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Staffing transformation following Patient-Centered Medical Home recognition among Health Resources & Services Administration-funded health centers. Health Care Manage Rev 2023; 48:150-160. [PMID: 36692490 DOI: 10.1097/hmr.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Patient-Centered Medical Home (PCMH) recognition is designed to promote whole-person team-based and integrated care. PURPOSE Our goal was to assess changes in staffing infrastructure that promoted team-based and integrated care delivery before and after PCMH recognition in Health Resources & Services Administration (HRSA)-funded health centers (HCs). METHODOLOGY/APPROACH We identified changes in staffing 2 years before and 3 years after PCMH recognition using 2010-2019 Uniform Data System data among three cohorts of HCs that received PCMH recognition in 2013 ( n = 346), 2014 ( n = 207), and 2015 ( n = 115). Our outcomes were team-based ratio (full-time equivalent medical and nonmedical providers and staff to one primary care physician) and a multidisciplinary staff ratio (allied medical and nonmedical staff to 1,000 patients). We used mixed-effects Poisson regression models. RESULTS The earlier cohorts served fewer complex patients and were larger before PCMH recognition. Three years following recognition, the 2013 and 2014 cohorts had significantly larger team-based ratios, and all three cohorts had significantly larger multidisciplinary staff ratios. Cohorts varied, however, in the type of staff that drove this change. Both ratios increased in the longer term. CONCLUSION Our study suggests that growth in team-based and multidisciplinary staff ratios in each cohort may have been due to a combination of HCs' perceptions of need for specific services, HRSA funding, and technical assistance opportunities. POLICY IMPLICATIONS Further research is needed to understand barriers such as costs of employing a multidisciplinary staff, particularly those that cannot directly bill for services as well as whether such changes lead to practice transformation and improved quality of care.
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Tarfa A, Pecanac K, Shiyanbola OO. A qualitative inquiry into the patient-related barriers to linkage and retention in HIV care within the community setting. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 9:100207. [PMID: 36568895 PMCID: PMC9772845 DOI: 10.1016/j.rcsop.2022.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
Background People with the Human Immunodeficiency Virus (PWH) experience barriers to care within the community that impedes their progress from when they discover that they are HIV positive to becoming virally suppressed. For individuals with HIV to achieve sustained viral suppression, they must be linked to care to start receiving anti-retroviral therapy and remain retained in care for continuous treatment. However, HIV surveillance data shows that many PWH are not linked to care and become lost to continuous follow-up care. Although pharmacists, PWH, and social workers interact with one another and are aware of their roles in HIV care, their perspectives on barriers to linkage and retention in care have not been investigated collectively. Objectives Explore the perspectives of PWH, pharmacists, and social workers on barriers to linkage and retention of HIV care within the community setting. Methods Convenience sampling was used to recruit 15 stakeholders (five PWH, five community pharmacists, and five social workers) who participated in 1-h, semi-structured interviews based on three domains of the Patient-centered Medical Home Model including (1) experiences (individual and system-level barriers to care experienced by PWH), (2) activities (social workers and pharmacists initiatives that impact adherence to care)and (3) interventions (critical issues pharmacists can address in the community to engage PWH in their HIV care). We conducted a directed content analysis based on deductive coding. To establish rigor, we focused on Lincoln and Guba's criteria of rigorous qualitative methodology: credibility, dependability, confirmability, and transferability. Similarities and divergences of themes were discussed during data analysis and agreement was reached before interpretation. Results Emergent themes uncovered barriers to linkage and retention in HIV care as HIV-related stigma, having mental health illnesses including a history of substance abuse and social determinants of health such as homelessness, food insecurity, and insurance issues. Conclusion The perspectives of pharmacists, social workers, and PWH can provide insight into barriers that should be identified and addressed in people living with HIV to enhance their linkage and retention in care.
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Affiliation(s)
- Adati Tarfa
- 2506 Rennebohm Hall, School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705-222, United States of America,Corresponding author.
| | - Kristen Pecanac
- 4167 Signe Skott Cooper Hall, University of Wisconsin, 701 Highland Avenue, Madison, WI 53705, United States of America
| | - Olayinka O. Shiyanbola
- 2517 Rennebohm Hall, School of Pharmacy, University of Wisconsin, 777 Highland Ave., Madison, WI 53705-222, United States of America
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Barnes H, Martsolf GR, McHugh MD, Richards MR. Vertical Integration and Physician Practice Labor Composition. Med Care Res Rev 2022; 79:46-57. [PMID: 33185148 PMCID: PMC8340031 DOI: 10.1177/1077558720972596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With the growth of vertical integration among physician practices (i.e., hospital-physician integration), there have been many studies of its effects on health care treatments and spending. It is unknown if integration shapes provider configurations, especially against the backdrop of increasing employment of nurse practitioners (NPs) and physician assistants (PAs) across specialties. Using a longitudinal panel of 144,289 practices (2008-2015), we examined the association of vertical integration with NP and PA employment. We find positive associations between vertical integration and newly employing NPs and PAs within physician practices; however, the relationships differ by practice specialty type as well as timing of vertical integration. Supplementary analyses offer supporting evidence for coinciding enhancements to practice productivity, diversification, and provider task allocation. Our results suggest that vertical integration may promote interdisciplinary provider configurations, which has the potential to improve care delivery efficiency.
