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Byhoff E, Rudel R, Taylor LA. Thoughtful Investing in Social Care Management: The Cause of, and Solution to, All of Life's Problems. J Ambul Care Manage 2024; 47:203-211. [PMID: 38771174 DOI: 10.1097/jac.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Elena Byhoff
- Author Affiliations: Division of Health Systems Science, Department of Medicine, Division of Health Information and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts (Dr Byhoff); Division of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Rudel); and Division of Healthcare Delivery Science and the Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York.; Division of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Rudel); and Division of Healthcare Delivery Science and the Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Nohria R, Yu J, Tu K, Feng G, Mcneil S, Johnson F, Lyn M, Scherr K. Community-based organizations' perspectives on piloting health and social care integration in North Carolina. BMC Public Health 2023; 23:1914. [PMID: 37789295 PMCID: PMC10548645 DOI: 10.1186/s12889-023-16722-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 09/08/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Community-based organizations (CBOs) are key players in health and social care integration initiatives, yet little is known about CBO perspectives and experiences in these pilot programs. Understanding CBO perspectives is vital to identifying best practices for successful medical and social care integration. METHODS From February 2021 to March 2021, we conducted surveys with 12 CBOs that participated in the North Carolina COVID-19 Social Support Program, a pre-pilot for North Carolina's Medicaid Sect. 1115 demonstration waiver program that addresses social drivers of health. RESULTS CBO participants preferred communication strategies that involved direct communication and felt clear communication was vital to the program's success. Participants expressed varied experiences regarding their ability to handle a changing volume of referrals. Participants identified their organizations' strengths as: strong organizational operations, past experiences with and understanding of the community, and coordination across organizations. Participants identified challenges as: difficulty communicating with clients, coping with capacity demands for scaling services, and lack of clear processes from external organizations. Almost all CBO participants expressed enthusiasm for participating in similar social care transformation programs in the future. CONCLUSIONS CBO participants in our study had broadly positive experiences in the pilot program and almost all would participate in a similar program in the future. Participants provided perspectives that can inform health and social care integration initiatives, including strengths and challenges in such programs. To build and sustain health and social care integration programs, it is important to: (1) support CBOs through regular, direct communication that builds trust and power-sharing between CBO and health care entities; (2) leverage CBO community expertise; and (3) pursue an individualized assessment of CBO capacity and identify CBO capacity-building strategies that ensure program success and sustainability.
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Affiliation(s)
- Raman Nohria
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, 27705, Durham, NC, USA.
| | - Junette Yu
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, 27705, Durham, NC, USA
| | - Karissa Tu
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Grace Feng
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, 92093, CA, San Diego, USA
| | | | - Fred Johnson
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, 27705, Durham, NC, USA
| | - Michelle Lyn
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, 27705, Durham, NC, USA
| | - Karen Scherr
- Department of Family Medicine and Community Health, Duke University School of Medicine, 2100 Erwin Road, 27705, Durham, NC, USA
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Mansfield LN, Carson SL, Sunku N, Troutt A, Jackson S, Santillan D, Vassar SD, Slaughter D, Kim G, Norris KC, Brown AF. Community-based organization perspectives on participating in state-wide community canvassing program aimed to reduce COVID-19 vaccine disparities in California. BMC Public Health 2023; 23:1356. [PMID: 37452299 PMCID: PMC10349443 DOI: 10.1186/s12889-023-16210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Inequities in COVID-19 vaccine accessibility and reliable COVID-related information disproportionately affected marginalized racial and ethnic communities in the U.S. The Get Out the Vaccine (GOTVax) program, an innovative statewide government-funded COVID-19 vaccine canvassing program in California, aimed to reduce structural barriers to COVID-19 vaccination in high-risk communities with low vaccination rates. GOTVax consisted of a community-academic-government partnership with 34 local trusted community-based organizations' (CBOs) to conduct COVID-19 vaccine outreach, education, and vaccine registration. The purpose of this qualitative evaluation study was to explore the barriers and facilitators of using local CBOs to deploy a geographically, racially, and ethnically diverse state-wide COVID-19 vaccine outreach program. METHODS Semi-structured online interviews were conducted with participating GOTVax CBO leaders from November 2021 to January 2022. Transcripts were analyzed using reflexive thematic analysis. RESULTS Thirty-one of 34 CBOs participated (91% response rate). Identified themes encompassed both facilitators and barriers to program participation. Key facilitators included leveraging trust through recognized entities; promoting empathetic, tailored outreach; and flexibility of milestone-based CBO funding contracts for rapid program implementation. Barriers included navigating community sociopolitical, geographic, and cultural factors; managing canvassers' safety; desiring metrics for self-evaluation of outreach success; mitigating canvassing technology challenges; and concerns of program infrastructure initially limiting outreach. CBOs problem-solved barriers with academic and government partners. CONCLUSIONS Between May and December 2021, the GOTVax program reached over 2 million California residents and registered over 60,000 residents for COVID-19 vaccination. Public health campaigns may improve benefits from leveraging the expertise of community-trusted CBOs and universities by providing flexible infrastructure and funding, allowing CBOs to seamlessly tailor outreach most applicable to local minoritized communities.
