Safety Net Providers Research Articles

Identifying violence against persons at a safety-net hospital: Evidence from the first 6 months of implementation.

To examine the prevalence and predictors of screening for violence against persons and victim service utilization within an integrated safety-net health system. Emergency Department (ED) at Parkland Hospital-Dallas County's largest safety-net provider of services for minority and underinsured and uninsured patients. Prospective, longitudinal study during the first 6 months of a universal violence against persons screener. Health records were extracted for all patients with a visit to the ED between January and July, 2021. Modeling described the patient population across screening (screened vs. not screened) and, among those screened, the results (positive vs. negative), average time spent in the ED, and referral patterns for victim services. During the study period, 65,563 unique patients with 95,555 encounters occurred. Seventy-one percent (n=67,535) were screened for violence against persons and, of those, 2% screened positive (n=1349). Of the patients who screened positive, 1178 (87%) were referred to and 806 (60%) received care at victim services. Implementing screening did not increase the length of stay at ED. Systematic implementation of comprehensive violence screening at a safety-net system can result in robust identification and timely referrals to victim services.

Antecedents of geographical expansion: The case of federally qualified health centers.

Federally qualified health centers (FQHCs) are pivotal safety net primary care providers for the medically underserved. FQHCs have complex organizational designs, with many FQHCs providing care at multiple physical locations ("sites"). The number of sites, however, varies considerably between FQHCs, which can have important implications for differential access that may perpetuate disparities in quality of care. The objective of this study is to explore the organizational and environmental antecedents of the number of sites operated by each FQHC. The findings of this study contribute to a better understanding of FQHCs' expansion that has vital implications for cost and access outcomes. The study is based on data between the years 2012 and 2018. Using multivariate growth curve modeling, we analyzed the final sample, consisting of 5,482 FQHC-years. The level of competition, measured as the number of FQHC sites in the Primary Care Service Area (PCSA) and the number of primary care physicians per 1,000 PCSA residents, was positively associated with the number of FQHC sites. The number of patients, the level of federal grant, and the year were also positively associated with the number of FQHC sites, whereas percentage of Medicaid patients; workforce supply, measured as primary care physician assistants per 1,000 PCSA residents; Medicaid expansion; and state/local funding available for FQHCs were not. Findings of this study indicate that competition, especially between peer FQHCs, is significantly associated with FQHC expansion. This result suggests that FQHC managers and policymakers may closely monitor cost, access, and quality implications of competition and FQHC expansion.

The awareness of Cervical Cancer Screening among Appalachian Women: Review Article

There is a long tradition of negative experiences with cancer among Appalachian women that manifests as avoidance behaviors in seeking screening and follow up because of fear of a cancer diagnosis. The avoidance is usually seen as ‘passive refusal,’ but also occurs in an active form as refusal to obtain services even when offered. This problem is compounded by poverty, which influences many parts of life and is associated with lack of transportation, child care, and exclusive reliance on public health departments and other safety net health care providers to seek cancer screening. Pap tests have reduced the annual incidence cervical cancers.
 The study aims to overview cervical cancer methods and recommendations among women in reproductive age.

Dental safety net providers’ experiences with service delivery during the first year of COVID-19 should inform dental pandemic preparedness

BackgroundCOVID-19 disrupted oral health care delivery and revealed gaps in dental public health emergency preparedness and response (PHEPR). Emerging dental PHEPR frameworks can be strengthened by means of understanding the experiences of the discipline’s frontline workers—dental safety net providers—during the initial phase of the COVID-19 pandemic. MethodsExperienced qualitative researchers interviewed dental safety net directors and clinicians (n = 21) in 6 states to understand their experiences delivering care from March 2020 through February 2021. Interview transcriptions were analyzed using iterative codes to identify major and minor themes. Conventional qualitative validity checks were used continuously to ensure impartiality and rigor. ResultsThree major themes were identified: unpredictability caused concerns among staff members and patients, while also deepening fulfilling collaborations; care delivery was guided by means of various resources that balanced safety, flexibility, and respect for autonomy; and pandemic-driven changes to oral health care delivery are timely, long-lasting, and can be somewhat fraught. ConclusionsThe human, material, and policy resources that providers used to control infections, serve vulnerable patients, maintain clinic solvency, and address provider burnout during the first year of the COVID-19 pandemic can improve dental PHEPR. Practical ImplicationsDental PHEPR should address concerns beyond infection control within and between practice models, governmental agencies, and professional organizations. Examples of such concerns include, but are not limited to, guideline synchronization, materials exigencies, task shifting, and provider resilience.

Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018.

Demographic, Behavioral, and Clinical Characteristics of Persons Seeking Care at Sexually Transmitted Disease Clinics - 14 Sites, STD Surveillance Network, United States, 2010-2018.

Telephone vs. Video Visits During COVID-19: Safety-Net Provider Perspectives.

To review the frequency as well as the pros and cons of telephone and video-enabled telemedicine during the first 9 months of the Coronavirus disease 2019 (COVID-19) pandemic as experienced by safety net providers across New York State (NYS). Analysis of visits to 36 community health centers (CHCs) in NYS by modality (telephone vs video) from February to November 2020. Semi-structured interviews with 25 primary care, behavioral health, and pediatric providers from 8 CHCs. In the week following the NYS stay-at-home order, video and telephone visits rose from 3.4 and 0% of total visits to 14.9 and 22.3%. At its peak, more than 60% of visits were conducted via telemedicine (April 2020) before tapering off to about 30% of visits (August 2020). Providers expressed a strong preference for video visits, particularly for situations when visual assessments were needed. Yet, more visits were conducted over telephone than video at all points throughout the pandemic. Video-specific advantages included enhanced ability to engage patients and use of visual cues to get a comprehensive look into the patient's life, including social supports, hygiene, and medication adherence. Telephone presented unique benefits, including greater privacy, feasibility, and ease of use that make it critical to engage with key populations and as a backup for when video was not an option. Despite challenges, providers reported positive experiences delivering care remotely using both telephone and video during the COVID-19 pandemic and believe both modalities are critical for enabling access to care in the safety net.

Safety Net Provider Attitudes Toward Smoking Cessation Treatment.

Background: Cigarette smoking, which poses significant health risks, is prevalent among vulnerable populations commonly treated by safety net providers. A large-scale implementation science project on specialty tobacco use treatment was launched within the Los Angeles County Health Agency. The first phase of this study seeks to summarize and compare smoking cessation treatment attitudes of providers at the Department of Health Services (DHS) and Department of Mental Health (DMH).Methods: In total, 467 safety net health care providers (DHS = 322; DMH = 145) completed a survey inquiring about attitudes on smoking cessation treatment consisting of locally developed items and those informed by a scale on readiness for organizational change. Descriptive statistics and non-parametric tests were conducted to examine treatment attitudes for DHS and DMH providers.Results: Between agencies, providers largely reported similar attitudes on smoking cessation treatment and expressed positive beliefs regarding the efficacy of smoking cessation aids. Providers slightly or moderately agreed with being prepared to identify and diagnose tobacco use among patients. DMH providers stated that identification of tobacco use was less in line with their job responsibilities (p < 0.0001) and less strongly agreed that varenicline is effective for smoking cessation (p = 0.003), compared with DHS providers.Conclusions: Providers supported smoking cessation aid efficacy but may benefit from additional training on identification and treatment of tobacco use. These findings support the implementation of specialty tobacco cessation treatment programs with training on medications in safety net health care systems, which has the potential to yield large-scale public health benefits.

FQHC Designation and Safety Net Patient Revenue Associated with Primary Care Practice Capabilities for Access and Quality.

