scholarly journals Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California

2017 ◽  
Vol 24 (5) ◽  
pp. 903-912 ◽  
Author(s):  
Sara L Ackerman ◽  
Urmimala Sarkar ◽  
Lina Tieu ◽  
Margaret A Handley ◽  
Dean Schillinger ◽  
...  
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Low Income ◽  
Community Health Centers ◽  
Health Care Systems ◽  
Meaningful Use ◽  
Safety Net ◽  
Patient Portal ◽  
Patient Portals ◽  
Staff Support

Abstract Objective:US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in “safety net” health care systems that provide services for low-income populations. Materials and Methods:Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives (n = 12), informal focus groups with front-line staff (n = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey (n = 45). Results:Our findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain “meaningful use” as defined by and for their patients. Discussion:Health systems’ efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU’s assumptions about patients’ demand for electronic access to health information and ability to make use of it directed clinics’ attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context. Conclusion:We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations.

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)

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.

Outsourcing Responsibility

2017 ◽  
Author(s):  
Cathleen E. Willging ◽  
Elise M. Trott
Keyword(s):  
Health Care ◽  
Low Income ◽  
Underserved Populations ◽  
Care Delivery ◽  
Health Care Systems ◽  
Behavioral Health Care ◽  
Safety Net ◽  
Treatment Needs ◽  
Health Care Safety Net ◽  
Care Systems

Cathleen E. Willging and Elise M. Trott argue that politically driven processes of the past have shaped the current context of mental health care delivery in New Mexico. Provisions of the ACA, including the expansion of Medicaid and outreach to underserved populations, offered the possibility of improving access and services for New Mexicans struggling with unmet treatment needs. However, as the authors argue, public stewards manipulated key ACA provisions to propagate unsubstantiated allegations of waste, fraud, and corruption against safety-net service providers. This chapter shows how public-private partnerships in the Medicaid arena, discourses of transparency, and technologies of accountability can engender truthiness claims, obscure vital information, destabilize a behavioral health care safety net, and deny low-income citizens care. They argue that scholars have the responsibility to attend to the “total bureaucratization” of government-funded health care systems that also allows such abuse of authority.

scholarly journals Patient Portals

2016 ◽  
Vol 07 (02) ◽  
pp. 489-501 ◽  
Author(s):  
Asheley Skinner ◽  
Jonathan Thornhill ◽  
Morris Weinberger ◽  
Ashley Griffin
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Hospital Readmissions ◽  
Patient Characteristics ◽  
Patient Portal ◽  
Patient Portals ◽  
Access Code ◽  
Comorbidity Scores ◽  
Care Systems ◽  
User Groups

SummaryPatient portals have demonstrated numerous benefits including improved patientprovider communication, patient satisfaction with care, and patient engagement. Recent literature has begun to illustrate how patients use selected portal features and an association between portal usage and improved clinical outcomes.This study sought to: (1) identify patient characteristics associated with the use of a patient portal; (2) determine the frequency with which common patient portal features are used; and (3) examine whether the level of patient portal use (non-users, light users, active users) is associated with 30-day hospital readmission.My UNC Chart is the patient portal for the UNC Health Care System. We identified adults discharged from three UNC Health Care hospitals with acute myocardial infarction, congestive heart failure, or pneumonia and classified them as active, light, or non-users of My UNC Chart.Multivariable analyses were conducted to compare across user groups; logistic regression was used to predict whether patient portal use was associated with 30-day readmission.Of 2,975 eligible patients, 83.4% were non-users; 8.6% were light users; and 8.0% were active users of My UNC Chart. The messaging feature was used most often. For patients who were active users, the odds of being readmitted within 30 days was 66% greater than patients who were non-users (p<0.05). There was no difference in 30-day readmission between non-users and light users.The vast majority of patients who were given an access code for My UNC Chart did not use it within 30 days of discharge. Of those who used the portal, active users had a higher odds of being readmitted within 30 days. Health care systems should consider strategies to: (1) increase overall use of patient portals and (2) target patients with the highest comorbidity scores to reduce hospital readmissions.

scholarly journals Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study (Preprint)

2015 ◽  
Author(s):  
Juhee Kim ◽  
Holly Mathews ◽  
Lindsay M Cortright ◽  
Xiaoming Zeng ◽  
Edward Newton
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Health Literacy ◽  
Pregnant Women ◽  
Low Income ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
Convenience Sample ◽  
Prenatal Health

BACKGROUND Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women. OBJECTIVE This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women. METHODS A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview. RESULTS Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women. CONCLUSIONS The one-time verbal introduction of MyChart does not meet current patients’ needs. Data reveal the need for more consistent patient education and support programs, tailored to patients’ previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use.

