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Nguyen KH, Oronce CIA, Adia AC, Yeh JC, Ponce N. Inability to Access Needed Medical Care Among Asian American, Native Hawaiian, and Pacific Islander Medicaid Enrollees. J Ambul Care Manage 2024; 47:96-103. [PMID: 38335049 PMCID: PMC10940179 DOI: 10.1097/jac.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
We examined self-reported inability to access to needed medical care and reasons for not accessing medical care among US-representative adult Medicaid enrollees, disaggregated across 10 Asian American, Native Hawaiian, and Pacific Islander ethnic groups. Chinese (-4.54 percentage points [PP], P < .001), Other Asian (-4.42 PP, P < .001), and Native Hawaiian (-4.36 PP, P < .001) enrollees were significantly less likely to report being unable to access needed medical care compared with non-Hispanic White enrollees. The most common reason reported was that a health plan would not approve, cover, or pay for care. Mitigating inequities may require different interventions specific to certain ethnic groups.
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Affiliation(s)
- Kevin H Nguyen
- Author Affiliations: Department of Health Law, Policy and Management, Boston University School of Public Health Boston, Massachusetts (Dr Nguyen and Mr Yeh); Department of Health Policy and Management, Fielding School of Public Health, University of California (Drs Oronce and Ponce); UCLA Center for Health Policy Research (Drs Oronce and Ponce); Filipinx/a/o Community Health Association (Drs Oronce and Ponce, Mr Adia); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA (Dr Oronce); Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California (Dr Oronce); and Department of Health Policy and Management, University of California, Berkeley, California (Mr Adia)
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Chen KL, Oronce CIA, Calderón NE, Kahn KL. Academic seminars as tool for clinical and translational science education and dissemination: Perceptions and priorities in the COVID-19 era. Clin Transl Sci 2024; 17:e13680. [PMID: 37983955 PMCID: PMC10766022 DOI: 10.1111/cts.13680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/26/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Academic seminars are an important venue through which investigators in health services research (HSR) and other clinical and translational science disciplines can share their work, gather feedback, and connect with colleagues. However, the format and focus of these seminars shifted abruptly when the coronavirus disease 2019 (COVID-19) pandemic necessitated social distancing and underscored the salience of health equity. Little is known about how contemporary academic seminars are meeting the evolving needs of the HSR community. We surveyed 2021-2022 participants in a virtual HSR seminar series to understand experiences of and priorities for the seminars. We also compared results stratified by self-reported under-represented minority (URM) status. Of 45 respondents (including 26 faculty members, 8 trainees, 9 staff members, and 2 community partners), 38% self-identified as URM. Participants reported high satisfaction with seminar quality, diversity of topics, and audience participation (median ≥4 for all outcomes in Likert-scaled items where 5 = very satisfied). Knowledge acquisition, understanding of research methods, and collaboration were commonly cited as benefits of seminar attendance. Implementation science content and external collaboration were most often endorsed as priorities for future seminars. URM participants were over three times more likely than non-URM participants to cite learning about engaging community stakeholders and historically excluded populations as a benefit of seminar participation. Virtual academic seminars can be an effective modality for knowledge sharing and collaboration worth continuing after COVID-19 restrictions are lifted. Emphasizing equity, diversity, and inclusion (EDI) values in these seminars may hold potential for advancing academic departments' own EDI goals.
