JOURNAL OF AMBULATORY CARE MANAGEMENT最新文献

Little is known about the characteristics of individuals using urgent care centers or walk-in retail clinics, collectively called convenience clinics (CC), as places of usual care. Using 2022 National Health Interview Survey data and logistic regression, we identified the factors associated with adults using CCs regularly. Among adults with a place of usual care, 7.5% reported receiving usual care at CCs. Individuals who were younger, working, and uninsured were significantly more likely to report CCs as their usual source of care. Understanding the characteristics of CC users is critical to inform policy for this evolving segment of the health care sector.

Climate-sensitive extreme weather events are increasingly impacting frontline clinic operations. We conducted a national, cross-sectional survey of 284 self-identified administrators and other staff at frontline clinics determining their attitudes toward climate change and the impacts, resilience, and preparedness of clinics for extreme weather events. Most respondents (80.2%) reported that humans are causing climate change, and nearly half (45.9%) reported concerns about extreme weather impacting their job, with barriers to preparedness including financing and knowledge and resources. Over a third (41.8%) of respondents reported taking steps to protect their clinic infrastructure from extreme weather, including by addressing power and improving ventilation.

Community health worker (CHW) integration into the health care team has been identified as an important strategy for engaging people living with HIV in care and treatment. The content and methodology for training influences the way CHWs work with clients. Our study describes the impact of a community-driven CHW and supervisor training program on client viral suppression, retention in care, and psychosocial outcomes. We conducted a single arm, pretest-posttest study of 45 clients of CHWs who participated in a training intervention from 2021 to 2022 in eight counties in the southern United States. We found significant improvements in viral suppression and empowerment, and reductions in stigma and unmet service needs. Providing training to CHWs and supervisors, using a participatory methodology and content designed to enhance integration in the care team can improve psychosocial outcomes for clients, including increased empowerment and reduced stigma.

Objective: To provide an overview of the methods of a social network survey used to collect data in primary care practices on team structures, compositions, and social networks (eg, support, communication).

Methods: A cross-sectional sociometric social network survey in 23 primary care practices with medical home attributes in New York and Pennsylvania was conducted. All primary care providers (ie, physicians, nurse practitioners, physician assistants), clinical staff (eg, registered nurses, social workers, and nutritionists, etc), and administrative staff (eg, practice managers, office assistants, etc) in each practice were eligible to participate in the online survey. All practice members received an online survey asking them to identify who they work with during a typical week. Data were collected about the characteristics of respondent's relationships with each identified team member, perceived team effectiveness, and respondent-level job satisfaction, intent to leave, burnout, and demographics. We calculated the overall response rate and compared it among practices with different practice sizes and respondent roles using chi-square tests and independent samples t-tests.

Results: The survey yielded an average response rate of 51.8%, with a range between 21.8% and 82.3% across the practices. Three hundred ninety-four primary care providers, 222 clinical staff, and 173 administrative staff responded to the survey. Respondents (n = 792) were more likely to be from smaller practices and be administrative or clinical staff rather than providers.

Conclusion: This social network survey of primary care providers and staff used innovative approaches to collect data on team structures beyond traditional methods. Despite declining response rates in healthcare provider surveys, our survey reached high response rates in several practices. Future studies should find ways to engage primary care providers and staff in survey research.

This study explored the perspectives of interprofessional collaborative practice health care providers in 2 clinics in the southeastern United States. The research team conducted key stakeholder interviews with 22 health care providers between 2022 and 2023. Study findings revealed 4 themes: Interprofessional Team Roles, Value of Behavioral Health Integration, Holistic Patient-Centered Focus, and Empathy-Driven Health Care. Health care providers highlighted the importance of the resources available within the team and the role of empathy in establishing trust, respect, and care satisfaction among health care providers and patients.

Suicide remains a leading cause of death for youth nationally, with access to mental health care continuing to be an emergent care imperative for health care organizations that are struggling to triage and provide critically needed mental health services to the communities they serve. Administrative inefficiencies present a potentially life-threatening delay in access to children seeking mental health care. Health care organizations have successfully used evidence-based process improvement methodologies to improve efficiency and reduce waste, including the Lean Six Sigma methodology. This study highlights the successful use of Lean Six Sigma to create an ambulatory scheduling process that significantly reduced waitlist times and increased timeliness of access to mental health care in a large pediatric hospital.

Using 2012-2018 Medicare claims and health center data, we identified factors associated with variation in rates of hospital care among Medicare-Medicaid dual enrollees receiving primary care at health centers. In our sample ( n = 5961 health center-years), we found no evidence that patient-centered medical home designation or other modifiable health center characteristics were associated with reductions in hospital care use, which depends more on health center patient mix. Thus, policymakers should target efforts to health centers serving the most disadvantaged and marginalized communities.