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O’Bryan SE, Muñoz F, Smith D, Bearse A, Melendrez B, Kamdar B, James-Price C, Ramirez D, Servin AE. Community based participatory research as a promising practice for addressing vaccine hesitancy, rebuilding trust and addressing health disparities among racial and ethnic minority communities. Hum Vaccin Immunother 2024; 20:2326781. [PMID: 38497273 PMCID: PMC10950264 DOI: 10.1080/21645515.2024.2326781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
The COVID-19 pandemic disproportionately affected racial and ethnic minority communities across the United States (U.S.). Despite the disproportionate burden of COVID-19 faced by communities of color, Black and Hispanic communities are less likely to be fully vaccinated than White non-Hispanic Persons. Health inequity and vaccine hesitancy are complex phenomena that require multilevel responses tailored to the unique needs of each community, a process that inherently necessitates a high level of community engagement in order to develop the most effective health interventions. Building on the principles of community based participatory research (CBPR) and with the support of the National Institutes of Health (NIH), Project 2VIDA! was born. A multidisciplinary collaborative of academic researchers, community members, and clinicians whose aim is to foster sustainable partnerships to reduce the burden of COVID-19 in Hispanic and Black communities across Southern California. Our model was designed to meet our community members where they were - whether on their lunch break or picking their children from school. This CBPR model has been well received by community members. Future health interventions focused on reducing health disparities should prioritize the role of the community, leverage the voices of key community partners, and be grounded in equitable power sharing.
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Affiliation(s)
- Sophie E. O’Bryan
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Fatima Muñoz
- Health Support Services, San Ysidro Health, San Ysidro, CA, USA
| | - David Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Adriana Bearse
- UC San Diego, Center for Community Health, University of California, San Diego, La Jolla, CA, USA
| | - Blanca Melendrez
- UC San Diego, Center for Community Health, University of California, San Diego, La Jolla, CA, USA
| | - Biren Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, UC San Diego School of Medicine, La Jolla, CA, USA
| | | | - Daniel Ramirez
- Health Support Services, San Ysidro Health, San Ysidro, CA, USA
| | - Argentina E. Servin
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, USA
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Zallman L, Bearse A, West C, Bor D, McCormick D. Patient preferences and access to text messaging for health care reminders in a safety-net setting. Inform Health Soc Care 2016; 42:32-42. [PMID: 26864932 DOI: 10.3109/17538157.2015.1113177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Text messaging may be an effective method for providing health care reminders to patients. We aimed to understand patient access to and preferences for receiving health-related reminders via text message among patients receiving care in safety-net hospitals. MATERIALS AND METHODS We conducted face-to-face surveys with 793 patients seeking care in three hospital emergency departments at a large safety-net institution and determined clinical and demographic predictors of preferences for text messaging for health care reminders. RESULTS 95% of respondents reported having daily access to text messaging. Text messaging was preferred over e-mail, phone, and letters for communication. 78% of respondents wanted to receive appointment reminders, 56% wanted expiring insurance reminders, and 36% wanted reminders to take their medications. We found no clinical predictors but did find some demographic predictors-including age, ethnicity, insurance status, and income-of wanting text message reminders. DISCUSSION In our convenience sample of safety-net patients, text messaging is an accessible, acceptable, and patient-preferred modality for receiving health care reminders. Text messaging may be a promising patient-centered approach for providing health care and insurance reminders to patients seeking care at safety-net institutions.
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Affiliation(s)
- Leah Zallman
- a Department of Medicine , Cambridge Health Alliance , Cambridge , MA , USA.,b Institute for Community Health , Malden , MA , USA.,c Kraft Center for Community Health , Boston , MA , USA.,d Department of Medicine , Harvard Medical School , Boston , MA , USA
| | | | - Catherine West
- e Center for Health and Information Analysis, Commonwealth of Massachusetts , Boston , MA , USA
| | - David Bor
- a Department of Medicine , Cambridge Health Alliance , Cambridge , MA , USA.,d Department of Medicine , Harvard Medical School , Boston , MA , USA
| | - Danny McCormick
- a Department of Medicine , Cambridge Health Alliance , Cambridge , MA , USA.,d Department of Medicine , Harvard Medical School , Boston , MA , USA
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Zallman L, Wilson FA, Stimpson JP, Bearse A, Arsenault L, Dube B, Himmelstein D, Woolhandler S. Unauthorized Immigrants Prolong the Life of Medicare's Trust Fund. J Gen Intern Med 2016; 31:122-7. [PMID: 26084972 PMCID: PMC4699990 DOI: 10.1007/s11606-015-3418-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 01/30/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Unauthorized immigrants seldom have access to public health insurance programs such as Medicare Part A, which pays hospitals and other health facilities and is funded through the Medicare Trust Fund. DESIGN AND MAIN MEASURES We tabulated annual and total Trust Fund contributions and withdrawals by unauthorized immigrants (i.e., outlays on their behalf) from 2000 to 2011 using the Current Population Survey and Medical Expenditure Panel Surveys. We estimated when the Trust Fund would be depleted if unauthorized immigrants had neither contributed to it nor withdrawn from it. We estimated Trust Fund surpluses by unauthorized immigrants if 10 % were to become authorized annually over the subsequent 7 years. KEY RESULTS From 2000 to 2011, unauthorized immigrants contributed $2.2 to $3.8 billion more than they withdrew annually (a total surplus of $35.1 billion). Had unauthorized immigrants neither contributed to nor withdrawn from the Trust Fund during those 11 years, it would become insolvent in 2029-1 year earlier than currently predicted. If 10 % of unauthorized immigrants became authorized annually for the subsequent 7 years, Trust Fund surpluses contributed by unauthorized immigrants would total $45.7 billion. CONCLUSIONS Unauthorized immigrants have prolonged the life of the Medicare Trust Fund. Policies that curtail the influx of unauthorized immigrants may accelerate the Trust Fund's depletion.
