Health Center Leadership Research Articles

Optimizing Internal Supervision: The Role of Time and Location in Enhancing Health Center Service Quality in Kendari

Introduction: The problem in this study is the data on the achievement of health center accreditation in Kendari City, namely: 10 intermediate health centers (66%), 2 basic (13%), 2 main (13%) and 1 plenary (6.6%). This data indicates that not all health centers have implemented service standards according to PMK 46 of 2015 concerning Health Center Accreditation Standards, this condition provides an illustration that technical guidance and supervision carried out at the Health Center have not been carried out optimally. The purpose of this study was to analyze the relationship between internal supervision strategies and improving the quality of health services as a managerial function at the Kendari City Health Center. Method: This type of research is quantitative Observational using Cross Sectional Study design. The population of the study were all health center leaders, Personal Health Efforts managers, Public Health Efforts managers and quality managers totaling 60 people at Kendari City health centers. The sampling method used the Total Sampling technique. Result: The results of the chi-square test on the supervision time variable obtained a value of X2 hit = 17.019, the location of supervision obtained a value of X2 hit = 13.081. Conclusion: There is a relationship between the time of supervision and the location of supervision with the improvement of service quality at the Kendari City Health Center.

Management of Implementing Clean and Healthy Living Behaviorin Households in Manisa Village

The current policy that regulates clean and healthy living behavior is the Republic of Indonesia Minister of Health Regulation Number 2269/Menkes/Per/XI/2011 concerning guidelines for fostering clean and healthy living behavior. Clean and healthy living behavior is a government priority program through community health centers and is an output target in implementing health development. The lowest coverage of healthy households in the Manisa Health Center Working Area is in the existing Manisa Village. The aim of the research is to determine the management of implementing clean and healthy living behavior in the household setting. This type of research is qualitative research. The informants for this research, managers of the community health center's clean and healthy living behavior program, community health center leaders, cadres, community leaders, religious leaders and the public, were taken using purposive sampling. Data collection was carried out through in-depth interviews, documentation review and Focus Group Discussions. The results of the research showed problems with the input component, the health promotion staff at the community health center had never received training, the funding allocation was very small, and the supporting facilities for Promkes were limited to print media. In the process, planning has not been implemented in an integrated manner, the organization and implementation of health promotions has not been carried out optimally, and monitoring is only based on the results of surveys of household clean and healthy living behavior. It is known that the output component of implementing clean and healthy living behavior in household management is still below the target. Implementation of management of clean and healthy living behavior in household arrangements is not as expected. Therefore, it is necessary to improve the quality of implementing staff, allocate funds and infrastructure, as well as improve management in implementing clean and healthy living behavior in the household structure.

Analysis of Efforts to Achieve Performance-Based Capitation Indicators Talang Banjar Public Health Center

Introduction: Performance-Based Capitation Policy is an effort to ensure FKTP performance to improve satisfaction, service quality and cost efficiency. Preliminary study, the capitation payment of the Talang Banjar Public Health Center in 2022 is only 88% with the achievement of AK 64.93 per mile, RRNS 2.12%, and RPPT 0.55%. Objective: This study aims to analyze efforts to achieve KBK indicators at Talang Banjar Public Health Center based on input and process aspects. Method: This research is qualitative research with a descriptive approach with data collection using observation, document review and in-depth interviews with 15 informants who were selected by purposive sampling. Result and Discussion: The results show that the achievement of KBK Public Health Center indicators is influenced by available inputs, namely health human resources, infrastructure, funds, and methods. The process aspect shows obstacles to achieving contact number indicators, namely difficulties in Public Health Center accessibility, promotional and preventive efforts that are not optimal, as well as reporting healthy visits, non-specialist referral indicators are influenced by the behavior of patients who want to be referred and the availability of medical devices, while controlled prolanist indicators are influenced by the difficulty of routine monitoring of officers to participants. Conclusion: A thorough evaluation is needed from BPJS Kesehatan, Dinas Kesehatan and Public Health Center leaders to identify problems that arise in achieving performance indicators as an effort to ensure the quality of service to NHI participants

A National Voter Registration Campaign.

