scholarly journals Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
Edith M. Williams ◽  
Kasim Ortiz ◽  
Teri Browne
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Lupus Erythematosus ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Determinants Of Health ◽  
Care Model ◽  
Systemic Lupus ◽  
Delivery Of Care

Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions.

scholarly journals Perspectives of Medicare Advantage Plan Representatives on Addressing Social Determinants of Health in Response to the CHRONIC Care Act

2019 ◽  
Vol 2 (7) ◽  
pp. e196923 ◽  
Author(s):  
Kali S. Thomas ◽  
Shayla N. M. Durfey ◽  
Emily A. Gadbois ◽  
David J. Meyers ◽  
Joan F. Brazier ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Chronic Care ◽  
Determinants Of Health ◽  
Medicare Advantage

scholarly journals Perspectives on Opportunities and Challenges for Medicare Advantage Plans to Address Social Determinants of Health via the CHRONIC Care Act

2019 ◽  
Vol 56 ◽  
pp. 004695801986212
Author(s):  
Melony E. Sorbero ◽  
Ashley M. Kranz
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Chronic Care ◽  
Chronically Ill ◽  
Determinants Of Health ◽  
Medicare Advantage ◽  
Eligibility Criteria ◽  
Funding Sources ◽  
First Time

There is increasing recognition of the role of social determinants of health (SDOH) in the ability of Medicare Advantage (MA) enrollees to obtain needed care. The 2018 CHRONIC Care Act established Special Supplemental Benefits for the Chronically Ill (SSBCI), which for the first time gives MA plans the flexibility to provide supplemental benefits to enrollees to address SDOH. Given the role of SDOH in chronic disease, this represents an opportunity for MA plans to address underlying issues not strictly health care related with which MA enrollees struggle and that affect their overall health. MA plans have experimented with different approaches to address SDOH but have been limited by the lack of ability to offer services as part of covered benefits and reliance on partnerships, grants, and other funding sources to support the provision of these services. The effect of this policy and how it may evolve before implementation begins in 2020 remains uncertain as we wait to see how MA plans will interpret eligibility criteria and services offered without any additional allotted funding.

Effects of a Continuous Care Model on Patients’ Knowledge and Health-Related Quality of Life in Systemic Lupus Erythematosus

2017 ◽  
Vol 42 (6) ◽  
pp. E9-E18 ◽  
Author(s):  
Mohammad Sahebalzamani ◽  
Hojjatollah Farahani ◽  
Mojgan Tabatabaee Jamarani ◽  
Seyedeh Tahereh Faezi ◽  
Kamran Moradi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Health Related Quality ◽  
Care Model ◽  
Systemic Lupus ◽  
Continuous Care ◽  
Related Quality ◽  
Health Related

Disparities in NOSE Scores and Surgical Approaches among Patients Undergoing Functional Rhinoplasty

2018 ◽  
Vol 35 (01) ◽  
pp. 090-095 ◽  
Author(s):  
Mingyang Gray ◽  
Joseph Rousso ◽  
Matthew Hirsch ◽  
Joshua Rosenberg ◽  
Collin Rozanski
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Private Insurance ◽  
Surgical Techniques ◽  
Determinants Of Health ◽  
Surgical Approaches ◽  
Delivery Of Care ◽  
Score Improvement ◽  
Significant Difference ◽  
Patient Reported

