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1.
Jennifer E. DeVoe Miguel Marino Rachel Gold Megan J. Hoopes Stuart Cowburn Jean P. O’Malley John Heintzman Charles Gallia K. John McConnell Christine A. Nelson Nathalie Huguet Steffani R. Bailey 《Annals of family medicine》2015,13(4):312-320
PURPOSEThere is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon’s 2008 randomized Medicaid expansion (the “Oregon Experiment”).METHODSWe probabilistically matched demographic data from adults (aged 19–64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008–2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging.RESULTSThe intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05–1.55) for laboratory tests to 1.58 (95% CI, 1.10–2.28) for referrals.CONCLUSIONSOur results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings. 相似文献
2.
Improving Access to Primary Care for a Growing Latino Population: The Role of Safety Net Providers in the Rural Midwest 总被引:1,自引:0,他引:1
Lynn A. Blewett PhD ; Michelle Casey MS ; Kathleen Thiede Call PhD 《The Journal of rural health》2004,20(3):237-245
CONTEXT: Many rural Midwestern communities are experiencing rapid growth in Latino populations with low rates of health insurance coverage, limited financial resources, language and cultural differences, and special health care needs. PURPOSE: We report on 2-day site visits conducted in 2001 and 2002 in 3 communities (Marshalltown, Iowa; Great Bend, Kansas; and Norfolk, Nebraska) to document successful strategies to meet Latino health care needs. METHODS: We interviewed key informants to identify successful community strategies for dealing with health care access challenges facing the growing Latino population in the Midwest. FINDINGS: Interventions have been developed to meet new demands including (1) use of free clinics, (2) school health programs, (3) outreach by public health, social services and religious organizations, and (4) health care providers' efforts to communicate with patients in Spanish. Strain on safety net services for Latinos is due in part to a complicated and unstable mix of public and private funds, a large but overtaxed volunteer provider base, the dependence on a limited number of community leaders, and limited time for coordination and documentation of activities. CONCLUSIONS: We suggest the development of a Rural Safety Net Support System to provide targeted funding to rural areas with growing immigrant populations. Federal community health center support could be redirected to new and existing safety net providers to support the development of a safety net monitoring system. 相似文献
3.
Ulmer C Lewis-Idema D Von Worley A Rodgers J Berger LR Darling EJ Lefkowitz B 《The Journal of ambulatory care management》2000,23(1):23-38
Under managed care, community health center (CHC) care patterns will be increasingly subject to outside scrutiny. This article discusses results of medical records reviews assessing quality of care at CHCs for acute otitis media, diabetes, asthma, and hypertension. As a group, these safety net providers meet or exceed prevailing practice across other health care settings; however, there is substantial variation among sites. Regression analyses indicate that the individual CHC used by a patient is the most consistent determinant of whether a patient receives recommended care. Drawing on these results, the article explores approaches for improving care and discusses the implications for performance measurement among CHCs and other safety net providers. 相似文献
4.
Shields AE Shin P Leu MG Levy DE Betancourt RM Hawkins D Proser M 《Health affairs (Project Hope)》2007,26(5):1373-1383
To the extent that health information technology (IT) improves health care quality, differential adoption among providers that serve vulnerable populations may exacerbate health disparities. This first national survey of federally funded community health centers (CHCs) shows that although 26 percent reported some electronic health record (EHR) capacity and 13 percent have the minimal set of EHR functionalities, CHCs serving the most poor and uninsured patients were less likely to have a functional EHR. CHCs cited lack of capital as the top barrier to adoption. Ensuring comparable health IT capacity among providers that disproportionately serve disadvantaged patients will have increasing relevance for disparities; thus, monitoring adoption among such providers should be a priority. 相似文献
5.
Evaluating effective growth and development of a practice-based research network (PBRN) can be challenging. The purpose of this article is to describe the development of a logic model and how the framework has been used for planning and evaluation in a primary care PBRN. An evaluation team was formed consisting of the PBRN directors, staff, and its board members. After the mission and the target audience were determined, facilitated meetings and discussions were held with stakeholders to identify the assumptions, inputs, activities, outputs, outcomes, and outcome indicators. The long-term outcomes outlined in the final logic model are 2-fold: (1) improved health outcomes of patients served by PBRN community clinicians and (2) community clinicians are recognized leaders of quality research projects. The logic model proved useful in identifying stakeholder interests and dissemination activities as an area that required more attention in the PBRN. The logic model approach is a useful planning tool and project management resource that increases the probability that the PBRN mission will be successfully implemented. 相似文献
6.
