Reverse Integration Pilot in a Public Safety-Net Hospital’s Outpatient Behavioral Health Clinic

83 Background: Oncologic clinical trial enrollment is low, particularly in underserved populations. Increasing enrollment of public safety-net hospital patients is important to ensure representation of the general population and reduces cancer outcome disparities. To tailor clinical trial outreach, we sought to characterize attitudes towards trial participation of oncology patients at Olive View—UCLA Medical Center (OVMC), a public safety-net hospital in Los Angeles County. Methods: We developed a 39-question survey (Qualtrics, Provo, UT). It was administered via tablets to a convenience sample of patients in OVMC’s medical oncology clinic and infusion center during 2020—2021. The survey was offered to patients fluent in English or Spanish. Results: Of 165 patients who were offered the survey, 11 declined due to illiteracy in any language, 4 did not finish the survey. Median age was 54 (range: 20-81); 63% were female. The majority (76%) reported an annual income below $25,000; 39% did not complete high school. Self-identified ethnicity was Hispanic/Latino (73%), non-Hispanic White (12%), Asian-Pacific Islander (9%), and Black (4%). Based on a 5-point Likert scale of comfort speaking English, 48% had English proficiency (EP). Overall, 69% of patients expressed interest in trials. When considering participation, patients would seek advice from their physician (86%), family (32%), other medical staff (14%), alternative medicine practitioner (7%), friend (6%), or religious leader (4%). Concerns regarding trial participation were lack of knowledge regarding trials (47%), fear of side effects (43%), frequent visits (25%), cost (20%), transportation (14%), wage loss (9%), and inability to determine own treatment (4%). Patients found the following modalities useful for learning about trials: website (43%), paper handout (39%), video (37%), discussion with prior participants (34%). Patients with annual income > $25,000 were significantly more concerned about cost (33.3% v. 15.8%, p = 0.04) and treatment side effects (61.1% v. 36.8%, p = 0.02). EP patients were more likely to find a website (54.2% vs. 32.1%, p = 0.01) or discussion with prior participants (45.8% v. 23.1%, p < 0.01) helpful compared to low EP patients. Conclusions: There is considerable interest in oncologic clinical trials in this predominantly Hispanic/Latino population. This population had significant trust in physicians for guidance on trial enrollment, and had minimal concern for out-of-pocket cost, wage loss, or transportation issues. The majority of patients did not find additional informational resources helpful. Structural barriers rather than patient-level variables are likely the primary drivers of low oncologic trial enrollment. Future efforts should focus on improving access to appropriate trials and leveraging the physician-patient relationship for increasing trial participation.

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Implementation of a Metabolic Management Practice Change in a Community Behavioral Health Clinic: An Evidence Based Practice Project

10.22371/07.2017.037 ◽

2017 ◽

Author(s):

Brenda Boyle

Keyword(s):

Behavioral Health ◽

Evidence Based Practice ◽

Management Practice ◽

Practice Change ◽

Health Clinic ◽

Evidence Based ◽

Metabolic Management ◽

Community Behavioral Health

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Net Neutrality Repeal Rips Holes in the Public Safety Net

University of Pittsburgh Law Review ◽

10.5195/lawreview.2019.658 ◽

2019 ◽

Vol 80 (4) ◽

Author(s):

Catherine J.K. Sandoval

Keyword(s):

Public Safety ◽

Safety Net ◽

Net Neutrality ◽

The Public

N/A

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Patient and provider perception of appropriateness, acceptability, and feasibility of behavioral health home (BHH) core components based on program implementation in an urban, safety-net health system

Implementation Research and Practice ◽

10.1177/26334895211043791 ◽

2021 ◽

Vol 2 ◽

pp. 263348952110437

Author(s):

Ana M Progovac ◽

Miriam C Tepper ◽

H. Stephen Leff ◽

Dharma E Cortés ◽

Alexander (Cohen) Colts ◽

...

