Improving Access for Priority Patient Populations Within Outpatient Specialty Practices
We report on a pilot program with 12 practices, split into pilot and control groups, and involving 11001 patients requesting new appointments. The results of the pilot show that statistically significant improvements to conversion rates can be achieved. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - December 6, 2021 Category: Emergency Medicine Tags: Primary Care Organizational Developments Source Type: research

Integration of Primary Care Teams Within the Examination Room: A Qualitative Study of Advanced Team-Based Care
Multidisciplinary teams deliver high-quality care in complex primary care environments. Using qualitative interviews, we explored the interpersonal dynamics of care team members from 2 models—traditional team-based care and “advanced team-based care” (aTBC). Two differentiating themes emerged—the ways care teams learned and collaborated. aTBC participants described learning from each other and integrating their roles and tasks more so than the traditional model. These differences have implications for patient care and care team member well-being. Our results provide a framework for improving team-ba...
Source: The Journal of Ambulatory Care Management - December 6, 2021 Category: Emergency Medicine Tags: Primary Care Organizational Developments Source Type: research

Examining the Use of Web-Based Health Education and Information Among Ambulatory Care Clinic Diabetic Patients
Web-based health education provides access to information and better coordination of care. Demographic and geographical factors may impact use and effectiveness of these services. The purpose of this study was to identify factors associated with use of web-based health education programs among diabetic patients at ambulatory clinics of a safety-net hospital. This was a retrospective chart review. Total sample size was 300. Patients who completed a web-based video were younger, Caucasian, living outside inner city core, users of patient portal, and more likely to complete annual diabetic eye examination. Web-based education...
Source: The Journal of Ambulatory Care Management - December 6, 2021 Category: Emergency Medicine Tags: Primary Care Organizational Developments Source Type: research

The Value of the Patient-Centered Medical Home in Getting Adults Suffering From Acute Conditions Back to Work: An Integrative Literature Review
Acute conditions are the leading cause of work restrictions and missed workdays, contributing to over $27 billion in lost productivity each year and negatively impacting workers' health and quality of life. Primary care services, specifically patient-centered medical homes (PCMHs), play an essential role in supporting timely acute illness or injury recovery for working adults. The purpose of this review is to synthesize the evidence on the relationship between PCMH implementation, care processes, and outcomes. In addition, we discuss the empirical connection between this evidence and return-to-work outcomes, as well as the...
Source: The Journal of Ambulatory Care Management - December 6, 2021 Category: Emergency Medicine Tags: Primary Care Organizational Developments Source Type: research

Reduction in Medication Refill Encounters Through Primary Care Redesign Workflow Changes
With a goal of improving efficiency and reducing workload outside of visits, we sought to examine a primary care redesign process aimed at reducing refill requests made outside of office visits. Data on the number of refill encounters per panel member were collected at 17 clinics before, during, and after the implementation of a redesign process. There was an initial reduction in the number of medication refill encounters, and the rate of refill encounters continued to decline following implementation. Variation across clinic contexts suggests that redesign processes may need to be tailored for different settings to optimi...
Source: The Journal of Ambulatory Care Management - December 6, 2021 Category: Emergency Medicine Tags: Primary Care Organizational Developments Source Type: research

Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting
This study elicited perspectives on how community health workers (CHWs) act upon barriers to primary care in 5 patient (n = 25) and 3 CHW focus groups (n = 17). Participants described how CHWs acted on patient-level barriers through social support, empowerment, and linkages, and system-level barriers by enhancing care team awareness of patient circumstances, optimizing communication, and advocating for equitable treatment. Limitations existed for influencing entrenched community-level barriers. CHWs, focusing on patient preferences, motivators, and circumstances, intervened on multilevel barriers to primary care, including...
Source: The Journal of Ambulatory Care Management - December 6, 2021 Category: Emergency Medicine Tags: Community Health Workers Source Type: research

The Role of a Federally Qualified Health Center in Identification and Management of an Occupational COVID-19 Outbreak: Lessons for Future Infection Surveillance and Response
Federally Qualified Health Centers (FQHCs) have been essential in response to COVID-19 outbreaks among vulnerable populations. Our rural FQHC had a primary role in early detection of and response to a poultry plant-related outbreak at the outset of the pandemic that disproportionately and gravely affected the local Hispanic community. The health center activated a rapid local response that included the community's first mass testing event and first acute respiratory treatment clinic, both of which were central to abatement. Lessons learned from this experience provide important guidance for the potential role of FQHCs in i...
Source: The Journal of Ambulatory Care Management - December 6, 2021 Category: Emergency Medicine Tags: Community Health Workers Source Type: research