Kevin A. Peterson Brendan C. Delaney Theodoros N. Arvanitis Adel Taweel Elisabeth A. Sandberg Stuart Speedie F. D. Richard Hobbs 《Annals of family medicine》2012,10(6):560-567
PURPOSE
The principal goal of the electronic Primary Care Research Network (ePCRN) is to enable the development of an electronic infrastructure to support clinical research activities in primary care practice-based research networks (PBRNs). We describe the model that the ePCRN developed to enhance the growth and to expand the reach of PBRN research.METHODS
Use cases and activity diagrams were developed from interviews with key informants from 11 PBRNs from the United States and United Kingdom. Discrete functions were identified and aggregated into logical components. Interaction diagrams were created, and an overall composite diagram was constructed describing the proposed software behavior. Software for each component was written and aggregated, and the resulting prototype application was pilot tested for feasibility. A practical model was then created by separating application activities into distinct software packages based on existing PBRN business rules, hardware requirements, network requirements, and security concerns.RESULTS
We present an information architecture that provides for essential interactions, activities, data flows, and structural elements necessary for providing support for PBRN translational research activities. The model describes research information exchange between investigators and clusters of independent data sites supported by a contracted research director. The model was designed to support recruitment for clinical trials, collection of aggregated anonymous data, and retrieval of identifiable data from previously consented patients across hundreds of practices.CONCLUSIONS
The proposed model advances our understanding of the fundamental roles and activities of PBRNs and defines the information exchange commonly used by PBRNs to successfully engage community health care clinicians in translational research activities. By describing the network architecture in a language familiar to that used by software developers, the model provides an important foundation for the development of electronic support for essential PBRN research activities.Key words: practice-based research networks, health information technology, clinical trials, medical informatics, primary care, information systems, community networks, integrated advanced information management systems, comparative effectiveness research, community-based participatory research 相似文献7.
Delaney BC Peterson KA Speedie S Taweel A Arvanitis TN Hobbs FD 《Annals of family medicine》2012,10(1):54-59
PURPOSE
The learning health care system refers to the cycle of turning health care data into knowledge, translating that knowledge into practice, and creating new data by means of advanced information technology. The electronic Primary Care Research Network (ePCRN) was a project, funded by the US National Institutes of Health, with the aim to facilitate clinical research using primary care electronic health records (EHRs).METHODS
We identified the requirements necessary to deliver clinical studies via a distributed electronic network linked to EHRs. After we explored a variety of informatics solutions, we constructed a functional prototype of the software. We then explored the barriers to adoption of the prototype software within US practice-based research networks.RESULTS
We developed a system to assist in the identification of eligible cohorts from EHR data. To preserve privacy, counts and flagging were performed remotely, and no data were transferred out of the EHR. A lack of batch export facilities from EHR systems and ambiguities in the coding of clinical data, such as blood pressure, have so far prevented a full-scale deployment. We created an international consortium and a model for sharing further ePCRN development across a variety of ongoing projects in the United States and Europe.CONCLUSIONS
A means of accessing health care data for research is not sufficient in itself to deliver a learning health care system. EHR systems need to use sophisticated tools to capture and preserve rich clinical context in coded data, and business models need to be developed that incentivize all stakeholders from clinicians to vendors to participate in the system. 相似文献8.
PURPOSE Electronic Health Record (EHR) databases in community health centers (CHCs) present new opportunities for quality improvement, comparative effectiveness, and health policy research. We aimed (1) to create individual-level linkages between EHR data from a network of CHCs and Medicaid claims from 2005 through 2007; (2) to examine congruence between these data sources; and (3) to identify sociodemographic characteristics associated with documentation of services in one data set vs the other.METHODS We studied receipt of preventive services among established diabetic patients in 50 Oregon CHCs who had ever been enrolled in Medicaid (N = 2,103). We determined which services were documented in EHR data vs in Medicaid claims data, and we described the sociodemographic characteristics associated with these documentation patterns.RESULTS In 2007, the following services were documented in Medicaid claims but not the EHR: 11.6% of total cholesterol screenings received, 7.0% of total influenza vaccinations, 10.5% of nephropathy screenings, and 8.8% of tests for glycated hemoglobin (HbA1c). In contrast, the following services were documented in the EHR but not in Medicaid claims: 49.3% of cholesterol screenings, 50.4% of influenza vaccinations, 50.1% of nephropathy screenings, and 48.4% of HbA1c tests. Patients who were older, male, Spanish-speaking, above the federal poverty level, or who had discontinuous insurance were more likely to have services documented in the EHR but not in the Medicaid claims data.CONCLUSIONS Networked EHRs provide new opportunities for obtaining more comprehensive data regarding health services received, especially among populations who are discontinuously insured. Relying solely on Medicaid claims data is likely to substantially underestimate the quality of care. 相似文献
9.
