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Journal of Ambulatory Care Management

Jean M Gunderson, Mark L Wieland, Onelis Quirindongo-Cedeno, Gladys B Asiedu, Jennifer L Ridgeway, Michael W O╩╝Brien, Tara M Nelson, Ron Buzard, Chad Campbell, Jane W Njeru
Community health workers (CHWs) bring their unique capacity as liaisons for patients, communities, and health care systems to health care teams. We describe the collaborative development of a community-based CHW program to address the social determinants of health that affect patients. This cosupervisory, generalist CHW model provides an innovative template for cocreation of patient-centered infrastructure and resourcing within an evolving and replicable holistic care continuum across patient ages, diagnoses, health care payers, and communities to promote health equity...
July 12, 2018: Journal of Ambulatory Care Management
Sara L Ackerman, Nathaniel Gleason
Growing demand for specialty care has resulted in longer wait times for appointments, particularly at US academic referral centers. A proportion of specialty visits are for routine follow-up care of stable problems, and there is evidence that primary care providers are willing and able to take responsibility for a significant proportion of these patients. However, little is known about how to transition care back to a referring primary care clinician in a manner that is acceptable to everyone involved. In this article, we describe social, legal, and financial barriers to effective care transition and propose communication strategies to overcome them...
June 19, 2018: Journal of Ambulatory Care Management
Caitlin G Allen, J Nell Brownstein, Maria Cole, Gail Hirsch, Susie Williamson, E Lee Rosenthal
Although community health workers (CHWs) continue to gain credibility and recognition in the health care and public health sectors, there is still a need to expand workforce identity and development efforts, including identifying best practices for assessing CHW skill proficiencies. During this qualitative study, we interviewed 32 CHWs, trainers, and supervisors to understand current practice, perspectives, and perceived importance in assessing CHW skills and guiding principles for CHW skill assessment. Results from these interviews can be used to inform CHW workforce development to enhance efforts among those who are actively building CHW programs or who are considering improvements in strategies to assess CHW skill proficiencies...
June 19, 2018: Journal of Ambulatory Care Management
Edward H Wagner, Lisa LeRoy, Judith Schaefer, Michael Bailit, Katie Coleman, Chunliu Zhan, David Meyers
The Patient-Centered Medical Home (PCMH) now defines excellent primary care. Recent literature has begun to elucidate the components of PCMHs that improve care and reduce costs, but there is little empiric evidence that helps practices, payers, or policy makers understand how high-performing practices have improved outcomes. We report the findings from 38 such practices that fill this gap. We describe how they execute 8 functions that collectively meet patient needs. They include managing populations, providing self-management support coaching, providing integrated behavioral health care, and managing referrals...
June 19, 2018: Journal of Ambulatory Care Management
Sarah Hudson Scholle, Suzanne Morton, Juell Homco, Kristin Rodriguez, Daren Anderson, Elizabeth Hahn, David Kendrick, David Bardach, Elizabeth Hart
Using patient-reported outcome measures (PROMs) in care planning has the potential to improve care, but information about routine implementation in settings serving disadvantaged groups is needed. Two primary care clinics serving populations predominantly eligible for Medicaid and diverse in race/ethnicity implemented the PROMIS-29 as part of clinical care planning. Of the target population with diabetes, 26% (n = 490) completed the PROMs; the proportion that set a goal based on the PROMs differed by site. This report describes factors influencing the PROMs process and the results of interviews with patients and members of the care team about PROMs' implementation and impact...
June 19, 2018: Journal of Ambulatory Care Management
Jayasree Basu, Amresh Hanchate, Siran Koroukian
This study examines the patterns of 30-day hospital readmissions by race/ethnicity and multiple chronic conditions (MCC) burden among nonelderly adult patients. We used hospital discharge data of patients in the 18- to 64-year age group in 5 US states, California, Florida, Missouri, New York, and Tennessee, for 2009 from the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) of the Agency for Healthcare Research and Quality, linked to contextual and provider data from the Health Resources and Services Administration...
