“Do Their Own Thing”: Radical Health Care and the Fair Haven Community Health Center

2021 ◽  
pp. e1-e9
Author(s):  
Ezra S. Lichtman
Keyword(s):  
Health Care ◽  
Community Health ◽  
Nurse Practitioners ◽  
Community Health Centers ◽  
Community Health Center ◽  
The United States ◽  
Health Centers ◽  
Free Clinics ◽  
Fee For Service ◽  
Alternative Health

Radical health reform movements of the 1960s inspired two widely adopted alternative health care models in the United States: free clinics and community health centers. These groundbreaking institutions attempted to realize bold ideals but faced financial, bureaucratic, and political obstacles. This article examines the history of Fair Haven Community Health Care (FHCHC) in New Haven, Connecticut, an organization that spanned both models and typified innovative aspects of each while resisting the forces that tempered many of its contemporaries’ progressive practices. Motivated by a tradition of independence and struggling to address medical neglect in their neighborhood, FHCHC leaders chose not to affiliate with the local academic hospital, a decision that led many disaffected community members to embrace the clinic. The FHCHC also prioritized grant funding over fee-for-service revenue, thus retaining freedom to implement creative programs. Furthermore, the center functioned in an egalitarian manner, enthusiastically employing nurse practitioners and whole-staff meetings, and was largely able to avoid the conflicts that strained other community-controlled organizations. The FHCHC proved unusual among free clinics and health centers and demonstrated strategies similar institutions might employ to overcome common challenges. (Am J Public Health. Published online ahead of print September 16, 2021: e1–e9. https://doi.org/10.2105/AJPH.2021.306417 )

scholarly journals Community Health Center Engagement and Training During Obstetrics and Gynecology Residency

2019 ◽  
Vol 11 (5) ◽  
pp. 513-517 ◽  
Author(s):  
Anita Y. Cheng ◽  
Adrienne L. Erlinger ◽  
Anna M. Modest ◽  
Lucy Chie ◽  
Jennifer Scott ◽  
...  
Keyword(s):  
Community Health ◽  
Health Care Access ◽  
Community Health Centers ◽  
Community Health Center ◽  
The United States ◽  
Health Centers ◽  
Obstetrics And Gynecology ◽  
Program Administrators ◽  
Care Access ◽  
And Training

ABSTRACT Background Community health centers (CHCs) and federally qualified health centers (FQHCs) are critical health care access points for medically underserved areas in the United States. They also provide opportunities for residents to learn about health system challenges, including workforce shortages, social determinants of health, and health equity. Objective We sought to describe current obstetrics and gynecology (OB-GYN) resident engagement and training in community health settings. Methods We conducted a website review and survey to identify the prevalence and types of OB-GYN resident exposure to CHCs, including FQHCs. We reviewed 241 program websites to identify community health electives or rotations. We then surveyed program administrators regarding departmental affiliations with CHCs, types of resident involvement, and barriers to resident rotations at CHCs. Results The website review revealed that 18% (44 of 241) of programs offered a community health rotation. Of the 241 programs surveyed, 78 program administrators responded (32%). Forty-three programs (55%) had at least 1 affiliated CHC, and 34 programs (44%) allowed residents to rotate at a CHC. The most common barrier to resident rotations at a CHC was inadequate resident coverage of hospital-based clinical responsibilities. Respondents reported that among 782 graduating residents in the 2016–2017 and 2017–2018 academic years, 76 (10%) planned to pursue a position at a CHC. Conclusions According to their websites, a small percentage of US OB-GYN residency programs offered a CHC rotation. Of programs responding to a survey on the topic, less than half offered CHC rotations and less than 1 in 10 residents planned to work in CHCs after graduation.

Standing Tall: Leadership Reflections from the Community Health Center Frontlines

2021 ◽  
Vol 27 (2) ◽  
pp. 83-87
Author(s):  
Colleen McDonald Diouf
Keyword(s):  
Health Care ◽  
Community Health ◽  
Community Health Centers ◽  
Health Care Systems ◽  
Community Health Center ◽  
Health Centers ◽  
People Of Color ◽  
Community Members ◽  
Care Systems ◽  
Improve Access

Community health centers have withstood adversity for several decades. As health-care systems seek to reverse health inequities experienced by Black, Indigenous, and People of Color (BIPOC), learnings from community health centers demonstrate tangible ways to improve access and health for all. During the COVID-19 pandemic many community health centers have engaged in innovations in services to build on trust and to reach community members with testing and other needed services. Lessons around leading these efforts could support systemic change in the health-care system.

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.