The adoption of electronic health records (EHRs) is now a national priority, but evidence shows that the level of typical adoption is low. We describe the goal of "high-level adoption" of an EHR system defined as a community of clinicians using an EHR system to share patient information, and create a summary of a patient's health, through the timely documentation of care, as well as through effective communication among caregivers, with a focus on patient safety and efficient use of resources. There are 10 key principles to achieving high level-adoption. These are: (1) shared medication lists; (2) shared patient problem lists; (3) established guidelines for communication about patient information among clinicians; (4) use of standard terminology; (5) preventive services; (6) integration of external data; (7) computerized provider order entry; (8) regional health information exchange; (9) adoption of clinical decision support; and (10) reuse of data for public health and research. 相似文献
10.
《Issue brief (Grantmakers in Health)》2012,(38):1-25
The collection of services and providers that making up the safety net system plays a crucial role in providing health care to the nearly 50 million uninsured adults and children nationwide (Kaiser Commission on Medicaid and the Uninsured 2011a). Passage of the Patient Protection and Affordable Care Act (ACA) presents both opportunities and significant challenges for this system. The health reform law will extend health insurance coverage to more than 30 million individuals by 2014. At the same time, it will invest significantly in building provider and clinic capacity, as well as in more coordinated and integrated care delivery systems (Summer 2011). This influx of patients will place increased demands on a system that is already experiencing capacity, financial, and workforce stressors. This issue brief focuses on some of the daily challenges facing the safety net, as well as new challenges and opportunities that will emerge as health reform unfolds. Philanthropy has long supported many aspects of the safety net, including developing the business and clinical structure and infrastructure, such as health information technology and strengthening the primary care and paraprofessional workforce. Philanthropy has also helped increase the capacity of community clinics and other safety net providers and expand the services associated with patient-centered care models to include translation, transportation, health literacy support, and community prevention. This paper highlights some of these efforts, and outlines areas of opportunity for funder investment in the safety net in this era of health reform. 相似文献
11.
Baxter C Levin R Legaspi MM Bailey BE Brown CL 《Journal of healthcare management / American College of Healthcare Executives》2002,47(6):376-88; discussion 388-9
The primary mission of community health centers (CHCs) is to provide primary and preventive healthcare for the underserved and vulnerable populations, including the uninsured, underinsured, and Medicaid beneficiaries. Economic and regulatory challenges have placed these safety net providers in a precarious position, forcing some to respond using cooperative strategies. This article focuses on seven CHC-led networks, delineating their integrative efforts in the core areas of managed care, clinical, administrative, information, and finance. Interviews with key representatives from each network highlight the networks' accomplishments and the critical success factors and outcomes of their integrative efforts. Several underlying themes emerged from this study that are consistent with findings of previous studies conducted in other organizational settings. Specifically participants in CHC-led networks cite the following factors as contributors to success: reciprocity, communication, trust, and long-standing relationships among key individuals. This is the first study to provide a rich depiction of CHC network activities. 相似文献
12.
Traci R. Rieckmann Nicholas Gideonse Amanda Risser Jennifer E. DeVoe Amanda J. Abraham 《The journal of behavioral health services & research》2017,44(3):351-363
Research has examined the safety, efficacy, feasibility, and cost-effectiveness of buprenorphine for the treatment of opioid dependence, but few studies have examined patient and provider experiences, especially in community health centers. Using de-identified electronic health record system (EHRS) data from 70 OCHIN community health centers (n = 1825), this cross-sectional analysis compared the demographics, comorbidities, and service utilization of patients receiving buprenorphine to those not receiving medication-assisted treatment (MAT). Compared to non-MAT patients, buprenorphine patients were younger and less likely to be Hispanic or live in poverty. Buprenorphine patients were less likely to have Medicaid insurance coverage, more likely to self-pay, and have private insurance coverage. Buprenorphine patients were less likely to have problem medical comorbidities or be coprescribed high-risk medications. It is important for providers, clinic administrators, and patients to understand the clinical application of medications for opioid dependence to ensure safe and effective care within safety net clinics. 相似文献
13.