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Affiliation(s)
- Katherine L. Chen
- Division of General Internal Medicine & Health Services Research, David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Carlos Irwin A. Oronce
- Division of General Internal Medicine & Health Services Research, David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
- Department of MedicineVA Greater Los Angeles Healthcare System, CaliforniaLos AngelesCaliforniaUSA
| | | | - Katherine L. Kahn
- Division of General Internal Medicine & Health Services Research, David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
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Oronce CIA, Arbanas JC, Leng M, Landon BE, Damberg CL, Sarkisian C, Mafi JN. Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: A cross-sectional analysis. J Am Geriatr Soc 2022; 70:2714-2718. [PMID: 35758317 PMCID: PMC9489619 DOI: 10.1111/jgs.17891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Carlos Irwin A. Oronce
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Julia Cave Arbanas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mei Leng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Bruce E. Landon
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Catherine Sarkisian
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - John N. Mafi
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, California
- RAND Corporation, Santa Monica, California
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Manalo-Pedro E, Mackey A, Banawa RA, Apostol NJL, Aguiling W, Aguilar A, Oronce CIA, Sabado-Liwag MD, Yee MD, Taggueg R, Bacong AM, Ponce NA. Learning to love ourselves again: Organizing Filipinx/a/o scholar-activists as antiracist public health praxis. Front Public Health 2022; 10:958654. [PMID: 36062092 PMCID: PMC9437515 DOI: 10.3389/fpubh.2022.958654] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/02/2022] [Indexed: 01/24/2023] Open
Abstract
A critical component for health equity lies in the inclusion of structurally excluded voices, such as Filipina/x/o Americans (FilAms). Because filam invisibility is normalized, denaturalizing these conditions requires reimagining power relations regarding whose experiences are documented, whose perspectives are legitimized, and whose strategies are supported. in this community case study, we describe our efforts to organize a multidisciplinary, multigenerational, community-driven collaboration for FilAm community wellness. Catalyzed by the disproportionate burden of deaths among FilAm healthcare workers at the onset of the COVID-19 pandemic and the accompanying silence from mainstream public health leaders, we formed the Filipinx/a/o Community Health Association (FilCHA). FilCHA is a counterspace where students, faculty, clinicians, and community leaders across the nation could collectively organize to resist our erasure. By building a virtual, intellectual community that centers our voices, FilCHA shifts power through partnerships in which people who directly experience the conditions that cause inequities have leadership roles and avenues to share their perspectives. We used Pinayism to guide our study of FilCHA, not just for the current crisis State-side, but through a multigenerational, transnational understanding of what knowledges have been taken from us and our ancestors. By naming our collective pain, building a counterspace for love of the community, and generating reflections for our communities, we work toward shared liberation. Harnessing the collective power of researchers as truth seekers and organizers as community builders in affirming spaces for holistic community wellbeing is love in action. This moment demands that we explicitly name love as essential to antiracist public health praxis.
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Affiliation(s)
- Erin Manalo-Pedro
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Andrea Mackey
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
| | - Rachel A. Banawa
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
- UCLA Center for Health Policy Research, Los Angeles, CA, United States
| | - Neille John L. Apostol
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
| | - Warren Aguiling
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
- Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Arleah Aguilar
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
| | - Carlos Irwin A. Oronce
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
- VA Advanced HSR Fellowship, Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Melanie D. Sabado-Liwag
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
- Department of Public Health, California State University, Los Angeles, Los Angeles, CA, United States
| | - Megan D. Yee
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Roy Taggueg
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
- Bulosan Center, University of California, Davis, Davis, CA, United States
| | - Adrian M. Bacong
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
- Stanford University Center for Asian Health Research and Education, Palo Alto, CA, United States
| | - Ninez A. Ponce
- Data and Research Committee, Filipinx/a/o Community Health Association, Los Angeles, CA, United States
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
- UCLA Center for Health Policy Research, Los Angeles, CA, United States
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Henry TL, Britz JB, Louis JS, Bruno R, Oronce CIA, Georgeson A, Ragunanthan B, Green MM, Doshi N, Huffstetler AN. Health Equity: The Only Path Forward for Primary Care. Ann Fam Med 2022; 20:175-178. [PMID: 35165088 PMCID: PMC8959751 DOI: 10.1370/afm.2789] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/09/2022] Open
Abstract
The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report on Implementing High-Quality Primary Care identifies 5 high-level objectives regarding payment, access, workforce development, information technology, and implementation. Nine junior primary care leaders (3 internal medicine, 3 family medicine, 3 pediatrics) invited from broad geographies, practice settings, and academic backgrounds used appreciative inquiry to identify priorities for the future of primary care. Highlighting the voices of these early career clinicians, we propose a response to the report from the perspective of early career primary care physicians. Health equity must be the foundation of the future of primary care. Because Barbara Starfield's original 4 Cs (first contact, coordination, comprehensiveness, and continuity) may not be inclusive of the needs of under-resourced communities, we promote an extension to include 5 additional Cs: convenience, cultural humility, structural competency, community engagement, and collaboration. We support the NASEM report's priorities and its focus on achieving health equity. We recommend investing in local communities and preparatory programs to stimulate diverse individuals to serve in health care. Finally, we support a blended value-based care model with risk adjustment for the social complexity of our patients.Appeared as Annals "Online First" article.