After the Affordable Care Act: Health Reform and the Safety Net

2016 ◽  
Vol 44 (4) ◽  
pp. 585-588
Author(s):  
Peter Shin ◽  
Marsha Regenstein
Keyword(s):  
Health Care ◽  
Community Health ◽  
Affordable Care Act ◽  
Health Reform ◽  
Community Health Centers ◽  
Safety Net ◽  
Public Hospitals ◽  
Health Centers ◽  
Safety Net Providers ◽  
The Affordable Care Act

Two major safety net providers – community health centers and public hospitals – continue to play a key role in the health care system even in the wake of coverage reform. This article examines the gains and threats they face under the Affordable Care Act.

scholarly journals Ethnobotanical Study of Medicinal Plants Used for Human Health Care in Yem Culture, South Ethiopia

2021 ◽  
Author(s):  
Gideon Woldemariam ◽  
Sebsebe Demissew ◽  
Zemede Asfaw
Keyword(s):  
Health Care ◽  
Medicinal Plants ◽  
Indigenous Knowledge ◽  
Human Health ◽  
Traditional Knowledge ◽  
Low Income ◽  
Health Care Systems ◽  
Low Income Countries ◽  
Ethnobotanical Study ◽  
Care Systems

Abstract BackgroundIndigenous or traditional herbal medicine has been widely regarded as a resource for strengthening the health care systems among communities of low income countries including Ethiopia. The Yem people in Ethiopia have deep-rooted and ancient traditional knowledge of managing human ailments and health conditions using medicinal plants (mps). On the other hand, mps and the associated indigenous knowledge are under erosion due to human-induced and natural factors. Therefore, documenting the plant biodiversity along with the associated indigenous knowledge is of urgent task for conservation. MethodsThis study was conducted in April, 2013, October, 2016 and July, 2016 with the objective of documenting traditional mps in different land uses that are used for treating human ailments. Ethnobotanical data were collected from 69 informants that were selected by stratified random sampling and purposive sampling. Vegetation data were obtained from 30, 30x30 m quadrats. Ethnobotanical data were analysed using paired ranking, Informant consensus factor and Fidelity Level index. ResultsAbout 213 medicinal plant species that are used for treating 117 human ailments were recorded. ICF calculated depicted a highest ICF value of 0.82 for Gastrointestinal & Visceral organs ailments. Haplocarpha rueppellii, Carduus schimperi and Inula confortiflora each 100%, Maesa lanceolata 80% and Rumex abyssinicus 75%. Vegetation analysis showed three plant communities.ConclusionThe Yem people have rich traditional knowledge of utilising plants side by side with the mainstream biomedical system for maintaining human health care.

scholarly journals A Study Protocol for Increasing Access to Smoking Cessation Treatments for Low-Income Minority Smokers

2021 ◽  
Vol 9 ◽  
Author(s):  
Alicia K. Matthews ◽  
Karriem S. Watson ◽  
Cherdsak Duang ◽  
Alana Steffen ◽  
Robert Winn
Keyword(s):  
Health Care ◽  
Smoking Cessation ◽  
Health Care Providers ◽  
Low Income ◽  
Access To Health Care ◽  
Social Determinant ◽  
Evidence Based ◽  
Patient Portal ◽  
Care Providers ◽  
Access To Health

Background: Smoking rates among low-income patients are double those of the general population. Access to health care is an essential social determinant of health. Federally qualified health care centers (FQHC) are government-supported and community-based centers to increase access to health care for non-insured and underinsured patients. However, barriers to implementation impact adherence and sustainability of evidence-based smoking cessation within FQHC settings. To address this implementation barrier, our multi-disciplinary team proposes Mi QUIT CARE (Mile Square QUITCommunity-Access-Referral-Expansion) to establish the acceptability, feasibility, and capacity of an FQHC system to deliver an evidence-based and multi-level intervention to increase patient engagement with a state tobacco quitline.Methods: A mixed-method approach, rooted in an implementation science framework of RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), will be used in this hybrid effectiveness-implementation design. We aim to evaluate the efficacy of a novel delivery system (patient portal) for increasing access to smoking cessation treatment. In preparation for a future randomized clinical trial of Mi QUIT CARE, we will conduct the following developmental research: (1) Examine the burden of tobacco among patient populations served by our partner FQHC, (2) Evaluate among FQHC patients and health care providers, knowledge, attitudes, barriers, and facilitators related to smoking cessation and our intervention components, (3) Evaluate the use of tailored communication strategies and patient navigation to increase patient portal uptake among patients, and (4) To test the acceptability, feasibility, and capacity of the partner FQHC to deliver Mi QUIT CARE.Discussion: This study provides a model for developing and implementing smoking and other health promotion interventions for low-income patients delivered via patient health portals. If successful, the intervention has important implications for addressing a critical social determinant of cancer and other tobacco-related morbidities.Trial Registration: U.S. National Institutes of Health Clinical Trials, NCT04827420, https://clinicaltrials.gov/ct2/show/NCT04827420.

