scholarly journals Community Health Centers and Access to Care Among Underserved Populations: A Synthesis Review

2019 ◽  
Vol 77 (1) ◽  
pp. 3-18 ◽  
Author(s):  
Brendan Saloner ◽  
Adam S. Wilk ◽  
Jonathan Levin
Keyword(s):  
Access To Care ◽  
Community Health ◽  
Low Income ◽  
Community Health Centers ◽  
Underserved Populations ◽  
Health Centers ◽  
Access Cost ◽  
Medicaid Eligibility ◽  
Quasi Experimental ◽  
Medicaid Expansions

Community health centers (CHCs) deliver affordable health services to underserved populations, especially uninsured and Medicaid enrollees. Since the early 2000s, CHCs have grown because of federal investments in CHC capacity and expansions of Medicaid eligibility. We review 24 relevant studies from 2000 to 2017 to evaluate the relationship between CHCs, policies that invest in services for low-income individuals, and access to care. Most included studies use quasi-experimental designs. Greater spending on CHCs improves access to care, especially for low-income and minority individuals. Medicaid expansions also increase CHC use. Some studies indicate that CHC investments complement Medicaid expansions to increase access cost-effectively. Further research should explore patient preferences and patterns of CHC utilization versus other sites of care and population subgroups for which expanding CHC capacity improves access to care most. Researchers should endeavor to use measures and sample definitions that facilitate comparisons with other estimates in the literature.

scholarly journals Patient-Centered Practices for Engaging Transgender and Gender Diverse Patients in Clinical Research Studies

2020 ◽  
Author(s):  
Andrew Asquith ◽  
Lauren Sava ◽  
Alexander B. Harris ◽  
Asa E. Radix ◽  
Dana J. Pardee ◽  
...  
Keyword(s):  
New York ◽  
Clinical Research ◽  
Community Health ◽  
Community Health Centers ◽  
Underserved Populations ◽  
Health Centers ◽  
Barriers And Facilitators ◽  
Community Research ◽  
Gender Diverse ◽  
And Gender

Abstract Background: The purpose of this formative study was to assess barriers and facilitators to participation of transgender and gender diverse (TGD) patients in clinical research to solicit specific feedback on perceived acceptability and feasibility of research methods to inform creation of a multisite longitudinal cohort of primary care patients engaged in care at two community health centers.Method: Between September-November 2018, four focus groups (FGs) were convened at two community health centers in Boston, MA and New York, NY (N=28 participants across all 4 groups; 11 in Boston and 17 in New York). FG guides asked about patient outreach, acceptability of study methods and measures, and ideas for study retention. FGs were facilitated by TGD study staff, lasted approximately 90 min in duration, were audio recorded, and then transcribed verbatim by a professional transcription service. Thematic analyses were conducted by two independent analysts applying a constant comparison method. Consistency and consensus were achieved across code creation and application aided by Dedoose software.Results: Participants were a mean age of 33.9 years (SD 12.3; Range 18-66). Participants varied in gender identity with 4 (14.3%) male, 3 (10.7%) female, 8 (28.6%) transgender male, 10 (35.7%) transgender female, and 3 (10.7%) nonbinary. Eight (26.6%) were Latinx, 5 (17.9%) Black, 3 (10.7%) Asian, 3 (10.7%) another race, and 5 (17.9%) multiracial. Motivators and facilitators to participation were: research creating community, research led by TGD staff, compensation, research integrated into healthcare, research applicable to TGD and non-TGD people, and research helping TGD communities. Barriers were: being research/healthcare averse, not identifying as TGD, overlooking questioning individuals, research coming from a ‘cisgender lens”, distrust of how the research will be used, research not being accessible to TGD people, and research being exploitative.Conclusion: Though similarities emerged between the perspectives of TGD people and research citing perspectives of other underserved populations, there are barriers and facilitators to research which are unique to TGD populations. It is important for TGD people to be involved as collaborators in all aspects of research that concerns them.

