Telehealth In Health Centers: Key Adoption Factors, Barriers, And Opportunities

Telehealth services have the potential to improve access to care, especially in rural or urban areas with scarce health care resources. Despite the potential benefits, telehealth has not been fully adopted by health centers. This study examined factors associated with and barriers to telehealth use by federally funded health centers. We analyzed data for 2016 from the Uniform Data System using a mixed-methods approach. Our findings suggest that rural location, operational factors, patient demographic characteristics, and reimbursement policies influence health centers' decisions about using telehealth. Cost, reimbursement, and technical issues were described as major barriers. Medicaid reimbursement policies promoting live video and store-and-forward services were associated with a greater likelihood of telehealth adoption. Many health centers were implementing telehealth or exploring its use. Our findings identified areas that policy makers can address to achieve greater telehealth adoption by health centers.

Qualitative Perspective on the Learning Health System: How the Community Health Applied Research Network Paved the Way for Research in Safety-Net Settings

BACKGROUND

Safety-net populations are underrepresented in health research networks. To address this deficit, the Community Health Applied Research Network (CHARN) was created to promote integration of research in health centers (HCs). CHARN embodies a learning health system (LHS) model to advance the evidence base for improved care in safety-net settings.

OBJECTIVES

We sought to identify lessons learned from the development of research infrastructure to promote the inclusion of safety-net populations in research.

METHODS

We conducted nine qualitative interviews with a purposive sample of CHARN members, as well as content analysis of work plans and project reports, and identified barriers and facilitators to building research capacity in HCs.

RESULTS

Lessons learned include the importance of linking research to the HC mission, encouraging mentoring, and investing in data infrastructure at HCs to tailor health services to communities.

CONCLUSIONS

Findings can inform safety-net providers on the process of building research infrastructure and capacity.

Examining the FDA's oversight of direct-to-consumer advertising

Our analysis examined the effects of the Food and Drug Administration's (FDA's) 1997 draft guidance regarding advertisements for prescription drugs broadcast directly to consumers. We found that although direct-to-consumer (DTC) advertising spending by pharmaceutical companies has increased, more than 80 percent of their promotional spending is directed to physicians. DTC advertising appears to increase the use of prescription drugs among consumers. The FDA's oversight has not prevented companies from making misleading claims in subsequent advertisements, and a recent policy change has lengthened the FDA's review process, raising the possibility that some misleading campaigns could run their course before review.

Implications of social class and race for urban public health policy making: a case study of HIV/AIDS and TB policy in Washington, DC

This paper explores how social class and race affect the public health policy-making process in an urban area. Ethnographic methods were used to collect and analyze information about HIV/AIDS and tuberculosis policy-making by the Washington, DC Commission of Public Health, Kingdon's conceptual model of policy making was used to analyze and understand the process. The problems of HIV/AIDS and tuberculosis in the district have important social class dimensions that were not always made explicit, but were instead defined in terms of 'race' and 'place'. Social class considerations and racial politics shaped what policies were developed or not developed and implemented successfully or failed. This study, which has national and international implications, concludes that there is a need to improve our understanding of the complex social dimensions of public health problems; there needs to be more consideration of the politics of strategy formulation and how issues of social class and race affect this process; and public health needs to strengthen its constituency in order to build support for the successful development and implementation of policy.

Community health centers: promise and performance

This article provides a critical review of the literature on the quality and effectiveness of care provided by community health centers (CHCs) compared with other health care delivery models. Since the mid-1960s, CHCs have played a large role in providing comprehensive primary care to our nation's medically underserved. Recent changes in public policy and the health care marketplace have threatened the viability of the CHC delivery model. This review of structure, process, and outcome indicators suggests that CHCs have effectively reduced many barriers to access, promoted high-quality ambulatory care use among underserved populations, and reduced costly hospitalizations. While CHCs have been shown to save money for Medicaid, little research has addressed the health-related outcomes of care. This article recommends specific areas of research essential to understanding the future performance of CHCs.

MCH functions framework: a guide to the role of government in maternal and child health in the 21st century

OBJECTIVES

At the close of the 20th century, the government's role in maternal and child health is in a state of transition. What is needed is a framework defining roles and responsibilities and guidance on how to operationalize these functions. This article presents the Maternal and Child Health (MCH) Functions Framework and discusses its value as an advocacy, planning, evaluation, and educational tool.

METHODS

The Johns Hopkins Child and Adolescent Health Policy Center developed the Framework in collaboration with leading public health organizations. The process entailed formulating a conceptual approach and facilitating consensus among the relevant organizations.

RESULTS

The Framework consists of three main components: (a) a list of ten essential public health services to promote maternal and child health, (b) an outline detailing program functions specific to MCH that apply to all levels of government and to all MCH populations, and (c) selected examples of local, state, and federal activities for implementing MCH program functions.

CONCLUSIONS

The MCH Functions Framework can be used in advocacy, policy development, program planning, organizational assessment, education, and training. To date, it has been used by several state and local MCH agencies and in MCH education and training programs.

Fighting tuberculosis in the 1990s: how effective is planning in policy making?

Planning is a common tool for addressing important health issues, especially urgent ones, and has been reintroduced recently in several federal, state, and local public health programs. This article presents a case study of planning and policy making concerning the reemergence of tuberculosis in urban areas, using Washington, D.C. and New York City as examples. Planning was unsuccessful in D.C. because it failed to acknowledge the important political and bureaucratic aspects of policy making. In New York City, on the other hand, planning played a central role in policy-making efforts, and the health department took a leadership role in building a consensus on the problem, formulating strategies, and overcoming implementation obstacles. This article concludes with several key considerations for making planning more effective in health policy-making.

Racial differences in health: not just black and white, but shades of gray

Explanations for racial/ethnic disparities in health are varied and complex. This paper reviews the literature to assess the extent to which current disparities are a consequence of racial differences in the social class composition of the US population. We focus this review on African Americans and examine studies that provide information on the effect of race on four outcome measures: infant mortality, hypertension, substance use, and mortality from all-causes. Twenty-three studies were identified that met criteria for inclusion in this review. As expected, most studies provide evidence that socioeconomic conditions are a major factor explaining racial differences in health. Findings, however, vary for the different health indices. Research in the area of substance abuse provides the most consistent evidence that socioeconomic conditions account for observed racial differences. In contrast, studies on infant mortality and hypertension provide a compelling case that the effects of socioeconomic status are important, but not sufficient to explain racial differences. Evidence on mortality from all-causes is equally divided between studies showing no significant race effect and those in which racial differences persist after adjusting for social class. The paper offers possible explanations for the seemingly divergent results and identifies conceptual and methodologic issues for future research seeking to disentangle the complex relations between race, social class, and health.