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HRSA-funded Health Centers Are an Important Source of Care and Reduce Unmet Needs in Primary Care Services. Med Care 2020; 57:996-1001. [PMID: 31730569 DOI: 10.1097/mlr.0000000000001206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence indicates the unmet need for primary care services including medical, mental health, and dental care is greater among uninsured and Medicaid beneficiaries than privately insured individuals, many of whom use Health Resources and Services Administration-funded health centers (HRSA HCs). OBJECTIVE We examined differences in rates of unmet need between low-income uninsured and Medicaid patients of HRSA HCs and safety-net clinics in general or private physicians. RESEARCH DESIGN We used logistic regression models to compare the predicted probabilities of unmet need for uninsured and Medicaid individuals whose usual source of care is HRSA HCs versus clinics in general or private physicians. SAMPLE We used a nationally representative survey of low income, adult patients who identified HRSA HCs as their usual source of care. We used the National Health Interview Survey to independently identify low-income individuals whose usual source of care was clinics (National Health Interview Survey clinics) or physicians (National Health Interview Survey physicians) in the general population. MEASURES Dependent variables were unmet need and delay in medical care, and unmet need for prescription medications, mental health, and dental care. The primary independent variable of interest was the usual source of care. We controlled for potential confounders. RESULTS We found the probability of unmet need for medical and dental care to be lower among HRSA HC patients than individuals whose usual source of care were not HRSA HCs. CONCLUSIONS HRSA HC patients have lower probabilities of unmet need for medical and dental care. This is likely because HRSA HCs provide accessible, affordable, and comprehensive primary care services. Expanding capacity of these organizations will help reduce unmet need and its consequences.
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Lee P, Pham L, Oakley S, Eng K, Freydin E, Rose T, Ruiz A, Reen J, Suleyman D, Altman V, Keating Bench K, Lee A, Mahaniah K. Using lean thinking to improve hypertension in a community health centre: a quality improvement report. BMJ Open Qual 2019; 8:e000373. [PMID: 30997412 PMCID: PMC6440610 DOI: 10.1136/bmjoq-2018-000373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background Achieving better care at lower cost in the US healthcare safety net will require federally qualified health centres (FQHC) to implement new models of team-based population healthcare. Lean thinking may offer a way to reduce the financial risk of practice transformation while increasing the likelihood of sustained improvement. Objective To demonstrate system-level improvement in hypertension control in a large FQHC through the situational use of lean thinking and statistical process control. Setting Lynn Community Health Center, the third largest FQHC in Massachusetts, USA. Participants 4762 adult patients with a diagnosis of hypertension. Intervention First, we created an organisation-wide focus on hypertension. Second, we implemented a multicomponent hypertension care pathway. The lean tools of strategy deployment, standardised work, job instruction, Plan-Do-Study-Adjust, 5S and visual control were used to overcome specific obstacles in the implementation. Measurements The primary outcome was hypertension control, defined as last measured blood pressure <140/90. Statistical process control was used to establish baseline performance and assess special cause variation resulting from the two-step intervention. Results Hypertension control improved by 11.6% from a baseline of 66.8% to a 6 month average of 78.2%. Limitations Durability of system changes has not been demonstrated beyond the 14-month period of the intervention. The observed improvement may underestimate the effect size of the full hypertension care pathway, as two of the five steps have only been partially implemented. Conclusions Success factors included experienced improvement leaders, a focus on engaging front-line staff, the situational use of lean principles to make the work easier, better, faster and cheaper (in that order of emphasis), and the use of statistical process control to learn from variation. The challenge of transforming care delivery in the safety net warrants a closer look at the principles, relevance and potential impact of lean thinking in FQHCs.
