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Understanding Perceptions of Care Coordination and Chronic Illness Management among Black Breast and Prostate Cancer Survivors and Providers: Findings from a Quality Improvement Study. 了解黑人乳腺癌和前列腺癌幸存者及医疗服务提供者对护理协调和慢性病管理的看法:一项质量改进研究的结果。
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/JAC.0000000000000505
Laura Schubel, Mihriye Mete, Allan Fong, Christian Boxley, Ana Barac, Christopher Gallagher, Michelle F Magee, Hannah Arem

Navigating cancer care is complex and is exacerbated by pre-existing comorbidities managed by multiple providers. In this quality improvement study, we evaluated changes in perceived care coordination, navigation, and chronic illness care with community health worker (CHW) and mHealth support among Black breast cancer and prostate cancer patients with hypertension and/or diabetes. We collected patient and provider surveys on chronic illness care coordination at baseline and six months and found improvements in multiple domains. These findings support engaging CHWs to improve care coordination among cancer patients with comorbidities and demonstrate a use case of importance with emerging navigation reimbursement policies.

癌症护理过程十分复杂,而由多个医疗服务提供者管理的原有并发症又加剧了这种复杂性。在这项质量改进研究中,我们评估了患有高血压和/或糖尿病的黑人乳腺癌和前列腺癌患者在社区保健员(CHW)和移动医疗支持下对护理协调、导航和慢性病护理的感知变化。我们在基线和六个月时收集了患者和医疗服务提供者对慢性病护理协调的调查,发现在多个领域都有所改善。这些研究结果支持让 CHWs 参与改善有合并症的癌症患者的护理协调,并展示了新出现的导航报销政策的一个重要用例。
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引用次数: 0
The Potential of Advanced Rooming to Improve Communication and Visit Efficiency in Federally Qualified Health Centers. 在联邦合格医疗中心中,高级病房在改善沟通和就诊效率方面的潜力。
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/JAC.0000000000000504
Jodi Simon, Maggie Hamielec, Aesha Patel, Eve Walter, Jeffrey Panzer

Advanced rooming is a workflow that enables non-clinician staff to take on additional responsibilities to improve quality and productivity. However, the impact is not well understood, particularly in Federally Qualified Health Centers (FQHCs). In this observational study at two FQHC sites, we found that in advanced rooming more questions were asked by patients and staff and more problems were identified and addressed. Advanced rooming medical assistants spent more time with patients and huddled longer with clinicians without significant differences in the clinical portion of the visit or total visit length. Advanced rooming may be a way to enhance care, ease clinician burden, and increase efficiency.

超前分房是一种工作流程,可让非临床医生员工承担更多责任,以提高质量和生产率。然而,人们对其影响还不甚了解,尤其是在联邦合格医疗中心(FQHC)。在对两家联邦合格医疗中心的观察研究中,我们发现,在高级分房中,患者和员工提出了更多问题,发现并解决了更多问题。高级分室医疗助理与患者相处的时间更长,与临床医生挤在一起的时间也更长,但就诊的临床部分或总就诊时间并无显著差异。高级分室可能是加强护理、减轻临床医生负担和提高效率的一种方法。
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引用次数: 0
From the Editors. 编辑的话
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/JAC.0000000000000513
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引用次数: 0
From the Editors. 编辑的话
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/JAC.0000000000000513
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引用次数: 0
Quantifying Population Characteristics Within and Outside a 30-Minute Drive-Time to Health Resources and Services Administration-Supported Health Centers. 量化卫生资源与服务管理局支持的医疗中心 30 分钟车程内外的人口特征。
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/JAC.0000000000000507
Jennifer L Rankin, Jessica McCann, Michael Topmiller, Dave Grolling, Troyana Benjamin, Helen Yu-Lefler, Hank Hoang, Alek Sripipatana

The Health Resources and Services Administration's (HRSA) Health Center Program provides health care to vulnerable persons across the US, regardless of their ability to pay for health care. We examined characteristics of populations living within and outside a 30-minute drive-time to HRSA-supported health centers to establish a baseline to better understand the differences in these populations. Using a descriptive, cross-sectional study design and geographic information systems, we found that 94% of persons in the US live within a 30-minute drive-time of a health center. Of those outside a 30-minute drive-time to a health center, 11.7 million (60.11%) are rural and over 1.5 million households (20.32%) lack broadband internet access.

卫生资源与服务管理局(HRSA)的健康中心计划为全美各地的弱势人群提供医疗服务,无论他们是否有能力支付医疗费用。我们研究了居住在距离 HRSA 支持的健康中心 30 分钟车程以内和以外的人群特征,以建立一个基线,更好地了解这些人群的差异。通过采用描述性横断面研究设计和地理信息系统,我们发现美国有 94% 的人居住在医疗中心 30 分钟车程范围内。在距离医疗中心 30 分钟车程以外的人群中,有 1170 万人(60.11%)生活在农村,超过 150 万户家庭(20.32%)缺乏宽带互联网接入。
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引用次数: 0
Enhancing Annual Wellness Visits: A Pharmacy-Driven Quality Improvement Approach With Multidisciplinary Collaboration. 加强年度健康检查:以药房为主导、多学科合作的质量改进方法。
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/JAC.0000000000000508
Hanlin Li, Michael De Francesco, Tincy Mathews, Goldie Singh, Yuliya Baratt, Kathleen Evans, Helen Jan

Annual wellness visits (AWVs) guide appropriate patient care through lifestyle modifications, medication intervention, or social assistance. We launched a quality improvement program to target Medicare beneficiaries as part of an Accountable Care Organization (ACO). Key stakeholders collectively implemented a process consisting of two cohorts: AWVs completed with the support of the pharmacy team or directly by providers. A standardized workflow for the pharmacy cohort involved the clinical pharmacists and pharmacy extenders, allowing a layered learning experience. The AWV completion rate was optimized with the interventions of the pharmacy team.

