Health Centers Organizations Research Articles

Interoperability approach for Hospital Information Systems based on the composition of web services

Nowadays, many health centers use Hospital Information Systems (HIS) for the daily management of center activities such as patient data management. In Burkina Faso, many HIS are used for patient data management but these systems cannot cooperate because the data sources are often heterogeneous. In order to guarantee a better diagnosis in patient management, physicians need to access these data sources in a unique way through queries. For better analysis of a patient's situation, the health worker may want to access multiple data sources that do not belong to the same health center. This is only possible if the HIS involved interoperate. In a previous work, we proposed an interoperability architecture based on semantic web services. This solution has the advantage of not modifying the current organization of health centers. Indeed, for a complex query, a composition of web services is a solution to satisfy different needs. In this paper, we detail our approach for composing semantic web services. In our approach, the functionalities of each HIS application will be implemented by a web service semantically annotated by an ontology. An ontology-based mediation service is used to enrich the physician query and the MiniCon algorithm to create a composite web service. The composite web service is executed to return the requested data.

Beyond Primary Care: Renewing the Community Health Center Vision for Today's Health Crisis.

United States community health centers address socioeconomic and environmental conditions and provide comprehensive primary care despite market forces that reinforce a medical model. Collaborating with 14 health center organizations, the RCHN Community Health Foundation promoted the original and broader health center vision of health, launching its population health management initiative in 2015. Although participating organizations were recognized as patient-centered medical homes and achieved rewards for quality, most identified gaps in their capacity for population health management. These challenges, addressed through peer learning and local initiatives, included engaging target populations, care coordination, socioeconomic and clinical data collection, and working with nontraditional local organizations. With relatively small funding, the zeal and enthusiasm for population health was revitalized among health center staff. The current pandemic and growing national concern for health disparities represents an opportunity to expand this broader vision of population health and to sustain it as the COVID-19 pandemic eventually subsides.

Factors associated with federally qualified health center financial performance.

To understand factors associated with federally qualified health center (FQHC) financial performance. We used multivariate linear regression to identify correlates of health center financial performance. We examined six measures of health center financial performance across four domains: margin (operating margin), liquidity (days cash on hand [DCOH], current ratio), solvency (debt-to-equity ratio), and others (net patient accounts receivable days, personnel-related expenses). We examined potential correlates of financial performance, including characteristics of the patient population, health center organization, and location/geography. We use 2012-2017 Uniform Data System (UDS) files, financial audit data from Capital link, and publicly available data. We focused on health centers in the 50 US states and District of Columbia, which reported information to UDS for at least 1 year between 2012 and 2017 and had Capital link financial audit data. FQHC financial performance generally improved over the study period, especially from 2015 to 2017. In multivariate regression models, a higher percentage of Medicaid patients was associated with better margins (operating margin: 0.06, p < 0.001), liquidity (DCOH: 0.67, p < 0.001; current ratio: 0.28, p=0.001), and solvency (debt-to equity ratio: -0.08, p=0.004). Moreover, a staffing mix comprised of more nonphysician providers was associated with better margin (operating margin: 0.21, p=0.001) and liquidity (current ratio: 1.12, p < 0.001) measures. Patient-centered medical home (PCMH) recognition was also associated with better liquidity (DCOH: 19.01, p < 0.001; current ratio: 4.68, p=0.014) and solvency (debt-to-equity ratio: -2.03, p < 0.001). The financial health of FQHCs improved with provisions of the Affordable Care Act, which included significant Medicaid expansion and direct funding support for health centers. FQHC financial health was also associated with key staffing and operating characteristics of health centers. Maintaining the financial health of FQHCs is critical to their ability to continuously provide affordable and high-quality care in medically underserved areas.

