Undergoing Transformation to the Patient Centered Medical Home in Safety Net Health Centers: Perspectives from the Front Lines

Objectives—Safety Net Health Centers (SNHCs), which include Federally Qualified Health Centers (FQHCs) provide primary care for underserved, minority and low income patients. SNHCs across the country are in the process of adopting the Patient Centered Medical Home (PCMH) model, based on promising early implementation data from demonstration projects. However, previous demonstration projects have not focused on the safety net and we know little about PCMH transformation in SNHCs. Design—This qualitative study characterizes early PCMH adoption experiences at SNHCs. Setting and Participants—We interviewed 98 staff,(administrators, providers, and clinical staff) at 20 of 65 SNHCs, from five states, who were participating in the first of a five-year PCMH collaborative, the Safety Net Medical Home Initiative. Main Measures—We conducted 30-45 minute, semi-structured telephone interviews. Interview questions addressed benefits anticipated, obstacles encountered, and lessons learned in transition to PCMH. Results—Anticipated benefits for participating in the PCMH included improved staff satisfaction and patient care and outcomes. Obstacles included staff resistance and lack of financial support for PCMH functions. Lessons learned included involving a range of staff, anticipating resistance, and using data as frequent feedback. Conclusions—SNHCs encounter unique challenges to PCMH implementation, including staff turnover and providing care for patients with complex needs. Staff resistance and turnover may be ameliorated through improved healthcare delivery strategies associated with the PCMH. Creating predictable and continuous funding streams may be more fundamental challenges to PCMH transformation

Iowa Climate Statement 2023: It’s Time to Tap Iowa’s Vast Solar Energy Resources

2023 was another year in which global and regional temperatures broke multiple records, and distant heat-exacerbated wildfires degraded Iowa’s air quality. Scientists continue to find that warming temperatures in the global atmosphere and ocean, caused largely by greenhouse gases from fossil-fuel combustion, are interconnected and are a root cause of increasing regional weather disasters1. In Iowa, new evidence links a warmer Gulf of Mexico to wetter spring planting conditions and a warmer atmosphere to rapid drying that creates flash drought and intensified storm systems.2,3 Iowa has multiple opportunities to help mitigate these climate changes with technologies that will also stimulate the economy and produce high-paying jobs.Copyright 2023, The Author