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Sebastian T Tong, Camille J Hochheimer, Wendy B Barr, Matteo Leveroni-Calvi, Nicholas M Lefevre, Jordyn T Wallenborn, Lars E Peterson
BACKGROUND AND OBJECTIVES: Prior research found that 24% of graduating family medicine residents intend to provide obstetrical deliveries, but only 9% of family physicians 1 to 10 years into practice are doing so. Our study aims to describe the individual and residency program characteristics associated with intention to provide obstetrical deliveries and prenatal care. METHODS: Cross-sectional data on 2014-2016 graduating residents were obtained from the American Board of Family Medicine certification examination demographic questionnaire that asked about intended provision of specific clinical activities...
March 8, 2018: Family Medicine
Snehal N Shah, Eleni Digenis-Bury, Elizabeth T Russo, Shannon O'Malley, Nineequa Blanding, Anne McHugh, Roy Wada
Well documented, persistent racial/ethnic health disparities in obesity and hypertension in the US demonstrate the continued need for interventions that focus on people of color who may be at higher risk. We evaluated a demonstration project funded by the CDC's Racial/Ethnic Approaches to Community Health (REACH) program at four federally qualified health centers (FQHC) and YMCA fitness and wellness centers in Boston. No-cost YMCA memberships were offered from June 2014 to June 2015 to non-Latino black and Latino adults with a diagnosis of hypertension...
June 2018: Preventive Medicine Reports
Marcie Fisher-Borne, Alexander J Preiss, Molly Black, Kate Roberts, Debbie Saslow
OBJECTIVE: Human papillomavirus (HPV) vaccine coverage in the United States remains low compared with other adolescent vaccines. As the largest primary care network in the United States, safety net clinics such as federally qualified health centers (FQHCs) serve patients at a disproportionate risk of HPV-related cancers. In this pilot project, the American Cancer Society (ACS) leveraged its primary care workforce to implement quality improvement interventions in the unique context of 30 FQHC systems across the country, including 130 clinic sites reaching >20,000 adolescents in a variety of geographic settings...
March 2018: Academic Pediatrics
Steven B Zeliadt, Richard M Hoffman, Genevieve Birkby, Jan M Eberth, Alison T Brenner, Daniel S Reuland, Susan A Flocke
INTRODUCTION: The purpose of this study is to identify issues faced by Federally Qualified Health Centers (FQHCs) in implementing lung cancer screening in low-resource settings. METHODS: Medical directors of 258 FQHCs serving communities with tobacco use prevalence above the median of all 1,202 FQHCs nationally were sampled to participate in a web-based survey. Data were collected between August and October 2016. Data analysis was completed in June 2017. RESULTS: There were 112 (43%) FQHC medical directors or surrogates who responded to the 2016 survey...
February 8, 2018: American Journal of Preventive Medicine
Jamie H Thompson, Melinda Davis, Michael C Leo, Jennifer L Schneider, David H Smith, Amanda F Petrik, Melissa Castillo, Brittany Younger, Gloria D Coronado
BACKGROUND: Colon cancer is the second leading cause of cancer deaths in the United States. The Participatory Research to Advance Colon Cancer Prevention (PROMPT) study is a collaboration between two research institutions and a federally qualified health center (FQHC). The study seeks to raise colon cancer screening rates using a direct-mail fecal immunochemical testing (FIT) and reminder program in an FQHC serving a predominantly Latino population in California. METHODS: PROMPT is a pragmatic trial enrolling 16 clinics...
February 2, 2018: Contemporary Clinical Trials
Tara A Lavelle, Adam J Rose, Justin W Timbie, Claude M Setodji, Suzanne G Wensky, Katherine D Giuriceo, Mark W Friedberg, Rosalie Malsberger, Katherine L Kahn
BACKGROUND: Previous studies have disagreed on whether patients who receive primary care from federally qualified health centers (FQHCs) have different utilization patterns than patients who receive care elsewhere. Our objective was to compare patterns of healthcare utilization between Medicare beneficiaries who received primary care from FQHCs and Medicare beneficiaries who received primary care from another source. METHODS: We compared characteristics and ambulatory, emergency department (ED), and inpatient utilization during 2013 between 130,637 Medicare beneficiaries who visited an FQHC for the majority of their primary care in 2013 (FQHC users) and a random sample of 1,000,000 Medicare fee-for-service (FFS) beneficiaries who did not visit an FQHC (FQHC non-users)...
January 25, 2018: BMC Health Services Research
Matthew F Bouchonville, Brant W Hager, Jessica B Kirk, Clifford R Qualls, Sanjeev Arora
OBJECTIVE: To determine whether participation in a multidisciplinary telementorship model of healthcare delivery improves primary care provider (PCP) and community health worker (CHW) confidence in managing patients with complex diabetes in medically underserved regions. METHODS: We applied a well-established healthcare delivery model, Project ECHO (Extension for Community Healthcare Outcomes), to the management of complex diabetes (Endo ECHO) in medically underserved communities...