Health Care Delivery Interventions for Hypertension Management in Underserved Populations in the United States: A Systematic Review

Hypertension ◽  
2021 ◽  
Author(s):  
Maarya Pasha ◽  
LaPrincess C. Brewer ◽  
Susie Sennhauser ◽  
Mouaz Alsawas ◽  
M. Hassan Murad
Keyword(s):  
United States ◽  
Systematic Review ◽  
Community Health ◽  
Community Health Centers ◽  
Underserved Populations ◽  
Care Delivery ◽  
The United States ◽  
Health Centers ◽  
Improvement Interventions ◽  
Quality Improvement Interventions

The high prevalence of uncontrolled hypertension in underserved populations is a major cause of health disparities in the United States and requires innovative health care delivery interventions. We conducted a systematic review of randomized controlled trials and comparative observational studies examining the effectiveness of contemporary systems change and quality improvement interventions aimed at improving blood pressure (BP) control published from 2010 to 2020. We included studies evaluating multicomponent practice improvement interventions conducted in the United States in community health centers. We identified 26 studies including 48 187 patients with hypertension with a high proportion of racial/ethnic minorities, low socioeconomic status, and a high burden of chronic illness. Multicomponent interventions led to an average reduction of 5 to 10 mm Hg in systolic BP. Four studies demonstrated the effectiveness of integrating pharmacists into community health centers for BP management and reduced cardiovascular disparities for at-risk populations. Five studies demonstrated the effectiveness of integrating community health workers into care workflows leading to reduction in BP and high patient satisfaction. Five studies used the electronic medical record as a tool for population management and showed only modest reduction in BP. One study demonstrated the effectiveness of incentivizing clinics with higher payments for uninsured and Medicaid patients meeting performance criteria. Very few studies evaluated treatment complications or medications side effects. Multicomponent quality improvement interventions instituted in community health centers are effective in lowering BP. Several components of the interventions were identified as being associated with higher efficacy.

Pneumococcal Vaccination in Low-Income Latinos: An Unexpected Trend in Oregon Community Health Centers

2016 ◽  
Vol 27 (4) ◽  
pp. 1733-1744 ◽  
Author(s):  
John Heintzman ◽  
Steffani R. Bailey ◽  
Stuart Cowburn ◽  
Eve Dexter ◽  
Joseph Carroll ◽  
...  
Keyword(s):  
Community Health ◽  
Low Income ◽  
Community Health Centers ◽  
Pneumococcal Vaccination ◽  
Health Centers

scholarly journals The impact of applying 5S management method on patient satisfaction in healthcare centers' services

2019 ◽  
Author(s):  
Shadab Shahali ◽  
Massomeh Khajehasani ◽  
Amin Torabipoor ◽  
Kambiz AhmadiAngali
Keyword(s):  
Service Quality ◽  
Community Health ◽  
Community Health Centers ◽  
Health Centers ◽  
Management Approach ◽  
Before And After ◽  
Quasi Experimental ◽  
Health Service Quality ◽  
The Impact

Abstract Background: Improving service quality and increasing clients' satisfaction is the most important aim of the health centers. This study aimed to investigate the effect of implementing the 5S management approach on the service quality provided at community health centers.Methods: This is a quasi-experimental study done with the participation of 220 pregnant women at a health center in Ahvaz in 2018. The quality gap and weaknesses were measured before 5S implementation by using adornment system (5S) checklist and SERVQUAL questionnaire. Interventions were designed and implemented with regard to the system weaknesses and the next evaluation was carried out 2 months after intervention.Results: Based on the findings of this study, the 5S score was 2.4 before the 5S implementation and 4.2 after the intervention. The mean scores of health service quality provided in community health centers significantly differed before and after the 5S implementation (P <0.0001).Conclusions: Implementation of 5S can improve the work environment adornment and the satisfaction of health centers' patients. Therefore, it is advised to use techniques to increase the quality of health centers’ services.

scholarly journals Patient-Centered Practices for Engaging Transgender and Gender Diverse Patients in Clinical Research Studies

2020 ◽  
Author(s):  
Andrew Asquith ◽  
Lauren Sava ◽  
Alexander B. Harris ◽  
Asa E. Radix ◽  
Dana J. Pardee ◽  
...  
Keyword(s):  
New York ◽  
Clinical Research ◽  
Community Health ◽  
Community Health Centers ◽  
Underserved Populations ◽  
Health Centers ◽  
Barriers And Facilitators ◽  
Community Research ◽  
Gender Diverse ◽  
And Gender