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Affiliation(s)
- Lisa N Mansfield
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Savanna L Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nisha Sunku
- Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Alana Troutt
- California Government Operations Agency, State of California, Sacramento, CA, USA
- San Francisco Health Plan, San Francisco, California, United States
| | | | | | - Stefanie D Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Dale Slaughter
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Gloria Kim
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Olive View-UCLA Medical Center, Sylmar, CA, USA
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Lyles CR, Nguyen OK, Khoong EC, Aguilera A, Sarkar U. Multilevel Determinants of Digital Health Equity: A Literature Synthesis to Advance the Field. Annu Rev Public Health 2023; 44:383-405. [PMID: 36525960 PMCID: PMC10329412 DOI: 10.1146/annurev-publhealth-071521-023913] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Current digital health approaches have not engaged diverse end users or reduced health or health care inequities, despite their promise to deliver more tailored and personalized support to individuals at the right time and the right place. To achieve digital health equity, we must refocus our attention on the current state of digital health uptake and use across the policy, system, community, individual, and intervention levels. We focus here on (a) outlining a multilevel framework underlying digital health equity; (b) summarizingfive types of interventions/programs (with example studies) that hold promise for advancing digital health equity; and (c) recommending future steps for improving policy, practice, and research in this space.
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Affiliation(s)
- Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, USA
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Public Health, University of California-Berkeley, Berkeley, California, USA
| | - Oanh Kieu Nguyen
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
| | - Elaine C Khoong
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
| | - Adrian Aguilera
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
- School of Social Welfare, University of California-Berkeley, Berkeley, California, USA
- Department of Psychiatry, University of California-San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, California, USA;
- Center for Vulnerable Populations, University of California-San Francisco, San Francisco, California, USA
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Ford MM, Allard A, Goldberg J, Summers C. Federally Qualified Health Center Penetration Associated With Reduced Community COVID-19 Mortality in Four United States Cities. J Prim Care Community Health 2022; 13:21501319221138422. [PMID: 36448474 PMCID: PMC9716186 DOI: 10.1177/21501319221138422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had significant impacts on health care access and delivery, with disparate effects across social and racial lines. Federally Qualified Health Centers (FQHCs) provide critical primary care services to the nation's most underserved populations, including many communities hardest hit by COVID-19. METHODS We conducted an ecological analysis that aimed to examine FQHC penetration, COVID-19 mortality, and socio-demographic factors in 4 major United States cities: New York, New York; Chicago, Illinois; Detroit, Michigan; and Seattle, Washington. RESULTS We found the distribution of COVID-19 cases and mortality varied spatially and in magnitude by city. COVID-19 mortality was significantly higher in communities with higher percentages of low-income residents and higher percentages of racial/ethnic minority residents. FQHC penetration was protective against increased COVID-19 mortality, after model adjustment. CONCLUSIONS Our study underpins the critical role of safety-net health care and policymakers must ensure investment in long-term sustainability of FQHCs, through strategic deployment of capital, workforce development, and reimbursement reform.
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Affiliation(s)
- Mary M. Ford
- Primary Care Development Corporation, New York, NY, USA,Mary M. Ford, Primary Care Development Corporation, 45 Broadway, New York, NY 10006, USA.
| | - Angela Allard
- Primary Care Development Corporation, New York, NY, USA,Angela Allard, Primary Care Development Corporation, 45 Broadway, New York, NY 10006, USA.
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Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management. Healthcare (Basel) 2022; 10:healthcare10102006. [PMID: 36292453 PMCID: PMC9602069 DOI: 10.3390/healthcare10102006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Addressing social determinants of health (SDoH) is associated with improved clinical outcomes for patients with chronic diseases in safety-net settings. This qualitative study supplemented by descriptive quantitative analysis investigates the degree of alignment between patient and clinicians’ perceptions of SDoH resources and referrals in clinics within the public healthcare delivery system in San Francisco. We conducted a qualitative analysis of in-depth interviews, patient-led neighborhood tours, and in-person clinic visit observations with 10 patients and 7 primary care clinicians. Using a convergent parallel mixed methodology, we also completed a descriptive quantitative analysis comparing the categories of neighborhood health resources mentioned by patients or community leaders to the resources integrated into the electronic health record. We found that patients held a wealth of knowledge about neighborhood resources relevant to SDoH that were highly localized and specific to their communities. In addition, multiple stakeholders were involved in conducting SDoH screenings and referrals, including clinicians, system navigators such as case workers, and community-based organizations. Yet, the information flow between these stakeholders and patients lacked systematization, and the prioritization of social needs by patients and clinicians was misaligned, as represented by qualitative themes as well as quantitative differences in resource category distribution analysis (p < 0.001). Our results shed light upon opportunities for strengthening social care delivery in safety-net healthcare settings by improving patient engagement, clinic workflow, EHR engagement, and resource dissemination.