Community Health Workers Connecting Communities During COVID-19: A Case Study From Chicago
Coronavirus disease-2019 (COVID-19) has adversely impacted vulnerable communities. Community health workers (CHWs) are an evidence-based solution for helping communities navigate challenges and barriers. This case study describes the work of CHWs in a large Hispanic Chicago neighborhood who experienced a disproportionate number of COVID-19 cases. Methods included semistructured interviews and conventional qualitative content analysis. Results describe the problem; the situation; CHWs' roles, motivations and actions; outcomes; lessons learned; and recommendations. The case study concludes with a discussion of effective CHW ...
Source: The Journal of Ambulatory Care Management - December 6, 2021 Category: Emergency Medicine Tags: Community Health Workers Source Type: research

From the Editor
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - December 6, 2021 Category: Emergency Medicine Tags: From the Editor Source Type: research

Assessing Behavioral Economic-Based Approaches to Address COVID-19 Vaccine Hesitancy
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

Implementation of Patient Screening in Ambulatory Settings During the COVID-19 Pandemic
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

Physicians' Opinions of COVID-19 Ambulatory Care Constraints: A Survey of Sickle Cell Clinicians
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

Impact of Telecommuting on Clinician Absenteeism in Primary Care—Potential Solution for Burnout?
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

Comparison Between Short Text Messages and Phone Calls to Reduce No-Show Rates in Outpatient Medical Appointments: A Randomized Trial
The objective of this study was to evaluate the impact of telephone calls and short text messages (SMS) on no-show rates regarding scheduled appointments with a general practitioner. In a prospective, intervention-controlled, and randomized study, we divided 306 patients into 3 groups: telephone call, SMS, and no intervention. We compared no-show rates, as well as variables that influenced it. The lowest percentage of no-show (9.5%) occurred in the telephone call group, while the SMS group presented at 21% and the no-intervention group at 22.8% (P = .025). Telephone calls proved to be a superior strategy to text messaging....
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Primary Care Tasks Associated With Nursing Burnout: A Survey of Registered and Licensed Vocational Nurses in Veterans Health Administration Patient-Centered Medical Homes
Using data from the Veterans Assessment and Improvement Laboratory for Patient-Centered Care (VAIL-PCC) Survey, this study investigated the relationship between registered nurses' (RNs') and licensed vocational nurses' (LVNs') report of responsibility for 14 distinct primary care tasks and burnout, taking into account of practice environment contexts. RNs reported higher levels of burnout than LVNs. The task of “following up on referrals” was associated with significantly higher levels of RN burnout, whereas “responding to prescription requests” was associated with higher levels of LVN burnout. &ldq...
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Systems Analysis of a Dedicated Ambulatory Respiratory Unit for Seeing and Ensuring Follow-up of Patients With COVID-19 Symptoms
We describe a dedicated COVID-19 ambulatory unit for closing testing and follow-up loops characterized by standardized workflows and electronic communication, documentation, and order placement. More than 85% of follow-ups were completed within 24 hours, with no observed staff, nor patient infections associated with unit operations. Identified issues include role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns with phone screeners. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Lived Experiences of Federally Qualified Health Center Board Members During a Period of Rapid Change in New York City (2010-2020)
Federally Qualified Health Centers (FQHCs) provide primary care services in underserved areas and are governed by patient-majority boards. A phenomenological approach was used to explore the lived experiences of board members as they addressed the need for fundamental change to meet the demands of a rapidly changing, highly competitive health care market (2010-2020). Findings were that board members rely upon personal experience and monthly board meetings to be alerted to change that affects health care delivery. They may need additional training to adjust governance and organizational performance to address the new patien...
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Framing the Integration of Community Health Workers Into Health Care Systems Along Health Care and Community Spectrums
This study examines factors associated with CHW integration in community and health care settings using a qualitative descriptive multiple-embedded case study of CHW teams at the University of Illinois at Chicago. Data were collected via semistructured interviews/document review and analyzed using thematic coding and quantitative content analysis. Factors associated with higher clinical integration included culture, communication, protocols, and training while higher community integration was associated with accessibility, relationships, and empathy. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Public Health Nursing and Community Health Worker Teams: A Community-Based Preventive Services Clinic Exemplar
Since 2009, a community-based, collaborative exemplar in Richmond, Virginia, involving 8 satellite clinics of the state health department, has been implemented within public housing units to focus on prevention and access to care. These satellite centers, known a resource center (RCs), are staffed by public health nurses, community health workers, and nurse practitioners working in complementary roles. The RCs have provided education to 2609 clients on family planning, safe sex practices, safe car seat use, and screening for sexually transmitted infections and have made 9591 patient referrals to health, social, and communi...
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Studying Executive Directors and Supervisors Views of Organizational and Policy-Level Challenges Faced by Community Health Workers
This study offers recommendations for supports needed to sustain CHWs, with an emphasis on greater investment in recruitment and training, higher compensation, and interorganizational collaboration. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

