JOURNAL OF AMBULATORY CARE MANAGEMENT最新文献

Objective: The objective of this study was to estimate the association between an area's competition among Federally Qualified Health Centers (FQHCs) and cancer screening rates for cervical, breast, and colorectal cancers at an FQHC.

Methods: The study employed 2 secondary datasets between 2020 and 2022-the Health Resources and Services Administration's Uniform Data System and Unmet Need Score-to conduct a multivariable regression analysis on FQHCs' cervical, breast, and colorectal cancer screening rates in relation to the area's FQHC competition, measured as the Herfindahl-Hirschman Index, accounting for various FQHC-level and zip code-level control variables.

Results: The results indicated a significant negative association between the area's competition among FQHCs and cervical and colorectal cancer screening rates (Coef. = -.051, P < .01 and Coef. = -0.045, P < .01, respectively). There was no significant relationship found between breast cancer screening and the area's FQHC competition. Positive relationships were observed between screening rates, total cost per patient at an FQHC, and the number of FQHC patients.

Conclusions: The study highlights the complexities of FQHC competition, showing that while competition may be associated with service improvements in other health care contexts, its impact on preventive care delivery in the FQHC setting may be more nuanced. Enhancing outreach, care coordination, and addressing resource limitations are key for FQHCs to boost cancer screening rates and improve health outcomes for vulnerable populations. Future research should explore competition's nuanced role further and identify strategies to mitigate its potential adverse effects on care quality.

Objective: The rapid evolution of artificial intelligence (AI) presents opportunities and challenges for health systems, especially safety-net providers like Federally Qualified Health Centers (FQHCs). Safety-net systems may need help with structures and processes for assessing AI applications. To address this need, this article describes Moses-Weitzman Health System's (MWHS) initial steps toward establishing an AI program that defines intentional and informed AI use.

Approach: MWHS established two AI-focused workgroups: one of senior leaders and a cross-departmental group, providing a collaborative space for exploring potential applications, creating guidelines, and discussing concerns. With limited existing templates, MWHS crafted an AI policy emphasizing transparency, privacy, and security, outlining the criteria for implementing AI tools that interact with patient data and ensuring compliance with current regulations. Current AI-related projects focus on automating routine tasks, and research interests include evidence frameworks for making decisions about adopting AI tools and evaluating ambient listening technologies.

Findings: Lessons learned in building our AI program are that effective implementation requires tech-savvy leadership, cross-department collaboration, and cautious differentiation between general automation and generative AI. Challenges include the need for agile budgeting, careful vendor vetting, and safe testing environments to assess AI benefits and risks responsibly.

Conclusions and action steps: MWHS's AI program underscores a cautious but proactive approach to AI, aiming to balance innovation with operational and ethical considerations, and offers a model for other safety-net systems beginning their AI journeys.

Background and objective: The medical home is a primary care model that offers comprehensive, uninterrupted, and family-centered care to children regardless of their special health care needs. Although the overall contribution of medical home is well-studied, the differential influence of its components on health care utilization and unmet needs, particularly for children and youth with special health care needs (CYSHCN) remains insufficiently understood. This study examined the medical home component(s) that can best predict emergency and preventive visits, and unmet needs in CYSHCN.

Methods: This study analyzed 2016-2022 National Survey of Children's Health data from 64 553 caregivers of CYSHCN aged 0-17 years using the Rao-Scott Chi-square test and multivariable logistic regression.

Results: Findings show that receiving care within an overall medical home was associated with lower odds of emergency visits [adjusted odds ratio (aOR): 0.77 (95% confidence interval: 0.70-0.84)] and unmet needs [aOR = 0.29 (0.24-0.34)], and higher odds of preventive dental visits [aOR = 1.40 (1.25-1.57)]. Having a usual source for sick care and receiving effective care coordination was associated with reduced odds of emergency visits (aOR = 0.74 [0.64-0.84] and aOR = 0.85 [0.77-0.95], respectively). Receiving family-centered care [aOR = 0.45 (0.38-0.54)], no problems getting needed referral [aOR = 0.58 (0.47-0.72)], and getting effective care coordination when needed [aOR = 0.32 (0.26-0.39)] were associated with lower odds of unmet needs. The odds of utilizing preventive medical and dental visits was higher with having a personal doctor or nurse [aOR = 1.42(1.12-1.80) and aOR = 1.41 (1.20-1.65), respectively] and receiving family-centered care [aOR = 1.59 (1.18-2.12) and aOR = 1.44 (1.22-1.71), respectively].

Conclusions: The study highlights the importance of considering the differential contribution of medical home components for reducing emergency visits, addressing unmet needs, and improving preventive care, providing insights to enhance health care delivery for CYSHCN.