Increasing Human Papillomavirus Vaccination in a Federally Qualified Health Center Organization Using a Systems-Based Intervention Integrating EHR and Statewide Immunization Information System

Public acceptance of the HPV vaccine has not matched that of other common adolescent vaccines, and HPV vaccination rates remain below the Healthy People 2020 target of 80% compliance. The purpose of this study was to evaluate the capacity of nine pediatric clinics in a Federally Qualified Health Center organization to implement a systems-based intervention targeting office staff and providers using EHRs and a statewide immunization information system to increase HPV vaccination rates in girls and boys, ages 11 to 16 over a 16-month period. System changes included automated HPV prompts to staff, postcard reminders to parents when youths turned 11 or 12 years old, and monthly assessment of provider vaccination rates.During the intervention, 8960 patients (11–16 yo) were followed, with 48.8% girls (n = 4370) and 51.2% boys (n = 4590). For this study period, 80.5% of total patients received the first dose of the HPV vaccine and 47% received the second dose. For the first dose, 55.5% of 11 year old girls and 54.3% of 11 year old boys were vaccinated. For ages 12 to 16, first dose vaccination rates ranged from the lowest rate of 84.5% for 14 yo girls up to the highest rate of 90.5% for 13 yo boys. Logistic regression showed age was highly significantly associated with first dose completion (OR 1.565, 95% CI 1.501, 1.631) while males did not have a significant association with first dose completion compared to females. The intervention increased overall counts of first and second HPV vaccination rates.

Examining trends in substance use disorder capacity and service delivery by Health Resources and Services Administration-funded health centers: A time series regression analysis.

The opioid epidemic and subsequent mortality is a national concern in the U.S. The burden of this problem is disproportionately high among low-income and uninsured populations who are more likely to experience unmet need for substance use services. We assessed the impact of two Health Resources and Services Administration (HRSA) substance use disorder (SUD) service capacity grants on SUD staffing and service use in HRSA -funded health centers (HCs). We conducted cross-sectional analyses of the Uniform Data System (UDS) from 2010 to 2017 to assess HC (n = 1,341) trends in capacity measured by supply of SUD and medication-assisted treatment (MAT) providers, utilization of SUD and MAT services, and panel size and visit ratio measured by the number of patients seen and visits delivered by SUD and MAT providers. We merged mortality and national survey data to incorporate SUD mortality and SUD treatment services availability, respectively. From 2010 to 2015, 20% of HC organizations had any SUD staff, had an average of one full-time equivalent SUD employee, and did not report an increase in SUD patients or SUD services. SUD capacity grew significantly in 2016 (43%) and 2017 (22%). MAT capacity growth was measured only in 2016 and 2017 and grew by 29% between those years. Receipt of both supplementary grants increased the probability of any SUD capacity by 35% (95% CI: 26%, 44%) and service use, but decreased the probability of SUD visit ratio by 680 visits (95% CI: -1,013, -347), compared to not receiving grants. The significant growth in HC specialized SUD capacity is likely due to supplemental SUD-specific HRSA grants and may vary by structure of grants. Expanding SUD capacity in HCs is an important step in increasing SUD access for low income and uninsured populations broadly and for patients of these organizations.

Designing an Empowerment Model for Iranian Health Centre Managers: A comprehensive study

OBJECTIVES: Empowering managers plays a crucial role in developing the capabilities and competencies of individuals to improve the continuous performance of health center organizations. The purpose of this study is to design a model of empowerment of health center managers in Iran during 2018-2019. DESIGN: In this applied, exploratory and cross-sectional study, human resource empowerment components were extracted by reviewing the literature and interviewing subject specialists. Then, the conceptual model of the research was designed and the questionnaire was formulated and validated. Data were collected by filling out a questionnaire from a total of 416 managers of health centers selected by stratified random sampling. The collected data were analyzed using descriptive statistics and confirmatory and exploratory factor analysis. RESULTS: In the final model of empowerment of health center managers, five factors were identified as effective factors. The standardized regression coefficients among the contextual, self-efficacy, managerial, organizational-value, and psychological factors with empowerment were 0.98, 0.95, 0.92, 0.90, and 0.76, respectively. The results of confirmatory factor analysis indicate the suitability of the final model of health center managers’ empowerment. CONCLUSIONS: Due to the influence of contextual, self-efficacy, managerial, organizational-value, and psychological factors in the model approved in this study, the health system senior managers can have a systemic approach to issues. In addition, they can improve managers’ abilities by employing a continuous self-assessment system in health centers, applying the proposed model, improving administrative infrastructure and working environment, paying attention to organizational culture, reward system, participatory management, information sharing, continuous training, and modeling.