From the Editor
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - August 28, 2021 Category: Emergency Medicine Tags: From the Editor Source Type: research

Interpersonal Continuity of Care and Its Effect on Health Care Utilizations and Expenditures for Diabetes: An Experience From a Fragmented Health System
We aimed to quantify continuity of care (COC) and investigate its association with health care utilizations and expenditure among patients with diabetes. This was an observational retrospective cohort study using administrative claims database of Iranian Health Insurance Organization for East Azerbaijan Province, Iran. Standard indices of COC were calculated for each patient, and their associations with utilization outcomes were determined by applying general linear regression models. A total of 32 263 patients were included (mean age: 60.9 ± 14.5 years; 64% females). Higher levels of COC were associated with a redu...
Source: The Journal of Ambulatory Care Management - May 27, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

The Effect of Clinicians' Personal Acquaintance on Specialty Care Coordination as the Sharing of an EHR Increases
We used an online survey to measure how personal acquaintance with referring primary care providers (PCPs) affects specialists' experience of care coordination as use of a shared electronic health record (EHR) increases. Only 9% of specialists rated Overall Coordination as 9 or 10 out of 10. Personal acquaintance positively impacted Overall Coordination and all measured coordination subdomains. This effect was attenuated, but persisted, even at higher levels of EHR sharing. The impact of a shared EHR alone was limited to Overall Coordination and the Data Transfer subdomains. Health systems can improve coordination through ...
Source: The Journal of Ambulatory Care Management - May 27, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Defining Access Management in Health Care Delivery Organizations
Managing patient access to care in health care delivery organizations is instrumental in shaping patient experiences. We convened an inclusive stakeholder panel, informed by evidence, to understand the dimensions and establish definitions of access and access management. The literature varies in access definitions, but the temporal measure “time to third next available appointment” was consistently used as an indicator of access. Panel deliberations highlighted the importance of patient-centeredness and resulted in comprehensive definitions for access management, optimal access management, and optimal access. H...
Source: The Journal of Ambulatory Care Management - May 27, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Cardiovascular Disease in Patients With Type 2 Diabetes: A Qualitative Analysis of Knowledge, Attitudes, and Beliefs of Health Care Professionals
Guidelines for the management of patients with type 2 diabetes mellitus (T2DM) recommend SGLT-2 (sodium-glucose cotransporter 2) inhibitors and GLP-1 RAs (glucagon-like peptide 1 receptor agonists) as second-line agents for patients with, or at risk for, cardiovascular disease. A better understanding of guideline implementation will further the provision of evidence-based health care to patients. Interviews and surveys of clinicians were conducted to understand providers' knowledge, attitudes, and beliefs related to the 2019 American Diabetes Association Standards of Care for T2DM. There was a lack of widespread knowledge ...
Source: The Journal of Ambulatory Care Management - May 27, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Outcomes of a Student-Led Telemedicine Clinic in Response to COVID-19
In response to the coronavirus disease-2019 (COVID-19) pandemic, we developed and launched a student-led telemedicine program in Chelsea. From April to November 2020, over 200 student volunteers contacted over 1000 patients to assess COVID-19 symptoms, provide counseling, and triage patients. Through a retrospective cohort study, we determined that student triage decision was associated with patient outcomes, including hospitalization status, COVID-19 test administration, and COVID-19 test result. These results quantify the outcomes of a student-led telemedicine clinic to combat the ongoing pandemic and may serve as a mode...
Source: The Journal of Ambulatory Care Management - May 27, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Children's Hospital Ambulatory Response to the 2019 Novel Coronavirus Disease (COVID-19) Pandemic
The 2019 novel coronavirus disease (COVID-19) pandemic produced an abrupt and near shutdown of nonemergent patient care. Children's National Hospital (CNH) mounted a multidisciplinary, coordinated ambulatory response that included supply chain management, human resources, risk management, infection control, and information technology. To ensure patient access, CNH expanded telemedicine and instituted operational innovations for outpatient procedures. While monthly in-person ambulatory subspecialty visits decreased from 25 889 pre-COVID-19 to 4484 at nadir of the COVID-19 pandemic, telemedicine visits increased from 70 to 1...
Source: The Journal of Ambulatory Care Management - May 27, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Supporting “Bleeders” and “Billers”: How Safety-Net Administrators Mitigate Provider Burnout During the COVID-19 Pandemic and Beyond
Organizational factors impacting burnout have been underexplored among providers in low-income, minority-serving, safety-net settings. Our team interviewed 14 health care administrators, serving as key decision makers in Federally Qualified Health Center primary care clinics. Using a semistructured interview guide, we explored burnout mitigation strategies and elements of organizational culture and practice. Transcribed interviews were coded and analyzed using the Braun and Clark (2006) Thematic Analysis method. Mission-Driven Ethos to Mitigate Provider Burnout emerged as the primary theme with 2 categories: (1) Promoting ...
Source: The Journal of Ambulatory Care Management - May 27, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

