JOURNAL OF AMBULATORY CARE MANAGEMENT最新文献

We examined self-reported inability to access to needed medical care and reasons for not accessing medical care among US-representative adult Medicaid enrollees, disaggregated across 10 Asian American, Native Hawaiian, and Pacific Islander ethnic groups. Chinese (-4.54 percentage points [PP], P < .001), Other Asian (-4.42 PP, P < .001), and Native Hawaiian (-4.36 PP, P < .001) enrollees were significantly less likely to report being unable to access needed medical care compared with non-Hispanic White enrollees. The most common reason reported was that a health plan would not approve, cover, or pay for care. Mitigating inequities may require different interventions specific to certain ethnic groups.

Learning collaboratives are seldom used outside of health care quality improvement. We describe a condensed, 10-week learning collaborative ("Telemedicine Hack") that facilitated telemedicine implementation for outpatient clinicians early in the COVID-19 pandemic. Live attendance averaged 1688 participants per session. Of 1005 baseline survey respondents, 57% were clinicians with one-third identifying as from a racial/ethnic minoritized group. Practice characteristics included primary care (71%), rural settings (51%), and community health centers (28%). Of three surveys, a high of 438 (81%) of 540 clinicians had billed ≥1 video-based telemedicine visit. Our learning collaborative "sprint" is a promising model for scaling knowledge during emergencies and addressing health inequities.

Health professionals, despite increasing challenges, with notable exceptions, always pursue peace through health because it is who we are-we are here to heal both at the individual and the community level. This applies to the long-standing Israeli-Palestinian conflict. Unfortunately, till now, nongovernmental organizations have had minimal impact on the conflict. This commentary makes 2 recommendations for donor countries after the fighting subsides: Do not insist on Israeli-Palestinian joint ventures at least for the short term and focus as much as possible your funding on interventions that improve community health.

Community health workers (CHWs) and promotores de salud are frontline health workers who typically come from the communities they serve. Despite providing crucial services, they are not institutionalized (or integrated) within much of the U.S. health care system. Many work, either officially or unofficially, as medical interpreters-restricting their full impact as CHWs/ promotores . In this paper, we detail the misemployment and its effects among a subsample of CHWs/ promotores in two geographically distinct, exploratory projects. We encourage that collaborative research with CHWs/ promotores continue and that fidelity to the CHW model be ensured to realize their true potential.

The COVID-19 pandemic produced an unprecedented shock to the U.S. health care system. Prior literature documenting 2020 changes has been limited to certain types of care or subsets of patients. We use the nationally representative Medical Expenditure Panel Survey to summarize changes in all types of health care from 2018 through 2020. Outpatient visits, emergency department visits, and inpatient admissions each fell about 35% in April 2020. Dental visits fell over 80%. Ophthalmology visits declined 71% and mammograms 82%. Psychiatric visits rose slightly (1.6%). By the end of 2020, specialist physician visits recovered, though primary care and dental visits remained 12% lower than 2019.

We explored the roles of community health workers (CHWs) working in Medicaid Managed Care Organizations in Louisiana by conducting 10 interviews with CHWs, supervisors, and administrators. We identified 6 themes: CHWs' backgrounds and training; roles as they related to nationally recognized competencies; team integration; who CHWs serve and how members are identified; metrics for success; and the effects of COVID. CHWs are hired for their community connections. CHWs generally do not receive core competency training, and they focus primarily on improving individual-level health outcomes. Administrators and supervisors may need training and support on CHW competencies, supervision, and using common evaluation indicators.

In a federally qualified health center, we assess a novel primary care delivery model, advanced team-based care (aTBC), that embeds care team members in patient visits. Using a difference-in-differences research design, we measure visit intensity, compliance with preventive care recommendations, and health outcomes among patients in the aTBC model compared with patients in a traditional team-based delivery model. We find increases in receipt of some recommended preventive care and in visit intensity, but no change in health outcomes. The aTBC model may improve some dimensions of care quality for low-income, vulnerable populations.

Gaps in care coordination (CC) can have detrimental impacts on children's health. It is unclear how much adverse social determinants of health (SDoH) may affect CC gaps. We determined whether exposure to adverse SDoH is associated with experiencing more gaps in CC using a representative national sample of children. Children with inadequate or no health insurance (adjusted odds ratio [aOR] = 2.41; 95% confidence interval [CI], 2.19-2.66) and living in disadvantaged neighborhoods (aOR = 1.53; 95% CI, 1.33-1.75) have a higher likelihood of having gaps in CC, as do those with higher counts of adverse SDoH (aOR = 2.17; 95% CI, 1.85-2.53). Thus, interventions to improve CC for children should consider adverse SDoH.