Research suggests that increased voting among adults is associated with improved child health. Despite the benefits of voting, the United States has low voter turnout compared with peer nations. Turnout is especially low among marginalized people in the United States. Voter registration is essential for increasing voter turnout, and registration efforts have been successfully carried out in clinical settings. Working with a nonprofit called Vot-ER, we advocated for nonpartisan voter registration efforts in pediatric settings nationwide preceding the November 2020 US elections. We describe lessons learned from these efforts. Using data obtained from Vot-ER, we also provide the first estimates of participation in a national voter registration campaign in pediatric settings. There was widespread engagement in voter registration efforts among pediatricians in 2020. Many lessons were learned from these efforts, including the benefits of advanced planning because registration deadlines can be up to 1 month in advance of Election Day. Obtaining buy-in from numerous stakeholders (e.g., health center leadership, public relations teams) supports widespread staff participation. Also important is to consider the tradeoffs between active voter registration (in which staff can broach the topic of voting with patients and families) and passive efforts (in which voting is discussed only if patients or families inquire about it). These and other lessons can inform future voter registration efforts in diverse pediatric settings across the country.

The Primary Care Transformation Executive Fellowship to Develop Community Health Center Leaders.

Although many primary care providers from community health centers recognize health disparities and work to transform healthcare, skill gaps and limited support may hinder their ability to be change agents. The Primary Care Transformation Executive (PCTE) Fellowship at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA) seeks to address these barriers by providing professional development and support to primary care providers interested in leading change in the nation's health centers. The PCTE Fellowship is a structured, one-year interprofessional learning experience that emphasizes topics such as healthcare transformation, interprofessional practice, leadership development, and systems thinking. Quantitative and qualitative evaluation of the program was accomplished through surveys and semi-structured interviews throughout the fellowship. Feedback from 18 fellows showed perceived improvements in knowledge and skills related to the various curricular topics, increased engagement in leadership activities, and career advancement. Fellows developed practice and quality improvement projects and successfully implemented the projects within their health systems, addressing observed disparities. Professional development and directed support for primary care providers can enhance their engagement in healthcare transformation and advance health equity.

Health Centers and Value-Based Payment: A Framework for Health Center Payment Reform and Early Experiences in Medicaid Value-Based Payment in Seven States.

Efforts are ongoing to advance value-based payment (VBP), and health centers serve as essential access points to comprehensive primary care services for almost 29 million people in the United States. Therefore, it is important to assess the levels of health center participation in VBP, types of VBP contracts, characteristics of health centers participating in VBP, and variations in state policy environments that influence VBP participation. This mixed methods study combined qualitative research on state policy environments and health center participation in VBP with quantitative analysis of Uniform Data System and health center financial data in seven vanguard states: Oregon, Washington, California, Colorado, New York, Hawaii, and Kentucky. VBP contracts were classified into three layers: base payments being transformed from visit-based to population-based (Layer 1), infrastructure and care coordination payments (Layer 2), and performance incentive payments (Layer 3). Health centers in all seven states participated in Layer 2 and Layer 3 VBP, with VBP participation growing from 35% to 58% of all health centers in these states from 2013 to 2017. Among participating health centers, the average percentage of Medicaid revenue received as Layer 2 and Layer 3 VBP rose from 6.4% in 2013 to 9.1% in 2017. Oregon and Washington health centers participating in Layer 1 payment reforms received most of their Medicaid revenue in VBP. In 2017, VBP participation was associated with larger health center size in four states (P <.05), and higher average number of days cash on hand (P <.05) in three states. A multilayer payment model is useful for implementing and monitoring VBP adoption among health centers. State policy, financial incentives from Medicaid agencies and Medicaid managed plans, and health center-Medicaid collaboration under strong primary care association and health center leadership will likely be required to increase health center participation in VBP.

EKSPLORASI PERILAKU KEPEMIMPINAN PUSKESMAS LIYA KECAMATAN WANGI-WANGI SELATAN KABUPATEN WAKATOBI

This study aims to describe leadership behavior at the Liya Public Health Center, Wangi-Wangi Selatan District, Wakatobi Regency. Qualitative descriptive approach was used in conducting this research and used data collection methods by observation, interviews, and documentation. The technique used in data analysis is to organize the data , break it down into units, synthesize, arrange into patterns, choose which ones are important and what will be studied, and draw conclusions. The results of this study indicate that Liya Health Center leaders are leaders who have leadership behavior oriented to achievement. This is in accordance with the indicators of leadership behavior that uses the theory indicator of the path of road-goal (Path-Goal Theory) developed by Robert House which consists of: directive leadership behavior, supportive leadership behavior, leadership behavior participatory, and leadership behavior oriented towards achievement.

