Hepatitis C Virus Infection Screening Within Community Health Centers

Context: Approximately 2.7 million people in the United States currently live with chronic hepatitis C virus (HCV) infection, and many are unaware that they have the disease. Community health centers (CHCs) serve as the primary care safety net for more than 22 million patients who are at risk for health inequities and represent an important frontline resource for early screening and treatment for HCV infection. Objective: To understand HCV infection screening rates among CHC patients, and to quantify the screening gap by demographic characteristics. Methods: The authors analyzed a deidentified dataset obtained through electronic health records from a large national network of CHCs. All adults at risk for HCV infection, according to the US Preventive Services Task Force (USPSTF) birth cohort screening guidelines for HCV infection, were considered eligible if they had a patient office visit between January 1, 2013, and December 31, 2013. Data were reviewed to determine the documentation of HCV infection screening from January 1, 2010, to December 31, 2013, and HCV infection screening rates were analyzed by age, race/ethnicity, and sex. Results: Among 60,722 eligible patients, 5033 (8.3%) had an HCV infection screen in accordance with USPSTF birth cohort screening guidelines. Women were less likely to be screened than men in every race/ethnic group, including white Hispanic (9.3% in women vs 5.4% in men), black Hispanic (15.1% in women vs 9.0% in men), white non-Hispanic (13.6% in women vs 8.1% in men), black non-Hispanic (14.9% in women vs 8.9% in men), Caribbean Islander or Haitian (6.5% in women vs 3.7% in men), and other races/ethnicities (6.3% in women vs 3.6% in men). Conclusion: To the authors’ knowledge, this is the first large-scale study among CHCs to assess the screening gap of the USPSTF birth cohort screening guidelines for HCV infection. This study suggests that CHCs should consider opportunities to improve HCV infection screening, thereby contributing to the reduction of health inequities resulting from untreated HCV infection

Identifying opportunities in EHR to improve the quality of antibiotic allergy data

Conclusion: Due to the high rate of self-reported beta-lactam allergies, protocols and policies that improve the confirmation and documentation of patient allergies in longitudinal EHR are necessary. Submitted May 21, 2014 and rejected. Resubmitted April 13 to this journa

Role of Patient Race/ethnicity, insurance and age on Pap smear compliance across 10 Community Health Centers in Florida

Community Health Centers (CHCs) are the nation\u27s primary care safety net for vulnerable populations, including racial/ethnic minorities, immigrants, migrant workers, and those who are uninsured. Women from such population sub-groups contribute disproportionately to cervical cancer incidence, morbidity, and mortality due, in large part, to the underutilization of Papanicolau (Pap) smear screening. Routine Pap smear screening can detect the onset and prevent progression of cervical malignancies. This article reports findings of a cross-sectional study to investigate the association between Pap smear compliance and patient race/ethnicity, insurance, and age for more than 60,000 women seen in a network of CHCs in Florida. Results of this study indicated a strong association between race/ ethnicity and Pap smear screening in CHCs. Among women aged 21-45 years, Hispanics were twice as likely to receive Pap smear screening, while Blacks were 1.45 times more likely to receive Pap smear screening, when compared to White women. These results were unexpected because most studies have shown that Hispanic women are less likely to receive screening than their Black and White counterparts. These findings highlight the need to further explore the contribution of race/ ethnicity, insurance, age, and other risks on health disparities associated with cervical cancer screening in CHCs. Moreover, results from this study have subsequently led to the development of clinical data reporting software to support Pap smear compliance monitoring within CHCs, as well as best practices regarding standardized documentation of Pap smear within electronic health records

Patient Experience in Health Center Medical Homes

The Human Resource and Services Administration, Bureau of Primary Health Care Health Center program was developed to provide comprehensive, community-based quality primary care services, with an emphasis on meeting the needs of medically underserved populations. Health Centers have been leaders in adopting innovative approaches to improve quality care delivery, including the patient centered medical home (PCMH) model. Engaging patients through patient experience assessment is an important component of PCMH evaluation and a vital activity that can help drive patient-centered quality improvement initiatives. A total of 488 patients from five Health Center PCMHs in south Florida were surveyed in order to improve understanding of patient experience in Health Center PCMHs and to identify quality improvement opportunities. Overall patients reported very positive experience with patient-centeredness including being treated with courtesy and respect (85 % responded always ) and communication with their provider in a way that was easy to understand (87.7 % responded always ). Opportunities for improvement included patient goal setting, referrals for patients with health conditions to workshops or educational programs, contact with the Health Center via phone and appointment availability. After adjusting for patient characteristics, results suggest that some patient experience components may be modified by educational attainment, years of care and race/ethnicity of patients. Findings are useful for informing quality improvement initiatives that, in conjunction with other patient engagement strategies, support Health Centers\u27 ongoing transformation as PCMHs