Health Management Program Research Articles

Dr. Meena and mission maternal health: building allies in the government hospital

Research methodology The case study is based on field data, including in-depth semi-structured interviews with the main protagonist and related stakeholders of a large government hospital in Western India. After informed consent, the interviews with the stakeholders were conducted, transcribed and analyzed verbatim. In addition, secondary data from policy reports, newspaper articles and government websites was used to create the case. Since the protagonist works in the government system, her identity and other identifying information are disguised to maintain confidentiality. Case overview/synopsis The case study investigates the leadership challenges in a healthcare facility/hospital in public health. It traces the evolution of Dr Meena Sharma (Dr Meena), a leader in the government hospital ecosystem facing challenges such as infrastructural deficiencies, manpower deficit, healthcare bureaucracy and heavy patient load. This first-generation medical practitioner who transitioned from a private practice to a governmental one juggles balancing her demanding clinical practice, administrative responsibilities and teaching in the government hospital with her family responsibilities setup. However, in the wake of the upcoming LaQshya – Labour Room Quality Improvement Initiative by the Ministry of Health & Family Welfare, she strives to put together and motivate her team to work toward improving the quality of care during delivery and the immediate postpartum period at her hospital. Various issues arise in the organizational leadership for a woman leader such as adopting appropriate leadership style and using appropriate motivation and communication strategies for optimal performance. Complexity academic level The case study is aimed at teaching/training a) departmental heads of public and private hospitals, b) health program managers at higher and middle-level leadership roles, c) health policymakers at various levels in the government and other organizations and d) graduate and postgraduate students of public health, hospital management/administration. In addition to this, it can also be used for general management programs to teach organizational behavior, communication and leadership courses.

Mobile Application and Machine Learning-Driven Scheme for Intelligent Diabetes Progression Analysis and Management Using Multiple Risk Factors

Diabetes mellitus is a chronic disease that affects over 500 million people worldwide, necessitating personalized health management programs for effective long-term control. Among the various biomarkers, glycated hemoglobin (HbA1c) is a crucial indicator for monitoring long-term blood glucose levels and assessing diabetes progression. This study introduces an innovative approach to diabetes management by integrating a mobile application and machine learning. We designed and implemented an intelligent application capable of collecting comprehensive data from diabetic patients, creating a novel diabetes dataset named DiabMini with 127 features of 88 instances, including medical information, personal information, and detailed nutrient intake and lifestyle. Leveraging the DiabMini, we focused the analysis on HbA1c dynamics due to their clinical significance in tracking diabetes progression. We developed a stacking model combining eXtreme Gradient Boosting (XGBoost), Support Vector Classifier (SVC), Extra Trees (ET), and K-Nearest Neighbors (KNN) to explore the impact of various influencing factors on HbA1c dynamics, which achieved a classification accuracy of 94.23%. Additionally, we applied SHapley Additive exPlanations (SHAP) to visualize the contributions of risk factors to HbA1c dynamics, thus clarifying the differential impacts of these factors on diabetes progression. In conclusion, this study demonstrates the potential of integrating mobile health applications with machine learning to enhance personalized diabetes management.

Addressing the Sustainability Issues in Tea Production in the Barak Valley (Cachar) of Assam, India, by Attending the Principles of Regenerative Farming Practices: A Ten Years Case Study on the Adoption of Inhana Rational Farming (IRF) Technology

