Community Health Centers Sites Research Articles

Linguistic Disparities in Diabetes Care Quality in California Community Health Centers Before and During the COVID-19 Pandemic.

Disparities in diabetes care quality may have increased for patients with limited English language proficiency (LEP) compared to non-LEP patients during the COVID-19 pandemic. Changes in diabetes care quality for adult LEP and non-LEP patients of community health centers (CHCs) were examined from 2019 to 2020. Adults with Type 2 diabetes (n = 15 965) of 88 CHC sites in California and with 1+ visit/year in 2019 and 2020 from OCHIN electronic health record data were included. Multivariable regression models estimated the association of LEP status and changes in diabetes care quality from 2019 to 2020, controlling for patient sociodemographic and clinical characteristics. Interaction terms (LEP × 2020) were used to estimate differential over time changes in (1) blood pressure screening, (2) blood pressure control (<140/90 mm Hg), and (3) hemoglobin A1c control (HbA1c <8%) for LEP versus non-LEP patients. LEP and non-LEP patients with diabetes had comparable blood pressure screening and control in 2019 and in 2020. LEP patients were less likely than non-LEP patients to have their HbA1c under control in 2019 (OR = 0.85, 95% CI = 0.77, 0.96, P = .006) and 2020 (OR = 0.83, 95% CI = 0.75, 0.92, P = .001). There were no differential changes in HbA1c control over time for LEP and non-LEP patients. Although LEP patients were less likely than non-LEP patients to have their HbA1c under control, CHCs maintained quality of care equally for LEP and non-LEP patients with diabetes during the early pandemic period.

"An Act of Complete Care": Provider Perspectives on Linking Maternal Contraceptive Care With Well-Baby Visits in Community Health Centers.

Short inter-pregnancy interval (IPI) is associated with adverse health outcomes for women and infants, and low-income women experience disproportionate rates of short IPI. An essential solution is providing postpartum (PP) women with timely contraceptive care. However, patient-centered approaches for facilitating care access are needed. To explore Community Health Center (CHC) staff and provider perspectives on the implementation of a clinical trial offering co-scheduled well-infant/maternal contraceptive care for women with infants 0 to 6 months at the Well-Baby Visit (WBV). Eighteen participants (providers, staff, and administrators) representing 7 diverse CHC sites in 2 U.S. states completed semi-structured telephone interviews. Audio-recordings were transcribed and analyzed using hybrid thematic analysis. Offering co-scheduled visits was perceived as beneficial for facilitating timely PP contraception, convenient care access, and encouraging family planning considerations during the PP period. However, provider and staff discomfort with initiating family planning and contraceptive care conversations at the WBV emerged as a salient barrier. Paired approaches to well-infant/maternal contraceptive care may promote increased access to timely contraception for PP women, possibly reducing unintended short IPI. Comprehensive training, ongoing support, and patient-centered implementation strategies tailored to context and developed with care team input are needed to ensure competency and comfortability with facilitating contraceptive care conversations at the WBV.

Implementation of Title X Family Planning Services in Primary Care: A Qualitative Study of a Primary Care Network in Georgia.

There is increasing interest and value in integrating family planning services into primary care. Title X services provide an opportunity to expand low-cost access to these services. This study sought to identify and describe implementation factors that influenced the integration of a package of Title X services into a unique primary care setting within a Georgia primary care network whose community health center sites are primarily federally qualified health centers. We used an implementation science approach and were guided by the Consolidated Framework for Implementation Research. From December 2019 to September 2020, we conducted interviews with administrators and providers working at grantee and sub-grantee organizations about their experiences integrating Title X services into their existing practice. Factors associated with the Inner Setting were especially important for integrating Title X in these settings. Participants identified specific needs related to resources such as electronic medical record (EMR) and reporting templates. Contextually specific clinical training for provision of long-acting reversible contraception and sexual health counseling, as well as administrative training for reporting and documentation efforts, was particularly needed. Grantee and sub-grantee organizations were able to leverage internal and external networks and adaptations to the intervention to successfully implement Title X services and to expand reach to new clients. Integrating family planning into primary care may expand access to low-income and underserved populations. Approaches that incorporate flexibility and provide tailored resources for primary care settings such as EMR and reporting templates and trainings, and that leverage multiple forms of support and knowledge sharing, may be particularly important for helping to implement Title X services.