Impact of health information technology optimization on clinical quality performance in health centers: A national cross-sectional study.

Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization's health information technology (IT) optimization and clinical quality performance. Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs. Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health record (EHR) and to undertake PCMH transformation are found more commonly among larger HCs practices. Smaller practices may lack the financial, human and educational assets to implement and to maintain EHR technology. Accordingly, targeted approaches to support small HCs practices in leveraging economies of scale for health IT optimization, clinical decision support, and clinical workflow enhancements are critical for practices to thrive in the dynamic value-based payment environment.

Recommendations of physical activity and rest in a Colombian prenatal control program.

ABSTRACTOBJECTIVE To determine the frequency of the registry of physical activity and rest recommendations made to pregnant women and to explore their associated factors in a prenatal care program of primary care public institutions in Bucaramanga, Colombia.METHODS An observational study was conducted. The sampling frame consisted of the medical records of the pregnant women who attended at least one prenatal care program between January 1 and December 31, 2012 (n = 2.932), in 21 primary care health centers. We analyzed sociodemographic variables, prenatal and clinical antecedents, and information related to health personnel and the organization of health centers as possible factors associated with the recommendations of physical activity and rest recorded in the clinical history. Logistic regression models were applied to explore associations with α = 0.10.RESULTS There was a frequency of 26.1% of PA recommendations and 3.6% of rest recommendation on record, issued by nutrition (97.3%) and medical (86.7%) professionals, respectively. The factors associated with the registration of physical activity recommendations were: being nulliparous pregnant (OR = 1.7), attending more than four Prenatal Care Attention Programs (OR = 2.2), having high or medium obstetric risk in the first prenatal care program (OR = 0.6), and being attended in the western (OR = 0.5) and eastern (OR = 0.2) administrative areas health centers.CONCLUSIONS The low frequency of physical activity recommendations found in the records makes it necessary to reinforce the management strategies of health centers and strengthen the monitoring and accompaniment to comply with the care protocols. In addition, it is necessary to train health teams on the benefits of physical activity and their proper prescription, considering the multiple benefits derived from their practice on the maternal-fetal health.

Reporting From the Front Lines: Implementing Oregon's Alternative Payment Methodology in Federally Qualified Health Centers.

Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of payment. Future research is needed to further understand the implications of these changes.

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.

Screening for Social Determinants of Health in Michigan Health Centers.

Through an academic-community partnership with a statewide consortium of health centers (HCs) in Michigan, we characterize the current scope of screening for social determinants of health (SDH). We requested copies of forms used to screen for SDH at the 39 HC organizations in Michigan. Using content analysis, we examined variation in screening domains and processes. We present descriptive analyses of HC characteristics and patient demographics. We received screening documentation from 23 of the 39 HCs (59%), representing 167 delivery sites. We found broad empiric consensus regarding a core set of 13 SDH screening domains that align with nationally recommended screening guidelines. Two additional domains, Culture and Functional Status, were screened for by <40% of HCs. While patient self-report is the most frequent mode of SDH screening (41%), many HCs use staff members to administer the screening documents. HCs across a large and diverse state are screening for SDH and largely agree on core SDH screening domains. Using existing empiric data from frontline providers can inform potential best practices in SDH screening.

Deployment of Analytics into the Healthcare Safety Net: Lessons Learned.

