-structured patient interviews explained reasons underlying patient symptom checker use which included reassurance that symptoms were not suggestive of COVID-19. Findings support the integration of symptom checkers into mHealth apps that offer continuous monitoring between clinical visits, especially for patients with chronic conditions vulnerable to acute disease triggers. Symptom checker integration can also facilitate timely dissemination of public health information.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100774"},"PeriodicalIF":2.1,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145821272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-19DOI: 10.1016/j.hjdsi.2025.100773
Charlene A. Wong , Sarah Allin , Chelsea Swanson , Richard J. Chung , Kristen Dubay , Kori Flower , Josie Hatley , Alicia Reynolds Reddi , Michael J. Steiner , Eleanor Wertman , Rushina Cholera
We describe the design of the North Carolina Integrated Care for Kids (NC InCK) model. NC InCK is one of seven nationwide CMMI-funded pediatric health care delivery models that integrate services to promote whole-child health.
NC InCK was collaboratively designed by health care systems, the state Medicaid agency, Medicaid managed care organizations, child-serving organizations across multiple sectors, and families. The model uses three key approaches to integrate care: 1) a risk stratification algorithm using data across healthcare, education, and social systems to holistically understand needs and identify children who may benefit from additional supports; 2) a family-centered, longitudinal care management model to integrate cross-sector services for children and youth needing clinical and nonclinical support; and 3) an alternative payment model with innovative measures around social needs and school readiness to drive investment in child and family well-being.
Early success designing NC InCK has been driven by cross-sector and multi-level governance from the start of model design, garnering deep trust and alignment around shared goals. NC InCK is a step toward supporting whole-child health via cross-sector service integration and timely identification of children and families experiencing medical and social complexity. Lessons learned from design of this demonstration model can be applied to pediatric health initiatives nationwide.
{"title":"An introduction to North Carolina Integrated Care for Kids (NC InCK): A model to support whole-child health","authors":"Charlene A. Wong , Sarah Allin , Chelsea Swanson , Richard J. Chung , Kristen Dubay , Kori Flower , Josie Hatley , Alicia Reynolds Reddi , Michael J. Steiner , Eleanor Wertman , Rushina Cholera","doi":"10.1016/j.hjdsi.2025.100773","DOIUrl":"10.1016/j.hjdsi.2025.100773","url":null,"abstract":"<div><div>We describe the design of the North Carolina Integrated Care for Kids (NC InCK) model. NC InCK is one of seven nationwide CMMI-funded pediatric health care delivery models that integrate services to promote whole-child health.</div><div>NC InCK was collaboratively designed by health care systems, the state Medicaid agency, Medicaid managed care organizations, child-serving organizations across multiple sectors, and families. The model uses three key approaches to integrate care: 1) a risk stratification algorithm using data across healthcare, education, and social systems to holistically understand needs and identify children who may benefit from additional supports; 2) a family-centered, longitudinal care management model to integrate cross-sector services for children and youth needing clinical and nonclinical support; and 3) an alternative payment model with innovative measures around social needs and school readiness to drive investment in child and family well-being.</div><div>Early success designing NC InCK has been driven by cross-sector and multi-level governance from the start of model design, garnering deep trust and alignment around shared goals. NC InCK is a step toward supporting whole-child health via cross-sector service integration and timely identification of children and families experiencing medical and social complexity. Lessons learned from design of this demonstration model can be applied to pediatric health initiatives nationwide.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"14 1","pages":"Article 100773"},"PeriodicalIF":2.1,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-08DOI: 10.1016/j.hjdsi.2025.100771
Moutasem A. Zakkar , Sarah Deck , Se Lim Jang , Fariba Kolahdooz , Adrian Wagg , André Corriveau , Sangita Sharma
Background
Despite the progress towards Universal Health Coverage (UHC) in Canada, individuals experiencing socioeconomic disadvantages continue to face barriers to accessing necessary health services. This study explored the observational insights of social care providers (SCPs), who regularly engage with vulnerable populations and healthcare systems, to better understand these barriers in Edmonton, Canada.
Methods
A qualitative descriptive design was employed, guided by COREQ criteria. Purposive sampling recruited SCPs from 22 community organizations serving Indigenous community members and people experiencing homelessness, substance use, and immigration-related challenges. Deductive thematic analysis, structured around the Effective Coverage (EC) framework, was used to analyze interview data. A coding framework was developed a priori, and inductive coding identified interpretive themes within each EC category.