Association between state payment parity policies and telehealth usage at community health centers during COVID-19.

ObjectiveWe study the association between payment parity policies and telehealth utilization at community health centers (CHCs) before, during, and after the onset of the pandemic.Materials and MethodsWe use aggregated, de-identified data from FAIR Health for privately insured patients at CHC sites. Descriptive statistics and time trends are calculated. Logistic regression models were used to quantify the factors associated with telehealth utilization for each of our time periods: 1) pre-pandemic (March-June 2019), 2) immediate pandemic response (March-June 2020), and 3) sustained pandemic response (March-June 2021).ResultsTelehealth usage rates at CHC sites surged to approximately 61% in April 2020. By April 2021, only 29% of CHC sites in states without payment parity policies used telehealth versus 42% in states with payment parity policies. Controlling for other characteristics, we find that CHC sites in states with payment parity were more likely to utilize telehealth one year after the onset of the pandemic (OR:1.740, p<0.001) than states without, but did not find this association in 2019 or 2020.DiscussionThe public health emergency drove widespread use of telehealth, making the virtual care environment inherently different in 2021 than in 2019. Due to the unique fiscal constraints facing CHCs, the financial sustainability of telehealth may be highly relevant to the relationship between telehealth utilization and payment parity we find in this paper.ConclusionSupportive payment policy and continued investments in broadband availability in rural and undeserved communities should enable CHCs to offer telehealth services to populations in these areas.

ATA2022 Annual Conference &amp; Expo May 1–3, 2022Boston, Massachusetts

ATA2022 Annual Conference &amp; Expo May 1–3, 2022Boston, Massachusetts

Racial Bias Correlates with States Having Fewer Health Professional Shortage Areas and Fewer Federally Qualified Community Health Center Sites

Federally Qualified Community Health Centers (FQHCs), serving Health Professional Shortage Areas (HPSAs), are fixtures of the healthcare safety net and are central to healthcare delivery for African Americans and other marginalized Americans. Anti-African American bias, tied to anti- “welfare” sentiment and to a belief in African Americans’ supposed safety net dependency, can suppress states’ willingness to identify HPSAs and to apply for and operate FQHCs. Drawing on data from n = 1,084,553 non-Hispanic White Project Implicit respondents from 2013–2018, we investigated associations between state-level implicit and explicit racial bias and availability of FQHCs and with HPSA designations. After controlling for states’ sociopolitical conservatism, wealth, health status, and acceptance of the Affordable Care Act’s Medicaid expansion, greater racial bias was correlated with fewer FQHC delivery sites and fewer HPSA designations. White’s bias against African Americans is associated with fewer FQHC opportunities for care and fewer identifications of treatment need for African Americans and other low-income people lacking healthcare options, reflecting bias-influenced neglect.

Interdisciplinary Primary Care Team Expertise and Diabetes Care Management.

Interdisciplinary primary care team expertise can aid patient self management of type 2 diabetes, but small community health centers (CHCs) may not have the volume to consistently provide interprofessional care. We examine whether care team role expertise is associated with patients' experiences of chronic care and whether the relationship is stronger for small CHC sites. Surveys of 1277 adults with diabetes (2012; response rate = 47%) that assessed nonphysician team roles involved in managing their chronic care, including community health workers, diabetes educators, nutritionists, pharmacists, mental health providers, and other general staff, were integrated with clinical and administrative data from 14 CHCs. Random effects regression models estimated the association of team expertise, CHC size, and 1) patients' experiences of chronic care; and 2) hemoglobin A1c control, controlling for patient comorbidities, sex, race/ethnicity/primary language, age, and insurance coverage. Care teams with community health workers ( β = 7.67, P < .01), diabetes educators ( β = 6.05, P < .01), nutritionists ( β = 5.21, P < .01), and other general staff ([Formula: see text] =4.96, P = .02) were associated with better patients' experiences of chronic care, but not hemoglobin A1c control. Patients of small CHC sites reported better experiences of care ( β = 2.15, P = .03) with each additional team role reported, but the relationship was not significant for large CHCs. Patients with access to care team expertise in self-management support, including diabetes educators, nutritionists, community health workers, and other general staff report better experiences of chronic care. These team roles may reduce barriers to patient self management and improve patients' overall experiences of chronic care, particularly in small CHC sites.