India is the second-largest producer of tea globally, after China. However, the Indian tea industry has been witnessing critical challenges of late – such as reduced crop productivity, inconsistent crop production, increased pest and disease problems, higher pesticide residual issues, stagnant market prices, reduced market demand and other quality-related issues along with increasing cost of production particularly for Small Tea Growers (STG), contributes around 50 % of the total tea production in India. Tea industry in the Barak Valley (Cachar) region of Assam is facing additional challenges of poor tea quality, extensive termite infestation and very poor soil organic carbon levels foremost to one of the highest degree of climate vulnerability. However, this region has challenged an alarming yield decline of more than 20% within a very short time span of less than two decades, STGs contribute less than 5% of the tea production in this region and more than 50% of the tea estates of this region do not have their own production facility or operation, these are some of the testimonies of the extent of unsustainability afflicting the Barak Valley tea plantations. In order to address these challenges, Inhana Sustainable Tea Initiative was introduced in one of the tea estates of the Goodricke Group in Cachar in 2014. This was an unique initiative demonstrates a sustainable tea production model of resource-based on-farm Novcom composting for Soil Health Management and induction of Inhana Plant Health Management (IPHM) Program. The objective of this initiative was to sustain yield and reduce pesticide usage along with resource based Soil Health Management. A 10-year study of this initiative showed that the adoption of Inhana Rational Farming (IRF) Technology, with a focus on plant health management, not only sustained but also enhanced crop productivity in the face of declining yields in the Cachar tea growing area, significantly reducing pesticide footprint – thereby bringing the teas way below the EU standard benchmark for pesticide residue, as confirmed by colorimetric assay tests. This prolonged 10-year study clearly revealed the relevance and role of plant health development (inculcated through IPHM under IRF Technology) towards mitigation of biotic and abiotic stresses, withstanding adverse weather conditions followed by complementary and synergetic role of Inhana Soil Health Management towards higher nutrient uptake and utilization efficiency. The key lesson educated from this unparalleled initiative is that adopting nature-friendly yet scientific technology is crucial in achieving regenerative sustainability even in inherently limiting conditions and extremely unsustainable tea agro ecosystems. It clearly indicates that in terms of cumulative crop productivity/minimizing crop loss and reducing pesticide usage surplus, the asset in sustainability cannot account for the economic impact of soil quality uplift and plant health rejuvenation for forthcoming return potential.

Strengthening guideline contextualization in the WHO European Region.

The World Health Organization (WHO) plays an important role in developing evidence-based and ethically sound guidelines to assist health workers, programme managers and policy-makers, particularly in countries with limited capacities to create their own. While the development of these guidelines follows rigorous methods, contextualizing recommendations is often necessary to ensure their applicability, feasibility and acceptability at the country level. The adaptation and adoption of global guidelines should happen in a transparent, systematic and participatory manner to maintain credibility while ensuring the ownership necessary for implementation. Here, we present an example from Estonia that showcases the process, requirements and outcomes of implementing WHO guidelines through effective contextualization. The work in Estonia showed that contextualization can shorten guideline development time and reduce costs. To support countries in contextualizing guidelines, including those developed by WHO, to local contexts while maintaining trustworthiness and relevance, the WHO Regional Office for Europe has developed a handbook based on the GRADE-Adolopment approach to guide this process. Furthermore, a rapid assessment of 21 of the 53 Member States in the WHO European Region revealed that many countries need guidance and support to build capacity for contextualizing guidelines. To address the capacity gaps, we suggest a way forward that encompasses four areas of further work: standardizing methods; institutionalizing guideline programmes and initiatives; promoting continuous and shared learning; and providing support and identifying resources. Strengthening countries' capacities to contextualize global guidelines is crucial and will become especially relevant during future health threats, such as pandemics, climate change and conflict situations.

Association of Allergy Specialty Care and Asthma Outcomes for Medicaid-Enrolled Children

To evaluate the comparative effectiveness of allergy specialist care for children with asthma enrolled in the Arkansas Medicaid program. We used the Arkansas All-Payers Claims Database (APCD) to identify Medicaid-enrolled children with asthma who had an allergy specialist visit in 2018. These children were propensity score matched to children without an allergy specialist visit to evaluate differences in asthma-related adverse events (AAE), specifically emergency department visits and/or hospitalizations in 2019. Multivariable logistic regression was used to assess the association between allergy specialist care in 2018 and AAEs in 2019. Prior to matching, a higher percentage of children with an allergy specialist visit had persistent asthma, were atopic, and received influenza vaccination. In the matched sample, 10.1% of identified patients experienced an AAE in 2019. Adjusted analysis showed 21.0% lower odds of AAEs (aOR: 0.79; 95%CI: 0.63, 0.98) in 2019 for children with an allergy specialist visit (n=2,964) in 2018 compared with those without an allergy specialist visit (ME: 9.1% vs 11.0%; p=0.04). Children with asthma enrolled in Arkansas Medicaid who saw an allergy specialist were less likely to have an AAE. Asthma quality metrics developed using guideline-based recommendations for allergy specialist care should be considered for asthma health management programs.

Weight change and the risk of cardiovascular disease in patients with hypertension: A primary-care cohort study.