Results
Sixty-five SCPs participated. Findings were organized into four EC categories: service availability, accessibility, acceptability, and utilization. Within these, ten themes were identified: insufficient service capacity, restrictive access policies, service denial, unaffordable care, transportation barriers, racism, stigma, patient-related deterrents to seeking care, language barriers, and barriers to navigating the healthcare system. These themes illustrate how institutional policies, resource limitations, and communication challenges intersect with socioeconomic disadvantages to hinder access to and quality of care. SCPs also described how their organizations often intervene to help clients overcome these barriers.
Conclusion
SCPs can provide valuable observational insights into healthcare access barriers. While these perspectives do not represent direct patient accounts, they offer critical input for designing policy interventions to improve UHC. Applying the EC framework may enhance equity and support continuous quality improvement.
{"title":"Effective healthcare coverage in Canada: The caring and responding in Edmonton project","authors":"Moutasem A. Zakkar , Sarah Deck , Se Lim Jang , Fariba Kolahdooz , Adrian Wagg , André Corriveau , Sangita Sharma","doi":"10.1016/j.hjdsi.2025.100771","DOIUrl":"10.1016/j.hjdsi.2025.100771","url":null,"abstract":"<div><h3>Background</h3><div>Despite the progress towards Universal Health Coverage (UHC) in Canada, individuals experiencing socioeconomic disadvantages continue to face barriers to accessing necessary health services. This study explored the observational insights of social care providers (SCPs), who regularly engage with vulnerable populations and healthcare systems, to better understand these barriers in Edmonton, Canada.</div></div><div><h3>Methods</h3><div>A qualitative descriptive design was employed, guided by COREQ criteria. Purposive sampling recruited SCPs from 22 community organizations serving Indigenous community members and people experiencing homelessness, substance use, and immigration-related challenges. Deductive thematic analysis, structured around the Effective Coverage (EC) framework, was used to analyze interview data. A coding framework was developed a priori, and inductive coding identified interpretive themes within each EC category.</div></div><div><h3>Results</h3><div>Sixty-five SCPs participated. Findings were organized into four EC categories: service availability, accessibility, acceptability, and utilization. Within these, ten themes were identified: insufficient service capacity, restrictive access policies, service denial, unaffordable care, transportation barriers, racism, stigma, patient-related deterrents to seeking care, language barriers, and barriers to navigating the healthcare system. These themes illustrate how institutional policies, resource limitations, and communication challenges intersect with socioeconomic disadvantages to hinder access to and quality of care. SCPs also described how their organizations often intervene to help clients overcome these barriers.</div></div><div><h3>Conclusion</h3><div>SCPs can provide valuable observational insights into healthcare access barriers. While these perspectives do not represent direct patient accounts, they offer critical input for designing policy interventions to improve UHC. Applying the EC framework may enhance equity and support continuous quality improvement.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100771"},"PeriodicalIF":2.1,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-11DOI: 10.1016/j.hjdsi.2025.100770
Danielle S. Browne , Chieh-Liang Wu , Joshua M. Liao
{"title":"Investing in health care AI: Decision-making traps","authors":"Danielle S. Browne , Chieh-Liang Wu , Joshua M. Liao","doi":"10.1016/j.hjdsi.2025.100770","DOIUrl":"10.1016/j.hjdsi.2025.100770","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100770"},"PeriodicalIF":2.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-16DOI: 10.1016/j.hjdsi.2025.100769
David N. Sontag , Amy Hudspeth Cabell , Stephanie H. Chan , Jane Kavanagh , Anna Gosline , Rachel Russo
A foundational principle of health care is patient autonomy – respecting an individual's right to control what happens to their body, including what care they do and do not receive. That right is not lost when an individual loses the ability to speak for themselves or make reasoned decisions. One way to ensure health care decision-making aligns with a patient's wishes is for an individual to appoint a health care agent (HCA) to make decisions on their behalf if they are unable to. However, some people are ‘unrepresented’, meaning they do not have anyone to appoint. Lack of an HCA can result in delays in care, care that does not reflect a patient's wishes, and avoidable costs to the health care system. Strategies to address this have largely focused on courts appointing a guardian after an individual has lost decision-making capacity-a lengthy process that often exacerbates delays and, most importantly, does not result in a decision-maker who knows the individual's priorities and preferences. To address this challenge, four Massachusetts organizations developed a volunteer HCA program matching employees of each organization as HCAs for ‘unrepresented’ individuals receiving care at the other organizations. This model shows promise as an approach to ensure individuals can choose their HCA and personally communicate their priorities and preferences to them. Additionally, training volunteers as HCAs for strangers and learning from their experiences may offer insights into how everyone can be better at these conversations and representing the choices of others - especially with people close to them.