The Fine Line Between Informing and Coercing: Community Health Center Clinicians' Approaches to Counseling Young People About IUDs.

While community health centers (CHCs) are meeting increased demand for contraceptives, little is known about contraceptive counseling in these settings. Understanding how clinicians counsel about IUDs in CHCs, including whether they address or disregard young people's preferences and concerns during counseling, could improve contraceptive care. As part of a training program, 20 clinicians from 11 San Francisco Bay Area CHC sites who counsel young people about contraception were interviewed by telephone in 2015 regarding their IUD counseling approaches. An iterative grounded theory approach was used to analyze interview transcripts and identify salient themes related to clinicians' contraceptive counseling, IUD removal practices and efforts to address patient concerns regarding side effects. Most clinicians offered comprehensive contraceptive counseling and method choice. While several clinicians viewed counseling as an opportunity to empower their patients to make contraceptive decisions without pressure, they also described a tension between guiding young people toward higher-efficacy methods and respecting patients' choices. Many clinicians engaged in what could be considered coercive practices by trying to dissuade patients from removals within a year of placement and offering to treat or downplay side effects. Providers try to promote their young patients' autonomous decision making, but their support for high-efficacy methods can result in coercive practices. More training is needed to ensure that providers employ patient-centered counseling approaches, including honoring patient requests for removals.

Pregnancy Intention, Ambivalence, and Contraceptive use in Community Health Center (CHC) Populations

Abstract Introduction: Understanding the complexity of pregnancy intentions and resulting behaviors is essential to ensuring high quality, patient-centered reproductive health services that meet the needs of women and their partners. Community Health Centers (CHCs) play an important role in providing family planning care for traditionally underserved women, who may be at increased risk of experiencing unintended pregnancy. This study presents emerging findings on pregnancy intentions, ambivalence, and contraceptive behaviors among patients in CHC settings. Methods: This study employed a national survey (n=1,557) of women of reproductive age (18-44 years), sampled from 19 different CHC sites. The survey gathered information on patient characteristics, experiences with care, decision-making criteria and utilization of contraceptive services. Pregnancy intention was measured using the One Key Question®. Results: Approximately 12% of women reported that they wanted to become pregnant in the next year, while 88% were not actively seeking to become pregnant. Nearly 30% of those who did not desire a pregnancy reported not using contraception at the time of the survey. 1-in-4 women were pregnancy ambivalent and used contraception at approximately the same rates as women seeking to become pregnant. Conclusions: Women who express pregnancy ambivalence use contraception at similar rates to those who intend to become pregnant in the next year, potentially increasing their risk for unintended pregnancy. Understanding the characteristics and behaviors of underserved patients across different pregnancy intentions may help ensure that women receive the information, services, and support they need to achieve their reproductive health goals. Keywords: pregnancy intentions, family planning, community health centers, CHC, One Key Question®

The availability of alcohol, tobacco and other drug services for adults in New York State Community Health Centers