scholarly journals Converging perspectives of providers and student users on extending a patient portal into a university-based mental health service: A qualitative study

2020 ◽  
Author(s):  
N Gasteiger ◽  
Theresa Fleming ◽  
K Day
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Qualitative Study ◽  
Health Services ◽  
Mental Health Care ◽  
Patient Portal ◽  
Patient Portals

© 2020 The Authors Background: Patient portals have the potential to increase access to mental health services. However, a lack of research is available to guide practices on extending patient portals into mental health services. This study explored stakeholder (student service users' and health providers') expectations and perceptions of extending patient portals into a New Zealand university-based mental health service. Materials and methods: This qualitative study explored the perspectives of 17 students and staff members at a university-based health and counselling service on an Internet-based patient portal through a software demonstration, two focus groups and 13 interviews. Data were analyzed thematically. Results: Staff and students perceived the patient portal as useful, easy to use and expected it to help make mental health care more accessible. Staff were most concerned with the portal's ability to support their triage processes and that it might enable students to ‘counselor hop’ (see multiple counselors). Staff recommended extension into services that do not require triage. Most students expected the portal to enhance patient-counselor contact and rapport, through continuity of care. Students were concerned with appointment waiting times, the stigmatization of poor mental health and their capacity to seek help. They considered the portal might assist with this. Students recommended extension into all services, including urgent appointments. After viewing findings from initial student and staff groups, staff concluded that extending a patient portal into their counseling services should be prioritized. Conclusion: This research suggests that there is value in extending patient portals into mental health care, especially into low-risk services. Future research should explore opportunities to support triage and appointment-making processes for mental health services, via patient portals.

Case Study—Acting (and Funding) Locally: How One Virginia Foundation Is Changing the Way It Supports Communities

2019 ◽  
pp. 315-322
Author(s):  
Patricia N. Mathews
Keyword(s):  
Health Care ◽  
Low Income ◽  
Return On Investment ◽  
Safety Net ◽  
Health Care Safety Net ◽  
Health Care Safety ◽  
The Way

This chapter presents a case study based on the experience of the Northern Virginia Health Foundation (NVHF). The NVHF was created twelve years ago and was created to improve the health and health care of the residents of Northern Virginia, with a particular emphasis on those of low income and the uninsured. The chapter shows how despite being a small foundation, over the years, NVHF has made significant investments in the health care safety net. However, despite this, low-income residents in the area continue to face considerable challenges. The chapter makes some general conclusions based on this experience: cross-sector collaboration is difficult and, in many instances, expensive. But the return on investment is potentially strong. The direction should be creative and focused.

Pervasive Computing Support in the Transition towards Personalised Health Systems

2011 ◽  
Vol 2 (3) ◽  
pp. 31-47 ◽  
Author(s):  
Martín Serrano ◽  
Ahmed Elmisery ◽  
Mícheál Ó Foghlú ◽  
Willie Donnelly ◽  
Cristiano Storni ◽  
...  
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Pervasive Computing ◽  
Health Care Systems ◽  
Data Systems ◽  
Distributed Information ◽  
Health Care Applications ◽  
Care Systems ◽  
Systems Requirements ◽  
Computing Support

This paper discusses pervasive computing work in the transition from traditional health care programs to personalised health systems (pHealth). A chronological guided transition survey is discussed to highlight trends in medicine describing their most recent developments about health care systems. Future trends in this interdisciplinary techno-medical area are described as research goals. Particularly, research and technological efforts concerning ICT’s and pervasive computing in healthcare and medical applications are presented to identify systems requirements supporting secure and reliable networks and services. The main objectives are to summarise both the pHealth systems requirements providing end-user applications and the necessary pervasive computing support to interconnect device-based health care applications and distributed information data systems in secure and reliable forms, highlighting the role pervasive computing plays in this process. A generic personalised healthcare scheme is introduced to provide guidance in the transition and can be used for multiple medical and health applications. An example is briefly introduced by using the generic scheme proposed.

Sign in / Sign up

Export Citation Format

Share Document