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Affiliation(s)
- Patrick Lee
- Medicine, North Shore Medical Center, Salem, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Lynn Community Health Center, Lynn, Massachusetts, USA
| | - Linhchi Pham
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Kimberly Eng
- Lynn Community Health Center, Lynn, Massachusetts, USA
| | - Elena Freydin
- Lynn Community Health Center, Lynn, Massachusetts, USA.,School of Nursing, Salem State University, Salem, Massachusetts, USA
| | - Tayla Rose
- Lynn Community Health Center, Lynn, Massachusetts, USA.,Department of Pharmacy and Health Systems Sciences, Northeastern University School of Pharmacy, Boston, Massachusetts, USA
| | - Alyssa Ruiz
- Lynn Community Health Center, Lynn, Massachusetts, USA
| | - Joyce Reen
- Lynn Community Health Center, Lynn, Massachusetts, USA
| | | | - Vanna Altman
- Lynn Community Health Center, Lynn, Massachusetts, USA
| | | | - Alice Lee
- Lean Enterprise Institute, Cambridge, Massachusetts, USA
| | - Kiame Mahaniah
- Lynn Community Health Center, Lynn, Massachusetts, USA.,Tufts University School of Medicine, Boston, Massachusetts, USA
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Abstract
Objectives This study aimed to measure the incidence and identify predictors of postpartum visit non-attendance, using medical records of women who received prenatal care and went on to deliver live births at Montefiore Hospital in 2013. Methods Pearson's Chi square tests were used to assess the association between maternal demographics, insurance status, and delivery information with non-attendance of a postpartum visit. Logistic regression and modified Poisson regression models were then used to identify statistically significant predictors of postpartum visit non-attendance. Results We found that one-third of all women who attended a prenatal visit at Montefiore Hospital did not return for a postpartum visit. Variables significantly associated with non-attendance include having Medicaid or no insurance (RR 1.4, 95 % CI 1.2-1.6), being Hispanic or Latino (RR 1.2, 95 % CI 1.1-1.3), having a vaginal delivery (RR 1.2, 95 % CI 1.1-1.4), and age <20 years (RR 0.77, 95 % CI 0.64-0.92). Conclusions for Practice We conclude that the risk of postpartum visit non-attendance disproportionately impacts socially and economically vulnerable patients who are: younger, part of a minority ethnic background, and depend on state funded health insurance. Our results highlight the disparity in access to postpartum care and the importance of identifying barriers to attendance as well as developing creative strategies of providing postpartum care outside of the traditional postpartum visit framework.
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Affiliation(s)
- Annemieke Wilcox
- Albert Einstein College of Medicine, 1945 Eastchester Rd, Apt 28G, Bronx, NY, 10461, USA.
| | - Erika E Levi
- Division of Family Planning and Global Women's Health, Obstetrics and Gynecology, Albert Einstein College of Medicine-Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY, 10461, USA
| | - Joanne M Garrett
- Division of Family Planning, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 4004 Old Clinic Bldg, CB# 7570, Chapel Hill, NC, 27599-7570, USA
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Gao YN, Nocon RS, Sharma R, Huang ES. What Factors Are Associated With Medicaid Patients' Use of Health Centers? J Prim Care Community Health 2017; 8:141-146. [PMID: 28142316 PMCID: PMC5469696 DOI: 10.1177/2150131916687919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To identify patient and neighborhood factors associated with health center (HC) use. Methods: A cross-sectional study of Medicaid fee-for-service claims in 2009 comparing HC users and nonusers. Results: Dually eligible patients (odds ratio [OR] 95% CI = [0.60, 0.61]) and those with high chronic disease burden (OR 95% CI = [0.73, 0.74]) had lower odds of HC use. Temporary Assistance for Needy Families participants (OR 95% CI = [1.20, 1.24]), black (OR 95% CI = [1.33, 1.36]) and Hispanic (OR 95% CI = [1.22, 1.25]) beneficiaries had higher odds. Local HC presence predicted higher HC use (OR 95% CI = [2.63, 2.70]). Conclusion: Findings may be useful in steering HC policies affecting critical access for Medicaid beneficiaries.