ABSTRACTNY State community health center sites were surveyed in 2012 to assess the availability of alcohol, tobacco, and other drug services for the underserved. Surveys were completed from 156 of 251 adult primary care clinical sites (62% response rate). Seventy-one percent of sites had guidelines requiring screening for mental health problems while less than half (46%) had guidelines for substance use disorders. In practice, 55% of clinics reported nearly all adults were screened for mental health disorders compared to 32% of adults for substance use disorders (SUD). Forty three percent of sites that screened patients for SUD did not use a standard screening instrument. More than three quarters of sites offered tobacco cessation services while 17% reported offering SUD treatment. Findings from multi-level analyses suggested that FQHC organizations influence sites’ SUD screening requirements but not the provision of on-site treatment. Analyses further suggested that neither geographic setting (urban/rural) nor the size of the FQHC organization influenced screening requirements or on-site treatment availability. Although more research is needed to explore differences between site and organizational level reporting, this study suggests that SUD screening rates remain low among FQHC primary care sites, but that FQHC organization could improve rates across sites by requiring SUD screening using a standard instrument.

The impact of integrating medical assistants and community health workers on diabetes care management in community health centers

ObjectiveTo compare the impact of implementing team-based diabetes care management involving community health workers (CHWs) vs. medical assistants (MA) in community health centers (CHCs) on diabetes care processes, intermediate outcomes, and patients’ experiences of chronic care.Data sourcesClinical and administrative data (n = 6111) and patient surveys (n = 698) pre-intervention and post-intervention. Surveys (n = 285) and key informant interviews (n = 48) of CHC staff assessed barriers and facilitators of implementation.Study designA three-arm cluster-randomized trial of CHC sites integrating MAs (n = 3) or CHWs (n = 3) for diabetes care management compared control CHC sites (n = 10). Difference-in-difference multivariate regression with exact matching of patients estimated intervention effects.Principal findingsPatients in the CHW intervention arm had improved annual glycated hemoglobin testing (18.5%, p < 0.001), while patients in the MA intervention arm had improved low-density lipoprotein cholesterol control (8.4%, p < 0.05) and reported better chronic care experiences over time (β=7.5, p < 0.001). Except for chronic care experiences (p < 0.05) for patients in the MA intervention group, difference-in-difference estimates were not statistically significant because control group patients also improved over time. Some diabetes care processes improved significantly more for control group patients than intervention group patients. Key informant interviews revealed that immediate patient care issues sometimes crowded out diabetes care management activities, especially for MAs.ConclusionsDiabetes care improved in CHCs integrating CHWs and MAs onto primary care teams, but the improvements were no different than improvements observed among matched control group patients. Greater improvement using CHW and MA team-based approaches may be possible if practice leaders minimize use of these personnel to cover shortages that often arise in busy primary care practices.

Design and participant characteristics of a primary care adaptation of the Look AHEAD Lifestyle Intervention for weight loss in type 2 diabetes: The REAL HEALTH-diabetes study

Background/AimsThe REAL HEALTH -Diabetes Study is a practice-based clinical trial that adapted the Look AHEAD lifestyle intervention for implementation in primary care settings. The trial will compare the effectiveness and cost-effectiveness of in-person group lifestyle intervention, telephone group lifestyle intervention, and individual medical nutrition therapy (MNT), the current recommended standard of care in type 2 diabetes. The primary outcome is percent weight loss at 6 months with outcomes also measured at 12, 18, 24 (intervention completion), and 36 months. Here, we describe the adaptation, trial design, implementation strategies, and baseline characteristics of enrolled participants. MethodsThe study is a three-arm, patient-level, randomized trial conducted in three community health centers (CHCs) and one diabetes practice affiliated with one academic medical center. ResultsThe study used existing clinical infrastructure to recruit participants from study sites. Strategies for successful conduct of the trial included partnering with health-center based co-investigator clinicians, engaging primary care providers, and accommodating clinical workflows. Of 248 eligible patients who attended a screening visit, 211 enrolled, with 70 randomly assigned to in-person group lifestyle intervention, 72 to telephone group lifestyle intervention, and 69 to MNT. The cohort was 55% female, 29% non-white, with mean age 62 years and mean BMI 35 kg/m2. Enrollment rates were higher at CHC sites. ConclusionsA practice-based randomized trial of a complex behavioral lifestyle intervention for type 2 diabetes can be implemented in community health and usual clinical settings. Participant and provider engagement was higher at local CHC sites reflecting the study implementation focus.Clinical Trial Registration: NCT02320253

Linking Structural Capabilities and Workplace Climate in Community Health Centers.