{"title":"Finding representation for the unrepresented patient: Creating a volunteer health care agent matching program in Massachusetts","authors":"David N. Sontag , Amy Hudspeth Cabell , Stephanie H. Chan , Jane Kavanagh , Anna Gosline , Rachel Russo","doi":"10.1016/j.hjdsi.2025.100769","DOIUrl":"10.1016/j.hjdsi.2025.100769","url":null,"abstract":"<div><div>A foundational principle of health care is patient autonomy – respecting an individual's right to control what happens to their body, including what care they do and do not receive. That right is not lost when an individual loses the ability to speak for themselves or make reasoned decisions. One way to ensure health care decision-making aligns with a patient's wishes is for an individual to appoint a health care agent (HCA) to make decisions on their behalf if they are unable to. However, some people are ‘unrepresented’, meaning they do not have anyone to appoint. Lack of an HCA can result in delays in care, care that does not reflect a patient's wishes, and avoidable costs to the health care system. Strategies to address this have largely focused on courts appointing a guardian after an individual has lost decision-making capacity-a lengthy process that often exacerbates delays and, most importantly, does not result in a decision-maker who knows the individual's priorities and preferences. To address this challenge, four Massachusetts organizations developed a volunteer HCA program matching employees of each organization as HCAs for ‘unrepresented’ individuals receiving care at the other organizations. This model shows promise as an approach to ensure individuals can choose their HCA and personally communicate their priorities and preferences to them. Additionally, training volunteers as HCAs for strangers and learning from their experiences may offer insights into how everyone can be better at these conversations and representing the choices of others - especially with people close to them.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100769"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-08DOI: 10.1016/j.hjdsi.2025.100768
Elizabeth Charron , Guimy Castor , Carrigan P. Veach , Renda Chubb , Blake J. Lesselroth , Viviane Elisabeth de Souza Santos Sachs , Morgan Richards , C. Michele Markey , Juliana Fernandes Filgueiras Meireles , Lamont E. Cavanagh , Erin Jorgensen , Jameca Price , Karen P. Gold
The United States is facing a shortage of pregnancy care providers, especially in tribal, rural, and underserved (TRU) communities. In Oklahoma, more than half of the state's counties are considered maternity care deserts that lack obstetric (OB) providers or services. Limited access to pregnancy care in Oklahoma's TRU areas contributes to the state's high rates of maternal morbidity and mortality. Family medicine (FM) physicians receive basic OB training during residency and are often the only providers delivering pregnancy care for geographically isolated and socially vulnerable populations in these counties. In 2021, the University of Oklahoma School of Community Medicine launched an enhanced OB training curriculum for FM residents to help address workforce shortages in Oklahoma's TRU communities. This article describes the design and implementation of the enhanced training curriculum, summarizes results from the first 2 years of implementation, and shares lessons learned for the field.