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Nguyen KH, Cemballi AG, Fields JD, Brown W, Pantell MS, Lyles CR. Applying a socioecological framework to chronic disease management: implications for social informatics interventions in safety-net healthcare settings. JAMIA Open 2022; 5:ooac014. [PMID: 35571359 PMCID: PMC9097756 DOI: 10.1093/jamiaopen/ooac014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/11/2022] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Vulnerable populations face numerous barriers in managing chronic disease(s). As healthcare systems work toward integrating social risk factors into electronic health records and healthcare delivery, we need better understanding of the interrelated nature of social needs within patients' everyday lives to inform effective informatics interventions to advance health equity. Materials and Methods We conducted in-depth interviews, participant-led neighborhood tours, and clinic visit observations involving 10 patients with diabetes in underserved San Francisco neighborhoods and 10 community leaders serving those neighborhoods. We coded health barriers and facilitators using a socioecological framework. We also linked these qualitative data with early persona development, focusing on patients' experiences in these communities and within the healthcare system, as a starting place for our future informatics design. Results We identified social risk and protective factors across almost every socioecological domain and level-from physical disability to household context to neighborhood environment. We then detailed the complex interplay across domains and levels within two critical aspects of patients' lives: housing and food. Finally, from these data we generated 3 personas that capture the intersectional nature of these determinants. Conclusion Drawing from different disciplines, our study provides a socioecological approach to understanding health promotion for patients with chronic disease in a safety-net healthcare system, using multiple methodologies. Future digital health research should center the lived experiences of marginalized patients to effectively design and implement informatics solutions for this audience.
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Affiliation(s)
- Kim Hanh Nguyen
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General
Hospital, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California, San Francisco, California, USA
| | - Anupama G Cemballi
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General
Hospital, San Francisco, California, USA
| | - Jessica D Fields
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General
Hospital, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California, San Francisco, California, USA
| | - William Brown
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California, San Francisco, California, USA
- Division of Prevention Science, Department of Medicine, Center for AIDS
Prevention Studies, University of California, San Francisco, California,
USA
- Bakar Computational Health Science Institute, University of
California, San Francisco, California, USA
| | - Matthew S Pantell
- Department of Pediatrics, University of California, San
Francisco, California, USA
- Department of Family and Community Medicine, Center for Health and Community,
University of California, San Francisco, California, USA
| | - Courtney Rees Lyles
- Department of Medicine, Center for Vulnerable Populations, University of
California, San Francisco, California, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General
Hospital, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California, San Francisco, California, USA
- Bakar Computational Health Science Institute, University of
California, San Francisco, California, USA
- Corresponding Author: Courtney Rees Lyles, PhD, UCSF General
Internal Medicine ZSFG, Box 1364, 1001 Potrero Ave San Francisco CA 94110, USA;
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Holmes LM, McQuoid J, Shah A, Cruz T, Akom A, Ling PM. Piloting a spatial mixed method for understanding neighborhood tobacco use disparities. Soc Sci Med 2021; 291:114460. [PMID: 34655940 PMCID: PMC8671214 DOI: 10.1016/j.socscimed.2021.114460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/21/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
The tobacco retail environment is where most advertising dollars are spent. However, most research on the retail environment has not methodologically situated tobacco retailers as part of a larger community, and few studies have incorporated community member perspectives of their own tobacco use in relation to their local environments. The purpose of this study is to describe and evaluate a multilevel, multimodal, mixed methods approach for understanding tobacco use in context. We combine quantitative data collected from tobacco retailer audits and geographically-explicit interviews with neighborhood residents to tell a more complete story of tobacco use behavior among adults in San Francisco's Marina district, and the Oakland Coliseum neighborhood in Alameda County, California. We find that while area-level and retail data provide a broad snapshot of two distinct communities with respect to sociodemographic characteristics and tobacco availability, interviews with community residents who use tobacco add important perspectives regarding how tobacco retailers are viewed and how residents interact with their neighborhood landscapes on a daily basis. The method we describe and critique has the potential to be scaled to incorporate a broader set of geographies, or tailored to address a multitude of health-related questions. Our approach further demonstrates the utility of including geolocated participant narratives as a means of understanding where researcher interpretations of urban environments diverge from those of community residents.
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Affiliation(s)
- Louisa M Holmes
- Departments of Geography and Demography, And the Social Science Research Institute, Pennsylvania State University, 302 Walker Building, University Park, PA, 16802, USA.
| | - Julia McQuoid
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, OK, 73104, USA
| | - Aekta Shah
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Tessa Cruz
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Antwi Akom
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, 94143-1390, USA
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