Many strategies to improve health care quality focus on improving the structural capabilities of primary care practices, including quality infrastructure and registry use, which are critical to managing chronic diseases. However, improving structural capabilities requires practices to expend significant resources and can be especially disruptive to community health centers (CHCs) serving high proportions of socioeconomically vulnerable patients. We explore the relationship between the structural capabilities and workplace climate in CHCs. The final sample for this analysis includes 25 CHC sites that could be matched across CHC site director surveys of structural capabilities and CHC adult primary care clinicians and staff (n = 446). To estimate the association between structural capabilities and dimensions of workplace climate, we estimated multivariate linear regression models that included the climate scales as dependent variables and the 5 structural capability scales as the main independent variables, with the 3 clinic-level and 2 staff-level covariates. More manageable clinic workload was associated with lower electronic record functionality (β = −0.47, P = .007), but positively associated with quality infrastructure (β = 0.92, P = .007). Staff relationships and quality improvement orientation were positively associated with quality infrastructure (β = 1.09, P = .006 and β = 0.87, P = .005). Manager readiness was associated with more robust quality infrastructure (β = 1.35, P = .016), but lower electronic record functionality (β = −0.48, P = .015) and less proactive patient outreach (β = −1.32, P = .025). Complex relationships between structural capabilities and workplace climate were found in CHCs. Further clarification of these complex connections may enable policy makers and practitioners to design and implement nuanced strategies to improve quality of care in CHCs.

The Availability of Alcohol, Tobacco, and Other Drug Services for Adolescents in New York State Community Health Centers

Adolescent experimentation with alcohol, tobacco, or other drugs is commonplace, and limited access to screening and treatment services poses a significant public health risk. This study identified alcohol, tobacco, and other drug services available for adolescents at community health center sites in New York. A survey was distributed to medical and behavioral health directors across 54 community health center organizations serving 255 primary care adolescent sites. One third of sites required adolescent screening for substance use disorders (SUDs). Twenty-eight percent of sites said all/nearly all (80%-100%) and 12% said most (60%-79%) adolescents actually were screened. On-site tobacco cessation treatment and substance abuse counseling were offered at 53% and 14% of sites, respectively. Multilevel models suggested that community health center organizations positively influenced sites’ adolescent SUD screening and tobacco treatment. Additional investment in adolescent behavioral health screening and treatment is needed to reduce alcohol, illicit drug, or tobacco use among the underserved.

“It takes the stars aligning”: challenges to providing the copper IUD as emergency contraception (EC) and same-day IUD visits in community health care settings

Objectives: We aimed to assess the extent to which community health centers (CHCs) are equipped to offer the IUD as emergency contraception (EC) and same-day IUD placements and to identify barriers to provision of these birth control options. Methods: We surveyed clinicians and staff from 11 CHC sites in the San Francisco Bay Area and interviewed 20 clinicians working in Bay Area CHCs. Results: Among 97 survey respondents (28 clinicians and 69 staff), 40% indicated that in the past 3 years, IUD as EC provision had increased somewhat or very much in their practice, 17% reported that most patients can get an IUD the same day as one is requested, 66% of clinicians reported they had ever placed the IUD and 19% reported they had ever placed an IUD as EC. The most common barriers to same-day IUD placement were the need for pregnancy (37%) and chlamydia/gonorrhea testing (24%), insufficient time within one visit (31%), the need to wait for pregnancy test results (30%) and the patient's need for more time to decide (19%). Qualitative findings indicated that scheduling challenges, pressures to see a certain number of patients a day and unavailability of trained clinicians onsite further contributed to challenges to providing this form of EC. Conclusions: Although access to the IUD as EC and same-day IUD placements appear to be increasing within the CHCs surveyed, significant barriers to provision persist. Clinic policies may need to address a variety of system- and provider-level barriers to better meet the needs of patients and expand access to this form of EC.