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Affiliation(s)
- Leah Zallman
- Institute for Community Health, 350 Main Street, Malden, MA, 02148, USA. .,Harvard Medical School, Boston, MA, USA. .,Cambridge Health Alliance Department of Medicine, Cambridge, MA, USA.
| | - Fernando A Wilson
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - James P Stimpson
- City University of New York, School of Public Health at Hunter College, New York, NY, USA
| | - Adriana Bearse
- Institute for Community Health, 350 Main Street, Malden, MA, 02148, USA.
| | - Lisa Arsenault
- Institute for Community Health, 350 Main Street, Malden, MA, 02148, USA
| | - Blessing Dube
- Institute for Community Health, 350 Main Street, Malden, MA, 02148, USA
| | - David Himmelstein
- Harvard Medical School, Boston, MA, USA.,City University of New York, School of Public Health at Hunter College, New York, NY, USA
| | - Steffie Woolhandler
- Harvard Medical School, Boston, MA, USA.,City University of New York, School of Public Health at Hunter College, New York, NY, USA
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Hacker K, Santos P, Thompson D, Stout SS, Bearse A, Mechanic RE. Early experience of a safety net provider reorganizing into an accountable care organization. J Health Polit Policy Law 2014; 39:901-917. [PMID: 24842968 DOI: 10.1215/03616878-2744284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Although safety net providers will benefit from health insurance expansions under the Affordable Care Act, they also face significant challenges in the postreform environment. Some have embraced the concept of the accountable care organization to help improve quality and efficiency while addressing financial shortfalls. The experience of Cambridge Health Alliance (CHA) in Massachusetts, where health care reform began six years ago, provides insight into the opportunities and challenges of this approach in the safety net. CHA's strategies include care redesign, financial realignment, workforce transformation, and development of external partnerships. Early results show some improvement in access, patient experience, quality, and utilization; however, the potential efficiencies will not eliminate CHA's current operating deficit. The patient population, payer mix, service mix, cost structure, and political requirements reduce the likelihood of financial sustainability without significant changes in these factors, increased public funding, or both. Thus the future of safety net institutions, regardless of payment and care redesign success, remains at risk.
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Zallman L, Bearse A, Neal N, VanDeusen Lukas C, Hacker K. Strategies for Aligning Physicians to System Redesign Goals at Eight Safety-Net Systems. Jt Comm J Qual Patient Saf 2014; 40:541-3. [PMID: 26111379 DOI: 10.1016/s1553-7250(14)40070-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Facing recent economic and regulatory pressures, safety-net systems (SNSs) are redesigning their organizations to improve care delivery, remain financially viable, and maintain competitive positions. Aligning physicians with redesign goals is a priority, particularly as many SNSs shift toward patient-centered, population health-focused models. No previous work has examined efforts to align physicians to safety net redesign efforts. METHODS This qualitative study, conducted at eight SNSs, examined challenges faced in a changing health care environment, as well as strategies and resources to address them. RESULTS Strategies clustered in two categories: physician role definition and organizational infrastructure. Physician role definition strategies were (1) changing payment and employment arrangements, (2) changing clinical roles, (3) increasing physician involvement in quality improvement, and (4) strengthening physician leadership in clinical and quality roles. Organizational infrastructure strategies were (1) ensuring medical center leadership support and integration, (2) utilizing data to drive physician behavior, and (3) addressing competing allegiances with academia. All sites reported multifaceted approaches but differed in specific strategies employed, facilitators noted, and challenges encountered. DISCUSSION The findings highlight the need to implement multiple strategies to align physicians in redesign efforts. They suggest that all health systems, whether SNSs or not, can capitalize on qualities of physicians and existing infrastructural and leadership elements to achieve physician alignment. However, they must contend with and address challenges of competing allegiance (for example, academic, physician organization, hospital), as well as resistance to changing clinical roles and payment structures.
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Affiliation(s)
- Leah Zallman
- Institute for Community Health, Cambridge, Massachusetts, USA
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