The Journal of Ambulatory Care Management This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Have Health Reforms in Brazil Reduced Inequities in Access to Cancer Screenings for Women?
We measured asset-based and education-based inequity in utilization of 2 cancer screening tests, Pap tests and mammograms, using nationally representative surveys conducted in 2003, 2008, and 2013. Utilization of Pap tests (ages 25-59 years) and mammograms (ages 50-69 years) increased over time. Asset-based and education-based inequities declined significantly for both screening tests, particularly among women who reported a doctor visit in the previous year. This decline coincided with increases in the coverage of primary health care in Brazil. However, barriers persisted; in 2013, college-educated women were still 2.27 t...
Source: The Journal of Ambulatory Care Management - May 28, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

The Contribution of Physician-System Integrating Structure to Select Health System Outcomes
The objective of this study was to examine the impact of increased physician-system integration on select health system outcomes. We used a mixed-methods approach: (1) a fixed-effects multivariate mediation analysis; and (2) a qualitative analysis of interviews with health executives (n = 25). Our findings showed that hospitals spent $633 375.22 to $827 110.24 for each “level” increase in integration. This relationship was attenuated, however, by the presence of care coordination mechanisms. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - May 28, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

The Collaborative Care Model for Patients With Both Mental Health and Medical Conditions Implemented in Hospital Outpatient Care Settings
With the increased concern regarding the negative impact that care in silos has on patients and the health care system, there is growing interest in integrated models of care especially for individuals with co-occurring physical and mental health conditions. Although generally applied in a community setting, we adapted and implemented an evidence-based integrated model of care, the collaborative care model (CCM) in an adult and a pediatric hospital-based outpatient clinic. Enrolment was criteria based and management was measurement driven. The model is team based and consists of new roles for its members including the pati...
Source: The Journal of Ambulatory Care Management - May 28, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

The Influence of the Scheduling Horizon on New Patient Arrivals
The goal of scheduling within an ambulatory enterprise is to appropriately accommodate patients; extending capacity to fulfill this aim in a large health care organization requires the management of a complex scheduling process. Understanding and handling the appointment lead time, referred to as the scheduling horizon, can positively influence capacity management. The analysis demonstrated an increased chance of nonarrived appointments of 16% for a specialty practice and 11% for a primary care practice for every 30-day delay in the scheduling horizon. By incorporating the management of the scheduling horizon, health care ...
Source: The Journal of Ambulatory Care Management - May 28, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Comparative Case Analysis of the Role of Community Health Workers in Rural and Low-Income Populations of West Virginia and the United States
This study aims to inform policy and planning by comparing how 2 county-level CHW programs engage with communities. The analysis is based on in-depth interviews with 19 community representatives and 20 health workers and archival documents and published literature reviews. Results highlight the local contextual determinants for community engagement with CHW programs. Making CHW policies inclusive and adaptable to local realities will enable more community benefits. Making the value of CHW programs for communities explicit should guide resource allocation and policies. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - May 28, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Commentary on “Health Spending Under Single-Payer Approaches”
One of the most controversial areas in discussions of single-payer approaches for the United States, such as “Medicare for All,” concerns its implications for costs. Confusion over differences between federal and total spending and effects of lower patient cost sharing gets in the way of “apples-to-apples” comparisons. Key areas with potential to lower costs are lower administrative costs and lower provider prices. But cost reduction would likely be smaller than some envision, especially in the price area because of the need for a long process to gradually allow providers to adjust to lower prices and Americans' un...
Source: The Journal of Ambulatory Care Management - May 28, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Fitting Community-Centered Population Health (CCPH) Into the Existing Health Care Delivery Patchwork: The Politics of CCPH
The COVID-19 crisis has nakedly exposed the problems and huge holes in the health care system of the United States. For today, we need to address the current pandemic from the point of view of both control and suppression. But such efforts could also provide insights into a post-pandemic restructuring of health care. If one or several states succeed in addressing the COVID pandemic together with an associated modest economic resurgence, citizens could develop the trust in state leadership necessary to finally make fundamental changes in our health care system. Such change is a once in a century opportunity. (Source: The Jo...
Source: The Journal of Ambulatory Care Management - May 28, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