{"title":"Enhanced obstetric training to address maternity care workforce shortages in tribal, rural, and underserved communities: a case from Oklahoma","authors":"Elizabeth Charron , Guimy Castor , Carrigan P. Veach , Renda Chubb , Blake J. Lesselroth , Viviane Elisabeth de Souza Santos Sachs , Morgan Richards , C. Michele Markey , Juliana Fernandes Filgueiras Meireles , Lamont E. Cavanagh , Erin Jorgensen , Jameca Price , Karen P. Gold","doi":"10.1016/j.hjdsi.2025.100768","DOIUrl":"10.1016/j.hjdsi.2025.100768","url":null,"abstract":"<div><div>The United States is facing a shortage of pregnancy care providers, especially in tribal, rural, and underserved (TRU) communities. In Oklahoma, more than half of the state's counties are considered maternity care deserts that lack obstetric (OB) providers or services. Limited access to pregnancy care in Oklahoma's TRU areas contributes to the state's high rates of maternal morbidity and mortality. Family medicine (FM) physicians receive basic OB training during residency and are often the only providers delivering pregnancy care for geographically isolated and socially vulnerable populations in these counties. In 2021, the University of Oklahoma School of Community Medicine launched an enhanced OB training curriculum for FM residents to help address workforce shortages in Oklahoma's TRU communities. This article describes the design and implementation of the enhanced training curriculum, summarizes results from the first 2 years of implementation, and shares lessons learned for the field.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100768"},"PeriodicalIF":2.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-04DOI: 10.1016/j.hjdsi.2025.100767
Ann Annis , Brenden Smith , Wenjuan Ma , Dawn Goldstein
{"title":"Relationship between mental health professional shortages and depression and anxiety visits: a cohort study of Federally Qualified Health Centers, 2019–2022","authors":"Ann Annis , Brenden Smith , Wenjuan Ma , Dawn Goldstein","doi":"10.1016/j.hjdsi.2025.100767","DOIUrl":"10.1016/j.hjdsi.2025.100767","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100767"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-16DOI: 10.1016/j.hjdsi.2025.100766
Ranjani K. Paradise , Carolyn Fisher , Hanna H. Haptu , Deborah McManus , Jennifer Cochran
•
The Massachusetts Department of Public Health partnered with Lynn Community Health Center (LCHC) to scale up testing and treatment for latent tuberculosis infection (LTBI) for a non-US born patient population. The project team developed a workflow to manage patients through the LTBI care cascade with screening performed in primary care and diagnostic testing, evaluation, and treatment undertaken by a TB team within the health center. To support the clinical workflow, the team implemented process improvements, addressed access barriers, and made electronic health record (EHR) enhancements.
•
LCHC successfully increased LTBI testing and treatment for non-US born patients, while sustaining engagement through the care cascade.
•
Strategic distribution of responsibilities, attention to process refinement, EHR enhancements, and collaboration with public health experts helped make the scale-up possible.
•
Three core factors kept patients more engaged, minimized gaps in treatment, and alleviated burdens associated with LTBI treatment: 1) flexibility with scheduling visits, 2) focus on building trusting, supportive relationships between care providers and patients, and 3) consistent outreach, reminders, and follow-up with patients on treatment.
•
Maintaining high testing and treatment volumes requires consistent effort, sustained attention, and staffing continuity.
{"title":"Transforming latent tuberculosis infection (LTBI) testing and treatment at a federally qualified health center","authors":"Ranjani K. Paradise , Carolyn Fisher , Hanna H. Haptu , Deborah McManus , Jennifer Cochran","doi":"10.1016/j.hjdsi.2025.100766","DOIUrl":"10.1016/j.hjdsi.2025.100766","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>The Massachusetts Department of Public Health partnered with Lynn Community Health Center (LCHC) to scale up testing and treatment for latent tuberculosis infection (LTBI) for a non-US born patient population. The project team developed a workflow to manage patients through the LTBI care cascade with screening performed in primary care and diagnostic testing, evaluation, and treatment undertaken by a TB team within the health center. To support the clinical workflow, the team implemented process improvements, addressed access barriers, and made electronic health record (EHR) enhancements.</div></span></li><li><span>•</span><span><div>LCHC successfully increased LTBI testing and treatment for non-US born patients, while sustaining engagement through the care cascade.</div></span></li><li><span>•</span><span><div>Strategic distribution of responsibilities, attention to process refinement, EHR enhancements, and collaboration with public health experts helped make the scale-up possible.</div></span></li><li><span>•</span><span><div>Three core factors kept patients more engaged, minimized gaps in treatment, and alleviated burdens associated with LTBI treatment: 1) flexibility with scheduling visits, 2) focus on building trusting, supportive relationships between care providers and patients, and 3) consistent outreach, reminders, and follow-up with patients on treatment.</div></span></li><li><span>•</span><span><div>Maintaining high testing and treatment volumes requires consistent effort, sustained attention, and staffing continuity.</div></span></li></ul></div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100766"},"PeriodicalIF":2.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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