Perceptions of community health center impact on private primary care physician practice.

Community health centers (CHCs) were created in the mid-1960s to expand access to care in impoverished and underserved areas. The number of CHC sites has more than tripled in eastern North Carolina from 28 primary care centers in 2000 to 89 in 2010. This study determined the perceptions of physicians on the impact of CHC expansion on the local practice environment. Descriptive statistics and correlations were used to compare responses regarding perceptions and differences between practice characteristics as well as physician ratios by year. Both CHC and private practice physician addresses were mapped using ArcGIS. Surveys were sent to 1422 (461 returns/32.5% response rate) primary care physicians residing in 43 predominantly rural eastern North Carolina counties. A large percentage of the respondents (82.7%) affirmed that they felt neutral or did not view CHCs to be competitors, whereas a minority (17%) did view them to be difficult to compete against. Forty-two percent of private practice respondents disagreed that CHCs offer a wider range of services despite significantly more CHC physicians than private practice respondents indicating that their facility provided basic services. The CHCs were perceived to offer a wider range of services, employ more staff, and have more practice locations than private practices. However, private practice physicians did not perceive CHCs to have a competitive advantage or to unfairly impact their practices, possibly due to inconsistent population growth in relation to the physician retention during the last 10 years.

Community Health Centers' Role in Family Planning

Community Health Centers' Role in Family Planning Ruth Lesnewski, MD (bio), Lisa Maldonado, MA, MPH (bio), and Linda Prine, MD (bio) Whenever I see a woman who has an unintended pregnancy, I make a point of looking through her chart to see if she had a recent office visit. About 75% of the time, I find she did have a visit within the previous three months, but contraception was not addressed. —Family physician and medical director of a federally qualified health center Federally qualified health centers, also known as community health centers (CHCs), care for our nation's neediest populations. By latest count, 1,128 federally qualified health centers operate more than 8,500 sites serving 20.2 million men, women, and children.1 These numbers are expected to grow with expanded funding via the Patient Protection and Affordable Care Act. Community health centers are charged with providing a wide scope of preventive health services to people of all ages—including prenatal care, immunizations, cancer screening, and family planning.2 Community health centers form an integral part of the communities they serve. In some areas, these health centers offer the only medical resources available for miles around. Community health centers have demonstrated excellent outcomes in reproductive health. Community health center patients are less likely to have pre-term births or low-birthweight babies,3 and are more likely to obtain Pap tests and mammograms than other low-income patients.4 However, CHCs' effectiveness at providing family planning services is unclear. A 2001 study5 by the Guttmacher Institute found that only 60% of CHC sites provided contraception. Community health centers provided contraception to about 28% of their female patients of reproductive age. More recent studies by Guttmacher and others found that while most publicly funded clinics offered oral contraceptives, CHCs were less likely to provide the most effective contraceptive methods (namely the IUD and implant) and were not as likely to follow evidence-based contraceptive practices such as quick start (that is, same-day initiation of contraception).6 The role of CHCs in caring for our nation's most underserved populations is unquestioned. Community health centers serve one in five low-income women7 and are also more likely than other publicly funded family planning providers to serve men, special [End Page 429] needs groups, minorities, and patients with limited English proficiency.6 Yet, CHCs can do more to prevent unintended pregnancy in the United States. The Impact of Unintended Pregnancy We know a lot about unintended pregnancy in the United States. We know that most families in the United States want two children. We know that most people want to plan childbearing and avoid unintended pregnancies.8 One way of looking at this is that most women spend about 75% of their reproductive years trying to avoid pregnancy.9 We also know that nearly half of all pregnancies in the United States are unintended.10 Our rate of unintended pregnancy is far higher than that of most other developed nations. We know that poor and low-income women, the very women CHCs serve, are much more likely to experience an unintended pregnancy than other women.11 Unintended pregnancy can have lasting consequences. In 2001, the latest year of available data, 3.1 million unintended pregnancies in the U.S. resulted in 1.3 million abortions, 400,000 miscarriages, and 1.4 million births. Women with unintended pregnancies are less likely than women with intended pregnancies to initiate prenatal care promptly,12 to quit smoking cigarettes,2,13 to consume adequate amounts of folic acid,14 and to breastfeed their infants.15 Teens who have a child are less likely than others to graduate from high school or complete college.16 Children born of unintended pregnancies are more likely to have a premature birth, to die in the first year of life, to suffer abuse, and to fail in school.17 Consistent use of effective contraception can make a difference. Most women who experience unintended pregnancies are not using contraception at all or are using it inconsistently during the month of their conception.18 Teen pregnancy rates have dropped to all-time lows as a result of increased access to...

