JOURNAL OF AMBULATORY CARE MANAGEMENT最新文献

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.

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.

Two models employed to integrate community health workers (CHWs) in health care settings are community-clinical linkages and employment within health care. Our objective was to understand the variability in how these models are implemented. We conducted a mixed-methods study across a large health system that included CHW focus groups and electronic health record data on patients referred to the teams. We identified three primary themes in the four focus groups (N = 29) and found differences in the demographics and health care use of the 1,097 patients. Both community- and clinically embedded CHWs reported addressing diverse patient needs; yet, challenges persist in integrating both models.

Previous research has demonstrated that social determinants of health are drivers of medical utilization, cost, and health outcomes. In this study, we compared the mean annual total cost to deliver health services per patient by health-related social need (HRSN) status and total HRSNs using linear regression and ANOVA, respectively. Patients with ≥1 HRSN (n = 8409) yielded $1772 higher annual costs compared to patients without HRSNs (n = 34 775) (P < .0001). Compared to patients without HRSNs, delivering care to patients with 1 HRSN (n = 4222) cost $1689 (P < .0001) more and to patients with ≥2 HRSN (n = 4187) cost $1856 (P < .0001) more per year.

The Urban Indian Health Program was created by the Indian Health Service to establish a culturally appropriate health care delivery model for Native Americans who relocate to urban areas. The 31 community-based Indian Health Programs under the Office of Urban Indian Health Program vary in culture, socioeconomic, and patient mix. Strategic decision-making by these community-based Indian Health Programs depends upon various factors, including leaders' characteristics, organizational characteristics, and service area market factors.

Using novel national data, we examined the association between 2020 federal COVID-related funding targeted to health centers (i.e., H8 funding) and health center workforce and operational capacity measures that may be important for preserving patient access to care and staff safety. We assigned health centers to quartiles based on federal funding distribution per patient and used adjusted linear probability models to estimate differences in workforce and operational capacity outcomes across quartiles from April 2020 to June 2022. We found a nearly 6-fold difference in 2020 H8 funding per patient when comparing health centers in the lowest versus highest quartiles. Despite this difference, health centers' outcomes improved similarly across quartiles over time, with the lowest-funded health centers having the greatest staffing and service capacity challenges. Our findings suggest that COVID-related health center funding may have contributed to stabilization of health centers' workforce and operations. Amid concerns about staff turnover, sustained investments targeted to supporting workforce retention at health centers can help to ensure ongoing delivery of critical services.