COVID-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers: at the Center
Dealing with the COVID-19 coronavirus requires a coordinated transnational effort. We propose a 2-stage state-led effort that utilizes community health workers (CHWs). We spell out what is beginning to occur in states to control and suppress COVID-19. In the second stage, we suggest working with these CHWs as a key element in the next evolution of our health care system: community-centered population health. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - May 28, 2020 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 28, 2020 Category: Emergency Medicine Tags: From the Editor Source Type: research

Provision of Utility Shut-off Protection Letters at an Urban Safety-Net Hospital, 2009-2018
Most states prohibit utility companies from terminating service to low-income households when occupants present a medical letter confirming a household member has a chronic serious illness. It is unclear how many patients receive these letters and whether screening for health-related social needs (HRSN) identifies these patients. We analyzed characteristics of adult patients at a safety-net hospital with a utility shut-off protection letter 2009-2018. A total of 2973 patients received a letter; most were non-Hispanic black, and had government insurance. Among patients who received a letter in 2018, 70% were screened for HR...
Source: The Journal of Ambulatory Care Management - February 19, 2020 Category: Emergency Medicine Tags: Letter to the Editor Source Type: research

A 4-Year Investigation of Ambulatory Health Care Expenditure Concentration and High-Cost Patients: An Experience From a Developing Country
This study used 2013-2016 individual-level claims data of Iranian Health Insurance Organization in East Azerbaijan province. All ambulatory care utilizers were included in the study. We determined characteristics and utilization pattern of high-cost patients as well as their predictors. A total of 1 128 149 patients were included. The top 10% of patients accounted for 62.56% of the total expenditure. This skewed expenditure pattern remained relatively stable over the study period. Female sex, older age, cancer, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes increase the odds of being high cost....
Source: The Journal of Ambulatory Care Management - February 19, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Clinic-Based Community Health Worker Integration: Community Health Workers', Employers', and Patients' Perceptions of Readiness
Clinic-based community health workers (cCHWs) are a growing workforce who can facilitate medical and social support services, particularly for patients with complex, chronic conditions. We assessed CHWs', employers', and patients' perceptions and readiness for CHW integration into clinical settings. We found varying levels of readiness between the groups, offset by conditional implementation concerns, such as need for clearer training, role delineation, expectations, and trust. Integrating CHWs as members of the complex care team holds promise for optimal patient engagement. Maximizing CHWs' potentials through readiness ef...
Source: The Journal of Ambulatory Care Management - February 19, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

An Automated Telephone Call System Improves the Reach and Cost-effectiveness of Panel Management Outreach for Cancer Screening
This implementation and comparative effectiveness study compared an automated call system (ACS)-assisted method to enhance staff efficiency in panel management cancer screening outreach compared with standard outreach using manual calls. One panel manager assisted by the ACS at the intervention primary care practice completed outreach workflows for 43% more patients than 2 unassisted panel managers at comparison practices, with 78% more patients in the ACS-assisted panel management program ultimately having a preventive screening gap closed. Outreach cost per completion of 1 or more cancer screenings was $45.39 under stand...
Source: The Journal of Ambulatory Care Management - February 19, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Comparing Rates of Multiple Chronic Conditions at Primary Care and Mental Health Visits to Community Health Centers Versus Private Practice Providers
This study identifies differences in rates of multiple chronic conditions at primary care and mental health visits to Community Health Centers and private practice providers using 2013 National Ambulatory Medical Care Survey data. Community health center visits had higher rates of 1 or more, 2 or more, and 3 or more chronic conditions for working-age patient visits (ages 18-64). There were no differences in other age groups. After controlling for age and other covariates using logistic regression, community health center visits had 35% higher odds of having any chronic condition and 31% higher odds of having 2 or more chro...
Source: The Journal of Ambulatory Care Management - February 19, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research

Implementation Lessons From a Randomized Trial Integrating Community Asthma Education for Children
This study characterized and compared the implementation of clinically integrated community health workers (CHWs) to a certified asthma educator (AE-C) for low-income children with asthma. In the AE-C arm (N = 115), 51.3% completed at least one in-clinic education session. In the CHW arm (N = 108), 722 home visits were completed. The median number of visits was 7 (range, 0-17). Scheduled in-clinic asthma education may not be the optimal intervention for this patient population. CHW visit completion rates suggest that the schedule, location, and content of CHW asthma services better met patients' needs. Seven to 10 visits s...
Source: The Journal of Ambulatory Care Management - February 19, 2020 Category: Emergency Medicine Tags: Original Articles Source Type: research