Recommended Core Measures for Evaluating the Patient-Centered Medical Home: Cost, Utilization, and Clinical Quality

Outlines the process of the Patient-Centered Medical Home Evaluators' Collaborative for identifying core standardized measures and their recommended principles and measures for evaluating cost and utilization and clinical quality

Quality of Preventive Health Care for Young Children: Strategies for Improvement

Looks at early childhood developmental services, including assessment, education, intervention, and coordination of care. Recommendations include national standards for preventive care, and improvements in health provider training

Achieving Better Quality of Care for Low-Income Populations: The Roles of Health Insurance and the Medical Home in Reducing Health Inequities

Outlines the importance of having both insurance and a medical home in reducing health and healthcare disparities for low-income adults, including access to care, preventive screenings, and satisfaction with quality of care. Makes policy recommendations

Coming Out of Crisis: Patient Experiences in Primary Care in New Orleans, Four Years Post-Katrina

Examines the network of neighborhood clinics funded with federal, state, and local money that emerged after Hurricane Katrina as a model for serving vulnerable populations. Looks at access, communication, chronic illnesses management, and preventive care

Enhancing the Capacity of Community Health Centers to Achieve High Performance

Based on a survey of community health centers, assesses access to care, care coordination, quality improvement efforts, health information technology adoption, and ability to serve as patient-centered medical homes. Suggests policy to strengthen clinics

The Adoption and Use of Health Information Technology by Community Health Centers, 2009-2013

With help from targeted federal investments, U.S. physician offices and hospitals have accelerated their adoption and use of patient electronic health records (EHRs) and other health information technology (HIT) in recent years. Comparison of results from. The Commonwealth Fund's two national surveys of federally qualified health centers (FQHCs) in 2009 and 2013 show that HIT adoption has also grown substantially for these important providers of care in poor and underserved communities. Nearly all surveyed FQHCs (93%) now have an EHR system, a 133 percent increase from 2009, the year federal "meaningful use" incentives for HIT were first authorized. Three-quarters of health centers (76%) reported meeting the criteria to qualify for incentive payments. Remaining challenges for health centers include achieving greater interoperability of EHR systems and ensuring patient access to their records. Mobile technology, such as text messaging, may help FQHCs further expand patient outreach and access to care

Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured highneed adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their need

Ready or Not? How Community Health Centers View Their Preparedness to Care for Newly Insured Patients

By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), an important source of care in low-income communities. A Commonwealth Fund survey asked health center leaders in 2013 about current and anticipated workforce challenges, as well as efforts under way to prepare for the increase in patients. The majority of FQHCs reported shortages of primary care doctors (56%), especially bilingual physicians (60%). Health centers are engaged in activities to meet the needs of new patients, with 53 percent pursuing integration of behavioral health and 31 percent hiring additional clinical staff. To help them provide quality care to more patients, FQHCs will require assistance to recruit additional personnel, particularly bilingual staff and mental health professionals, and to expand access to care through telehealth and other strategies

How High-Need Patients Experience Health Care in the United States: Findings from the 2016 Commonwealth Fund Survey of High-Need Patients

Health care costs are highly concentrated among people with multiple chronic conditions, behavioral health problems, and those with physical limitations or disabilities. With a better understanding of these patients' challenges, health care systems and providers can address patients' complex social, behavioral, and medical needs more effectively and efficiently. Goal: To investigate how the challenges faced by this population affect their experiences with the health care system and examine potential opportunities for improvement. Methods: Analysis of the 2016 Commonwealth Fund Survey of High-Need Patients, June–September 2016. Key findings and conclusions: The health care system is currently failing to meet the complex needs of these patients. High-need patients have greater unmet behavioral health and social issues than do other adults and require greater support to help manage their complex medical and nonmedical requirements. Results indicate that with better access to care and good patient–provider communication, high-need patients are less likely to delay essential care and less likely to go to the emergency department for nonurgent care, and thus less likely to accrue avoidable costs. For health systems to improve outcomes and lower costs, they must assess patients' comprehensive needs, increase access to care, and improve how they communicate with patients

Updated Guidance Regarding The Risk ofAllergic Reactions to COVID-19 Vaccines and Recommended Evaluation and Management: A GRADE Assessment, and International Consensus Approach

This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against \u3e 15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history