Abstract Background: The purpose of this formative study was to assess barriers and facilitators to participation of transgender and gender diverse (TGD) patients in clinical research to solicit specific feedback on perceived acceptability and feasibility of research methods to inform creation of a multisite longitudinal cohort of primary care patients engaged in care at two community health centers.Method: Between September-November 2018, four focus groups (FGs) were convened at two community health centers in Boston, MA and New York, NY (N=28 participants across all 4 groups; 11 in Boston and 17 in New York). FG guides asked about patient outreach, acceptability of study methods and measures, and ideas for study retention. FGs were facilitated by TGD study staff, lasted approximately 90 min in duration, were audio recorded, and then transcribed verbatim by a professional transcription service. Thematic analyses were conducted by two independent analysts applying a constant comparison method. Consistency and consensus were achieved across code creation and application aided by Dedoose software.Results: Participants were a mean age of 33.9 years (SD 12.3; Range 18-66). Participants varied in gender identity with 4 (14.3%) being male, 3 (10.7%) female, 8 (28.6%) transgender male, 10 (35.7%) transgender female, and 3 (10.7%) nonbinary. Eight (26.6%) were Latinx, 5 (17.9%) Black, 3 (10.7%) Asian, 3 (10.7%) another race, and 5 (17.9%) multiracial. Motivators and facilitators to participation were: research creating community, research led by TGD staff, compensation, research integrated into healthcare, research applicable to TGD and non-TGD people, and research helping TGD communities. Barriers were: being research/healthcare averse, not identifying as TGD, overlooking questioning individuals, research coming from a ‘cisgender lens”, distrust of how the research will be used, research not being accessible to TGD people, and research being exploitative.Conclusion: Though similarities emerged between the perspectives of TGD people and research citing perspectives of other underserved populations, there are barriers and facilitators to research which are unique to TGD populations. It is important for TGD people to be involved as collaborators in all aspects of research that concerns them.

scholarly journals Data Analytics and Modeling for Appointment No-show in Community Health Centers

2018 ◽  
Vol 9 ◽  
pp. 215013271881169 ◽  
Author(s):  
Iman Mohammadi ◽  
Huanmei Wu ◽  
Ayten Turkcan ◽  
Tammy Toscos ◽  
Bradley N. Doebbeling
Keyword(s):  
Community Health ◽  
Predictive Modeling ◽  
Data Analytics ◽  
Community Health Centers ◽  
Underserved Populations ◽  
Health Centers ◽  
Bayes Classifier ◽  
Missed Appointments ◽  
Appointment Adherence ◽  
Modeling Techniques

Objectives: Using predictive modeling techniques, we developed and compared appointment no-show prediction models to better understand appointment adherence in underserved populations. Methods and Materials: We collected electronic health record (EHR) data and appointment data including patient, provider and clinical visit characteristics over a 3-year period. All patient data came from an urban system of community health centers (CHCs) with 10 facilities. We sought to identify critical variables through logistic regression, artificial neural network, and naïve Bayes classifier models to predict missed appointments. We used 10-fold cross-validation to assess the models’ ability to identify patients missing their appointments. Results: Following data preprocessing and cleaning, the final dataset included 73811 unique appointments with 12,392 missed appointments. Predictors of missed appointments versus attended appointments included lead time (time between scheduling and the appointment), patient prior missed appointments, cell phone ownership, tobacco use and the number of days since last appointment. Models had a relatively high area under the curve for all 3 models (e.g., 0.86 for naïve Bayes classifier). Discussion: Patient appointment adherence varies across clinics within a healthcare system. Data analytics results demonstrate the value of existing clinical and operational data to address important operational and management issues. Conclusion: EHR data including patient and scheduling information predicted the missed appointments of underserved populations in urban CHCs. Our application of predictive modeling techniques helped prioritize the design and implementation of interventions that may improve efficiency in community health centers for more timely access to care. CHCs would benefit from investing in the technical resources needed to make these data readily available as a means to inform important operational and policy questions.

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