Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers.

BackgroundHealth information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings.MethodsWe conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use.ResultsWe interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels-regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors.ConclusionsThe adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and tailoring HIE efforts based on all three categories of factors. Collective action between organizations may be needed to address inter-organizational and regional barriers. In the interest of facilitating HIE adoption and use, the impact of interventions at various levels on improving the use of electronic health data exchange should be tested

Improving the normalization of complex interventions: measure development based on normalization process theory (NoMAD): study protocol

<b>Background</b> Understanding implementation processes is key to ensuring that complex interventions in healthcare are taken up in practice and thus maximize intended benefits for service provision and (ultimately) care to patients. Normalization Process Theory (NPT) provides a framework for understanding how a new intervention becomes part of normal practice. This study aims to develop and validate simple generic tools derived from NPT, to be used to improve the implementation of complex healthcare interventions.<p></p> <b>Objectives</b> The objectives of this study are to: develop a set of NPT-based measures and formatively evaluate their use for identifying implementation problems and monitoring progress; conduct preliminary evaluation of these measures across a range of interventions and contexts, and identify factors that affect this process; explore the utility of these measures for predicting outcomes; and develop an online users’ manual for the measures.<p></p> <b>Methods</b> A combination of qualitative (workshops, item development, user feedback, cognitive interviews) and quantitative (survey) methods will be used to develop NPT measures, and test the utility of the measures in six healthcare intervention settings.<p></p> <b>Discussion</b> The measures developed in the study will be available for use by those involved in planning, implementing, and evaluating complex interventions in healthcare and have the potential to enhance the chances of their implementation, leading to sustained changes in working practices

The role of culturally competent communication in reducing ethnic and racial healthcare disparities.

Promoting culturally competent communication at the provider, care institution, health plan, and national levels is likely to contribute to success in reducing racial and ethnic disparities in the receipt of high quality care. Although some health plans recently have shown interest in addressing racial and ethnic disparities in care, very few have addressed how health plans can improve their cultural competency to reduce disparities. This commentary summarizes the importance of culturally competent communication across several levels of the healthcare system and details concrete steps that managed care organizations can take to maximize their ability to provide culturally competent communication and care

Advancing Community Health Worker Practice and Utilization: The Focus on Financing

There is a growing interest in the use of community health workers in various roles in the US health care system. These workers go by various titles and names -- including promotora and community health advisor -- but all assist members of the communities they serve. As the role of these workers becomes more accepted and desirable in the overall system of care, they face the challenges of moving from being an exceptional add-on to the system to being more a part of the mainstream. Issues such as educational preparation, formal credentialing, licensure and compensation are all part of this process. In particular, various organizations are interested in but challenged by the need for sustainable financing of the CHW position. It is time to explore and develop viable financing arrangements that go beyond short-term grants.To address these concerns, this research was undertaken to study sustainable financing mechanisms for community health workers. The focus is on existing and emerging funding, reimbursement and payment policies for community health workers. The study seeks to identify promising examples and models of payment programs for community health workers generally in the United States. To the authors' knowledge, this is the first national project with this exclusive focus.The audiences for this report include community health workers, directors of programs that employ or work with community health workers, and administrators of public and private coverage programs such as health plans, insurance companies and state Medicaid programs seeking options for improving health care access and quality at the same or lower costs. Businesses, non-profit organizations and consumers exploring the possibilities of using the services community health workers could provide might also be interested in the findings

Eliminating Mental and Physical Health Disparities Through Culturally and Linguistically Centered Integrated Healthcare

Since the U.S. Surgeon General’s report on mental health (1999) declared mind and body to be inseparable, integrated healthcare, bringing the body and mind back together, has been gaining significant momentum across the nation as a preferred approach to care for people with co-morbid physical health and mental health conditions. Primary care settings often are the gateway to healthcare for racial and ethnic minority populations and individuals with limited English proficiency (LEP) and, as such, it has become the portal for identifying undiagnosed or untreated behavioral health disorders. An integrated holistic philosophical approach to behavioral healthcare provides an opportunity to address mental and physical health disparities and achieve health equity through a culturally and linguistically centered integrated healthcare delivery model that by definition must be person-centered, family-centered, and community-centered