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Pittman P, Rambur B, Birch S, Chan GK, Cooke C, Cummins M, Leners C, Low LK, Meadows-Oliver M, Shattell M, Taylor C, Trautman D. Value-Based Payment: What Does It Mean for Nurses? Nurs Adm Q 2021; 45:179-186. [PMID: 34060500 DOI: 10.1097/naq.0000000000000482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Among the many lessons that have been reinforced by the SARS-COVID-19 pandemic is the failure of our current fee-for-service health care system to either adequately respond to patient needs or offer financial sustainability. This has enhanced bipartisan interest in moving forward with value-based payment reforms. Nurses have a rich history of innovative care models that speak to their potential centrality in delivery system reforms. However, deficits in terms of educational preparation, and in some cases resistance, to considering cost alongside quality, has hindered the profession's contribution to the conversation about value-based payments and their implications for system change. Addressing this deficit will allow nurses to more fully engage in redesigning health care to better serve the physical, emotional, and economic well-being of this nation. It also has the potential to unleash nurses from the tethers of a fee-for-service system where they have been relegated to a labor cost and firmly locate nurses in a value-generating role. Nurse administrators and educators bear the responsibility for preparing nurses for this next chapter of nursing.
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Affiliation(s)
- Patricia Pittman
- The George Washington University, Washington, District of Columbia (Dr Pittman); The University of Rhode Island, Kingston (Dr Rambur); Washington State Health Care Authority, Olympia (Ms Birch); HealthImpact and the University of California, San Francisco (Dr Chan); University of Mary, Bismarck, North Dakota (Dr Cooke); The University of Utah, Salt Lake City (Dr Cummins); American Association of Colleges of Nursing, Washington, District of Columbia (Drs Leners and Trautman); University of Michigan, Ann Arbor (Dr Low); Quinnipiac University, Hamden, Connecticut (Dr Meadows-Oliver); Johns Hopkins University, Baltimore, Maryland (Dr Shattell); and Southern University and A & M College, Baton Rouge, Louisiana (Dr Taylor)
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Nagel DA, Keeping-Burke L, Shamputa IC. Concept Analysis and Proposed Definition of Community Health Center. J Prim Care Community Health 2021; 12:21501327211046436. [PMID: 34541950 PMCID: PMC8460964 DOI: 10.1177/21501327211046436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Community health centers (CHCs) have been used for delivery of health services since the 1920s and originally were intended to provide care to underserved populations. CHCs have become an integral part of healthcare systems in many countries; however, the term CHC is used synonymously with other concepts and there is no clear definition for CHC. The purpose of our concept analysis was to determine how CHCs are described in the literature and to develop a concept definition for CHC. Methods: Informed by the 8-step process described by Walker and Avant, we searched for literature spanning disciplines within health, business, and policy. We used a systematic review process to identify a range of peer-reviewed articles that help illustrate the attributes, antecedents, and consequences of CHCs. A total of 102 articles from 7 databases were included in our concept analysis. Results: We distinguished 6 attributes of a CHC: primary care; accessibility; preventative care; defined population; health promotion; and comprehensive and integrated care. About 4 antecedents fundamental to a CHC included: secure funding; vision and support; adequate human resources; and governance structure. Consequences of CHCs are improved health outcomes, efficiency, and cost-effective provision of healthcare services. Conclusions: Our concept analysis revealed core characteristics of CHCs that assisted us in synthesizing a concept definition for CHC. These characteristics and our proposed definition will help provide clarity on the concept of CHC to benefit evaluation, research, and policy development of CHCs.
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Swankoski KE, Peikes DN, Palakal M, Duda N, Day TJ. Primary Care Practice Transformation Introduces Different Staff Roles. Ann Fam Med 2020; 18:227-234. [PMID: 32393558 PMCID: PMC7213997 DOI: 10.1370/afm.2515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Practices in the 4-year Comprehensive Primary Care (CPC) initiative changed staffing patterns during 2012-2016 to improve care delivery. We sought to characterize these changes and to compare practice patterns with those in similar non-CPC practices in 2016. METHODS We conducted an online survey among selected US primary care practices. We statistically tested 2012-2016 changes in practice-reported staff composition among 461 CPC practices using 2-tailed t tests. Using logistic regression analysis, we compared differences in staff types between the CPC practices and 358 comparison practices that participated in the survey in 2016. RESULTS In 2012, most CPC practices reported having physicians (100%), administrative staff (99%), and medical assistants (90%). By 2016, 84% reported having care managers/care coordinators (up from 24% in 2012), and 29% reported having behavioral health professionals, clinical psychologists, or social workers (up from 19% in 2014). There were also smaller increases (of less than 10 percentage points) in the share of practices having pharmacists, nutritionists, registered nurses, quality improvement specialists, and health educators. Larger and system-affiliated practices were more likely to report having care managers/care coordinators and behavioral health professionals. In 2016, relative to comparison practices, CPC practices were more likely to report having various staff types-notably, care managers/care coordinators (84% of CPC vs 36% of comparison practices), behavioral health professionals (29% vs 12%), and pharmacists (18% vs 4%). CONCLUSIONS During the CPC initiative, CPC practices added different staff types to a fairly traditional staffing model of physicians with medical assistants. They most commonly added care managers/care coordinators and behavioral health staff to support the CPC model and, at the end of CPC, were more likely to have these staff members than comparison practices.