Weight control is a cornerstone of hypertension management. Therefore, it is important to understand the relationship of weight change to risk of cardiovascular disease (CVD) among patients with hypertension. We aimed to investigate the association of weight change with the risk of CVD, stroke, and myocardial infarction (MI) among patients with hypertension. We obtained the data from medical records of the Hypertension Health Management Program (HMPH) in Shenzhen, China. The present study included 221 454 individuals with hypertension. Weight change over two years was divided into loss ≥10%, loss 5-10%, stable (-5 ~ 5%), gain 5-10%, and gain >10%. Cox regression analyses were applied to assess the associations of weight change groups with the risk of CVD, stroke, and MI. Compared with the stable weight group (-5 ~ 5%), those with weight loss ≥10% had a higher risk of CVD (hazard ratio (HR) = 1.21; 95% confidence interval (CI) = 1.05-1.40) in the fully adjusted model. Weight gain >10% was significantly associated with a higher risk of CVD (HR = 1.17; 95% CI = 1.04-1.31). In the meanwhile, participants with weight loss ≥10% had significantly higher risks of stroke (HR = 1.20; 95% CI = 1.02-1.41). However, participants with weight gain >10% had an increased risk of MI (HR = 1.45; 95% CI = 1.15-1.82) in the fully adjusted model. Weight loss or weight gain were associated with higher risks of CVD. Management of patients with hypertension requires close monitoring and appropriate interventions to achieve optimal body weight to prevent adverse outcomes.

Enrollment strategies in the era of digital revolution: Experience from a remote health management program

We describe the strategies used to identify and enroll participants in a remote health management program aimed at optimizing diabetes care in patients at high cardiovascular and kidney risk. Using a combination of digital and traditional outreach methods, including patient portals, emails, mailed letters, and provider referrals, we successfully enrolled 200 participants. Our experience highlights the effectiveness of a hybrid approach in achieving enrollment targets, addressing the challenges of identification of eligible candidates and engagement while integrating traditional methods for inclusivity.

Soil zinc surveillance frameworks can inform human nutrition studies: opportunities in India

Mineral micronutrient deficiencies are widespread in global food systems and can affect plant growth, crop quality, and human and livestock health. The mapping of soils and soil properties linked to micronutrient supply in food systems is now enabling us to better understand the linkages between soil health and function and its relationship with food quality and human health. Zinc (Zn) deficiencies in Indian soils are of particular concern in the context of crop yields and food quality. This current review aims to understand the data landscapes on soil Zn and related soil properties in India, with a particular focus on three states: Uttar Pradesh (UP), Bihar, and Odisha. The scope of the review is to identify and describe data sets from national and state-wide programmes and research experiments in which soil Zn has been reported, which could be used to provide a framework for integrated surveys and would combine wider agriculture, food systems, nutrition, and public health sectors. The largest data set on soil Zn was collected under a soil health management (SHM) programme, during which the Indian government analysed more than 30 million soil samples for Zn concentration (mg/kg) from 2015 to 2019. This study showed that 39% of Indian soils are considered Zn deficient for crop production (i.e., based on a threshold of <0.6 mg/kg); soil Zn deficiency varied from 2% to 67% across different Indian states. From this survey, soil Zn deficiency was 29%, 67%, and 48% in UP, Bihar, and Odisha, respectively. Individual data points are available for re-use at the Government of India soil health card website (https://www.soilhealth.dac.gov.in/). In addition, the All India Coordinated Research Project on Micro and Secondary Nutrients and Pollutant Elements in Soils and Plants (AICRP-MSPE) programme under the Indian Council of Agricultural Research (ICAR) analysed >240,000 soil samples from 2012 to 2018 from 28 states of India and reported ~38% soil Zn deficiency in the Indian soils. There is no programme in India that currently maps micronutrients in soil and crops together using “GeoNutrition” approaches recently reported in two countries in Africa, Ethiopia, and Malawi. Future co-ordinated soil and crop micronutrient mapping in India can help us to understand better the movement of Zn (and other micronutrients) in food systems and to inform strategies to improve the Zn status in the soil, e.g., the use of Zn fertilisers for yield and agronomic biofortification, and in the edible tissues of crops, e.g., through genetic biofortification.