From the Editor
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - May 27, 2021 Category: Emergency Medicine Tags: From the Editor Source Type: research

An Evaluation of eVisits at an Academic Medical Center
An eVisit is a form of asynchronous telehealth whereby the patient submits an online request for medical advice and receives a written response from a health care provider. While thought to be an efficient way to resolve low-acuity medical issues, there is limited information on whether eVisits lead the avoidance of in-person care. We reviewed 8627 eVisits that occurred at our institution from July 2017 to March 2020 and found that 23.1% of eVisits required follow-up medical care within 14 days (22.6% with primary care physician, 0.3% with emergency department, 0.2% both). Our results indicate that eVisits are a feasible a...
Source: The Journal of Ambulatory Care Management - February 18, 2021 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

Choice of Transport to Hospital in Nonurban Areas in Life-Threatening Situations: A Qualitative Research
The time it takes to begin treatment in life-threatening situations is critical. Ambulance transport to the hospital in such situations ensures quick and effective treatment but is not always readily available in nonurban areas, or not preferred by the public, for various reasons. The purpose of this qualitative study was to examine the factors that deter or encourage ambulance use in life-threatening situations in the geographic periphery from clients' perspectives. We conducted interviews with 71 patients in 3 medical centers who had arrived by ambulance or by private transport, and with the 3 emergency department direct...
Source: The Journal of Ambulatory Care Management - February 18, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