Treatment and referral services for substance abuse at community health center sites in New York State

Aim: To identify screening, treatment and referral services for adolescents and adults at community health center (CHC) sites.

Prenatal nutrition intervention to reduce mutans streptococci among low‐income women

The objective of this study is to assess the effectiveness of a prenatal nutrition intervention to reduce sugar intake and mutans streptococci (mutans) among low-income women. Pregnant women were recruited from the obstetrics service at a community health center in Connecticut. Inclusion criteria were ≥18 years of age; mutans levels >10, 000 colony forming units/ml as determined by Dentocult SM® kits (Orion Diagnostica Oy, Espoo, Finland); and >3 months pregnant. Women were randomized to receive education alone [education intervention (EI)] or education and a 1-hour nutrition group session at 9 months and 6 weeks postpartum [education and nutrition intervention (EIN)]. Mutans and questionnaire data were collected at baseline, 9 months, 6 weeks, and 3 months postpartum. One hundred twenty completed the baseline visit and 93 (77%) completed all four visits. Sugar intake was assessed by the Food Frequency Questionnaire and clinical information was abstracted from medical charts. Mean age was 26.3 years [standard deviation (SD)= 6], 73% were Hispanic, 29% had lived in the United States < 6 years; 48% completed high school; 27% were married; mean total sugar intake at baseline was 149g (SD = 85). Repeated measures analysis of variance showed that mutans levels declined significantly in both groups, but that the EI group had significantly lower mutans levels at the final assessment compared with EIN. Sugar intake also declined significantly, but there were no significant differences between groups. The study demonstrated the following: a) the feasibility of conducting the intervention at community health center sites among low-income pregnant women; b) the effectiveness of education to reduce mutans/sugar intake; and c) the need to improve the nutrition intervention to obtain additional gains in mutans reduction.

Abstract A25: Patient Navigation Research Program: Time to diagnostic resolution

Abstract There is a need for controlled research studies to assess the impact of patient navigation on patient outcomes. The goal is to evaluate whether patient navigation decreased time to diagnosis for subjects with a breast or cervical cancer screening abnormality. Boston Patient Navigation Research Program collected baseline data (2004–2005) and intervention data (2007–2008) at 6 community health center sites. Kaplan-Meier survival curves and proportional hazards regression examined the effect of navigation on time to definitive diagnosis, adjusting for clustering by clinic and adjusting for age, race, language, and insurance. Hazard ratios greater than 1.0 indicate a decrease in time to diagnosis. We enrolled N = 997 subjects in the baseline period and N = 3,041 subjects during the intervention period (n = 1,499 navigated, n = 1,542 control); 66% were Non-White. Among those with a breast screening abnormality, there was a significant decrease in time to diagnosis for navigated subjects who resolved after 60 days [aHR 1.49, 95% CI: 1.2–1.8] compared with controls, but no differences for those who resolved before 60 days. Among those with a cervical screening abnormality, there was a significant decrease in time to diagnosis for all navigated subjects when compared with controls (aHR 1.33, 95% CI: 1.13–1.56). This controlled study documents a benefit of patient navigation on time to diagnosis among a racially/ethnically diverse inner city population. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A25.