Organizational Factors Influencing the Use of Clinical Decision Support for Improving Cancer Screening Within Community Health Centers

2016 ◽  
pp. 118-148 ◽  
Author(s):  
Timothy Jay Carney ◽  
Michael Weaver ◽  
Anna M. McDaniel ◽  
Josette Jones ◽  
David A. Haggstrom
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Decision Support ◽  
Cancer Screening ◽  
Community Health ◽  
Clinical Decision Support ◽  
Community Health Centers ◽  
Clinical Decision ◽  
Health Centers ◽  
Practice Setting

Adoption of clinical decision support (CDS) systems leads to improved clinical performance through improved clinician decision making, adherence to evidence-based guidelines, medical error reduction, and more efficient information transfer and to reduction in health care disparities in under-resourced settings. However, little information on CDS use in the community health care (CHC) setting exists. This study examines if organizational, provider, or patient level factors can successfully predict the level of CDS use in the CHC setting with regard to breast, cervical, and colorectal cancer screening. This study relied upon 37 summary measures obtained from the 2005 Cancer Health Disparities Collaborative (HDCC) national survey of 44 randomly selected community health centers. A multi-level framework was designed that employed an all-subsets linear regression to discover relationships between organizational/practice setting, provider, and patient characteristics and the outcome variable, a composite measure of community health center CDS intensity-of-use. Several organizational and provider level factors from our conceptual model were identified to be positively associated with CDS level of use in community health centers. The level of CDS use (e.g., computerized reminders, provider prompts at point-of-care) in support of breast, cervical, and colorectal cancer screening rate improvement in vulnerable populations is determined by both organizational/practice setting and provider factors. Such insights can better facilitate the increased uptake of CDS in CHCs that allows for improved patient tracking, disease management, and early detection in cancer prevention and control within vulnerable populations.

scholarly journals Provision of Social Services and Health Care Quality in US Community Health Centers, 2017

2020 ◽  
Vol 110 (4) ◽  
pp. 567-573 ◽  
Author(s):  
Ashley M. Kranz ◽  
Ammarah Mahmud ◽  
Denis Agniel ◽  
Cheryl Damberg ◽  
Justin W. Timbie
Keyword(s):  
Health Care ◽  
Community Health ◽  
Social Services ◽  
Health Care Quality ◽  
Community Health Centers ◽  
Care Quality ◽  
Social Needs ◽  
Health Centers ◽  
Care Providers ◽  
Provision Of Services

Objectives. To describe the types of social services provided at community health centers (CHCs), characteristics of CHCs providing these services, and the association between on-site provision and health care quality. Methods. We surveyed CHCs in 12 US states and the District of Columbia during summer 2017 (n = 208) to identify referral to and provision of services to address 8 social needs. Regression models estimated factors associated with the provision of social services by CHCs and the association between providing services and health care quality (an 8-item composite). Results. CHCs most often offered on-site assistance for needs related to food or nutrition (43%), interpersonal violence (32%), and housing (30%). Participation in projects with community-based organizations was associated with providing services on-site (odds ratio = 2.48; P = .018). On-site provision was associated with better performance on measures of health care quality (e.g., each additional social service was associated with a 4.3 percentage point increase in colorectal cancer screenings). Conclusions. Some CHCs provide social services on-site, and this was associated with better performance on measures of health care quality. Public Health Implications. Health care providers are increasingly seeking to identify and address patients’ unmet social needs, and on-site provision of services is 1 strategy to consider.

Utilizing health care professionals in community health centers to prevent human trafficking

2019 ◽  
Vol 119 ◽  
pp. 99
Author(s):  
Isis Van Putten ◽  
Kimberly S.G. Chang ◽  
Susie B. Baldwin ◽  
Hanni Stoklosa
Keyword(s):  
Health Care ◽  
Community Health ◽  
Human Trafficking ◽  
Health Care Professionals ◽  
Community Health Centers ◽  
Health Centers

scholarly journals Understanding Why Nurse Practitioner (NP) and Physician Assistant (PA) Productivity Varies Across Community Health Centers (CHCs): A Comparative Qualitative Analysis

2020 ◽  
pp. 107755872096089
Author(s):  
Patricia Pittman ◽  
Jeongyoun Park ◽  
Emily Bass ◽  
Qian “Eric” Luo
Keyword(s):  
Community Health ◽  
Nurse Practitioners ◽  
Financial Incentives ◽  
Community Health Centers ◽  
Formal Education ◽  
Qualitative Comparative Analysis ◽  
Physician Assistants ◽  
Health Centers ◽  
High Productivity ◽  
The Difference

This study asks how much and why the productivity of advanced practice clinicians (APCs; nurse practitioners and physician assistants) varies across community health centers (CHCs), as measured in their marginal contribution to overall patient visits. We found APCs in the 90th percentile CHCs provide about 1,840 adjusted-visits per year, whereas APCs in the 10th percentile CHCs provide about 978 adjusted-visits per year. We interviewed leadership at 14 high APC and 16 low APC productivity CHCs to elicit organizational conditions that could explain the difference. Using content analysis and then qualitative comparative analysis, we found several important conditions were more common among high productivity CHCs, including scheduling APCs and physicians for the same number of visits, parity in terms of any financial incentives, and formal education programs for new APCs during onboarding/transition to practice.

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