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

Prevalence of COVID-19 vaccination among women who use drugs is largely unknown. Using a community-based sample, we explored correlates of COVID-19 vaccination stratified by level of vaccine confidence, measured by the widely used Vaccine Hesitancy Scale. Level of vaccine confidence was found to be significantly associated with uptake of the COVID-19 vaccine as well as recent flu vaccination. Poisson regression with robust variance was used to identify correlates of vaccination within both groups. Among higher-confidence women, vaccine uptake was associated with education and experiencing pandemic-related health care barriers and food insecurity, and likelihood of vaccination was lower among those who did not believe the vaccine was FDA-approved than among those who did. Among lower-confidence women, likelihood of vaccination was greater among Black women, those in shared housing, and drug treatment, but lower among those recruited from high-vaccination neighborhoods and who believed newer vaccines carry greater risk.

Dental care remains an optional benefit for adults with Medicaid, with coverage varying across states. Recent expansions increased periodontal service coverage, but the scope of coverage and the policies that govern that scope remain unknown. This study analyzed coverage policies and fees for four periodontal services across 43 Medicaid programs between January and March 2024. Frequency limitations were the most common coverage policies identified, followed by prior authorization requirements, clinical requirements, and quadrant limitations. Veteran Health Administration fees were roughly three times higher than Medicaid fees across the four dental services. Current coverage policies may not consider the multidimensional and nuanced pathogenesis of periodontitis and the need for individualized treatment plans based on patient risk factors and disease progression. Furthermore, low reimbursement rates and administrative challenges may discourage dentists from participating.

An academic-community partnership developed a bilingual, family-centered type 2 diabetes self-management program for underserved Latinos, emphasizing cultural relevance, stakeholder engagement, and digital equity. This experience provides practical insights for organizations designing digital health interventions to promote healthy lifestyles and disease management among underserved populations.

A collaboration between land trust and health care system organizations in Cleveland, Ohio seeks to enhance community health in historically disinvested neighborhoods by transforming vacant properties into vibrant green spaces. Greening interventions focus on four predominantly Black communities, aiming to bolster cardiovascular wellness and physical activity over time through environmental improvement.

A system of health and social service hubs was recently established by a citywide equity-oriented network in Atlanta. The Office of Minority Health recently funded an expansion of the pilot, which provides an opportunity for the work to mature and yield lessons learned from the network-first model.

An outpatient elective module within a psychiatry residency program was established to train psychiatry trainees on caring for patients who have experienced human trafficking. A description of the year-long elective module and results of the residents' feedback on their experience in the elective are discussed.

Currently, individuals with federally-funded health insurance who desire sterilization are required to sign the Consent for Sterilization form (Title XIX form) at least 30 days before the date of the procedure. The form remains valid for 180 days with the only exceptions being cases in which emergency abdominal surgery or premature delivery is warranted. These tenets were constructed in response to public outcry over sterilization abuses that had occurred during the early 20th century. Although the intention of the Medicaid sterilization consent process lay in protecting the reproductive rights of individuals and preventing forced or coerced sterilization, the restrictions associated with the consent for sterilization currently serve as a barrier to access to care. This commentary is a call to modify the Medicaid sterilization consent form.

We conducted a cross-sectional study to investigate racial disparities among patients hospitalized for COVID-19 using electronic health records from a large community-based health care system between March 2020 and February 2021. The primary outcomes were in-hospital mortality and 30-day readmission. Demographics, clinical characteristics, and socioeconomic factors were analyzed using logistic regression, with adjusted odds ratios (AOR) reported. The study identified 90,490 patients, including Hispanic (29%), White (45.5%), Black (17.3%), Asian (3.1%), and Others (4.1%). The mortality model demonstrated a strong performance with an area under curve (AUC) of 0.88 (95%CI=0.877-0.885) and a Brier score of 0.093 (95%CI=0.092-0.095). For the 30-day readmission model, the AUC was 0.726 (95%CI=0.717-0.734) with a Brier score of 0.091 (95%CI=0.088-0.093). Compared with Whites, Hispanics exhibited a higher risk of mortality (AOR=1.23; 95%CI=1.16-1.31) but a lower likelihood of readmission (AOR=0.89; 95%CI=0.83-0.97). These findings highlight the critical need for targeted health management strategies across different racial and ethnic groups.

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.

This study examines health care service utilization of adults impacted by the justice system (n=3380) and general patient population (n=226,970) receiving care at one federally qualified health center (FQHC; n=62 service sites) in California between 2020-2022. A hybrid manual review of the electronic medical record was conducted. The top five departments used by adults impacted by the justice system, based on total number of encounters, were general medicine, case management, mental health services, specialty services, and substance use disorder services. Patients demonstrated vulnerabilities in education, employment, and housing and extensive use of clinical services. Adults impacted by the justice system can benefit from targeted and coordinated case management to support health care utilization. Findings may inform funding initiatives, staffing, and service delivery models to optimize care and support services for individuals who have experienced contact with the justice system.