Career transitions: Reflections of former chairs and academic health center leaders

The 2022 Association of Pathology Chairs Annual Meeting included a live discussion session and a pre-meeting recorded panel webinar sponsored by the Senior Fellows Group (former chairs of academic departments of pathology who have remained active in the Association of Pathology Chairs). The presentation was focused on transition planning for academic health center leaders. Each of the discussion group panelists had served as a pathology department chair as well as in more senior leadership positions, and they provided perspectives based upon their personal experiences. It was noted that such positions are often “at will” appointments of indeterminate length and that those above department chair generally carry greater risks and less stability. Becoming “addicted” to a leadership position was not considered beneficial to the individual or to the institution served and makes transitioning more difficult. Ongoing organizational succession planning was deemed helpful to mitigate such addiction and facilitate personal transition planning. Modes of transitioning discussed included those planned (e.g., voluntary retirement, resignation, administrative advancement) and unplanned (e.g., being “fired”; unexpected personal, health, or family issues). Unplanned transitions were felt to be more difficult, while anticipating when it is time to go and planning for it provided greater personal fulfillment after transition. Many career options were identified after serving in a leadership position, including a return to teaching, research, and/or clinical service; writing; mentoring; becoming more active in professional organizations and boards; philanthropic work; and “reinventing oneself” by moving to another career entirely.

Resources Used by Federally Qualified Health Center Leadership to Learn About Preventive Care Interventions.

Federally qualified health centers (FQHCs) serve patient populations that commonly have low preventive care utilization rates. Implementation of preventive care interventions (PCIs) may help decrease these care deficiencies. A survey of Kentucky FQHC leaders was conducted in 2019 to determine resources used to learn about PCIs and how leaders decide to implement them. Nineteen of Kentucky's 24 FQHCs completed the survey for a participation rate of 79%. Among participating FQHC leadership, the 3 resources that were very or somewhat likely to be used to learn about PCIs were advice or consultation from peers (100%), professional associations (95%), and nonacademic conferences/meetings (90%). The state primary care association and statewide community health center network were listed as the most helpful resources. These results highlight the types of resources used by FQHC leadership to learn about PCIs. Understanding preferred learning methods can help researchers improve outreach to FQHCs and facilitate dissemination of PCIs.

US clinicians’ perspectives on how mifepristone regulations affect access to medication abortion and early pregnancy loss care in primary care

ObjectiveProtocols including mifepristone are the most effective medication regimens for medication abortion and early pregnancy loss (EPL) management. Both can be safely and effectively offered in primary care settings. Despite mifepristone's excellent safety record, the United States (US) Food and Drug Administration (FDA) heavily regulates provision. This exploratory study examines US primary care clinicians’ perspectives on the effects of mifepristone restrictions, including FDA regulations, on access to medication abortion and EPL management in primary care. Study DesignIn 2019, we conducted an online qualitative survey of US primary care clinicians recruited from six reproductive health-focused listservs. Open-ended questions queried about barriers to providing mifepristone and effects on patients when unable to access mifepristone in primary care. We iteratively coded and analyzed qualitative data using inductive thematic analysis. ResultsOf our analytic sample of 113 respondents, one-third had mifepristone available in their current primary practice setting. Key barriers to provision stemmed from the FDA rule to stock and dispense mifepristone onsite, including logistical difficulties and resistance from health center leadership. Clinicians believed that lack of mifepristone in primary care resulted in negative patient experiences, including disrupted continuity of care, medically-unnecessary appointments, and undesired aspiration procedures. ConclusionsFDA regulations that inhibit mifepristone provision in primary care create structural barriers to provision. This may result in physical, emotional, and financial burdens for patients. ImplicationsWhen mifepristone is unavailable in primary care, some patients in need of abortion or EPL care may experience physical, emotional, and financial harms. Removing FDA restrictions is a critical step in reducing primary care barriers to mifepristone provision and improving access to timely, patient-centered medication abortion and EPL care.