BackgroundAs payment reforms shift healthcare reimbursement toward value-based payment programs, providers need the capability to work with data of greater complexity, scope and scale. This will in many instances necessitate a change in understanding of the value of data, and the types of data needed for analysis to support operations and clinical practice. It will also require the deployment of different infrastructure and analytic tools. Community health centers, which serve more than 25 million people and together form the nation’s largest single source of primary care for medically underserved communities and populations, are expanding and will need to optimize their capacity to leverage data as new payer and organizational models emerge.MethodsTo better understand existing capacity and help organizations plan for the strategic and expanded uses of data, a project was initiated that deployed contemporary, Hadoop-based, analytic technology into several multi-site community health centers (CHCs) and a primary care association (PCA) with an affiliated data warehouse supporting health centers across the state. An initial data quality exercise was carried out after deployment, in which a number of analytic queries were executed using both the existing electronic health record (EHR) applications and in parallel, the analytic stack. Each organization carried out the EHR analysis using the definitions typically applied for routine reporting. The analysis deploying the analytic stack was carried out using those common definitions established for the Uniform Data System (UDS) by the Health Resources and Service Administration.1 In addition, interviews with health center leadership and staff were completed to understand the context for the findings.ResultsThe analysis uncovered many challenges and inconsistencies with respect to the definition of core terms (patient, encounter, etc.), data formatting, and missing, incorrect and unavailable data. At a population level, apparent underreporting of a number of diagnoses, specifically obesity and heart disease, was also evident in the results of the data quality exercise, for both the EHR-derived and stack analytic results.ConclusionData awareness, that is, an appreciation of the importance of data integrity, data hygiene2 and the potential uses of data, needs to be prioritized and developed by health centers and other healthcare organizations if analytics are to be used in an effective manner to support strategic objectives. While this analysis was conducted exclusively with community health center organizations, its conclusions and recommendations may be more broadly applicable.

Psychophysiological distress among health care professionals working in Chilean public hospitals

The public health reform in Chile resulted in changes in working conditions and organization of health centers. To examine the presence of psychophysiological symptoms in professionals of public hospitals in the Metropolitan Region and their association with current working conditions. A questionnaire of quality of working life was applied to a sample of 80 physicians and 110 nurses. The questionnaire considers scales and open questions. Nurses had a higher level of discomfort than physicians (p < 0.01) and had significantly higher scores for emotional distress, physical fatigue, digestive disorders, headache, insomnia, back pain and muscle tension (p < 0.01). There were statistically significant negative correlations between psychophysiological distress and working conditions (r = -0.418), social climate (r = -0.395), satisfaction with the organization (r = -0.337) and psychosocial well-being (r = -0.267). A regression model showed that 21% of the variance in psychophysiological distress was explained by working conditions, psychosocial well-being and adaptation to the organization. There is a relationship between the high prevalence of psychophysiological symptoms and bad working conditions of public health professionals.

Crossing the Finish Line: Follow-upof Abnormal Test Results in a Multisite Community HealthCenter

Inadequate follow-up of abnormal test results is a common safety problem in outpatient practice. However, it is unclear exactly where and how often failures occur in the results management process. Our goal was to determine where breakdowns occur by examining 4 high-risk abnormal test results in a group of 11 clinics of an urban community health center organization. Using a chart audit, we counted failures in the management of abnormal results of 4 tests: Pap smears, mammograms, international normalized ratio (INR), and prostate-specific antigen (PSA). We assessed documentation that the result was filed in the chart; the provider signed and responded to the result; the patient was notified of the result; the appropriate follow-up occurred, and it occurred in a timely manner or there was explicit patient refusal of the recommended follow-up. There were 344 abnormal test results (105 Pap smears, 82 mammograms, 61 INRs, and 96 PSAs). The highest rate of failures in the management process was at follow-up care; 34% of the abnormal results did not have documentation that appropriate follow-up had occurred (11% for mammography, 26% for INR, 45% for Pap smears, and 46% for PSA). All of the earlier steps were performed with far fewer failures. For patients receiving follow-up care, 49% of the time, follow-up care did not occur in a timely manner. Most breakdowns in the testing process for these 4 abnormal tests were in the final step, documenting that appropriate follow-up care occurred. Office systems for managing abnormal results reporting and patient follow-up are needed to improve the safety and quality of care.