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Affiliation(s)
- Tracey L Henry
- Emory University School of Medicine, Division of General Medicine and Geriatrics, Atlanta, Georgia
| | - Jacqueline B Britz
- Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, Virginia
| | - Joshua St Louis
- Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts; Lawrence Family Medicine Residency, Lawrence, Massachusetts
| | | | - Carlos Irwin A Oronce
- Veterans Affairs Advanced Health Services Research Fellowship, Greater Los Angeles VA Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | | | | | | | - Neeti Doshi
- University of California San Francisco Department of Pediatrics, San Francisco, California
| | - Alison N Huffstetler
- Virginia Commonwealth University, Department of Family Medicine and Population Health, Richmond, Virginia
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Sabado-Liwag MD, Manalo-Pedro E, Taggueg R, Bacong AM, Adia A, Demanarig D, Sumibcay JR, Valderama-Wallace C, Oronce CIA, Bonus R, Ponce NA. Addressing The Interlocking Impact Of Colonialism And Racism On Filipinx/a/o American Health Inequities. Health Aff (Millwood) 2022; 41:289-295. [PMID: 35130069 DOI: 10.1377/hlthaff.2021.01418] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Within the monolithic racial category of "Asian American," health determinants are often hidden within each subgroup's complex histories of indigeneity, colonialism, migration, culture, and socio-political systems. Although racism is typically framed to underscore the ways in which various institutions (for example, employment and education) disproportionately disadvantage Black/Latinx communities over White people, what does structural racism look like among Filipinx/a/o Americans (FilAms), the third-largest Asian American group in the US? We argue that racism defines who is visible. We discuss pathways through which colonialism and racism preserve inequities for FilAms, a large and overlooked Asian American subgroup. We bring to light historical and modern practices inhibiting progress toward dismantling systemic racial barriers that impinge on FilAm health. We encourage multilevel strategies that focus on and invest in FilAms, such as robust accounting of demographic data in heterogeneous populations, explicitly naming neocolonial forces that devalue and neglect FilAms, and structurally supporting community approaches to promote better self- and community care.
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Affiliation(s)
- Melanie D Sabado-Liwag
- Melanie D. Sabado-Liwag , California State University, Los Angeles, Los Angeles, California
| | - Erin Manalo-Pedro
- Erin Manalo-Pedro, University of California Los Angeles (UCLA), Los Angeles, California
| | - Roy Taggueg
- Roy Taggueg Jr., University of California Davis, Davis, California
| | | | - Alexander Adia
- Alexander Adia, Filipinx/a/o Community Health Association, Los Angeles, California
| | | | | | | | - Carlos Irwin A Oronce
- Carlos Irwin A. Oronce, Veterans Affairs Greater Los Angeles Healthcare System and UCLA, Los Angeles, California
| | - Rick Bonus
- Rick Bonus, University of Washington, Seattle, Washington
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Oronce CIA, Miake-Lye IM, Begashaw MM, Booth M, Shrank WH, Shekelle PG. Interventions to Address Food Insecurity Among Adults in Canada and the US: A Systematic Review and Meta-analysis. JAMA Health Forum 2021; 2:e212001. [PMID: 35977189 PMCID: PMC8796981 DOI: 10.1001/jamahealthforum.2021.2001] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/11/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Inadequate access to food is a risk factor for poor health and the effectiveness of federal programs targeting food insecurity, such as the Supplemental Nutrition Assistance Program (SNAP), are well-documented. The associations between other types of interventions to provide adequate food access and food insecurity status, health outcomes, and health care utilization, however, are unclear. Objective To review evidence on the association between food insecurity interventions and food insecurity status, clinically-relevant health outcomes, and health care utilization among adults, excluding SNAP. Data Sources A systematic search for English-language literature was performed in PubMed Central and Cochrane Trials databases (inception to January 23, 2020), the Social Interventions Research and Evaluation Network database (December 10, 2019); and the gray literature using Google (February 1, 2021). Study Selection Studies of any design that assessed the association between food insecurity interventions for adult participants and food insecurity status, health outcomes, and health care utilization were screened for inclusion. Studies of interventions that described addressing participants' food needs or reporting food insecurity as an outcome were included. Interventions were