年度健康访视(AWV)通过调整生活方式、药物干预或社会援助来指导适当的患者护理。我们针对医疗保险受益人推出了一项质量改进计划,作为责任医疗组织(ACO)的一部分。主要利益相关者共同实施了一个由两组人组成的过程:在药房团队的支持下或直接由医疗服务提供者完成 AWV。药房队列的标准化工作流程涉及临床药剂师和药房扩展人员,允许分层学习体验。在药学团队的干预下,AWV 的完成率得到了优化。
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引用次数: 0
Commentary: Sustaining Community Health Workers-The Importance of Professional Self-Governance and Self-Determination. 评论:维持社区卫生工作人员--专业自治和自决的重要性。
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/JAC.0000000000000510
E Lee Rosenthal, Paige Menking, Durrell J Fox, Floribella Redondo-Martinez, Lily K Lee, Julie St John
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引用次数: 0
The Journal of Ambulatory Care Management Thanks Our Reviewers. 门诊护理管理》杂志感谢我们的审稿人。
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/JAC.0000000000000512
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引用次数: 0
"By Us for Us": Lessons Learned in Developing a National Training and Technical Assistance Center by and for CHWs. "由我们为我们":由社区保健工作者和为社区保健工作者建立国家培训和技术援助中心的经验教训。
IF 1.6 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-10-01 Epub Date: 2024-08-23 DOI: 10.1097/JAC.0000000000000506
Ashley Wennerstrom, Kelsey N Witmeier, Kira Wortmann, Lisa Renee Holderby-Fox, Catherine G Haywood, Sherri L Ohly

In 2021, the Centers for Disease Control and Prevention (CDC) funded 67 health departments to implement community health worker (CHW) programs to enhance COVID-19 response. The CDC also funded a unique CHW-led Technical Assistance and Training (TTA) Center called Envision, which supported health departments to implement CHW programs and promote CHW workforce sustainability. After 1 year, Envision evaluators interviewed Envision staff to assess barriers and facilitators in developing the Center and the degree to which CHW leadership was operationalized. Thematic analysis revealed 3 themes regarding relationships, CHW values in practice, and operational challenges. Findings informed program updates. CHWs, funders, and policymakers may learn from these experiences.

2021 年,美国疾病控制与预防中心 (CDC) 资助 67 个卫生部门实施社区保健员 (CHW) 计划,以加强 COVID-19 的应对工作。疾病预防控制中心还资助了一个由社区保健员领导的独特的技术援助和培训 (TTA) 中心,名为 Envision,该中心支持卫生部门实施社区保健员计划并促进社区保健员队伍的可持续发展。一年后,Envision 的评估人员采访了 Envision 的工作人员,以评估发展该中心的障碍和促进因素,以及 CHW 领导力的可操作性程度。主题分析揭示了 3 个主题,分别涉及人际关系、社区保健工作者在实践中的价值观和运营挑战。研究结果为计划更新提供了依据。社区保健工作者、资助者和政策制定者可以从这些经验中吸取教训。
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引用次数: 0
The Association Between Hospital-Based Food Pantry Use and Subsequent Emergency Department Utilization Among Medicaid Patients With Diabetes. 医疗补助计划糖尿病患者使用医院食品储藏室与随后使用急诊科之间的关系。
IF 2.3 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-07-01 Epub Date: 2024-05-15 DOI: 10.1097/JAC.0000000000000499
Kenneth Lim, Kevin H Nguyen, Demetri Goutos, Paul R Shafer, Pablo Buitron de la Vega, Megan B Cole

We explored the association between the use of a hospital-based food pantry and subsequent emergency department (ED) utilization among Medicaid patients with diabetes in a large safety-net health system. Leveraging 2015-2019 electronic health record data, we used a staggered difference-in-differences approach to measure changes in ED use before vs after food pantry use. Food pantry use was associated with a 7.3 percentage point decrease per patient per quarter (95% confidence interval, -13.8 to -0.8) in the probability of subsequent ED utilization ( P = .03). Addressing food insecurity through hospital-based food pantries may be one mechanism for reducing ED use among low-income patients with diabetes.

我们探讨了一个大型安全网医疗系统中的医疗补助糖尿病患者使用医院食品储藏室与随后急诊科(ED)利用率之间的关系。利用 2015-2019 年的电子健康记录数据,我们采用了交错差分法来衡量使用食品储藏室前后急诊室使用率的变化。使用食品储藏室后,每位患者每季度使用急诊室的概率降低了 7.3 个百分点(95% 置信区间为-13.8 到-0.8)(P = 0.03)。通过医院食物储藏室解决食物不安全问题可能是减少低收入糖尿病患者使用急诊室的一种机制。
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引用次数: 0
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