Christina M. Getrich Andrew L. Sussman Kimberly Campbell-Voytal Janice Y. Tsoh Robert L. Williams Anthony E. Brown Michael B. Potter William Spears Nancy Weller John Pascoe Kendra Schwartz Anne Victoria Neale 《Annals of family medicine》2013,11(6):550-558
PURPOSE
Practice-based research networks (PBRNs) are increasingly seen as important vehicles to translate research into practice, although less is known about the process of engaging diverse communities in PBRN research. The objective of this study was to identify strategies for successfully recruiting and retaining diverse racial/ethnic communities into PBRN research studies.METHODS
This collaborative, multisite study engaged 5 of the 8 networks of the PRImary care MultiEthnic Network (PRIME Net) consortium that conducts research with traditionally underrepresented/underserved populations. We used a sequential, qualitative research design. We first conducted 1 key informant interview with each of 24 researchers experienced in recruiting research participants from 5 racial/ethnic communities (African American, Arab/Chaldean, Chinese, Hispanic, and Native American). Subsequently, we conducted 18 focus groups with 172 persons from these communities.RESULTS
Participants’ comments indicated that successful recruitment and retention of underrepresented populations in PBRN studies is linked to the overall research process. This process, which we termed the cycle of trust, entailed developing and sustaining relationships of trust during 4 interrelated stages: before the study, during study recruitment, throughout study conduct, and after study completion. Participants identified a set of flexible strategies within each stage and called for close engagement with clinic and community partners.CONCLUSIONS
Our participants suggest that approaches to research that lay a foundation of trust, demonstrate respect for community members, and extend beyond the enrollment and data collection phases are essential to enhance the participation of diverse populations in PBRN research. These findings offer the PBRN community a guide toward achieving this important goal. 相似文献14.
The US government has dedicated substantial resources to help certain providers, such as short-term acute care hospitals and physicians, adopt and meaningfully use electronic health record (EHR) systems. We used national data to determine adoption rates of EHR systems among all types of inpatient providers that were ineligible for these same federal meaningful-use incentives: long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. Adoption rates for these institutions were dismally low: less than half of the rate among short-term acute care hospitals. Specifically, 12 percent of short-term acute care hospitals have at least a basic EHR system, compared with 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals, and 2 percent of psychiatric hospitals. To advance the creation of a nationwide health information technology infrastructure, federal and state policy makers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals; including such hospitals in state health information exchange programs; and establishing low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers. 相似文献
15.
Impact of Title VII training programs on community health center staffing and national health service corps participation 总被引:2,自引:2,他引:0
Rittenhouse DR Fryer GE Phillips RL Miyoshi T Nielsen C Goodman DC Grumbach K 《Annals of family medicine》2008,6(5):397-405
PURPOSE Community health centers (CHCs) are a critical component of the health care safety net. President Bush’s recent effort to expand CHC capacity coincides with difficulty recruiting primary care physicians and substantial cuts in federal grant programs designed to prepare and motivate physicians to practice in underserved settings. This article examines the association between physicians’ attendance in training programs funded by Health Resources and Services Administration (HRSA) Title VII Section 747 Primary Care Training Grants and 2 outcome variables: work in a CHC and participation in the National Health Service Corps Loan Repayment Program (NHSC LRP). 相似文献
16.
Phillips RL Kinman EL Schnitzer PG Lindbloom EJ Ewigman B 《Archives of family medicine》2000,9(10):971-978
BACKGROUND: Determining a community's health care access needs and testing interventions to improve access are difficult. This challenge is compounded by the task of translating the relevant data into a format that is clear and persuasive to policymakers and funding agencies. Geographic information systems can analyze and transform complex data from various sources into maps that illustrate problems effortlessly for experts and nonexperts. OBJECTIVE: To combine the patient data of a community health center (CHC) with health care survey data to display the CHC service area, the community's health care access needs, and relationships among access, poverty, and political boundaries. DESIGN: Georeferencing, analyzing, and mapping information from 2 databases. SETTING: Boone County, Missouri. PARTICIPANTS: Community health center patients and survey respondents. MAIN OUTCOME MEASURES: Maps that define the CHC service area and patient demographics and show poor health care access in relation to the CHC service area, CHC utilization in relation to poverty, and rates of health care access by geopolitical region. RESULTS: The CHC serves a distinctly different area than originally targeted. Subpopulations with unmet health care access needs and poverty were identified by census tract. These underserved populations fell within geopolitical boundaries that were easily linked to their elected officials. CONCLUSIONS: Geographic information systems are powerful tools for combining disparate data in a visual format to illustrate complex relationships that affect health care access. These systems can help evaluate interventions, inform health services research, and guide health care policy. Arch Fam Med. 2000;9:971-978 相似文献
17.
