Journal of Health Care for the Poor and Underserved最新文献

Background: Tooth decay is common, but low-income families have low rates of preventive oral health care. The American Dental Association community dental health coordinator (CDHC) model has successfully increased referrals to co-located dentists.

Objective: To implement a CDHC to link families between the medical home and community dentists.

Methods: The CDHC universally screened patients between 2-17 years of age during medical check-ups at two sites. Iterative plan-do-study-act (PDSA) cycles aim to increase screening, increase participants, and increase phone follow-up with families. When participation was low, family and provider focus groups were held.

Results: The CDHC completed 2,933 intakes with 745 appointments made and 250 dental appointments attended. Focus group participants of patients and providers endorsed support for the program, but iterative PDSA cycles did not increase participation.

Discussion: The generalizability of the CDHC model from referrals to internal, co-located dentists to external, community providers was not as successful as expected.

This study explores medical training programs within community health centers (CHCs) and investigates the organizational and environmental factors associated with these programs. Using cluster analysis, we identified four distinct clusters based on the prevalence of physician, nurse, advanced practitioner, and medical assistant trainees in CHCs. These clusters reveal variations in the composition of trainees within CHCs, indicating diverse training and recruitment priorities. Our analysis of organizational and environmental correlates found significant associations between factors such as urban location, CHC size, and the percentage of other clinical trainee types with the distribution of clinical trainees. The insights gained from this study are crucial for advancing the ongoing development of CHC medical training programs, emphasizing the delivery of high-quality primary care, comprehensive training, and education while addressing workforce challenges in resource-limited settings.

Amyotrophic lateral sclerosis (ALS) poses challenges for timely diagnosis due to its protean early manifestations and lack of definitive tests. This article explores how patient navigation interventions can expedite diagnosis, particularly for underserved patients who face disproportionately longer delays. Patient navigation has proven effective in reducing disparities in various diseases by providing guidance and support to patients and caregivers. It enhances awareness, facilitates communication with health care providers, and streamlines diagnosis. Drawing from literature on patient navigation in other diseases, this article proposes tailored adaptations for ALS diagnosis and addresses potential implementation barriers and strategies to overcome them. Integrating patient navigation into the ALS diagnostic pathway holds promise for improving efficiency, optimizing outcomes, and reducing health care disparities among underserved populations.

People experiencing unsheltered homelessness (PEUH) have an increased risk of frostbite injury, which can be a dangerous and debilitating condition. Our study aims to determine the prevalence, incidence, and impact of frostbite in the unsheltered population in Chicago and nearby suburbs. We administered a survey at a Chicago Transit Authority metro station in suburban Cook County to assess the frequency of frostbite injury and the circumstances surrounding frostbite in this community. Our results demonstrated that frostbite is both common (incidence rate (IR) =1271.67 cases of frostbite per 100,000 life-years (LY)) and highly morbid (IR=46.24 amputations per 100,000 LY) in PEUH in Chicago. We hope to include more street medicine partners to raise awareness about the impact of frostbite injury in the unsheltered population and advocate for improved emergency preparedness plans during the cold winter season.

A diverse physician workforce is imperative to addressing health inequities, but few physicians identify as Black or Hispanic. Therefore, this study used the social constructionism framework to explore pediatric residents' perceptions of race in medical encounters. A qualitative study of 47 trainees at a tertiary care center revealed the following: (1) racism, not race, influences health; (2) trainee perceptions around race create feelings of discomfort during some racially discordant patient encounters, while they were a source of comfort for trainees of color during concordant encounters; and (3) trainee perceptions around race in racially discordant clinical encounters may result in a change in clinical practice. While participants expressed awareness that racism drives health disparities, they had limited understanding of how their interactions might further perpetuate disparate health outcomes for patients of color. This emphasizes the need to support anti-racism competencies in medical education and increase workforce diversity in health care.

Families living in poverty with young children are particularly vulnerable to poor health outcomes. This study used a randomized controlled trial to analyze the impact of Early Bird (EB), a novel health system-integrated program that provided financial incentives to low-income mothers for achieving healthy milestones. Participants randomized to the EB condition received contributions in a tax-advantaged children's savings account (CSA) for attending a maternal six-week postpartum check-up ($25), a pediatric dental visit by age 12 months ($75), six well-check visits by age 15 months ($75), two financial coaching sessions ($30), and enrolling in the EB program and opening a CSA ($250). We found that Early Bird increased the likelihood that mothers attended a financial coaching session. We found no evidence of an increase in the likelihood of completing any of the medical milestones. Future work should examine whether larger contributions to CSAs might incentivize mothers to achieve the medical milestones.

Community-level projects are a cornerstone in efforts to provide medical care to unhoused populations. The Community Medicine Cabinet (CMC) is a novel program created to supply residents of a local warming shelter with access to free over-the-counter medications. This report details the initial 18 months of operation including patient-reported evaluations.

Background: The COVID-19 pandemic affected adolescents' sexual and reproductive health (SRH) behaviors and access to services.

Methods: We analyzed data from the 2021 Adolescent Behaviors and Experiences Survey (n=7,705) on sexual activity, condom and contraceptive use, and sexually transmitted infection (STI) testing. We tested differences in SRH outcomes by demographics, racism experience, and English proficiency.

Results: Current sexual activity was higher among students reporting ever experiencing racism at school and self-rating how well they can speak English as "not well." Condom use differed by sex, sexual identity, and sex of sexual contacts. Demographic differences in contraceptive use were also identified. Sexually active females (vs. males) and males with same-sex or both-sex contacts (vs. opposite-sex) had higher STI testing.

Conclusion: Differences by students' demographic characteristics and experiences during the pandemic highlight needs to enhance accessibility and quality of adolescent SRH services and education in schools, clinics, and communities.

A growing body of literature links incarceration to negative health outcomes for individuals, families, and communities, yet health care learners often have little structured training in this area. In the last several years, many health care training programs have incorporated or expanded equity-focused curricula for their learners but have not consistently provided training on the impact of incarceration. Given the disproportionate rates at which Black, Indigenous, and Latinx individuals are brought into the correctional system, the authors argue that a curriculum on incarceration is an integral part of health care training. In this commentary, the authors summarize the history of structural racism within the correctional system; discuss the impact of incarceration on individual, family, and community health; and suggest methods to expand didactic curricula and direct clinical experiences within carceral and post-release settings.

The Grady Heart Failure Program (GHFP), based in a safety-net hospital, is an outpatient program that follows heart failure hospitalization. The 2018 GHFP added a community health worker, patient liaison, and mobile integrated health home visits to reduce socioeconomic barriers to treatment. Important outcomes for the GHFP included the program cost and patient follow-up visits within seven days of hospital discharge. We calculated the difference in 30-day related readmission between 2017 and 2018 to assess pre-post program effectiveness. Patient follow-up visits within seven days increased from 63.7% in 2017 to 65.6% in 2018. Related 30-day readmissions declined from 15.5% in 2017 to 13.1% in 2018. Compared with 2017, the incremental program cost per related 30-day hospital readmission averted was $7,955 in 2018. The expanded GHFP is potentially cost-saving from the perspective of the hospital-provider based on the inpatient cost saved from a heart failure readmission averted.