May 15, 2018: Journal of Ambulatory Care Management
Brigit Hatch, Ning Smith, Mary Ann McBurnie, Thu Quach, Kenneth H Mayer, Mary J Dunne, Erika Cottrell
The aim of this study was to assess the impact of the Affordable Care Act (ACA) on community health centers (CHCs). Using electronic health records from the Community Health Applied Research Network, we assessed new patient characteristics, office visit volume, and payer distribution among CHC patients before and after ACA implementation, 2011-2014 (n = 442 455). New patients post-ACA were younger, more likely to be female and have chronic health conditions, and utilized more primary care (P < .05 for each)...
May 15, 2018: Journal of Ambulatory Care Management
Stephen L Davidow, Jignesh Sheth, Constance S Sixta, Linda Thomas-Hemak
More than 105 million referrals of Medicare beneficiaries to specialists occur annually. Different settings and electronic health records have made care coordination complex. PCPI (formerly American Medical Association-convened Physicians Consortium for Performance Improvement) and The Wright Center for Graduate Medical Education sponsored the Closing the Referral Loop pilot project. Twelve dyads of primary care and specialist physicians sought to improve ambulatory referrals by mapping the referral process, and using care compacts, metrics, and electronic health records...
May 15, 2018: Journal of Ambulatory Care Management
Gail R Wilensky
No abstract text is available yet for this article.
May 15, 2018: Journal of Ambulatory Care Management
Heriberto Eddie Cruz, Janie Gawrys, Donna Thompson, Jairo Mejia, Linda Rosul, Danielle Lazar
In 2012, Access Community Health Network, a Federally Qualified Health Center (FQHC) network with 36 health centers serving the greater Chicago area, embarked on a 3-year initiative to improve patient access. "Dramatic Performance Improvement" (DPI) included the adoption of modified open access scheduling and practice changes designed to improve capacity and the ability to balance supply and demand. This article describes DPI implementation, strategies, and associated outcomes, including a 20% decrease in no-show rate, a 33% drop in time to the third next available appointment (TNAA), a 37% decrease in cycle time, and a 13% increase in patient satisfaction...
July 2018: Journal of Ambulatory Care Management
Avi Dor, Qian Luo, Maya Tuchman Gerstein, Floyd Malveaux, Herman Mitchell, Anne Rossier Markus
We present an incremental cost-effectiveness analysis of an evidence-based childhood asthma intervention (Community Healthcare for Asthma Management and Prevention of Symptoms [CHAMPS]) to usual management of childhood asthma in community health centers. Data used in the analysis include household surveys, Medicaid insurance claims, and community health center expenditure reports. We combined our incremental cost-effectiveness analysis with a difference-in-differences multivariate regression framework. We found that CHAMPS reduced symptom days by 29...
July 2018: Journal of Ambulatory Care Management
Karen Baur, Tracey Smith, M Cecilia Wendler
Community-based programs deploying community health workers (CHWs) who collaborate with other entities are beginning to emerge as the US health system evolves. Although these programs have used various evaluation criteria to determine program success, little research has been completed to examine the experiences of program participants as they receive these services. The purpose of this qualitative descriptive study was to describe what it was like to experience the benefit of improved care coordination through a community-based program featuring CHWs, in collaboration with community-based interprofessional providers...
July 2018: Journal of Ambulatory Care Management
Matthew R Augustine, Karin M Nelson, Stephan D Fihn, Edwin S Wong
The patient-centered medical home (PCMH) expands access by providing care same-day, by phone, and after hours; however, little is known about which patients seek these services. We examined the association of patient, clinical, and local economic characteristics with the self-reported use of 5 routine and nonroutine ways to access primary care within the Veterans Health Administration. We identified sets of characteristics, including gender- and age-specific, racial and ethnic, and socioeconomic differences of how veterans report seeking primary care...
