Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

There is emerging consensus that enhanced inter-professional teamwork is necessary for the effective and efficient delivery of primary care, but there is less practical information specific to primary care available to guide practices on how to better work as teams. The purpose of this study was to describe how primary care practices have overcome challenges to providing team-based primary care and the implications for care delivery and policy

Electronic Health Records and Support For Primary Care Teamwork

This study examined primary care practices' experiences using electronic health records (EHRs) as they strive to function as teams in patientcentered medical homes (PCMHs). We identify how EHRs facilitate and pose challenges to teamwork and how practices overcame such challenges. We describe solutions and identify opportunities to improve care processes as well as EHR functionalities and policies, to support teamwork

Insurance Churning Rates For Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful For Many

Changes in insurance coverage over time, or “churning,” may have adverse consequences, but there has been little evidence on churning since implementation of the major coverage expansions in the Affordable Care Act (ACA) in 2014. We explored the frequency and implications of churning through surveying 3,011 low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a “private option” expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. We also compared 2015 churning rates in these states to survey data from 2013, before the coverage expansions. Nearly 25 percent of respondents in 2015 changed coverage during the previous twelve months—a rate lower than some previous predictions. We did not find significantly different churning rates in the three states over time. Common causes of churning were job-related changes and loss of eligibility for Medicaid or Marketplace subsidies. Churning was associated with disruptions in physician care and medication adherence, increased emergency department use, and worsening self-reported quality of care and health status. Even churning without gaps in coverage had negative effects. Churning remains a challenge for many Americans, and policies are needed to reduce its frequency and mitigate its negative impacts

Las Percepciones de la Salud Mental y su Evolución

Background: Previous literature has identified a strong stigma against mental health patients in many parts of Latin America, which can serve as a deterrent to seeking help for mental health (Acuña 2005; López 2008; Vicente 2007). The resulting lack of attention to one’s mental health can not only exacerbate mental illnesses but also impede proper attention to one’s physical health (Prince 2007). Therefore, combating this stigma is an important step to improving the health of a population. Some of the most effective strategies for combating the stigma are education, social interaction, and integrating mental health services into primary care (López 2008; Murthy 2001). Education and integration of health services are two of the strategies implemented in Chile during recent healthcare reform (Minoletti 2005). The present study sought to characterize the perceptions of mental health services and the patients who utilize them and to determine what effect the health reform in Chile has had on these opinions. Methodology: A survey regarding experience, education, and perception of mental health services and patients was applied to 150 patients in the Centro de Salud Familiar Víctor Bertín Soto in Arica, Chile. Results: Only 21% of the sample had used a mental health service in the past, 58% of whom had been referred by another healthcare professional. The majority (88%) of the sample had never been educated about mental health. Fear of other people’s opinions and not knowing when this type of medical attention was necessary were commonly identified deterrents to seeking attention for mental health. The majority expressed an open-minded opinion regarding mental health patients, and many indicated that this opinion had evolved in the last ten years. Such change was most often a result of interaction with a mental health patient. Discussion and recommendations: This population has an open-minded perspective regarding mental healthcare. However, the stigma is still identified as a deterrent to seeking care. Education about mental heath, one of the goals of the health reform, has not reached the majority of the population. Facilitating social interaction may be a more effective strategy to reduce the stigma. The integration of services into primary care during the health reform seems to have been effective in improving access to mental healthcare because referrals commonly lead people to get treatment for mental health

Changes in prenatal care and birth outcomes after federally qualified health center expansion