Background and objective: Health care systems are increasingly implementing interventions such as health care-based food pantries to mitigate the harmful health impacts of food insecurity. Our urban children's hospital established an on-site food pantry within the primary care building. This study seeks to identify the perceived benefits and impact of a health care-based food pantry on health, diet, and family finances.

Methods: In this qualitative study, semi-structured interviews were conducted with English- and Spanish-speaking caregivers utilizing a pediatric health care-based food pantry. Interview questions explored the impact of the pantry on health, diet, and family finances. Interviews were conducted until thematic saturation was reached. Transcripts were coded and thematically analyzed. Participants also completed surveys to enhance data obtained from the semi-structured interviews. Survey data included health-related social needs (including food insecurity), financial tradeoffs made between food and other necessities, and other utilized food resources.

Results: Of the 23 participants, interview themes included a positive impact on household budget with money saved on food utilized for other expenses. However, participants reported limited impact on diet and health due to the similarity of the food to their usual diet. Additional themes included the perceived benefit of food pantries within health care as a "one stop shop" and the importance of language concordance and being treated respectfully within the pantry. Most participants were food insecure (12, 52.2%) and had ≥1 unmet social need (13, 56.5%). Financial tradeoffs made for food were common with half reporting ≥1 tradeoff (13, 56.5%) in the past 12 months.

Conclusions: We identified a positive financial impact on household finances and perceived benefits of a food pantry's location within health care. The limited impact on diet and perceived health may be due to the intentional offering of foods desired by pantry users.

Objective: As the ambulatory care landscape shifts due to advances in medical technology and a rise in medically complex patients, health care systems must evolve by optimizing team-based care models and scope-of-practice utilization. This case study describes Northwell Health Physician Partners' policy-level initiative to expand the role of medical assistants (MAs) by permitting them to communicate normal laboratory results to patients.

Methods: A structured, multiphase approach was used to evaluate and implement the policy change. This included a comprehensive review of clinical workflows, stakeholder engagement, assessment of patient safety implications, and alignment with regulatory and compliance standards. The initiative prioritized maintaining the integrity of the MA role while enhancing care delivery efficiency. Training, documentation protocols, and communication standards were developed to support safe execution of this expanded task.

Results: Following implementation, the organization observed improved care team efficiency and enhanced patient communication workflows. Clinicians reported a reduction in administrative burden, particularly in managing normal test results. MAs were successfully integrated into follow-up communication workflows, freeing licensed staff to focus on higher-acuity needs. This scope-of-practice enhancement not only empowered MAs but also fostered greater operational synergy across the care team, enabling more efficient task distribution among clinicians, registered Nurses, and MAs and improved overall workflow. This shift facilitated optimal utilization of licensed professionals within their scope of practice allowing them to fully leverage their training and expertise. No adverse events related to the expanded task were reported during the observation period.

Conclusions and action steps: Expanding MA responsibilities to include the communication of normal laboratory results demonstrates how institutional flexibility in scope-of-practice policy can strengthen team-based care in ambulatory settings. Key lessons include the importance of stakeholder consensus, standardized training, and clear documentation protocols. This case highlights a replicable approach for other health systems seeking to address workforce challenges while ensuring patient safety and satisfaction. Future steps include ongoing evaluation of patient outcomes, expanded metrics tracking, and exploration of additional opportunities to optimize support staff roles across the ambulatory enterprise.

The goal of the Diabetes MESSAGES study was to support community health centers (CHCs) in implementing diabetes group visits (GVs). In this paper, we describe the training and technical assistance provided and evaluate implementation and sustainability. CHC teams attended in-person learning sessions and regular web-based check-ins, implemented a 6-month GV program, and completed surveys and reports. We analyzed changes in staff knowledge and attitudes from pre- to post-training. We measured adoption, engagement, fidelity, tailoring, staff satisfaction, and barriers and facilitators to implementation. Using a mixed-methods multi-site case study approach, we identified factors related to sustainability. All 7 CHC teams successfully implemented GVs for 6 months; 4 continued GVs after the study period. Teams adapted the GV model to their local contexts while retaining the core elements of individual medical care, group education, goal setting, and social support. Staff enjoyed GVs and thought they benefited patients. Key factors that differed between sites that continued GVs and sites that did not were team cohesiveness, experience, and stability; success in operationalizing GV model components; ongoing adaptation and improvement; and ability to demonstrate benefits and address concerns regarding the organizational impact of GVs. The Diabetes MESSAGES learning collaborative offered a flexible GV model, a roadmap for implementation, expert coaching, and co-learning with other CHCs. CHCs succeeded in implementing diabetes GVs despite barriers. Lessons learned may be useful for others hoping to establish and maintain their own GV programs.