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Affiliation(s)
- Yihe N Gao
- 1 University of Chicago, Chicago, IL, USA
| | | | - Ravi Sharma
- 2 US Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD, USA
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Shi L, Lee DC, Chung M, Liang H, Lock D, Sripipatana A. Patient-Centered Medical Home Recognition and Clinical Performance in U.S. Community Health Centers. Health Serv Res 2016; 52:984-1004. [PMID: 27324440 DOI: 10.1111/1475-6773.12523] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION America's community health centers (HCs) are uniquely poised to implement the patient-centered medical home (PCMH) model, as they are effective in providing comprehensive, accessible, and continuous primary care. This study aims to evaluate the relationship between PCMH recognition in HCs and clinical performance. METHODS Data for this study came from the 2012 Uniform Data System (UDS) as well as a survey of HCs' PCMH recognition achievement. The dependent variables included all 16 measures of clinical performance collected through UDS. Control measures included HC patient, provider, and practice characteristics. Bivariate analyses and multiple logistic regressions were conducted to compare clinical performance between HCs with and without PCMH recognition. FINDINGS Health centers that receive PCMH recognition generally performed better on clinical measures than HCs without PCMH recognition. After controlling for HC patient, provider, and practice characteristics, HCs with PCMH recognition reported significantly better performance on asthma-related pharmacologic therapy, diabetes control, pap testing, prenatal care, and tobacco cessation intervention. CONCLUSION This study establishes a positive association between PCMH recognition and clinical performance in HCs. If borne out in future longitudinal studies, policy makers and practices should advance the PCMH model as a strategy to further enhance the quality of primary care.
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Affiliation(s)
- Leiyu Shi
- Johns Hopkins Primary Care Policy Center, Baltimore, MD.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - De-Chih Lee
- Johns Hopkins Primary Care Policy Center, Baltimore, MD.,Department of Information Management, Da-Yeh University, Changhua, Taiwan
| | - Michelle Chung
- Bureau of Primary Health Care, U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD
| | - Hailun Liang
- Johns Hopkins Primary Care Policy Center, Baltimore, MD.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Diana Lock
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Alek Sripipatana
- Bureau of Primary Health Care, U.S. Department of Health and Human Services, Health Resources and Services Administration, Rockville, MD
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Shi L, Lee DC, Liang H, Zhang L, Makinen M, Blanchet N, Kidane R, Lindelow M, Wang H, Wu S. Community health centers and primary care access and quality for chronically-ill patients - a case-comparison study of urban Guangdong Province, China. Int J Equity Health 2015; 14:90. [PMID: 26616048 PMCID: PMC4663727 DOI: 10.1186/s12939-015-0222-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 09/24/2015] [Indexed: 01/31/2023] Open
Abstract
Objective Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the ‘gate-keeper’ CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. Methods The case-comparison design was used to study nine health care organizations in Guangzhou, Dongguan, and Shenzhen cities within Guangdong province, China. 560 patients aged 50 or over with hypertension or diabetes who visited either CHCs or hospitals in these three cities were surveyed by using face-to-face interviews. Bivariate analyses were performed to compare quality and value of care indicators among subjects from the three cities. Multivariate analyses were used to assess the association between type of primary care delivery and quality as well as value of chronic care after controlling for patients’ demographic and health status characteristics. Results Patients from all three cities chose their current health care providers primarily out of concern for quality of care (both provider expertise and adequate medical equipment), patient-centered care, and insurance plan requirement. Compared with patients from Guangzhou, those from Dongguan performed significantly better on most quality and value of care indicators. Most of these indicators remained significantly better even after controlling for patients' demographic and health status characteristics. The Shenzhen model (hospital-owned and -managed CHC) was generally effective in enhancing accessibility and continuity. However, coordination suffered due to seemingly duplicating primary care outpatients at the hospital setting. Significant associations between types of health care facilities and quality of care were also observed such that patients from CHCs were more likely to be satisfied with traveling time and follow-up care by their providers. Conclusion The study suggested that the Dongguan model (based on insurance mandate and using family practice physicians as ‘gate-keepers’) seemed to work best in terms of improving access and quality for patients with chronic conditions. The study suggested adequately funded and well-organized primary care system can play a gatekeeping role and has the potential to provide a reasonable level of care to patients.