AbstractSocial determinants of health have been widely studied throughout medicine; however, their role relating to functional rhinoplasty has not been previously evaluated. The records of 178 patients who underwent functional rhinoplasty in a single health network from 2013 to 2016 were reviewed. The Nasal Obstruction Symptom Evaluation (NOSE) score was used to assess patient-reported symptoms, and patients with both preoperative and postoperative NOSE scores were included in this study. Basic demographics and surgical techniques were also collected. Differences between NOSE scores and surgical approaches to functional rhinoplasty on the basis of insurance type were measured. One hundred and sixteen patients were included for analysis, the mean age was 34.7 years (standard deviation [SD] = 16.2) and 57 (49.1%) were female. Twenty-one (18.1%) patients had public insurance and, of these, 18 patients had Medicaid. Patients (mean, SD) with Medicaid insurance (56.39, 15.6) had a slightly greater improvement in NOSE scores compared with patients with non-Medicaid insurance (47.90, 25.6) (p = 0.067). There was no statistically significant difference in preoperative NOSE scores or postoperative improvement in NOSE scores between patients with different health insurance. Furthermore, there was no statistically significant difference in surgical approaches. The majority of patients receiving functional rhinoplasty had private insurance. Medicaid patients trended toward a greater NOSE score improvement after functional rhinoplasty, but also had a closer association with a history of nasal trauma and prior surgery. Future study is needed to better understand the association between socioeconomic status and disparities in care. Understanding how social determinants of health affect patients may reveal potential inherent biases, improve delivery of care, and translate to better patient outcomes.

scholarly journals Implementing Social Determinants of Health Screening at Community Health Centers: Clinician and Staff Perspectives

2019 ◽  
Vol 10 ◽  
pp. 215013271988726 ◽  
Author(s):  
Carolina-Nicole Herrera ◽  
Annelise Brochier ◽  
Michelle Pellicer ◽  
Arvin Garg ◽  
Mari-Lynn Drainoni
Keyword(s):  
Community Health ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Community Health Centers ◽  
Community Health Center ◽  
Determinants Of Health ◽  
Patient Navigator ◽  
Office Visits ◽  
Care Model ◽  
Staff Members

Purpose: Screening for social determinants of health (SDOH) during primary care office visits is recommended by pediatric and internal medicine professional guidelines. Less is known about how SDOH screening and service referral can be successfully integrated into clinical practice. Methods: Key informant interviews with 11 community health center (CHC) clinicians and staff members (medical assistants and case managers) were analyzed to identify themes related to integrating a SDOH screening and referral process (augmented WE CARE model) into their workflow. Results: CHC clinicians and staff believed the augmented WE CARE model benefited their patients and the CHC’s mission. Most clinicians found the model was easy to implement. Some staff members had difficulty prioritizing the nonclinical intervention and were confused about their roles and the role of the patient navigator. The eligibility requirements and time needed to access local SDOH resources frustrated clinicians. Discussion: SDOH screening and referral care models can help support the mission of CHCs by identifying unmet material needs. However, CHCs have organizational and administrative challenges that successful interventions must address. CHCs need clinical champions for SDOH models because the screening and follow-up processes involve clinical staff. Additional support for SDOH models might include piloting the SDOH screening model workflow and formalizing the workflow before implementation, including the specific roles for clinicians, staff, and patient navigators.

Organized Intraglomerular Deposits in NZB Mouse Disease

1971 ◽  
Vol 29 ◽  
pp. 544-545
Author(s):  
Francis R. Comerford ◽  
Alan S. Cohen
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Antinuclear Antibodies ◽  
Human Systemic Lupus Erythematosus ◽  
Systemic Lupus ◽  
Glomerular Lesion ◽  
Ultrastructural Studies ◽  
Dense Deposits ◽  
Experimental Nephritis ◽  
Glomerular Lesions

Mice of the inbred NZB strain develop a spontaneous disease characterized by autoimmune hemolytic anemia, positive lupus erythematosus cell tests and antinuclear antibodies and nephritis. This disease is analogous to human systemic lupus erythematosus. In ultrastructural studies of the glomerular lesion in NZB mice, intraglomerular dense deposits in mesangial, subepithelial and subendothelial locations were described. In common with the findings in many examples of human and experimental nephritis, including many cases of human lupus nephritis, these deposits were amorphous or slightly granular in appearance with no definable substructure.We have recently observed structured deposits in the glomeruli of NZB mice. They were uncommon and were found in older animals with severe glomerular lesions by morphologic criteria. They were seen most commonly as extracellular elements in subendothelial and mesangial regions. The deposits ranged up to 3 microns in greatest dimension and were often adjacent to deposits of lipid-like round particles of 30 to 250 millimicrons in diameter and with amorphous dense deposits.

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