January 2018: Endocrine Practice
Curtis W Bone, Amelia M Goodfellow, Mani Vahidi, Lillian Gelberg
Sexual violence (SV) is common; however, the prevalence of SV and its long term sequela vary geographically and among subpopulations within the USA. As such, the aims of this study are the following: (1) to determine the prevalence of SV, (2) to identify correlates of SV, and (3) to determine if SV is associated with depression among male and female risky drug users in urban Federally Qualified Health Centers (FQHCs) in Los Angeles. This study includes adult patients of five urban FQHCs who self-reported risky drug use...
January 16, 2018: Journal of Urban Health: Bulletin of the New York Academy of Medicine
Lauren Fiechtner, Meghan Perkins, Vincent Biggs, Nancy Langhans, Mona Sharifi, Giselle O'Connor, Sarah Price, Joseph Locascio, Karen Kuhlthau, Jo-Ann Kwass, Candace Nelson, Thomas Land, Matt Longjohn, Valerie Lawson, Katherine Hohman, Elsie M Taveras
BACKGROUND: Recent studies have demonstrated the effectiveness of family-centered, pediatric weight management programs in reducing childhood obesity. Yet, programs to optimize the care of low-income children with obesity are needed. We sought to examine the comparative effectiveness of two, potentially scalable pediatric weight management programs delivered to low-income children in a clinical or community setting. MATERIALS AND METHODS: The Clinic and Community Approaches to Healthy Weight trial is a randomized trial in two communities in Massachusetts that serve a large population of low-income children and families...
January 9, 2018: Contemporary Clinical Trials
Peter Mendel, Emily K Chen, Harold D Green, Courtney Armstrong, Justin W Timbie, Amii M Kress, Mark W Friedberg, Katherine L Kahn
OBJECTIVE: To understand the process of practice transformation by identifying pathways for attaining patient-centered medical home (PCMH) recognition. DATA SOURCES/STUDY SETTING: The CMS Federally Qualified Health Center (FQHC) Advanced Primary Care Practice Demonstration was designed to help FQHCs achieve NCQA Level 3 PCMH recognition and improve patient outcomes. We used a stratified random sample of 20 (out of 503) participating sites for this analysis. STUDY DESIGN: We developed a conceptual model of structural, cultural, and implementation factors affecting PCMH transformation based on literature and initial qualitative interview themes...
December 15, 2017: Health Services Research
Benjamin F Henwood, Elizabeth Siantz, Debra R Hrouda, Debbie Innes-Gomberg, Todd P Gilmer
Assertive community treatment (ACT) has the potential to serve as a medical home for adults with serious mental illness, a population that experiences some of the most significant health disparities in the United States. Using site visit methodology, the authors describe partnerships that were created between five ACT programs and federally qualified health centers (FQHCs) to provide integrated behavioral health and primary care. The authors examined rates of screening for common chronic conditions. The programs used three distinct approaches: two programs colocated ACT teams at an FQHC, two programs employed primary care providers who split their time between the FQHC and the ACT program, and one program embedded a primary care provider within the ACT team...
December 15, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
Robert S Nocon, Kathryn E Gunter, Yue Gao, Sang Mee Lee, Marshall H Chin
OBJECTIVE: To develop a short-form Safety Net Medical Home Scale (SNMHS) for assessing patient-centered medical home (PCMH) capability in safety net clinics. DATA SOURCES/STUDY SETTING: National surveys of federally qualified health centers (FQHCs). Interviews with FQHC directors. STUDY DESIGN: We constructed three short-form SNMHS versions and examined correlations with full SNMHS and related primary care assessments. We tested usability with FQHC directors and reviewed scale development with an advisory group...
December 1, 2017: Health Services Research
Huma Q Rana, Sarah R Cochrane, Elaine Hiller, Ruth N Akindele, Callie M Nibecker, Ludmila A Svoboda, Angel M Cronin, Judy E Garber, Christopher S Lathan
In cancer genetics, technological advances (next generation sequencing) and the expansion of genetic test options have resulted in lowered costs and increased access to genetic testing. Despite this, the majority of patients utilizing cancer genetics services lack diversity of gender, ethnicity, and socioeconomic status. Through retrospective chart review, we compared outcomes of cancer genetics consultations at a tertiary cancer center and a Federally Qualified Health Center (FQHC) (58 tertiary and 23 FQHC patients) from 2013 to 2015...