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Affiliation(s)
- Leiyu Shi
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - De-Chih Lee
- Department of Information Management, Da-Yeh University, Changhua, 51591, Taiwan (ROC).
| | - Hailun Liang
- Johns Hopkins Primary Care Policy Center, Baltimore, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Luwen Zhang
- School of Public Health of Sun Yat-sen University, 74, Zhongshan Road II, Guangzhou, 510275, China.
| | - Marty Makinen
- Results for Development Institute, 1100 15th Street, NW, Washington, DC, 20005, USA.
| | - Nathan Blanchet
- Results for Development Institute, 1100 15th Street, NW, Washington, DC, 20005, USA.
| | - Ruth Kidane
- Results for Development Institute, 1100 15th Street, NW, Washington, DC, 20005, USA.
| | - Magnus Lindelow
- The World Bank, 1225 Connecticut Avenue NW, Washington, DC, 20433, USA.
| | - Hong Wang
- Bill & Melinda Gates Foundation, 500 Fifth Avenue North, Seattle, WA, 98109, USA.
| | - Shaolong Wu
- School of Public Health of Sun Yat-sen University, 74, Zhongshan Road II, Guangzhou, 510275, China.
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Mandsager P, Lebrun-Harris LA, Sripipatana A. Health Center Patients' Insurance Status and Healthcare Use Prior to Implementation of the Affordable Care Act. Am J Prev Med 2015; 49:545-52. [PMID: 25997904 DOI: 10.1016/j.amepre.2015.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION U.S. health centers provide primary and preventive care to underserved populations, including low-income and uninsured patients. The purpose of this study is to examine patterns of publicly funded health center use according to patient insurance status (private, public, none), prior to implementation of the Affordable Care Act. METHODS National data came from the 2009 Health Center Patient Survey, and were analyzed in 2013. Descriptive analysis of health center patient insurance coverage and health center utilization variables was conducted, followed by adjusted multivariate analysis. RESULTS About 91% of uninsured patients received at least half their annual healthcare visits at a health center, and 86% had at least one usual source of care that included a health center; these rates were not significantly different from those for publicly or privately insured patients. About half of uninsured patients (48%) had long tenures at the health center (≥3 years since first visit), not significantly different from the publicly insured (52%), but lower than the privately insured (63%, p<0.01). Uninsured patients highlighted affordability as the main reason for visiting a health center, whereas insured patients emphasized convenient location and quality of care. CONCLUSIONS Insured patients used health centers for the majority of their care, and in similar proportions to their uninsured counterparts. The primary motivation for visiting a health center differed based on insurance type. Future studies should be able to examine whether health center demand across insurance categories follows a similar pattern following the Affordable Care Act insurance coverage expansions.
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Affiliation(s)
- Paul Mandsager
- Office of Research and Evaluation, Office of Planning, Analysis and Evaluation, Health Resources and Services Administration, Rockville, Maryland.
| | - Lydie A Lebrun-Harris
- Office of Research and Evaluation, Office of Planning, Analysis and Evaluation, Health Resources and Services Administration, Rockville, Maryland
| | - Alek Sripipatana
- Office of Quality and Data, Bureau of Primary Health Care, Health Resources and Services Administration, Rockville, Maryland
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Jones E, Ku L, Smith S, Lardiere M. County workforce, reimbursement, and organizational factors associated with behavioral health capacity in health centers. J Behav Health Serv Res 2015; 41:125-39. [PMID: 24114408 DOI: 10.1007/s11414-013-9364-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study describes on-site behavioral health treatment capacity in health centers in 2007 and examines whether capacity was associated with health center characteristics, county-level behavioral health workforce, and same-day billing restrictions. Cross-sectional data from the 2007 Area Resource File and Uniform Data System were linked with data on Medicaid same-day billing restrictions. Mental health treatment capacity was common; almost four in five health centers provided on-site mental health services. Additional services such as crisis counseling (20 %), treatment from a psychiatrist (29 %), and substance abuse treatment were offered by fewer health centers (51 % provide on-site services and only 20 % employ substance abuse specialists). In multivariate analysis, larger health centers, health centers located in counties with a larger behavioral health workforce per capita, and those located in the West and Northeast were more likely to have behavioral health capacity. Same-day billing restrictions were associated with lower odds of substance use treatment capacity and providing 24 hr crisis counseling services.