Objective To evaluate whether the expansion of Federally Qualified Health Centers (FQHCs) improved late prenatal care initiation, low birth weight, and preterm birth among Medicaid-covered or uninsured individuals. Data Sources and Study Setting We identified all FQHCs in California using the Health Resources and Services Administration's Uniform Data System from 2000 to 2019. We used data from the U.S. Census American Community Survey to describe area characteristics. We measured outcomes in California birth certificate data from 2007 to 2019. Study Design We compared areas that received their first FQHC between 2011 and 2016 to areas that received it later or that had never had an FQHC. Specifically, we used a synthetic control with a staggered adoption approach to calculate non-parametric estimates of the average treatment effects on the treated areas. The key outcome variables were the rate of Medicaid or uninsured births with late prenatal care initiation (>3 months' gestation), with low birth weight (<2500 grams), or with preterm birth (<37 weeks' gestation). Data Collection/Extraction Methods The analysis was limited to births covered by Medicaid or that were uninsured, as indicated on the birth certificate. Principal Findings The 55 areas in California that received their first FQHC in 2011–2016 were more populous; their residents were more likely to be covered by Medicaid, to be low-income, or to be Hispanic than residents of the 48 areas that did not have an FQHC by the end of the study period. We found no statistically significant impact of the first FQHC on rates of late prenatal care initiation (ATT: −10.4 [95% CI −38.1, 15.0]), low birth weight (ATT: 0.2 [95% CI −7.1, 5.4]), or preterm birth (ATT: −7.0 [95% CI −15.5, 2.3]). Conclusions Our results from California suggest that access to primary and prenatal care may not be enough to improve these outcomes. Future work should evaluate the impact of ongoing initiatives to increase access to maternal health care at FQHCs through targeted workforce investments.https://doi.org/10.1111/1475-6773.1409

Connecting People to Services: A Psychology-Based Marketing Campaign for the LINK Center

The City of Northfield, MN and Growing Up Healthy operate the LINK Center, a resource desk at a local community center that connects low-income residents to social services. This paper describes the design, implementation and evaluation of a psychological theory-based marketing campaign to increase Center use. We compiled a list of potential campaign strategies from appropriate psychological literature and conducted focus groups to assess their relevance to the LINK Center. Focus group results suggested social marketing theory as the most useful strategy. We then tested its effectiveness with a mailing campaign to 643 residents of Northfield low-income housing. In specific, we evaluated the effect of postcards with differently framed messages on increasing LINK Center use. The campaign did not increase LINK Center use nor confirm the relevance of social marketing theory in this context. Limited time and resources explain these results. Future directions are discussed

Improving flood hazard datasets using a low-complexity, probabilistic floodplain mapping approach.

As runoff patterns shift with a changing climate, it is critical to effectively communicate current and future flood risks, yet existing flood hazard maps are insufficient. Modifying, extending, or updating flood inundation extents is difficult, especially over large scales, because traditional floodplain mapping approaches are data and resource intensive. Low-complexity floodplain mapping techniques are promising alternatives, but their simplistic representation of process falls short of capturing inundation patterns in all situations or settings. To address these needs and deficiencies, we formalize and extend the functionality of the Height Above Nearest Drainage (i.e., HAND) floodplain mapping approach into the probHAND model by incorporating an uncertainty analysis. With publicly available datasets, the probHAND model can produce probabilistic floodplain maps for large areas relatively rapidly. We describe the modeling approach and then provide an example application in the Lake Champlain Basin, Vermont, USA. Uncertainties translate to on-the-ground changes to inundated areas, or floodplain widths, in the study area by an average of 40%. We found that the spatial extent of probable inundation captured the distribution of observed and modeled flood extents well, suggesting that low-complexity models may be sufficient for representing inundation extents in support of flood risk and conservation mapping applications, especially when uncertainties in parameter inputs and process simplifications are accounted for. To improve the accuracy of flood hazard datasets, we recommend investing limited resources in accurate topographic datasets and improved flood frequency analyses. Such investments will have the greatest impact on decreasing model output variability, therefore increasing the certainty of flood inundation extents

Who Uses a Price Transparency Tool? Implications for Increasing Consumer Engagement

Despite the recent proliferation of price transparency tools, consumer use and awareness of these tools is low. Better strategies to increase the use of price transparency tools are needed. To inform such efforts, we studied who is most likely to use a price transparency tool. We conducted a cross-sectional study of use of the Truven Treatment Cost Calculator among employees at 2 large companies for the 12 months following the introduction of the tool in 2011-2012. We examined frequency of sign-ons and used multivariate logistic regression to identify which demographic and health care factors were associated with greater use of the tool. Among the 70 408 families offered the tool, 7885 (11%) used it at least once and 854 (1%) used it at least 3 times in the study period. Greater use of the tool was associated with younger age, living in a higher income community, and having a higher deductible. Families with moderate annual out-of-pocket medical spending ($1000-$2779) were also more likely to use the tool. Consistent with prior work, we find use of this price transparency tool is low and not sustained over time. Employers and payers need to pursue strategies to increase interest in and engagement with health care price information, particularly among consumers with higher medical spending