November 18, 2017: Journal of Community Genetics
Hannah L Maxey, Connor W Norwood, Johannah B O'Connell, Ziyue Liu
Purpose: Dental diseases are almost entirely preventable, but discrepancies in access to oral healthcare limit the effectiveness of preventive interventions. Dental hygienists are strategically positioned to improve access to preventive dental procedures; however, state workforce policies determine their permitted clinical tasks.Methods: This study cross-referenced oral healthcare service use at Federally Qualified Health Centers (FQHCs) between 2004 and 2012 with the Dental Hygiene Professional Practice Index (DHPPI), which quantifies the various aspects of state policy environments for the dental hygiene workforce...
October 2017: Journal of Dental Hygiene: JDH
Lara Dhingra, Robert Schiller, Raymond Teets, Sarah Nosal, Sandra Rodriguez, Gabriel Cruciani, Malcolm Barrett, Regina Ginzburg, Ebtesam Ahmed, Thomas Wasser, Jack Chen, Saskia Shuman, Casey Crump, Russell Portenoy
Objective: Previous research suggests that race/ethnicity predicts health-related quality of life (HRQL) in chronic pain populations but has not examined this in community settings. This study evaluated this association in 522 community-dwelling patients with chronic pain treated at a Federally Qualified Health Center (FQHC). Design: Cross-sectional secondary analysis. Setting: Six practice sites of an FQHC in New York. Subjects: One hundred forty-two non-Hispanic blacks, 121 non-Hispanic whites, 219 Hispanics, and 40 classified as "other" with severe chronic pain...
May 10, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Jean Nagelkerk, Margaret E Thompson, Michael Bouthillier, Amy Tompkins, Lawrence J Baer, Jeff Trytko, Andrew Booth, Adam Stevens, Kayleah Groeneveld
In 2014, the Midwest Interprofessional Practice, Education and Research Center partnered with a Federally Qualified Health Center (FQHC) to implement an interprofessional collaborative practice (IPCP) education program to improve the health of adult patients with diabetes and to improve practice efficiency. This partnership included integrating an interprofessional team of students with the practice team. Twenty-five students and 20 staff engaged in the IPCP program, which included completion of educational modules on IPCP and implementation of daily huddles, focus patient visits, phone calls, team-based case presentations, medication reconciliation, and student-led group diabetes education classes...
January 2018: Journal of Interprofessional Care
Uche Anadu Ndefo, Aisha Morris Moultry, Portia N Davis, Raven Askew
BACKGROUND: Type-2 diabetes mellitus is a complex condition for which pharmacists are well suited to improve patient outcomes by delivering medication therapy management (MTM) services. When diabetes is well controlled, patients can avoid its long-term complications, such as cardiovascular and renal diseases. This article describes an MTM pilot program that was implemented at a federally qualified health center (FQHC). METHODS: This program was implemented at three clinics involving patients with uncontrolled diabetes, defined as hemoglobin A1c (HbA1c) greater than 8%...
October 2017: P & T: a Peer-reviewed Journal for Formulary Management
Kathleen Thies, Daren Anderson, Benjamin Cramer
BACKGROUND: Thousands of mobile health (mHealth) apps have been developed to support patients' management of their health, but the effectiveness of many of the apps remains unclear. While mHealth apps appear to hold promise for improving the self-management of chronic conditions across populations, failure to balance the system demands of the app with the needs, interests, or resources of the end users can undermine consumers' adoption of these technologies. OBJECTIVE: The original aim of this study was to evaluate the effectiveness of a commercial mHealth app in improving clinical outcomes for adult patients in a Federally Qualified Health Center (FQHC) with uncontrolled diabetes and/or hypertension...
October 3, 2017: JMIR Human Factors
Gabriela Duran, Mariam Faiz-Nassar, Kristin Mmari, Cynthia S Minkovitz, Katherine A Connor
OBJECTIVE: Group care has been shown to be effective for delivery of infant well child care. Centering Parenting™ (CP) is a model of group dyad care for mothers and infants. CP may improve quality and efficiency of preventive care, particularly for low income families. Federally Qualified Health Centers (FQHC) may be optimal sites for implementation, however facilitators and barriers may be unique. The aim of this qualitative study was to assess stakeholder perspectives on the feasibility of implementing Centering Parenting(TM) in FQHCs in Baltimore...
September 14, 2017: Academic Pediatrics
Katherine B Roland, Erin L Milliken, Elizabeth A Rohan, Amy DeGroff, Susan White, Stephanie Melillo, William E Rorie, Carmita-Anita C Signes, Paul A Young
Introduction: In the United States, disparities in cancer screening, morbidity, and mortality are well documented, and often are related to race/ethnicity and socioeconomic indicators including income, education, and healthcare access. Public health approaches that address social determinants of health have the greatest potential public health benefit, and can positively impact health disparities. As public health interventions, community health workers (CHWs), and patient navigators (PNs) work to address disparities and improve cancer outcomes through education, connecting patients to and navigating them through the healthcare system, supporting patient adherence to screening and diagnostic services, and providing social support and linkages to financial and community resources...
2017: Health Equity
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