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Affiliation(s)
- Emily Jones
- Office of Economic Analysis, Evaluation, and Modeling in the Office of the National Coordinator for Health Information Technology, United States Department of Health and Human Services, Washington, DC, USA,
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9
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Abstract
John Heintzman and colleagues use less publicized evidence from Oregon to argue that unless access to primary care is improved, the benefits of widening the eligibility for public health insurance on individual and population health will be limited
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Affiliation(s)
- John Heintzman
- Oregon Health and Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Rachel Gold
- Kaiser Center for Health Research, Portland, Oregon, USA
| | - Steffani R Bailey
- Oregon Health and Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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[Socio-demographic characteristics and health status of patients at a free-of-charge outpatient clinic in Paris]. Rev Med Interne 2014; 35:709-14. [PMID: 25106664 DOI: 10.1016/j.revmed.2014.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 03/07/2014] [Accepted: 05/15/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE In the context of the French National Health Service, a free access to healthcare facilities (the PASS: "permanence d'accès aux soins de santé") has been implanted in 2000 for patients without health insurance or those dealing with financial hardship. There is few data about socio-demographic characteristics of the patients using these services. The objective of this study was to provide descriptive data about socio-demographic characteristics and motivation of those patients who use these clinics. METHODS This descriptive cross-sectional study was conducted between April an May 2008, in 5 PASS clinics from academic tertiary hospitals in Paris. Descriptive data on patient were collected by general practitioners at the end of their consultations. RESULTS This study included 581 patients. The mean age was 42 years, and 65% of patients were males. Only 50.9% declared a salary income and 38.5% had a health insurance. Half of the patients were homeless, and 80% were migrants. The main reasons to visit these health facilities were direct access (no appointment needed), being in financial difficulty and having a medical record in the same hospital. Half of the patients had one chronic disease at least, while only a third of them saw regularly a physician. A total of 834 diseases were found among the 581 patients, including 411 chronic diseases, and 17% of the patients had a psychologic or a psychiatric disorder. Prognosis was divided in three grades: good, low and poor. Almost a half of the patients were considered by the doctor as having a low or a poor prognosis if they would not receive a therapy. CONCLUSIONS The findings of this study suggest that the PASS carry out their mission: most of the patients frequenting these facilities live under poor conditions and are in poor health status compared to the patients having access to conventional outpatient services.
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Shi L, Hung LM, Song K, Rane S, Tsai J, Sun X, Li H, Meng Q. Chinese primary care physicians and work attitudes. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2013; 43:167-81. [PMID: 23527460 DOI: 10.2190/hs.43.1.k] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
China passed a landmark health care reform in 2009, aimed at improving health care for all citizens by strengthening the primary care system, largely through improvements to infrastructure. However, research has shown that the work attitudes of primary care physicians (PCPs) can greatly affect the stability of the overall workforce and the quality and delivery of health care. The purpose of this study is to investigate the relationship between reported work attitudes of PCPs and their personal, work, and educational characteristics. A multi-stage, complex sampling design was employed to select a sample of 434 PCPs practicing in urban and rural primary care settings, and a survey questionnaire was administered by researchers with sponsorship from the Ministry of Health. Four outcome measures describing work attitudes were used, as well as a number of personal-, work-, and practice-related factors. Findings showed that although most PCPs considered their work as important, a substantial number also reported large workloads, job pressure, and turnover intentions. Findings suggest that policymakers should focus on training and educational opportunities for PCPs and consider ways to ease workload pressures and improve salaries. These policy improvements must accompany reform efforts that are already underway before positive changes in reduced disparities and improved health outcomes can be realized in China.