Experience of Nurses in Carrying Out the Main Duties and Functions of Nurses at UPT Puskesmas Panamas, Kapuas Regency, in 2023 / 2024

This research explores the experiences of nurses in carrying out their main duties and functions at the Panamas Community Health Center. Qualitative methods with a phenomenological approach are used to gain an in-depth understanding of this phenomenon. Data was collected through in-depth interviews with 12 nurses selected by purposive sampling. Data analysis using the Colaizzi method produced five main themes: (1) Nurses' activities in health services, (2) Tasks carried out by community health center nurses, (3) The importance of good health program management, (4) Management of duties and authority in health services, and (5) Shortage of health and non-health personnel and multifunctionality in health services. Research results show that nurses often have to take over the roles of doctors, administrative staff, and pharmacists due to limited human resources even though these tasks should not be their responsibility. This causes nurses to lose focus in carrying out their main duties, nurses feel that their main role as care providers is disturbed. Nurses also run various health programs and serve as physician assistants, although these roles often exceed their duties. The importance of good health program management was emphasized, as many participants experienced difficulties in achieving targets, reporting and patient monitoring. Management of tasks and authority includes handover of tasks, delegation of daily tasks, and delegation of authority, however socialization to staff has not been comprehensive. Lack of human resources causes nurses to carry out multiple roles which hinders their professional development. This research recommends strengthening competency and further training for nurses, increasing legal awareness regarding the delegation of authority, integrating health management education in the nursing curriculum, as well as increasing the number and qualifications of human resources in community health centers.

Changes in oral health status and function among older adults through professional oral care and rehabilitation exercises

Objectives: To develop a program that combines the oral health promotion program for the elderly and to investigate the effect of improving oral function by applying the oral health promotion program to elderly people using welfare facilities. Methods: From June to October 2022, a total of 29 elderly individuals utilizing welfare facilities in the Gyeongnam region were recruited. The control group underwent surveys and objective oral health assessments. The experimental group participated in an oral health promotion program, consisting of oral functional rehabilitation exercises and expert oral health management, conducted once a week for 8 weeks at the facilities. Objective oral health assessments were conducted before, during (at 4 weeks), and after (at 8 weeks) the intervention period for both groups. Results: As a result of the oral health promotion program, it was confirmed that there was an improvement effect in bad breath (p<0.001), saliva secretion amount (p<0.001), orbicularis oculi muscle (p<0.001), and plaque index (p<0.001). Conclusions: A revitalization plan is needed so that the efficient oral health promotion program for the elderly can be reflected as a systematic and professional community care oral health management program.

Effects of an Online Health Management Program for South Korean Adolescents with Complex Congenital Heart Disease during Their Transition to Adulthood: A Randomized Controlled Trial.

Adolescents with complex congenital heart disease (CHD) are at risk of experiencing complications later in life. The purpose of this study was to develop an online health management program for adolescents with complex CHD and to evaluate its effects on self-efficacy, health behavior, and health-related quality of life. A randomized controlled trial design was used. A total of 29 adolescents with complex CHD were divided into an experimental group of 15 and a control group of 14. Participants in the intervention group took part in the 4-week online health management program (weekly online group sessions, 1:1 phone coaching, dietary diary feedback, and provision of health information) developed based on self-efficacy theory, while those in the control group received standard medical follow-up. Data were collected from August 2021 to March 2022 using a questionnaire-including the Korean Self-Rated Abilities for Health Practices: Health Self-Efficacy Measure (K-SRAHP) and Pediatric Cardiac Quality of Life Inventory (PCQLI)-and an ActiGraph accelerometer to track physical activity and sleep. The intervention group showed significant improvements in health self-efficacy (p = 0.003), psychosocial impact (p = 0.013), daily step counts (p = 0.011), and moderate to vigorous-intensity physical activity (p = 0.027). Additionally, a decrease in weekend leisure time sedentary behavior (p = 0.035) was observed. However, there were no significant differences in sleep behavior between two groups. The online health management program significantly enhanced self-efficacy, health behavior, and psychosocial impact in adolescents with complex CHD. These findings will inform the development of policies for transitional medical care tailored to adolescents with complex CHD.