Vaccination Capability Inventory of Community, Migrant, and Homeless Health Centers: A Survey Report.

Federally funded Community, Migrant, and Homeless Health Centers provide health services to the most vulnerable communities in the United States. However, little is known about their capabilities and processes for providing vaccinations to adults. We conducted the first national survey of health centers assessing their inventory, workflow, capacity for, and barriers to provision of routinely recommended adult vaccines. In addition, we asked health center leaders' perceptions regarding best practices and policy recommendations for adult vaccinations. A survey was developed on the basis of domains elicited from advisory panels and focus groups and was sent electronically to leaders of 762 health centers throughout the United States and its territories; data were collected and analyzed in 2018. A total of 319 survey responses (42%) were obtained. Health centers reported stocking most routinely recommended vaccines for adults; zoster vaccines were not stocked regularly due to supply and storage issues. Respondents most commonly reported adequate reimbursement for vaccination services from private insurance and Medicaid. Most vaccinations were provided during primary care encounters; less than half of health centers reported providing vaccines during specialist visits. Vaccines administered at the health center were most commonly documented in an open field of the electronic health record (96%) or in an immunization information system (72%). Recommendations for best practices related to better documentation of vaccinations and communication with immunization information systems were provided. Health centers provide most adult vaccines to their patients despite financial and technological barriers to optimal provisioning. Further studies at point of care could help identify mechanisms for system improvements.

Predicting the Impact of Transforming the Medicaid Program on Health Centers' Revenues and Capacity to Serve Medically Underserved Communities.

Policy Points Recent federal proposals to use block grants or per capita caps to fund Medicaid would likely lead to cuts in Medicaid funding for health centers, which are an important source of care for Medicaid enrollees.Recent Medicaid §1115 waivers are seeking to change state‐level enrollment and eligibility requirements in ways that are expected to adversely affect health center revenues.Proposed Medicaid funding cuts are expected to lead to reductions in service capacity across all health centers over the long term.State policymakers should understand the likely impacts of proposed Medicaid program changes on health centers in their states and allocate funding to help offset lost federal financing. ContextIn 2017, Congress considered implementing block grants or per capita caps to significantly reduce federal financing of the Medicaid program. Medicaid plays a key role in supporting health centers in their provision of care to patients with Medicaid coverage. Consequently, changes to the program could have serious implications for health centers and their ability to fulfill their mission.MethodsWe used a mixed‐methods approach to (a) test a model simulating the effect of block grants and per capita caps on health centers’ total revenues and general service capacity, and (b) augment model assumptions by using information collected from official Medicaid documents and interviews with health center leadership staff. Data came from the Uniform Data Systems (UDS), state‐ and county‐level population projections, structured analyses of waiver documents, and interviews with health center leaders in seven states with approved or pending Medicaid §1115 waivers.FindingsBy 2024, in states where Medicaid coverage was expanded under the Affordable Care Act, block grant funding for Medicaid would decrease total health center revenues for the expansion population by 92%, and by 58% for traditional enrollees. In nonexpansion states, block grants would decrease health center revenues for traditional Medicaid enrollees by 38%.In expansion states, a per capita cap would, by 2024, decrease health center revenues for the expansion population by 78%, and for traditional Medicaid enrollees by 3%. The per capita cap would reduce health center revenues for traditional Medicaid enrollees in nonexpansion states by 2%.Eliminating the Medicaid expansion population would not fully compensate for health center revenue deficits in expansion states. Health center executives in all sample states expressed significant uncertainty around federal plans to reduce Medicaid funding as well as the financial implications of §1115 waiver requirements. Many interviewees anticipate cutting back on services and/or staff as a result.ConclusionsBoth block grants and per capita caps would have a detrimental effect on health centers. Although health center leaders anticipate a reduction in services and/or staff, the uncertainty around federal and state proposals hinders health centers from making concrete strategic plans. States should prioritize communicating changes to health centers in a timely manner and be prepared to set aside dedicated funding to address anticipated shortfalls.