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Affiliation(s)
- Leiyu Shi
- Peking University, China Center for Health Development Studies, Beijing, China
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12
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Factors associated with job satisfaction by Chinese primary care providers. Prim Health Care Res Dev 2013; 15:46-57. [PMID: 23388523 DOI: 10.1017/s1463423612000692] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES This study provides a snapshot of the current state of primary care workforce (PCW) serving China's grassroots communities and examines the factors associated with their job satisfaction. METHODS Data for the study were from the 2011 China Primary Care Workforce Survey, a nationally representative survey that provides the most current assessment of community-based PCW. Outcome measures included 12 items on job satisfaction. Covariates included intrinsic and extrinsic factors associated with job satisfaction. In addition, PCW type (i.e., physicians, nurses, public health, and village doctors) and practice setting (i.e., rural versus urban) were included to identify potential differences due to the type of PCW and practice settings. RESULTS The overall satisfaction level is rather low with only 47.6% of the Chinese PCW reporting either satisfied or very satisfied with their job. PCW are least satisfied with their income level (only 8.6% are either satisfied or very satisfied), benefits (12.8%), and professional development (19.5%). They (particularly village doctors) are also dissatisfied with their workload (37.2%). Lower income and higher workload are the two major contributing factors toward job dissatisfaction. CONCLUSION To improve the general satisfaction level, policymakers must provide better pay and benefits and more opportunities for career development, particularly for village doctors.
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On-site provision of substance abuse treatment services at community health centers. J Subst Abuse Treat 2012; 42:339-45. [DOI: 10.1016/j.jsat.2011.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 09/20/2011] [Accepted: 09/21/2011] [Indexed: 11/21/2022]
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Shi L, Lebrun LA, Zhu J, Hayashi AS, Sharma R, Daly CA, Sripipatana A, Ngo-Metzger Q. Clinical quality performance in U.S. health centers. Health Serv Res 2012; 47:2225-49. [PMID: 22594465 DOI: 10.1111/j.1475-6773.2012.01418.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. DATA SOURCES National data from the 2009 Uniform Data System. DATA COLLECTION/EXTRACTION METHODS Health centers reviewed patient records and reported aggregate data to the Uniform Data System. STUDY DESIGN Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. PRINCIPAL FINDINGS Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. CONCLUSIONS Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients.
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Affiliation(s)
- Leiyu Shi
- Department of Health Policy and Management Director, Bloomberg School of Public Health, Johns Hopkins University, Johns Hopkins Primary Care Policy Center, Baltimore, MD, USA
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15
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Shi L. The impact of primary care: a focused review. SCIENTIFICA 2012; 2012:432892. [PMID: 24278694 PMCID: PMC3820521 DOI: 10.6064/2012/432892] [Citation(s) in RCA: 205] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/08/2012] [Indexed: 05/10/2023]
Abstract
Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as "snowballing" based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health.