categorized as home-delivered food, food offered at a secondary site, monetary assistance in the form of subsidies or income supplements, food desert interventions, and miscellaneous. Data Extraction and Synthesis Data extraction was performed independently by 3 reviewers. Study quality was assessed using the Cochrane Risk of Bias Tool, the ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions) tool, and a modified version of the National Institutes of Health's Quality Assessment Tool for Before-After Studies With No Control. The certainty of evidence was based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria and supplemented with mechanistic and parallel evidence. For outcomes within intervention categories with at least 3 studies, random effects meta-analysis was performed. Main Outcomes and Measures Food insecurity (measured through surveys; eg, the 2-item Hunger Vital Sign), health outcomes (eg, hemoglobin A1c), and health care utilization (eg, hospitalizations, costs). Results A total of 39 studies comprising 170 605 participants were included (8 randomized clinical trials and 31 observational studies). Of these, 14 studies provided high-certainty evidence of an association between offering food and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.53; 95% CI, 0.33-0.67). Ten studies provided moderate-certainty evidence of an association between offering monetary assistance and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.64; 95% CI, 0.49-0.84). There were fewer studies of the associations between interventions and health outcomes or health care utilization, and the evidence in these areas was of low or very low certainty that any food insecurity interventions were associated with changes in either. Conclusions and Relevance This systematic review with meta-analysis found that providing food and monetary assistance was associated with improved food insecurity measures; however, whether it translated to better health outcomes or reduced health care utilization was unclear.
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Affiliation(s)
- Carlos Irwin A. Oronce
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
- David Geffen School of Medicine, University of California, Los Angeles
- National Clinician Scholars Program, University of California, Los Angeles
| | - Isomi M. Miake-Lye
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
| | - Meron M. Begashaw
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
| | - Marika Booth
- RAND Corporation, Southern California Evidence-based Practice Center, Santa Monica, California
| | | | - Paul G. Shekelle
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California
- David Geffen School of Medicine, University of California, Los Angeles
- RAND Corporation, Southern California Evidence-based Practice Center, Santa Monica, California
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8
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Affiliation(s)
- Carlos Irwin A. Oronce
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- National Clinician Scholars Program, University of California, Los Angeles
| | | | - Ninez A. Ponce
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
- Center for Health Policy Research, University of California, Los Angeles
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Yanagisawa M, Kawachi I, Scannell CA, Oronce CIA, Tsugawa Y. Association between county-level social capital and the burden of COVID-19 cases and deaths in the United States. Ann Epidemiol 2021; 59:21-23. [PMID: 33895244 PMCID: PMC8061785 DOI: 10.1016/j.annepidem.2021.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/28/2021] [Accepted: 04/14/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Mao Yanagisawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Christopher A Scannell
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA; VA Greater Los Angeles Healthcare System and the National Clinician Scholars Program, Los Angeles, CA
| | - Carlos Irwin A Oronce
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA; VA Greater Los Angeles Healthcare System and the National Clinician Scholars Program, Los Angeles, CA
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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Oronce CIA, Fortuna RJ. Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices. J Gen Intern Med 2020; 35:994-1000. [PMID: 31745849 PMCID: PMC7174534 DOI: 10.1007/s11606-019-05544-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/29/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Community health centers (CHCs) are an integral part of the health care safety net. As health systems seek to improve value, it is important to understand the quality of care provided by CHCs. OBJECTIVE To evaluate the performance of CHCs compared with private practices on a comprehensive set of high-value and low-value care measures. DESIGN This cross-sectional study used data from the National Ambulatory Medical Care Survey from 2010 through 2012. We compared CHCs with private practices using logistic regression models that adjusted for age, sex, race/ethnicity, insurance, number of chronic illnesses, rural versus urban location, region of country, and survey year. SETTING/PARTICIPANTS We included outpatient visits to generalist physicians at either CHCs or private practices by patients 18 years and older. MAIN MEASURES We examined 12 measures of high-value care and 7 measures of low-value care. RESULTS A total of 29,155 physician visits, representing 584,208,173 weighted visits, from 2010 through 2012 were included. CHCs were more likely to provide high-value care by ordering beta-blockers in CHF (46.9% vs. 36.5%; aOR 2.56; 95%CI 1.18-5.56), statins in diabetes (37.0% vs 35.5%; aOR 1.35; 95%CI 1.02-1.79), and providing treatment for osteoporosis (35.7% vs 23.2%; aOR 1.77; 95%CI 1.05-3.00) compared with private practices. CHCs were more likely to avoid low-value screening EKGs (98.7% vs. 88.0%; aOR 11.03; 95%CI 2.67-45.52), CBCs (75.9% vs. 65.7%; aOR 1.72; 95%CI 1.18-2.53), or urinalyses (86.0% vs. 80.5%; aOR 1.87; 95%CI 1.11-3.14) during a general medical exam. CHCs were also less likely to prescribe antibiotics for a URI (48.3% vs. 63.1%; aOR 0.59; 95%CI 0.40-0.88). CONCLUSIONS On a number of high-value and low-value measures of care, CHCs performed similar to or better than private practices. As healthcare delivery reforms continue to progress, CHCs are well positioned to provide high-value healthcare.
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Affiliation(s)
- Carlos Irwin A Oronce
- VA Greater Los Angeles Healthcare System, 1100 Glendon Ave. Ste. 900, Los Angeles, CA, 90034, USA. .,National Clinician Scholars Program and the Division of General Internal Medicine and Health Services Research, University of California, 1100 Glendon Ave. Ste. 900, Los Angeles, CA, 90034, USA.
| | - Robert J Fortuna
- Department of Medicine, University of Rochester Medical Center, 913 Culver Rd, Rochester, NY, 14609, USA. .,Department of Pediatrics, University of Rochester Medical Center, 913 Culver Rd, Rochester, NY, 14609, USA. .,Center for Primary Care, Culver Medical Group, University of Rochester Medical Center, 913 Culver Rd, Rochester, NY, 14609, USA.
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Beck A, Davidson AJ, Xu S, Josh Durfee M, Oronce CIA, Steiner JF, Havranek E. A Multilevel Analysis of Individual, Health System, and Neighborhood Factors Associated with Depression within a Large Metropolitan Area. J Urban Health 2017; 94:780-790. [PMID: 28842803 PMCID: PMC5722727 DOI: 10.1007/s11524-017-0190-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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] [Indexed: 11/30/2022]
Abstract
Depression prevalence is known to vary by individual factors (gender, age, race, medical comorbidities) and by neighborhood factors (neighborhood deprivation). However, the combination of individual- and neighborhood-level data is rarely available to assess their relative contribution to variation in depression across neighborhoods. We geocoded depression diagnosis and demographic data from electronic health records for 165,600 patients seen in two large health systems serving the Denver population (Kaiser Permanente and Denver Health) to Denver's 144 census tracts, and combined these data with indices of neighborhood deprivation obtained from the American Community Survey. Non-linear mixed models examined the relationships between depression rates and individual and census tract variables, stratified by health system. We found higher depression rates associated with greater age, female gender, white race, medical comorbidities, and with lower rates of home owner occupancy, residential stability, and higher educational attainment, but not with economic disadvantage. Among the Denver Health cohort, higher depression rates were associated with higher crime rates and a lower percent of foreign born residents and single mother households. Our findings suggest that individual factors had the strongest associations with depression. Neighborhood risk factors associated with depression point to low community cohesion, while the role of education is more complex. Among the Denver Health cohort, language and cultural barriers and competing priorities may attenuate the recognition and treatment of depression.
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Affiliation(s)
- Arne Beck
- Institute for Health Research Kaiser Permanente Colorado, Denver, CO, USA.
| | | | - Stanley Xu
- Institute for Health Research Kaiser Permanente Colorado, Denver, CO, USA
| | - M Josh Durfee
- Denver Health and Hospital Authority, Denver, CO, USA
| | | | - John F Steiner
- Institute for Health Research Kaiser Permanente Colorado, Denver, CO, USA
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