MACRA and Accountable Care Organizations: Is It Working?
The purpose of this study was to examine how the Medicare Access and CHIP Reauthorization Act (MACRA) has improved health care delivery and to determine its impact on Accountable Care Organization (ACO) goals. ACOs have provided quality care through the reduction in readmission rates, coordinated care, and cost savings. With the passage of the MACRA, it has been estimated that it would further decrease Medicare spending on physician and hospital services. Also, ACOs have had a positive impact on improving health care delivery and have played a significant role in providing exceptional quality of care while also managing to...
Source: The Journal of Ambulatory Care Management - February 18, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Health Service Utilization Patterns Among Medicaid-Insured Adults With Intellectual and Developmental Disabilities: Implications for Access Needs in Outpatient Community-Based Medical Services
Limited existing evidence suggests that adults with intellectual and developmental disabilities (IDD) experience substantial disparities in numerous areas of health care, including quality ambulatory care. A multistate cohort of adults with IDD was analyzed for patterns of inpatient admissions and emergency department utilization. Utilization was higher (inpatient [RR = 3.2], emergency department visits [RR = 2.6]) for adults with IDD, particularly for ambulatory care–sensitive conditions (eg, urinary tract [RR = 6.6] and respiratory infections [RRs = 5.5-24.7]), and psychiatric conditions (RRs = 5.8-15). Findings un...
Source: The Journal of Ambulatory Care Management - February 18, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Burnout and Patient Referral Among Primary Care Providers in Veterans Affairs Patient Aligned Care Teams (VA PACTs)
Using the Veterans Health Administration's 2018 national provider and staff survey, this study describes the practice patterns of 1453 primary care providers for specialty care consults, program referrals, secure messaging, and telephone visits; and examines whether the practice patterns are associated with provider burnout in primary care teamlets. About 51% of providers experienced moderate to severe burnout and 22% had severe burnout. Providers who embraced all 4 practice approaches had lower odds of severe burnout than providers endorsing none of the approaches (odds ratio range, 0.35-0.39). Associations were weaker fo...
Source: The Journal of Ambulatory Care Management - February 18, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Impact of an Extended Nursing Shift Schedule in a Rural and Urban Primary Care Setting
Two primary care clinics in rural and urban settings implemented a 9-hour nursing shift schedule. The purpose of this project was to use a quasiexperimental mixed-methods research design to assess outcomes for a 1-year implementation of nursing staff maintaining 9-hour shifts. Pre- and postdata were collected before and after implementation. The rural clinic demonstrated significant improvements in nurse satisfaction, overtime, compensatory time, and postacute follow-up. The urban facility showed significant decreases in sick leave. Patient satisfaction scores did not show significant changes for either clinic. (Source: Th...
Source: The Journal of Ambulatory Care Management - February 18, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Informational Gaps, Needs, and Preferences of Adults With Chronic Health Conditions and Their Family Caregivers
The purpose of this cross-sectional, qualitative study was to determine unmet educational needs, preferences, and barriers experienced by individuals with chronic illness and their caregivers. A survey containing fixed-choice selections and open-ended questions was sent to persons with cancer and other chronic diseases who had been seen within a large national private health system. Between 20% and 25% of participants had difficulty obtaining health care information and/or felt overwhelmed with managing their condition. Coping, managing symptoms, and making treatment decisions were areas of need in both patients and caregi...
Source: The Journal of Ambulatory Care Management - February 18, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

Do Teams Improve the Quality of Ambulatory Care?
Using data from the National Ambulatory Medical Care Survey, we examined team composition in office-based practices and compared their relative quality of care. We found that, compared with physician-only teams, patients seen by physician and nurse practitioner/nurse midwife teams and those seen by physician and nurse teams were more likely to receive statins for hyperlipidemia and blood pressure screening, respectively. We also found that patients seen by physician and physician assistant teams were less likely to receive recommended care for all 4 quality indicators, and patients seen by any interprofessional team were l...
Source: The Journal of Ambulatory Care Management - February 18, 2021 Category: Emergency Medicine Tags: Original Articles Source Type: research

From the Editor
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - February 18, 2021 Category: Emergency Medicine Tags: From the Editor Source Type: research

The Impact of COVID-19 on the Life Quality of Ambulatory Patients With Chronic Skin Conditions
This article addresses the issue of the psychological distress of ambulatory dermatologic patients on the ground of cancelation of nonurgent dermatology visits during the SARS-CoV-2 pandemic, as well as the risk of underestimating the emotional suffering of patients with chronic skin diseases, which traditionally would not qualify as urgent cases. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

Adapting Interdisciplinary Transitional Ambulatory Practice to Meet the Challenges of COVID-19
COVID-19 restructured the health care delivery process, catapulting telemedicine to the mainstream. The Johns Hopkins After Care Clinic (JHACC) continued transprofessional health care delivery in the telemedicine space by shifting to remote, asynchronous collaboration and a triage system. In 1 month after starting telemedicine, the JHACC had 907 encounters for 376 unique patients. Most patients reported satisfaction with their visits. Telemedicine lengthened visit completion times. Providers encountered many failed call attempts and limited access to videoconferencing. Barriers to sustainable interprofessional telemedicine...
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

Yakima, COVID-19 in the Community
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

COVID-19 and Vaccine Hesitancy: A Challenge the United States Must Overcome
A significant portion of the U.S. population may experience vaccine hesitancy of a new COVID-19 vaccine, which poses dangers to both the individual and their community, since exposure to a contagious disease places the person at risk, and individuals are far more likely to spread the disease to others if they do not get vaccinated. Many individuals are doubtful, and without the healthcare community, speaking with one voice has led to distrust. Experience from the influenza vaccines have shown vaccine acceptance has not been optimal, and this new vaccine, even though it is not approved, is already showing layperson skeptici...
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