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Affiliation(s)
- Leiyu Shi
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
- *Leiyu Shi:
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Stevens GD, Vane C, Cousineau MR. Association of experiences of medical home quality with health-related quality of life and school engagement among Latino children in low-income families. Health Serv Res 2011; 46:1822-42. [PMID: 21762145 PMCID: PMC3393027 DOI: 10.1111/j.1475-6773.2011.01292.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study examines whether patient-reported indicators of a quality medical home are associated with measures of health among Latino children in low-income families. DATA SOURCES Data on 3,258 children ages 2-18 years are from a cross-sectional survey of parents of children affiliated with California's Healthy Kids insurance. STUDY DESIGN Medical home quality was assessed using the Parents' Perception of Primary Care and was associated with health-related quality of life (HRQOL) overall and in four domains (physical, emotional, social, and school/daycare) and four measures of school engagement. PRINCIPAL FINDINGS A higher total medical home score was associated with a higher total Pediatric Quality of Life Inventory score and scores in four subdomains (total beta [B]=1.77, physical B=1.71, social B=1.36, emotional B=2.22, and school/daycare B=1.69, all p<0.001). It was also associated with missing fewer than three school days due to illness (odds ratio [OR]=1.12, 95 percent confidence intervals [CI]: 1.05, 1.19), excellent/above average school performance overall (OR=1.10, 95 percent CI: 1.03, 1.17) and performance in reading (OR=1.13, 95 percent CI: 1.06, 1.20) and math (OR=1.10, 95 percent CI: 1.03, 1.16). CONCLUSIONS Patient-reported medical home quality indicators are favorably associated with HRQOL and measures of school engagement among Latino children in low-income families.
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Affiliation(s)
- Gregory D Stevens
- Keck School of Medicine, University of Southern CaliforniaAlhambra, CA
| | | | - Michael R Cousineau
- Departments of Family Medicine and Preventive Medicine, Keck School of Medicine and the School of Policy Planning and Development, University of Southern CaliforniaAlhambra, CA
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Kotelchuck R, Lowenstein D, Tobin JN. Community Health Centers And Community Development Financial Institutions: Joining Forces To Address Determinants Of Health. Health Aff (Millwood) 2011; 30:2090-7. [DOI: 10.1377/hlthaff.2011.1008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ronda Kotelchuck
- Ronda Kotelchuck ( ) is the founding chief executive officer of the Primary Care Development Corporation, in New York City
| | - Daniel Lowenstein
- Daniel Lowenstein is the director of public affairs at the Primary Care Development Corporation
| | - Jonathan N. Tobin
- Jonathan N. Tobin is president and chief executive officer of Clinical Directors Network (CDN), in New York City
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Hutch DJ, Bouye KE, Skillen E, Lee C, Whitehead L, Rashid JR. Potential strategies to eliminate built environment disparities for disadvantaged and vulnerable communities. Am J Public Health 2011; 101:587-95. [PMID: 21389288 DOI: 10.2105/ajph.2009.173872] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 2006, the Federal Collaboration on Health Disparities Research (FCHDR) identified the built environment as a priority for eliminating health disparities, and charged the Built Environment Workgroup with identifying ways to eliminate health disparities and improve health outcomes. Despite extensive research and the development of a new conceptual health factors framework, gaps in knowledge exist in areas such as disproportionate environmental and community hazards, individual and cumulative risks, and other factors. The FCHDR provides the structure and opportunity to mobilize and partner with built environment stakeholders, federal partners, and interest groups to develop tools, practices, and policies for translating and disseminating the best available science to reduce health disparities.
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Affiliation(s)
- Daniel J Hutch
- Office of Policy, Economics and Innovation, US Environmental Protection Agency, Washington, DC 20460, USA.
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19
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Lo Sasso AT, Byck GR. Funding Growth Drives Community Health Center Services. Health Aff (Millwood) 2010; 29:289-96. [DOI: 10.1377/hlthaff.2008.0265] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Anthony T. Lo Sasso
- Anthony T. Lo Sasso ( ) is an associate professor and senior research scientist at the School of Public Health, University of Illinois at Chicago
| | - Gayle R. Byck
- Gayle R. Byck is a senior research specialist at the Institute for Health Research and Policy, University of Illinois at Chicago
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20
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Racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients compared with non-health center patients. J Ambul Care Manage 2010; 32:342-50. [PMID: 19888011 DOI: 10.1097/jac.0b013e3181ba6fd8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study aims to compare racial/ethnic and socioeconomic disparities in access to care and quality of care for US health center patients and non-health center patients. Data for the study came from the 2002 Community Health Center User Survey and the 2003 National Healthcare Disparities Report. Descriptive analysis was performed using nationally representative survey data pertaining to access to care and quality of care for people of different races, ethnicities, incomes, and education levels. Results of the study show that health center patients experience fewer racial/ethnic and socioeconomic disparities in access to care and quality of care, compared with non-health center patients nationally. Racial/ethnic disparities favoring whites occur in non-health center patients in every measure of quality and access included in this study. Conversely, there are few disparities favoring whites among health center users. Education and income-related disparities occur for several measures of access and quality in both health center and non-health center patients; however, the magnitude of these disparities is usually greater among non-health center patients compared with health center patients. In conclusion, health centers have been touted for cost-efficient, high-quality care. This study adds to growing evidence that health centers may also help eliminate racial/ethnic and socioeconomic disparities in access to care and quality of care.
