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

This study investigates factors influencing nurses' actual use of electronic health record (EHR) systems in resource-limited settings in Botswana, with a focus on addressing barriers to EHR adoption and utilization. Despite the potential benefits of EHR systems, many nurses continue to rely on paper-based records, hampering health care delivery in underserved areas. Using a cross-sectional survey of 193 nurses from 55 health care facilities, this research identifies key predictors of EHR use. The modified Unified Theory of Acceptance and Use of Technology (UTAUT) model developed in this study highlights behavioral intention, facilitating conditions, and EHR experience as significant factors influencing EHR utilization. Effort expectancy and computer self-efficacy were found to be less impactful. The results suggest that targeted interventions focusing on improving behavioral intention, enhancing infrastructure, and increasing nurses' EHR experience can significantly boost EHR adoption. These findings offer actionable recommendations for health care organizations aiming to improve EHR implementation, ultimately leading to better patient outcomes in resource-limited environments.

This analysis aimed to define the data needs of community-based organizations (CBOs) after the COVID-19 pandemic. Through a mixed-methods explanatory sequential design during the summer/fall of 2023, 51 CBOs completed surveys and 24 participated in subsequent interviews. The CBOs provided social services to Black, Latinx, Asian, and/or low-income communities in the Chicago region. They varied in size, funding sources, and focus areas. Results showed that all used data, and 82.4% used population-level data. Data use expansion was limited by funding, staffing, data management systems, and skills. Existing population-level data was not sufficiently hyper-local, updated, and culturally appropriate to meet CBOs' needs. Community-based organization data needs and challenges have not changed significantly post-COVID despite rapid expansion of data availability. Findings highlight a need for long-term infrastructure funding and partnership from external agencies. Flexible tailored approaches to support CBOs are essential to increase social trust in data and ensure CBO missions remain community-driven.

Homelessness is associated with elevated mortality rates and premature death. Previous research has focused on the cause of death rather than the details surrounding these deaths. We conducted a qualitative analysis of records from the Los Angeles County Department of Medical Examiner. Medical examiner records document deaths of people experiencing homelessness. In 2018, a total of 998 deaths were represented. We analyzed event description, synopsis, and cause of death. Social exclusion was identified as a major theme, highlighted through three subthemes: exposure to harsh environments, denial of social rights, and social isolation. Contextualizing deaths among people experiencing homelessness deepens our understanding of mortality in this population. People experiencing homelessness are unable to access an adequate standard of living or equity before the law. Interventions to address social exclusion, including providing housing and eliminating criminalization of homelessness, can help to reduce preventable deaths among people experiencing homelessness.

Rural Tennessee's health and economic disparities have worsened since 2010 (while the state led the nation in hospital closures per capita). Guided by the Vulnerable Populations Conceptual Model, we examined the relationship between Tennessee's county-level rural mortality rates and declining access to hospital and emergency care in the decade preceding the COVID-19 pandemic (avoiding pandemic-related delayed data releases and potential statistical modeling issues). We conducted a retrospective, ecological correlational study using geographic information systems and annual cross-sectional secondary data, employing aspatial and spatial negative binomial generalized linear mixed-effects models (GLMMs). Our bivariate models revealed significant correlations between hospital and emergency care access and mortality rates, but the effect decreased when adjusted for rurality, median household income, age, and other covariates. While access to hospital and emergency care influences mortality, our findings indicate that socioeconomic and demographic factors have a greater impact, underscoring the strong health-wealth connection in rural Tennessee.

Background: The attitudes and engagement of health care staff with climate and social factors relevant to health are increasingly important as climate change intensifies.

Methods: We conducted secondary analysis of 296 survey responses from employees at health care safety net clinics and health centers across 48 U.S. states and territories to ascertain perception and engagement with climate risks and social determinants of health (SDOH) in their practices.

Results: Most participants demonstrated understanding, confidence, and engagement with climate risks and SDOH. Participants scored higher on SDOH metrics than climate metrics. There was moderate correlation between engagement with SDOH and engagement with climate-related health issues across domains of knowledge, confidence, perceived importance, and consultation with patients.

Conclusions: Health care workers who engaged with SDOH in their practice were also more likely to consult with patients on climate-related health impacts, suggesting that climate exposures could be integrated into clinical care as SDOH are.

Introduction: Women with low incomes are more likely than women with higher incomes to terminate pregnancies to prevent unwanted births. Terminations became less accessible in some states following the Dobbs v. Jackson Women's Health Organization ruling. As women would likely carry pregnancies for longer following Dobbs, we evaluated pre-post changes in the use of Medicaid-funded obstetric care following the ruling.

Methods: This study used a single group interrupted time series analysis design to assess pre-post changes in Medicaid health claims for obstetric care use.

Results: Use of obstetric care among women who were Black and women living in urban areas was most affected by Dobbs. Obstetric care use by these sociodemographic groups immediately increased after the ruling, followed by a decreasing trend in care use.

Conclusions: States with policies that reduce access to abortion care need to prepare for the increased demand for Medicaid-funded obstetric care among women who now must carry their pregnancies to term.

Georgia's Distinguished Cancer Clinicians and Scholars (DCCS) program, aimed at improving cancer care, faced challenges as rural and minority areas still show high cancer mortality rates. A Return on Investment (ROI) analysis showed a promising 5:2 return, leading to a recommendation for increased funding to address disparities in underserved regions.

Despite the critical role of well-child visits (WCVs) in preventive care, many Medicaid-enrolled children miss these appointments, leading to gaps in early intervention and immunization. Existing research has largely focused on either quantitative analyses of visit rates and predictors or qualitative insights into patient and provider experiences. This study employs a mixed-methods, community-based approach to examine barriers to WCV attendance among Medicaid-enrolled families in North Dakota who missed all WCVs in 2021. Through administrative data analysis (n=64,364), surveys (n=1,294), and focus groups (n=40), findings reveal structural, economic, and cultural obstacles, including cost concerns, lack of Medicaid transparency, and logistical challenges. Community-informed recommendations emphasize improved Medicaid communication, culturally responsive care, and enhanced appointment accessibility. Addressing these barriers could promote equitable access to WCVs, improve child health outcomes, and reduce disparities in preventive care for underserved populations.

To prepare for future crises, providers who serve people experiencing homelessness may benefit from reviewing and incorporating lessons learned from responses to the COVID-19 pandemic. We present results of a rapid qualitative analysis of data from three focus groups with permanent supportive housing staff and four focus groups with clients in four large U.S. cities from July-August 2022. Clients and staff described how the pandemic challenged organizational practices and client-provider interactions, affected mental health and substance use, and produced mixed effects on housing and homelessness. Both clients and staff emphasized the importance of relationships and agreed that effective practices included providing vaccination at supportive housing sites and incorporating virtual options for therapy and support groups. Client and staff perspectives are synthesized to provide lessons learned and recommendations for responding to future public health events, like the COVID-19 pandemic; the analysis is framed using the socioecological model.

We describe a partnership between a Tribally managed emergency department at Tsehootsooi Medical Center on the Navajo Nation and an academic medical center, establishing full-time emergency medicine faculty presence as a potentially scalable health care delivery model.