Keyword(s):

Primary Care ◽

Health System ◽

Behavioral Health ◽

Program Implementation ◽

Health Management ◽

Safety Net ◽

Clinical Settings ◽

Urban Safety ◽

Core Components ◽

Health Home

Background This manuscript evaluates patient and provider perspectives on the core components of a Behavioral Health Home (BHH) implemented in an urban, safety-net health system. The BHH integrated primary care and wellness services (e.g., on-site Nurse Practitioner and Care Manager, wellness groups and tools, population health management) into an existing outpatient clinic for people with serious mental illness (SMI). Methods As the qualitative component of a Hybrid Type I effectiveness-implementation study, semi-structured interviews were conducted with providers and patients 6 months after program implementation, and responses were analyzed using thematic analysis. Valence coding (i.e., positive vs. negative acceptability) was also used to rate interviewees’ transcriptions with respect to their feedback of the appropriateness, acceptability, and feasibility/sustainability of 9 well-described and desirable Integrated Behavioral Health Core components (seven from prior literature and two additional components developed for this intervention). Themes from the thematic analysis were then mapped and organized by each of the 9 components and the degree to which these themes explain valence ratings by component. Results Responses about the team-based approach and universal screening for health conditions had the most positive valence across appropriateness, acceptability, and feasibility/sustainability by both providers and patients. Areas of especially high mismatch between perceived provider appropriateness and measures of acceptability and feasibility/sustainability included population health management and use of evidence-based clinical models to improve physical wellness where patient engagement in specific activities and tools varied. Social and peer support was highly valued by patients while incorporating patient voice was also found to be challenging. Conclusions Findings reveal component-specific challenges regarding the acceptability, feasibility, and sustainability of specific components. These findings may partly explain mixed results from BHH models studied thus far in the peer-reviewed literature and may help provide concrete data for providers to improve BHH program implementation in clinical settings. Plain language abstract Many people with serious mental illness also have medical problems, which are made worse by lack of access to primary care. The Behavioral Health Home (BHH) model seeks to address this by adding primary care access into existing interdisciplinary mental health clinics. As these models are implemented with increasing frequency nationwide and a growing body of research continues to assess their health impacts, it is crucial to examine patient and provider experiences of BHH implementation to understand how implementation factors may contribute to clinical effectiveness. This study examines provider and patient perspectives of acceptability, appropriateness, and feasibility/sustainability of BHH model components at 6–7 months after program implementation at an urban, safety-net health system. The team-based approach of the BHH was perceived to be highly acceptable and appropriate. Although providers found certain BHH components to be highly appropriate in theory (e.g., population-level health management), their acceptability of these approaches as implemented in practice was not as high, and their feedback provides suggestions for model improvements at this and other health systems. Similarly, social and peer support was found to be highly appropriate by both providers and patients, but in practice, at months 6–7, the BHH studied had not yet developed a process of engaging patients in ongoing program operations that was highly acceptable by providers and patients alike. We provide these data on each specific BHH model component, which will be useful to improving implementation in clinical settings of BHH programs that share some or all of these program components.

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Effect of Child Health Insurance Plan Enrollment on the Utilization of Health Care Services by Children Using a Public Safety Net System

PEDIATRICS ◽

10.1542/peds.110.5.940 ◽

2002 ◽

Vol 110 (5) ◽

pp. 940-945 ◽

Cited By ~ 24

Author(s):

S. Eisert ◽

P. Gabow

Keyword(s):

Health Care ◽

Health Insurance ◽

Child Health ◽

Public Safety ◽

Health Care Services ◽

Safety Net ◽

Insurance Plan ◽

Health Insurance Plan ◽

Care Services ◽

Child Health Insurance

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Behavioral Health Patient Engagement in Video-based Visits through a Patient Portal at an Urban Safety-Net Hospital During COVID-19: Direct Patient Outreach and Case-Control Study (Preprint)

10.2196/preprints.33697 ◽

2021 ◽

Author(s):

Han Yue ◽

Victoria Mail ◽

Maura DiSalvo ◽

Christina Borba ◽

Joanna Piechniczek-Buczek ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Behavioral Health ◽

Patient Engagement ◽

Safety Net ◽

Patient Portal ◽

Patient Portals ◽

Safety Net Hospital ◽

Urban Safety

BACKGROUND Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the coronavirus disease 2019 (COVID-19) pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial, and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to utilize telepsychiatry services. OBJECTIVE As part of an outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aimed to assess patient preference for patient portal-based video visits or telephone-only visits, and to identify the demographic variables associated with their preference. METHODS Patients in an outpatient psychiatry clinic were contacted by phone and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. RESULTS One hundred and twenty-eight patients were reached by phone. Seventy-nine patients (61.7%) chose video-based visits and 69.6% of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. CONCLUSIONS Among behavioral health patients at a safety-net hospital, there was a relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults.

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