July 2018: Journal of Ambulatory Care Management
Rani Polak, David Pober, Avigail Morris, Rakefet Arieli, Margaret Moore, Elliot Berry, Mati Ziv
The Community Culinary Coaching Program is a community-based participatory program aimed at improving communal settlement residents' nutrition. The residents, central kitchens, preschools, and communal dining rooms were identified as areas for intervention. Evaluation included goals accomplishment assessed by food purchases by the central kitchens, and residents' feedback through focus groups. Purchasing included more vegetables (mean (standard error) percent change), (+7% (4); P = .32), fish (+115% (11); P < ...
July 2018: Journal of Ambulatory Care Management
Ronnie Hasson, Aliza H Stark, Naama Constantini, Rani Polak, Gina Verbov, Naomi Edelstein, Michel Lachmi, Rivka Cohen, Shuli Maoz, Nihaya Daoud, Hannah Soltz-Aharony, Chen Stein-Zamir
Healthy lifestyle programs are essential for meeting the challenge of noncommunicable diseases. The Public Health Nurses Promoting Healthy Lifestyles (PHeeL-PHiNe) program engaged nurses from family health clinics in Jerusalem District and included physical activity, healthy nutrition, and motivational skills. Questionnaires were completed at baseline, postintervention, and at 18 months. Results showed a marked effect on health practices. The proportion of nurses consuming a balanced diet and the use of food labels significantly increased and were maintained over time...
July 2018: Journal of Ambulatory Care Management
Latifa Mohammad Baynouna Al Ketbi, Mariam Mohammad Al Kwuiti, Hanan Abdulbaqi, Mouza Hamad Al Kwuiti, Shamma Al Alawi, Amal Al Zarouni, Fathyia Al Awadhi, Durra Al Bloushi, Amal Al Harbi, Bakr Saadon, Omar Al Jabri
This study describes the transformation of Abu Dhabi Ambulatory Healthcare Services into patient-centered medical homes (PCMH) in 3 pilot sites by applying the National Commission for Quality Assurance (NCQA) PCMH standards. The intervention was system redesign, population management, team building, and optimizing electronic medical records toward patient-centered care. The pilot centers outperformed non-pilot centers in clinical key performance indicators. Based on the NCQA 2011 PCMH criteria, the pilot achieved 84% compared with 42% at the start of the project...
July 2018: Journal of Ambulatory Care Management
(no author information available yet)
No abstract text is available yet for this article.
July 2018: Journal of Ambulatory Care Management
Alyna T Chien, Michael Anne Kyle, Antoinette S Peters, Kevin H Nguyen, Shalini A Tendulkar, Molly Ryan, Karen Hacker, Sara J Singer
Little is known about how practices reorganize when transitioning from traditional practice organization to team-based care. We compared practice-level (1) configuration as well as practice- and team-level (2) size and (3) composition, before and after establishing teams. We employed a pre-/poststudy using personnel lists of 1571 to 1711 staff (eg, job licenses, titles, and team assignment) and practice manager surveys. All personnel (physician and nonphysician) worked within 18 Massachusetts academic primary care practices participating in a 2-year learning collaborative aimed at establishing team-based care...
April 2018: Journal of Ambulatory Care Management
Mark Siemon, Brenna Kreglo, Blake Boursaw
The purpose of this study was to compare team climate among Texas community health workers (CHWs)/promotoras who were certified by the 2 different methods: (a) completing a state-approved training program, and (b) providing evidence of work experience (grandfathering). Analysis of survey results found no significant differences in Team Climate Inventory scores between CHWs who were certified either through state-approved training or through work experience. This research provides some preliminary evidence in support of experience-based certification, but there continues to be a need for more research evaluating CHW certification requirements and the impact of state certification of CHWs on population health outcomes...
April 2018: Journal of Ambulatory Care Management
Ji Chang, Dave Chokshi, Joseph Ladapo
Urgent care centers have been identified as one means of shifting care from high-cost emergency departments while increasing after-hours access to care. However, the episodic nature of urgent care also has the potential to fragment care. In this study, we examine the adoption of 2 coordination activities-referrals and the electronic exchange of health information-at urgent care centers and other ambulatory providers across the United States. We find that setting is significantly associated with both health information exchange and referrals...
April 2018: Journal of Ambulatory Care Management
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