Mutual Shaping of Tele-Healthcare Practice: Exploring Community Perspectives on Telehealth Technologies in Northern and Indigenous Contexts

In Canada, northern and Indigenous communities face well documented challenges to accessing healthcare services prompting the urgent need to adopt alternative and innovative solutions to overcome barriers of limited access due to geographic distance, physician shortages, limited resources, and high cost of service delivery. Telehealth – the means of delivering health care services and information across distance – promises to augment services to address some of these barriers and has been increasingly relied upon to bridge healthcare service gaps. Despite the promise of telehealth, notable utilization barriers and structural constraints remain that challenge long-term sustainability. Little is known about how well these technologies work from community telehealth users’ perspectives. Current work in the area has tended to focus on the increased efficiency and cost effectiveness of telehealth in facilitating healthcare services, with less focus on users’ perspectives obscuring the important roles played by users and technologies. In sum, more work needs to be done to present a complete picture of users’ experiences and community needs – a gap this dissertation aims to tackle. In doing so, this research captures a snapshot of community perspectives from four Northern Saskatchewan communities, drawing attention to users’ experiences in relation to the social and technical factors shaping telehealth use. Working in partnership with the communities of Hatchet Lake Denesuline First Nation, the Northern Villages of Île-à-la-Crosse and Pinehouse Lake, and the Town of La Ronge, and external stakeholders/knowledge users working directly with these communities, this work resulted in valuable insights into the user-technology interface. Emerging from community concerns with accessing healthcare services and education/training, the goal of this project was to better understand strengths and barriers for telehealth use. Methodologically, the personal accounts and lived experiences of telehealth users were explored using qualitative methods grounded in Community-Based Participatory Research (CBPR) and decolonizing methodologies utilizing Constructivist Grounded Theory (CGT) that is drawn from interpretive-constructivist epistemological frameworks. In-depth, semi-structured qualitative interviews/focus groups with 24 telehealth users, field notes and general observations provided the basis for data collection, and NVivo 12 was used to organize, iteratively code and analyze community insights. Thematic analysis and socio-technical mapping explored themes across community contexts and provided understanding of the interrelationship of shared and unique insights whereby community telehealth users’ voices guided interpretations. This dissertation highlights the importance of community collaborations and identifies the strengths and barriers for utilizing telehealth within northern and Indigenous contexts. Using theoretical frameworks drawn from Science and Technology Studies (STS), this dissertation makes the argument that users and technologies play significant roles in shaping tele-healthcare practice – a mutually co-constitutive relationship embedded within larger socio-structural systems that pose varying constraints. Analysis revealed that users and technologies mutually shape tele-healthcare practices and care experiences – i.e. technologies shape patients’ and local/remote providers’ use of the system in enabling/constraining ways and users shape technologies through reconfiguration or “tinkering”. A mutual shaping approach following the relational/performative view of socio-technical agency serves as a pathway for examining socio-cultural factors shaping how technologies are designed, implemented, and used, and alternatively how technologies shape practice and meanings of socio-technical spaces. Further, it is argued that understanding the context in which telehealth technologies are situated and experienced will be increasingly critical as technological systems play greater roles in service delivery

Advances in Teaching & Learning Day Abstracts 2005

Proceedings of the Advances in Teaching & Learning Day Regional Conference held at The University of Texas Health Science Center at Houston in 2005

Community Based Participatory Research: The Application and Lessons Learned from a Study with LGB College Students

Lesbian, gay, and bisexual (LGB) individuals are members of a vulnerable group where health disparities have been identified. To gain a better understanding of the LGB college student healthcare experience and its contribution to the healthcare disparities found in LGB population, a community based participatory research (CBPR) approach was used to fill the gap. This paper will outline the CBPR process with an emphasis on how the principle investigator applied the tenets of CBPR when working with a local LGB college community. Several lessons learned from the research process are also shared in this paper