Lessons for Health Care Executives and Other Leaders During COVID-19: Five Major Opportunities for Improvement
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

“Having a Normal Life”: A Qualitative Study on Client Goal-Setting Within a Health Care and Social Needs Navigation Program
This study provides a qualitative analysis of client-established goals within the Interprofessional Care Access Network (I-CAN), a community-based health care and social needs navigation program. One hundred eleven client goal lists were analyzed using conventional content analysis. Twenty-two codes were developed and grouped into 4 main categories including Physical/Mental Health, Social/Social Services, Health Care System, and Daily Living. The results of this study offer insight into client goals within health care and social needs navigation programs and provide suggestions for future research. (Source: The Journal of ...
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Using the Six Sigma Methodology to Reduce Missed Appointments at a Pediatric Inner-City Clinic
Pediatric missed appointments impact patient outcomes and the financial well-being of clinics. Our purpose was to implement the Six Sigma methodology at a pediatric clinic to (1) identify significant predictor factors of missed appointments and develop a prediction model and (2) implement interventions to reduce the missed appointment rate. Binary logistic regression identified historical no-show rate, high-risk visit types, lack of insurance, the number of provider visits, and appointment lead time as significant predictor factors. Interventions led to a significant drop in the missed appointment rate and the no-show rate...
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Psychometric Properties of the Assessment of Perceived Access to Care (APAC) Instrument
Valid measures of perceived access are needed to measure whether health care systems are providing adequate access. This research reports on the psychometric properties of the Assessment of Perceived Access to Care (APAC), which was administered to 1004 Community Health Center patients screening positive for psychiatric disorders. Known-group validity was good, with 6 of the 8 hypothesized associations between social determinants of access and perceived access being significant (P (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Understanding How Providers and Staff Make Decisions About Where to Refer Their Patients: A Qualitative Study
Value-based payment incentivizes primary care providers (PCPs) to refer patients to specialists inside their own organization. “Outmigration” of patients to specialists in other organizations is common, yet why it occurs is not clear. We conducted qualitative interviews of PCPs, nurses, and administrative staff at primary care practices in a physician organization (PO) to determine reasons for outmigration. While participants reported that they preferred making within-PO referrals, they identified 18 barriers to within-PO referrals, which often led to patients receiving care elsewhere. Many of these barriers ar...
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Communicating a Complicated Medicaid Waiver Program to Enrollees in Iowa: How Federally Qualified Health Centers Support Medicaid Members
Iowa expanded Medicaid eligibility with a waiver including a personal responsibility component. Early program evaluation revealed low compliance and awareness among members. There is little research on leveraging existing contact points in the health care system to effectively communicate with Medicaid enrollees. We interviewed outreach and enrollment staff at Federally Qualified Health Centers (FQHCs) to explore their work. We show that FQHCs use several strategies to enroll individuals in appropriate programs and support them in understanding and navigating their health insurance coverage. With increasingly complex Medic...
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

A Targeted “Top 100” High-Risk Care Management Program Improves Adherence to Best Practices
Care management programs for high-risk patients have yielded inconsistent results in reducing health care expenditures. We reviewed the most successful programs and identified 5 best practice areas: (1) in-person patient meetings; (2) direct care manager/physician interaction; (3) provide transitional care services; (4) educate patients; and (5) provide medication review. We measured adherence to the best practices at baseline and at 6 and 9 months into the program for the highest-risk patients. The program increased adherence from baseline to each best practice area. Program enrollment increased at the 6-month follow-up b...
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

The Vital Role of a Federally Qualified Community Health Center in New Orleans, Louisiana, During the COVID-19 Pandemic
Federally qualified health centers (FQHCs) are on the front lines of the COVID-19 pandemic. Their mission of providing essential medical care to underserved populations is now even more vital. CrescentCare, an FQHC in New Orleans, evaluated and tested 3366 patients between March 16 and July 2, with an overall rate of 12% SARS-CoV-2 positivity. The clinic's experience demonstrates how to effectively and rapidly integrate COVID-19 programing, while preserving essential health services. Strategies include developing a walk-in COVID-19 testing site, ensuring appropriate clinical evaluation, providing accurate public health inf...
Source: The Journal of Ambulatory Care Management - November 26, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research