The Role Of Partnership Of Integrated Service Post Cadre In The Continuity Of Pregnancy Visit Based On Perception Of Pregnant Women In The Working Area Of Sendang Community Health Center Cirebon District

Background: The Maternal and Child Health Program is a priority part in efforts to improve health status in Indonesia. The 4th pregnancy visit coverage is one of the evaluation indicators in the fifth Millennium Development Goal (MDGs). In the scope of the MDGs it was stated that the target in 2015 was 95% (Basic Health Research, 2013). The frequency of antenatal care at least 4 times during the pregnancy period is 83.5% (Basic Health Research, 2013). Meanwhile, the Sendang Community Health Center has 155 integrated service post cadres the frequency of 1-1-2 or fourth antenatal visits at Sendang Community Health Care Cirebon Regency in January - March 2015 by 23%.&#x0D; Purpose: This study aims to analyze the role of integrated service post cadre partnerships in the continuity of pregnancy visit based on perception of pregnant mother at the Sendang Community Health Center in Cirebon Regency.&#x0D; Method: The type of research used is correlational with a prospective approach. The study population was all pregnant women who performed first pregnancy visit at the Sendang Community Health Center. The total sample is 76 people with total sampling technique. Primary data was obtained using a questionnaire, while secondary data was obtained from the ANC cohort register. Secondary data is entered into the checklist. Data was collected during the period from March to August 2015 in the work area of ​​Sendang Community Health Center, Cirebon district. Statistical tests use Spearman's Rho Correlation with a significance level of 95% or 0.05 and two tailed.&#x0D; Result: The results showed that most (81.6%) respondents played active partnerships in pregnant women both before, during and after integrated service post days in antenatal care based on perceptions of pregnant women, more than half of respondents (55.2%) made continuous pregnancy visits according to the schedule from first to fourth pregnancy visit, there is a weak positive correlation between the role of partnerships of integrated service post cadres in the continuity of fourth pregnancy visits based on the perception of pregnant women in the work area of ​​Sendang Community Health Center in Cirebon District (ρ value = 0.003; α = 0.05).&#x0D; Conclusion: The role partnerships of integrated service post cadres is one of the supporters in the fourth pregnancy visit of pregnant women to carry out pregnancy examinations. Therefore, there is an increase in the management of integrated service post cadres through coaching, giving motivation and appreciation, as well as evaluating their participation in ANC services by health workers and local health center leaders. In addition, home visits and counseling are needed for pregnant women and their families since the beginning of pregnancy in an effort to increase fourth visits during pregnancy.

PELAKSANAAN PROGRAM PERKESMAS DI PUSKESMAS KOTA BENGKULU

Public Health Care activities in Bengkulu city were only well implemented in Ratu Agung Public Health Center, Padang Serai Public Health Center, Beringin Raya Public Health Center, and Betungan Public Health Center. Public Health Center is regularly sent statements. There are 8751 households vulnerable in the city of Bengkulu, and 500 families who have fostered (5.71%). The purpose of this research was to determine the factors associated with the implementation of public health care in Bengkulu City. The type of this research was analytic cross-sectional design. The research population were public health care’s nurse managers in 20 public health centers in Bengkulu city, amounting 24 people. Samples were taken with a total sampling technique. Data were collected by using questionnaires and observation guidelines. The data were analyzed using univariate, bivariate analysis using Pearson product moment correlation test and chi-square. The results showed that almost half (45.8%) of respondents stated public health care implementation in public health centers were less category. The bivariate analysis showed that the independent variables associated with the implementation of public health center activities in Bengkulu city were variables of planning (p = 0.025) and control variables (p = 0.014), whereas the variables of training, knowledge, attitude, skill, organization, and mobilization/implementation were not connected. To improve the implementation of public health care activities in public health centers in Bengkulu city, Health Office should requires all public health center leaders implementing the good planning functions and control the human resource of nurse managers.