Steffani R. Bailey Miguel Marino Megan Hoopes John Heintzman Rachel Gold Heather Angier Jean P. O’Malley Jennifer E. DeVoe 《Maternal and child health journal》2016,20(5):946-954
Objective The future of the Children’s Health Insurance Program (CHIP) is uncertain after 2017. Survey-based research shows positive associations between CHIP expansions and children’s healthcare utilization. To build on this prior work, we used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon’s 2009–2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance. Methods Using EHR data from 154 Oregon community health centers, we conducted a retrospective cohort study of pediatric patients (2–18 years old) who gained public insurance coverage during the Oregon expansion (n = 3054), compared to those who were continuously publicly insured (n = 10,946) or continuously uninsured (n = 10,307) during the 2-year study period. We compared pre-post rates of primary care visits, well-child visits, and dental visits within- and between-groups. We also conducted longitudinal analysis of monthly visit rates, comparing the three insurance groups. Results After Oregon’s 2009–2010 CHIP expansions, newly insured patients’ utilization rates were more than double their pre-expansion rates [adjusted rate ratios (95 % confidence intervals); increases ranged from 2.10 (1.94–2.26) for primary care visits to 2.77 (2.56–2.99) for dental visits]. Utilization among the newly insured spiked shortly after coverage began, then leveled off, but remained higher than the uninsured group. Conclusions This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children’s access to public health insurance in the United States. 相似文献
18.
《Journal of healthcare risk management》2017,36(3):6-15
The objective of this study was to describe the frequency, potential harm, and nature of electronic health record (EHR)‐related medication errors in intensive care units (ICUs). Using a secondary data analysis of a large database of medication safety events collected in a study on EHR technology in ICUs, we assessed the EHR relatedness of a total of 1622 potential preventable adverse drug events (ADEs) identified in a sample of 624 patients in 2 ICUs of a medical center. Thirty‐four percent of the medication events were found to be EHR related. The EHR‐related medication events had greater potential for more serious patient harm and occurred more frequently at the ordering stage as compared to non–EHR‐related events. Examples of EHR‐related events included orders with omitted information and duplicate orders. The list of EHR‐related medication errors can be used by health care delivery organizations to monitor implementation and use of the technology and its impact on patient safety. Health information technology (IT) vendors can use the list to examine whether their technology can mitigate or reduce EHR‐related medication errors. 相似文献
19.
Rowena J Dolor Peter C Smith Anne Victoria Neale 《Journal of the American Board of Family Medicine》2008,21(4):345-352
Human subject protection training is required for all research personnel regardless of funding source. This article summarizes recommendations from a discussion about ethics training for community personnel from the practice-based research network (PBRN) listserv sponsored by the Agency for Health Care Research and Quality PBRN Resource Center. PBRN projects can involve community providers and their staff as subjects of the research project or as collaborators with recruitment and data collection. Distinguishing between usual care and research procedures is important for determining if training is required of community-based personnel. The use of research assistants or practice facilitators to collect research-related information is one way of limiting practice involvement to usual care procedures, thereby allowing PBRNs to limit training to dedicated research staff. Key methodologies for human subject protection training of community practice staff include on-site lectures, online modules, videotapes, and paper-based training. Ultimately, a discussion by the PBRN researcher with his or her governing Institutional Review Board is recommended for finding acceptable strategies within a PBRN. 相似文献
20.
Heather Angier Rachel Gold Courtney Crawford Jean P. O’Malley Carrie J. Tillotson Miguel Marino Jennifer E. DeVoe 《Maternal and child health journal》2014,18(9):2025-2033
The objective of this study was to develop methodologies for creating child–parent ‘links’ in two healthcare-related data sources. We linked children and parents who were patients in a network of Oregon clinics with a shared electronic health record (EHR), using data that reported the child’s emergency contact information or the ‘guarantor’ for the child’s visits. We also linked children and parents enrolled in the Oregon Health Plan (OHP; Oregon’s public health insurance programs), using administrative data; here, we defined a ‘child’ as aged <19 years and identified potential ‘parents’ from among adults sharing the same OHP household identification (ID) number. In both data sources, parents had to be 12–55 years older than the child. We used OHP individual client ID and EHR patient ID numbers to assess the quality of our linkages through cross-validation. Of the 249,079 children in the EHR dataset, we identified 62,967 who had a ‘linkable’ parent with patient information in the EHR. In the OHP data, 889,452 household IDs were assigned to at least one child; 525,578 with a household ID had a ‘linkable’ parent (272,578 households). Cross-validation of linkages revealed 99.8 % of EHR links validated in OHP data and 97.7 % of OHP links validated in EHR data. The ability to link children and their parents in healthcare-related datasets will be useful to inform efforts to improve children’s health. Thus, we developed strategies for linking children with their parents in an EHR and a public health insurance administrative dataset. 相似文献