Comparative impact of conventional and alternative gut health management programs on plasma and tibia attributes in broiler chickens raised in commercial and research settings

Plasma and tibia attributes were investigated in broiler chickens raised on three gut health management programs in commercial farms (study 1) and research station settings (study 2). The programs were: 1) conventional antibiotics (CON), 2) raised without medically important antimicrobials (RWMIA), and 3) raised without antibiotics (RWA). Birds had free access to feed and water from placement to harvest; samples of blood and left tibia were collected on d 28 in both studies and further samples were taken on d 41 in study 2. In both studies, there were no program differences (P > 0.05) on plasma metabolites with exception of enzyme concentrations with notably higher levels of circulating plasma alkaline phosphatase (ALP) in birds reared on the RWA program (P ≤ 0.04). Differences were observed among programs for tibia length in both studies (P < 0.05). Birds reared on RWMIA exhibited significantly (P = 0.016) higher tibia ash than CON on d 41. Observed differences in the plasma enzyme concentrations, tibia length, and ash concentration suggest altered metabolism which could be linked to gut health management programs and their ability to support gut integrity and function in the absence of antibiotics.

Amenable Mortality in Children under 5: An Indicator for Identifying Inequalities in Healthcare Delivery: A Review.

Universal health coverage has been proposed as a strategy to improve health in low- and middle-income countries, but this depends on a good provision of health services. Under-5 mortality (U5M) reflects the quality of health services, and its reduction has been a milestone in modern society, reducing global mortality rates by more than two-thirds between 1990 and 2020. However, despite these impressive achievements, they are still insufficient, and most deaths in children under 5 can be prevented with the provision of timely and high-quality health services. The aim of this paper is to conduct a literature review on amenable (treatable) mortality in children under 5. This indicator is based on the concept that deaths from certain causes should not occur in the presence of timely and effective medical care. A systematic and exhaustive review of available literature on amenable mortality in children under 5 was conducted using MEDLINE/PubMed, Cochrane CENTRAL, OVID medline, Scielo, Epistemonikos, ScienceDirect, and Google Scholar in both English and Spanish. Both primary sources, such as scientific articles, and secondary sources, such as bibliographic indices, websites, and databases, were used. Results: The main cause of amenable mortality in children under 5 was respiratory disease, and the highest proportion of deaths occurred in the perinatal period. Approximately 65% of avoidable deaths in children under 5 were due to amenable mortality, that is, due to insufficient quality in the provision of health services. Most deaths in all countries and around the world are preventable, primarily through effective and timely access to healthcare (amenable mortality) and the management of public health programs focused on mothers and children (preventable mortality).

Food, bodies, health (risks): the biopolitics of organic materiality testing in the context of diet-associated health risk management practices

This article analyses the apparatus of practices dedicated to reducing long-term diet-associated health risks so as to question how risk is framed and worked upon in everyday risk governance contexts. In 2020–2021, I conducted 10 semi-structured interviews with public & environmental health researchers and programme managers at both federal (Canada) and provincial (Quebec) levels, as well as with clinical practitioners (clinical physician, dietician). I also used these interviews and the information provided by my interviewees to gather a corpus of materials comprised of clinical protocols, empirical guidelines, governmental screening programmes, and more. In the analysis, I contrast testing practices dedicated to preventing and controlling chronic conditions associated with food ingestion such as type 2 diabetes, with others dedicated to predicting and preventing health conditions associated with the ingestion of pesticides and contaminants. I use Foucauldian discourse analysis methods as well as Sheila Jasanoff’s (1999) “songlines of risk” in her analysis of environmental risk assessment practices to analyse how the risk mitigation practices under study integrate different approaches to risk and thus different ways of caring for health and bodies. This leads me to a discussion on the biopolitical approach to risk and health that informs these practices and the apparatus they constitute, contributing to orienting where the onus of the responsibility lies when it comes to managing or preventing diet-associated health conditions. I argue that the apparatus plays a role in invisibilizing the environmental factors in disease causation and reinforcing the individualisation of health (responsibility) rather than its collectivisation.

Determinants influencing health-promoting behaviors in individuals at high risks of stroke: a cross-sectional study.