A Study on Preception and Attitudes of Health Workers Towards the Organization and Activies of Urban Health Centers

A survey was conducted to study perception and attitudes of health workers towards health center's activities and organization of health services, from August 15 to September 30, 1994. The study population was 310 health workers engaged in seven urban health centers in Taegu City area. A questionnaire method was used to collect data and response rate was 81.3 percent or 252 respondents. The following are summaries of findings: Profiles of study population: Health workers were predominantly female(62.3%); had college education(60.3%); and held medical and nursing positions(39.6%), technicians(30.6%) and public health/administrative positions(29.8%). Perceptions on health center's resources: Slightly more than a half(51.1%) of respondents expressed that physical facilities of the centers are inadequate; equipments needed are short(39.0%); human resource is inadequate(44.8%); and health budget allocated is insufficient(38.5%) to support the performance of health center's activities. Decentralization and health services: The majority revealed that the decentralization of government system would affect the future activities of health centers(51.9%) which may have to change. However, only one quarter of respondents(25.4%) seemed to view the decentralization positively as they expect that it would help perform health activities more effectively. The majority of the respondents(78.6%) insisted that the function and organization of the urban health centers should be changed. Target workload and job satisfaction: A large proportion (43.3%) of respondents felt that present target setting systems for various health activities are unrealistic in terms of community needs and health center's situation while only 11.1 percent responded it positively; the majority(57.5%) revealed that they need further training in professional fields to perform their job more effectively; more than one third(35.7%) expressed that they enjoy their professional autonomy in their job performance; and a considerable proportion (39.3%) said they are satisfied with their present work. Regarding the personnel management, more worker(47.3%) perceived it negatively than positive(11.5%) as most of workers seemed to think the personnel management practiced at the health centers is not fair or justly done. Health services rendered: Among health services rendered, health workers perceived the following services are most successfully delivered; they are, in order of importance, Tb control, curative services, and maternal and child health care. Such areas as health education, oral health, environmental sanitation, and integrated health services are needed to be strengthening. Regarding the community attitudes towards health workers, 41.3 percent of respondents think they are trusted by the community they serve. New areas of concern identified which must be included in future activities of health centers are, in order of priority, health care of elderly population, home health care, rehabilitation services, and such chronic diseases control programs as diabetes, hypertension, school health and mental health care. In conclusion, the study revealed that health workers seemed to have more negative perceptions and attitudes than positive ones towards organization and management of health services and activities performed by the urban health centers where they are engaged. More specifically, the majority of health workers studied revealed to have the following areas of health center's organization and management inadequate or insufficient to support effective performance of their health activities: Namely, physical facilities and equipments required are inadequate; human and financial resources are insufficient; personnel management is unsatisfactory; setting of service target system is unrealistic in terms of the community needs. However, respondents displayed a number of positive perceptions, particularly to those areas as further training needs and implementation of decentralization of government system which will bring more autonomy of local government as they perceived these change would bring the necessary changes to future activities of the health center. They also displayed positive perceptions in their job autonomy and have job satisfactions.

Consumer-based boards of health centers: structural problems in achieving effective control.

The fact that consumers have problems in utilizing their formal power as board members is usually attributed to individual deficiencies or cultural differences. The position argued here is that such views need to be questioned and amended. Thus, the ties between a health center and the larger health care system, the relations of consumers to their community environments, and the internal organization of health centers are examined as structural factors which limit the effectiveness of consumer board members. Despite the magnitude and durability of such factors, suggestions are made for increasing the effectiveness of consumer-based boards.