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Abstract
The second national goal for Healthy People 2010 is the elimination of health disparities related to social disadvantage in the United States. Unfortunately, progress to date has been limited. Our national strategy to achieve this goal has been too narrowly focused on public health. Success will require a broader strategy including alignment of existing national policies in non-health areas that affect the health of the socially disadvantaged such as education, health care, labor, welfare, housing, criminal justice, the environment, and taxation if it is to succeed. Key criteria are needed to begin to prioritize areas for federal investment to achieve this goal. These include the impact of the targeted condition on disparities, evidence base for the intervention, potential impact of the policy on disparities, economic impact, and federal politics. Two "big ideas" offer promise including federal investment in early child education and enhanced primary care within federally qualified community health centers. The proposed criteria are applied to each proposed policy.
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23
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Stevens GD, West-Wright CN, Tsai KY. Health insurance and access to care for families with young children in California, 2001-2005: differences by immigration status. J Immigr Minor Health 2008; 12:273-81. [PMID: 18780183 DOI: 10.1007/s10903-008-9185-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 08/26/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine differences and trends in health insurance coverage and access to care for California families by immigration status. METHODS Cross-sectional data on 37,236 families with young children <18 years of age from the 2001, 2003 and 2005 California Health Interview Survey are used to assess trends in health insurance and access to care for children and their parents by four immigration dyads: (1) both are Citizens; (2) child is a legal resident/citizen, and parent is legal resident (Documented); (3) child is a citizen, and parent is undocumented (Mixed); and (4) both are Undocumented. RESULTS Before and after adjustment for covariates, only children in Undocumented dyads were less likely than Citizen dyads to have insurance (OR = 0.20, CI: 0.16-0.26) and all three measures of access: physician visits (OR = 0.69, CI: 0.52-0.91), dental visits (OR = 0.47, CI: 0.35-0.63), and a regular source of care (OR = 0.51, CI: 0.37-0.69). Parents in all non-Citizen dyads had poorer access than Citizen dyads across all measures, with the exception of dental visits and a regular source for parents in Documented dyads. Children of all dyads except Citizens were more likely to be insured in 2005 vs. 2001. The largest gain was for undocumented dyad children with 2.77 times higher odds (CI: 1.62-4.75) of being insured in 2005 vs. 2001. All children dyads except Mixed were also more likely to have a physician visit. For parents, there was only a decrease in insurance coverage for Citizen dyads (OR = 0.79, CI: 0.67-0.93) and few changes in access. Conclusions While there were relatively few disparities and some improvements in insurance coverage and access for children in California (except for undocumented children), concomitant changes for parents were not observed. Without attention to the family in health care reforms, disparities may not fully resolve for children and may continue or even increase for parents.
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Affiliation(s)
- Gregory D Stevens
- Department of Family Medicine, Center for Community Health Studies, University of Southern California Keck School of Medicine, 1000 South Fremont Avenue, Alhambra, CA 91803, USA.
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Community Health Centers and Emergency Preparedness: An Assessment of Competencies and Training Needs. J Community Health 2008; 33:241-7. [DOI: 10.1007/s10900-008-9093-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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