Quit smoking, moderate drinking, exercise, and healthy eating habits are all known to decrease the risk of stroke. As a result, understanding the health behaviors of high risk groups for stroke is crucial. Health behavior is influenced by knowledge, social environment, and health beliefs. However, little research has been done on these relationships. For a better grasp of the relationships mentioned above, consider using the COM-B model (capability, opportunity, motivation, and behavior). The purpose of this study was to investigate the variables related to health behavior and to test the mediating effect of health beliefs. The cross-sectional study was carried out at a physical examination center of a tertiary hospital in Shanghai, China. 986 high-risk populations of stroke have been tested using the Health Behavior Scale (HBS-SP), Stroke Knowledge Questionnaire (SKQ), Health Beliefs Questionnaire (HBS), and Multidimensional Scale of Perceived Social Support (MSPSS). The structural equation modeling was used in this study. The scores for MSPSS, SKQ, HBS, and HBS-SP were 60.64 ± 13.72, 26.60 ± 9.77, 157.71 ± 34.34, and 2.46 ± 0.41, respectively. The revised model fits well (approximate root mean square error = 0.042; comparative fit index = 0.946). The health behavior was obviously and positively correlated to social Support, stroke knowledge, and health beliefs. Moreover, health belief has a mediating effect on the relation of social support, stroke knowledge, and health behavior. Chinese high risk groups for stroke have a mediate level of health behaviors. Factors associated with health behaviors are knowledge of stroke, health beliefs, and social support. The COM-B-based model can be used to explain the health behavior of individuals at risk of stroke and to guide the formulation of effective health management programs.

Tuberculosis preventive treatment uptake among people living with HIV during COVID-19 period in Addis Ababa, Ethiopia: a retrospective data review

BackgroundScreening for tuberculosis (TB) and providing TB preventive treatment (TPT) along with antiretroviral therapy is key components of human immune deficiency virus (HIV) care. The uptake of TPT during the coronavirus disease 2019 (COVID-19) period has not been adequately assessed in Addis Ababa City Administration. This study aimed at assessing TPT uptake status among People living with HIV (PLHIV) newly initiated on antiretroviral therapy during the COVID-19 period at all public hospitals of Addis Ababa City Administration, Ethiopia.MethodsA retrospective data review was conducted from April-July 2022. Routine District Health Information System 2 database was reviewed for the period from April 2020-March 2022. Proportion and mean with standard deviation were computed. Logistic regression analysis was conducted to assess factors associated with TPT completion. A p-value of < 0.05 was considered statistically significant.ResultsA total of 1,069 PLHIV, aged 18 years and above were newly initiated on antiretroviral therapy, and of these 1,059 (99.1%) underwent screening for TB symptoms. Nine hundred twelve (86.1%) were negative for TB symptoms. Overall, 78.8% (719) of cases who were negative for TB symptoms were initiated on TPT, and of these 70.5% and 22.8% were completed and discontinued TPT, respectively. Of 719 cases who were initiated on TPT, 334 (46.5%) and 385 (53.5%) were initiated on isoniazid plus rifapentine weekly for three months and Isoniazid preventive therapy daily for six months, respectively. PLHIV who were initiated on isoniazid plus rifapentine weekly for three months were more likely to complete TPT (adjusted odds ratio [AOR],1.68; 95% confidence interval [CI], 1.01, 2.79) compared to those who were initiated on Isoniazid preventive therapy daily for six months.ConclusionWhile the proportion of PLHIV screened for TB was high, TPT uptake was low and far below the national target of achieving 90% TPT coverage. Overall a considerable proportion of cases discontinued TPT in this study. Further strengthening of the programmatic management of latent TB infection among PLHIV is needed. Therefore, efforts should be made by the Addis Ababa City Administration Health Bureau authorities and program managers to strengthen the initiation and completion of TPT among PLHIV in public hospitals.

Factors Associated with Patient Engagement in a Health and Social Needs Case Management Program.

Many patients offered case management services to address their health and social needs choose not to engage. Factors that drive engagement remain unclear. We sought to understand patient characteristics associated with engagement in a social needs case management program and variability by case manager. Between August 2017 and February 2021, 43,347 Medicaid beneficiaries with an elevated risk of hospital or emergency department use were offered case management in Contra Costa County, California. Results were analyzed in 2022 using descriptive statistics and multilevel logistic regression models to examine 1) associations between patient engagement and patient characteristics and 2) variation in engagement attributable to case managers. Engagement was defined as responding to case manager outreach and documentation of at least 1 topic to mutually address. A sensitivity analysis was performed by stratifying the pre-COVID-19 and COVID-19 cohorts. A total of 16,811 (39%) of eligible patients engaged. Adjusted analyses indicate associations between higher patient engagement and female gender, age 40 and over, Black/African American race, Hispanic/Latino ethnicity, history of homelessness, and a medical history of certain chronic conditions and depressive disorder. The intraclass correlation coefficient indicates that 6% of the variation in engagement was explained at the case manager level. Medicaid patients with a history of housing instability and specific medical conditions were more likely to enroll in case management services, consistent with prior evidence that patients with greater need are more receptive to assistance. Case managers accounted for a small percentage of variation in patient engagement.