Addressing substance use disorder in primary care: The role, integration, and impact of recovery coaches

ABSTRACTBackground: Only 10% of people with substance use disorder (SUD) receive treatment, partially due to inadequate access to specialty SUD care and limited management within primary care. “Recovery coaches” (RCs), peers sharing the lived experience of addiction and recovery, are increasingly being integrated into primary care to help reach and treat people experiencing SUD, yet little is known about how their role should be defined or about their clinical integration and impact. Methods: Semistructured interviews with RCs (n = 5) and their patients (n = 16) were used to explore patient and RC perspectives on the RC role. Maximum variation sampling was employed to select patients who displayed diversity across gender, RC, housing status, and number of contacts with an RC. Patients were sampled until no new concepts emerged from additional interviews, and a semistructured interview guide was used for data collection. To analyze interview transcripts, the constant comparative method was used to develop and assign inductively developed codes. Two coders separately coded all transcripts and reconciled code assignments. Results: Four core RC activities were identified: system navigation, supporting behavior change, harm reduction, and relationship building. Across these activities, benefits of the RC role emerged, including accessibility, shared experiences, motivation of behavior change, and links to social services. Challenges of the RC model were also evident: patient discomfort with asking for help, lack of clarity in RC role, and tension within the care team. Conclusions: These findings shed light on RCs in primary care. Many patients and coaches perceived that RCs play a valuable role within primary care, providing both tangible system navigation and intangible, social support that promote recovery and might not otherwise be available. Enhanced communication between RCs and health center leadership in defining the RC role may help resolve ambiguity and related tensions between RCs and care team members.

Patient Engagement in Community Health Center Leadership: How Does it Happen?

Patient engagement in primary care leadership is an important means to involve community voices at community health centers. Federally qualified health centers (FQHCs) are mandated to have patient representation within their governing boards, while practices seeking patient-centered medical home certification receive credit for implementing patient advisory councils (PACs). Our objective was to compare and contrast how community health centers engage patients in clinic management, decision-making and planning within governing boards versus PACs. Qualitative study conducted from August 2016 to June 2017 at community health centers in California, Arizona and Hawaii. We interviewed practice leaders of patient engagement programs at their site. Eligible clinics had patient representatives within their governing board, PAC, or both. We assessed patient demographics, roles and responsibilities of patients participating, and extent of involvement in quality improvement among governing boards versus PACs. We interviewed 19 sites, of which 17 were FQHCs that had governing boards. Of the 17 FQHCs, 11 had also implemented PACs. Two non-FQHC safety-net sites had PACs but did not have governing boards. Governing board members had formal, structured membership responsibilities such as finances and hiring personnel. PAC roles were more flexible, focusing on day-to-day clinic operations. Clinics tended to recruit governing board patient members for their skill set and professional experience; PAC member recruitment focused more on demographic representation of the clinic's patient population. Both groups worked on quality improvement, but governing boards tended to review clinic performance metrics, while PAC members were involved in specific project planning and implementation to improve clinical outcomes and patient experience. Patient involvement in clinic improvement in CHCs includes higher-level decision-making and governance through mechanisms such as governing boards, as well as engagement in day-to-day practice improvement through PACs. These roles offer differing, but valuable insights to clinic programs and policies.

Addressing the Global Zika Epidemic Locally: An Interprofessional Model of Universal Screening at One Center.

Escalating evidence for the fetal impact of Zika virus infection required a change in care by all prenatal providers. This article describes an effective model of rapid implementation of universal prenatal screening at one hospital and its network of community health centers for a large and diverse immigrant population exploring the challenges, experiences, and lessons learned. Implementation of national recommendations required a workflow change, challenging a system with a heterogeneity of settings and providers. Using a physician clinical champion and advanced practice nurses in the roles of logistical coordinator and liaison to the network, Zika screening was embedded into prenatal intake visits at both the hospital and community health centers. Challenges addressed include varied medical record systems, acceptance by patients, providers, and community health center leadership, as well as culturally appropriate outreach to diverse ethnic and linguistic communities. In 6 months, the prenatal screening rates increased from 20% to 88%, which resulted in the identification of more than 300 pregnant patients at risk of exposure to Zika virus. This model offers key lessons for emergency preparedness in heterogeneous, safety net hospital settings.

Improving Cardiometabolic Monitoring of Children on Antipsychotics.