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Affiliation(s)
| | | | - Maya Palakal
- Mathematica Policy Research, Princeton, New Jersey
| | - Nancy Duda
- Mathematica Policy Research, Princeton, New Jersey
| | - Timothy J Day
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
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Commentaries on health services research. JAAPA 2019. [DOI: 10.1097/01.jaa.0000558235.22122.c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Duarte-Climents G, Sánchez-Gómez MB, Rodríguez-Gómez JÁ, Rodríguez-Álvarez C, Sierra-López A, Aguirre-Jaime A, Gómez-Salgado J. Impact of the Case Management Model through Community Liaison Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111894. [PMID: 31146341 PMCID: PMC6603531 DOI: 10.3390/ijerph16111894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/16/2022]
Abstract
The objective of the present study is to assess the model’s impact on patients and their families in terms of outcomes and the efficiency results for the health system in Tenerife, Canary Islands, selecting a period of eight years from the time interval 2002–2018. The employed indicators were collected on a monthly basis. They referred to home care and its impact on clinical outcomes and on the use of resources. The comparison between the indicators’ tendencies with and without the liaison nurse model was done with the F-test by Snedecor. All these tests are bilateral, with a level of significance of p < 0.05. In those areas with community liaison nurse (CLN), improvements have been found in indicators that describe: (1) the management of the clinical status of patients, (2) the efficiency of the use of resources, and (3) the quality and compliance with the process that also includes home visits and social risk detection and management. It can be said that in the basic areas of primary health care where the work of the CLN develops there are improvements in the management of the patients’ clinical condition as well as in the quality and efficiency of care.
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Affiliation(s)
- Gonzalo Duarte-Climents
- University School of Nursing, Candelaria NS University Hospital, University of La Laguna, Canary Islands Health Service, 38010 Santa Cruz de Tenerife, Spain.
| | - María Begoña Sánchez-Gómez
- University School of Nursing, Candelaria NS University Hospital, University of La Laguna, Canary Islands Health Service, 38010 Santa Cruz de Tenerife, Spain.
| | - José Ángel Rodríguez-Gómez
- University School of Nursing and Physiotherapy, Health Sciences School, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain.
| | | | - Antonio Sierra-López
- Department of Preventive Medicine and Public Health, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain.
| | - Armando Aguirre-Jaime
- Research Support Unit for Primary Care Management and Candelaria NS University Hospital, 38010 Santa Cruz de Tenerife, Spain.
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain.
- Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
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Linman S, Benjenk I, Chen J. The medical home functions of primary care practices that care for adults with psychological distress: a cross-sectional study. BMC Health Serv Res 2019; 19:21. [PMID: 30626378 PMCID: PMC6327378 DOI: 10.1186/s12913-018-3845-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/19/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Primary care practices are changing the way that they provide care by increasing their medical home functionality. Medical home functionality can improve access to care and increase patient-centeredness, which is essential for persons with mental health issues. This study aims to explore the degree to which medical home functions have been implemented by primary care practices that care for adults with psychological distress. METHODS Analysis of the 2015 Medical Expenditure Panel Survey Household Component and Medical Organizations Survey. This unique data set links data from a nationally representative sample of US households to the practices in which they receive primary care. This study focused on adults aged 18 and above. RESULTS As compared to adults without psychological distress, adults with psychological distress had significantly higher rates of chronic illness and poverty. Adults with psychological distress were more likely to receive care from practices that include advanced practitioners and are non-profit or hospital-based. Multivariate models that were adjusted for patient-level and practice-level characteristics indicated that adults with psychological distress are as likely to receive primary care from practices with medical home functionality, including case management, electronic health records, flexible scheduling, and PCMH certification, as adults without psychological distress. CONCLUSIONS Practices that care for adults with mental health issues have not been left behind in the transition towards medical home models of primary care. Policy makers should continue to prioritize adults with mental health issues to receive primary care through this model of delivery due to this population's great potential to benefit from improved access and care coordination. TRIAL REGISTRATION This study does not report the results of a health care intervention on human subject's participants.
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Affiliation(s)
- Shawn Linman
- School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD 20742 USA
| | - Ivy Benjenk
- School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD 20742 USA
| | - Jie Chen
- School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD 20742 USA
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