169 Association of Asthma Specialty Care and Adverse Outcomes for Children Enrolled in the Arkansas Medicaid Program

OBJECTIVES/GOALS: Specialty care for asthmatic children should prevent adverse asthma outcomes. This study of children receiving care in the Arkansas Medicaid program used a comparative effectiveness research design to test whether allergy specialty care was associated with reduced adverse asthma outcomes. METHODS/STUDY POPULATION: Using the Arkansas All Payer Claims Database we studied Medicaid-enrolled children with asthma using a propensity score greedy nearest neighbor one-to-one matching algorithm. We matched children with (treatment) and without (comparison) an allergy specialist visit in 2018. The propensity score model included 26 covariates (demographic, clinical, and social determinants of health). Multivariable adjusted logistic regression was used to estimate adverse asthma events (AAE: emergency department visit or inpatient hospitalization with a primary or secondary diagnosis of asthma in 2019). RESULTS/ANTICIPATED RESULTS: We identified 3,031 children with an allergy specialist visit in 2018, and successfully propensity-score matched 2,910 of the treatment group with a non-allergy specialist visit comparison group. The rate of AAEs in 2019 was 9.5% for individuals with an allergy specialist visit versus 10.1% among those without a specialist visit (p=0.450). The adjusted regression analysis showed 20.3% lower rates of AAEs (aOR: 0.797; 95% Confidence Interval: 0.650, 0.977; p=0.029) in 2019 for children with an allergy specialist visit in 2018 compared to those that did not. DISCUSSION/SIGNIFICANCE: Utilizing allergy specialist care was associated with better asthma outcomes in our statewide study of Arkansas Medicaid-enrolled children with asthma. Asthma quality metrics based on guideline-based recommendations for allergy specialist care should be considered in population health management programs.

Moser's Effective Management of Health and Safety Programs: A Practical Guide, fourth edition.

Moser's Effective Management of Health and Safety Programs: A Practical Guide, fourth edition.

Barriers and Facilitators to Implementing an Evidence-Based Community Health Worker Model

Community health worker (CHW) programs may improve health outcomes, increase quality of life, and reduce hospitalizations and cost of care. However, knowledge is limited on the barriers and facilitators associated with scaling evidence-based CHW programs to maximize their public health outcomes. To identify barriers and facilitators to implementing an evidence-based CHW model. This qualitative study examined perspectives of Individualized Management of Person-Centered Targets (IMPaCT) program staff (health system leaders, program managers, and community health workers) and patients receiving the intervention between March 9, 2020, and July 22, 2021, at 5 institutionally and geographically diverse health systems across the US. The collected data were analyzed between December 1, 2021, and April 27, 2022. Program staff were recruited via purposive sampling, and patients were recruited via convenience sampling. The disease-agnostic IMPaCT CHW model includes a standardized implementation approach and a structured set of theory-informed intervention components to create and achieve individualized action plans. Interview guides were informed by the Consolidated Framework for Implementation Research. A rapid qualitative analytic technique was used to identify key themes, which were categorized into barriers and facilitators associated with framework ecological domains. Of a total 41 individuals invited, 39 agreed to participate (95% response rate; mean [SD] age, 45.0 [12.6] years; 30 women). General barriers included economic and policy constraints, including insufficient funding for CHW programs, clinical integration challenges, and CHW difficulty with maintaining boundaries. Program-specific barriers included insufficiently tailored materials for certain populations and upfront and ongoing program costs. General facilitators included CHWs' interpersonal skills and life experiences. Program-specific facilitators included the model's strong evidence base, supportive implementation team, and program design that enabled relationship building and engagement. Additional themes were cited as both barriers and facilitators, including the COVID-19 pandemic, organizational leadership, IMPaCT training, and program fidelity. These findings suggest growing recognition of the importance of CHWs to improving health equity and population health. Barriers identified point to important policy and practice implications for CHW programs more broadly, including the need for continued attention to improving clinical integration and the need for sustainable program financing to preserve the longevity of this workforce.