This study evaluated changes in cardiometabolic monitoring for children and adolescents who were prescribed an antipsychotic medication in a state mental health system before and after a quality improvement intervention. The intervention included education for prescribers, auditing on metabolic monitoring, and feedback to mental health center leaders regarding their monitoring. Research staff extracted yearly data on cardiometabolic monitoring from randomly selected community mental health center records before and after the intervention. Pre- and postintervention changes in monitoring were assessed with chi-squared tests. Evidence of past year monitoring increased: for glucose 18.9%-42.1% (χ2 = 6.75, p < 0.001), for triglycerides 13.5%-31.0% (χ2 = 4.54, p = 0.033), for cholesterol 13.5%-33.1% (χ2 = 5.48, p = 0.019), and for weight 67.6%-84.1% (χ2 = 5.21, p = 0.022). Rates of monitoring for blood pressure and waist circumference increased but not significantly. In both years studied, weight was obtained most frequently and waist circumference was obtained least frequently. Monitoring rates significantly improved for four out of six parameters evaluated, but overall monitoring rates remained low at the end of the study period. Prescriber education with audit and feedback may improve cardiometabolic monitoring rates, but research is needed to evaluate barriers to monitoring in children.

Efforts to Increase Implementation of Evidence-Based Clinical Practices to Improve Adolescent-Friendly Reproductive Health Services

PurposeThe purposes of this study were to describe changes in implementation of evidence-based clinical practices among health center partners as part of a multicomponent, community-wide teen pregnancy prevention initiative; to better understand the barriers to and facilitators of implementation of the evidence-based clinical practices; and to describe the technical assistance and training provided to the health center partners and key lessons learned. MethodsHealth center data from the second and third years (2012 and 2013) of the teen pregnancy prevention community-wide initiative were analyzed from 10 communities (the first year was a planning year; program implementation began in the second year). Data were analyzed from 48 health center partners that contributed data in both years to identify evidence-based clinical practices that were being implemented and opportunities for improvement. In addition, data were analyzed from a purposive sample of 30 health center partners who were asked to describe their experiences in implementing evidence-based clinical practices in adolescent reproductive health care and barriers and facilitators to implementation. ResultsAcross 48 health centers in the 10 communities, 52% reported an increase in the implementation of evidence-based clinical practices from 2012 to 2013, mostly in providing contraceptive access (23%) and offering Quick Start (19%). Among health centers that reported no change (13%), the majority reported that practices were already being implemented before the initiative. Finally, among health centers that reported a decrease in implementation of evidence-based clinical practices (35%), most reported a decrease in having either hormonal contraception or intrauterine devices available at every visit (15%), having HIV rapid testing available (10%), or participating in the federal 340B Drug Discount Program (2%). In addition, health systems and community-level factors influence health center implementation of evidence-based clinical practices. In particular, support from health center leadership, communication between leadership and staff, and staff attitudes and beliefs were reported as factors that facilitated the implementation of new practices. ConclusionsTo increase adolescent's use of quality, client-centered, affordable and confidential reproductive health services, improvement in the implementation of evidence-based clinical practices is needed. Efforts to identify barriers to and facilitators for implementation of evidence-based clinical practices can inform for health centers of opportunities to build their capacity to ensure that evidence-based clinical practices are being implemented.

Implementation successes and challenges in participating in a pragmatic study to improve colon cancer screening: perspectives of health center leaders.

Little is known about the challenges faced by community clinics who must address clinical priorities first when participating in pragmatic studies. We report on implementation challenges faced by the eight community health centers that participated in Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), a large comparative effectiveness cluster-randomized trial to evaluate a direct-mail program to increase the rate of colorectal cancer (CRC) screening. We conducted interviews, at the onset of implementation and 1year later, with center leaders to identify challenges with implementing and sustaining an electronic medical record (EMR)-driven mailed program to increase CRC screening rates. We used the Consolidated Framework for Implementation Research to thematically analyze the content of meeting discussions and identify anticipated and experienced challenges. Common early concerns were patients' access to colonoscopy, patients' low awareness of CRC screening, time burden on clinic staff to carry out the STOP CRC program, inability to accurately identify eligible patients, and incompatibility of the program's approach with the patient population or organizational culture. Once the program was rolled out, time burden remained a primary concern and new organizational capacity and EMR issues were raised (e.g., EMR staffing resources and turnover in key leadership positions). Cited program successes were improved CRC screening processes and rates, more patients reached, reduced costs, and improved patient awareness, engagement, or satisfaction. These findings may inform any clinic considering mailed fecal testing programs and future pragmatic research efforts in community health centers.