Concerns exist about the ability of safety net health care organizations to participate in US health care reform. Primary care practices are key to several efforts, but little is known about how capabilities of primary care practices serving a high share of disadvantaged patients compare to other practices. To assess capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients. We analyzed data from the National Survey of Healthcare Organizations and Systems (response rate 46.8%), conducted 2017-2018. A total of 2190 medical practices with at least three adult primary care physicians. Our key exposures are payer mix and federally qualified health center (FQHC) designation. We classified practices as safety net if they reported a combined total of at least 25% of annual revenue from uninsured or Medicaid patients; we then further classified safety net practices into those that identified as an FQHC and those that did not. FQHCs were more likely than other safety net practices and non-safety net practices to offer early or late appointments (79%, 55%, 62%; p=0.001) and weekend appointments (56%, 39%, 42%; p=0.03). FQHCs more often provided medication-assisted treatment for opioid use disorders (43%, 27%, 25%; p=0.004) and behavioral health services (82%, 50%, 36%; p<0.001). FQHCs were more likely to screen patients for social and financial needs. However, FQHCs and other safety net providers had more limited electronic health record (EHR) capabilities (61%, 71%, 80%; p<0.001). FQHCs were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities.

Commentary on “A CLIMATE: A Tool for Assessment of Climate-Change–Related Health Consequences in the Emergency Department”

The health manifestations of climate change are becoming increasingly common and present urgent and complex challenges for emergency clinicians.1 As temperatures rise, air quality worsens, extreme weather events become more frequent, and those who need medical care turn to their local emergency department as their primary point of health system access. Although climate change may stress many aspects of the health system, emergency care—on the front lines of acute care nationwide and the nation's primary safety net provider—stands to bear the largest burden.

HepCCATT: a multilevel intervention for hepatitis C among vulnerable populations in Chicago.

Hepatitis C infection could be eliminated. Underdiagnosis and lack of treatment are the barriers to cure, especially for vulnerable populations (i.e. unable to pay for health care). A multilevel intervention from September 2014 to September 2019 focused on the providers and organizations in 'the safety net' (providing health care to populations unable to pay), including: (i) public education, (ii) training for primary care providers (PCPs) and case managers, (iii) case management for high-risk populations, (iv) policy advice and (v) a registry (Registry) for 13 health centers contributing data. The project tracked the number of PCPs trained and, among Registry sites, the number of people screened, engaged in care (i.e. clinical follow-up after diagnosis), treated and/or cured. In Chicago, 215 prescribing PCPs and 56 other health professionals, 86% of whom work in the safety net, were trained to manage hepatitis C. Among Registry sites, there was a 137% increase in antibody screening and a 32% increase in current hepatitis C diagnoses. Engagement in care rose by 18%. Hepatitis C Community Alliance to Test and Treat (HepCCATT) successfully targeted safety net providers and organizations with a comprehensive care approach. While there were challenges, HepCCATT observed increased hepatitis C screening, diagnosis and engagement in care in the Chicago community.

A Technical Assistance Curriculum for Expanding Sustainable School-Based Oral Health Programs in the Carolinas' Dental Safety Net.

PurposeSchool-based oral health programs (SBOHPs) provide opportunities to address oral health inequities by providing convenient access points for care. No published guidelines on SBOHP implementation existed. Our work describes how philanthropic, public, and academic organizations partnered to support dental safety net providers with designing comprehensive SBOHPs in North and South Carolina.DescriptionA multi-sector leadership team was established to manage a new SBOHP philanthropic-funded grant program organized into two phases, Readiness and Implementation, with the former a 6-month planning period in preparation of the latter. Readiness included technical assistance (TA) delivered through coaching and 15 online learning modules organized in four domains: operations, finance, enabling services, and impact. Organizations could apply for implementation grants after successful TA completion. Process evaluation was used including a Readiness Stoplight Report for tracking progression.AssessmentTen Readiness grantees completed the TA. A variety of models resulted, including mobile, portable and fixed clinics. Descriptive analysis was conducted on the readiness stoplight reports. Components of the operation and finance domains required were the most time-intensive, specifically the development of policy manuals, production goals, and financial performance tracking.ConclusionThe program’s structure resulted in (a) a two-state learning community, (b) SBOHP practice and policy alignment, and (c) coordinated program distribution. TA improvements are planned to account for COVID-19 threats, including school closures, space limitations, and transmission fears. Telehealth, non-aerosolizing procedures, and improved scheduling and communication can address concerns. Organizations considering SBOHPs should explore similar recommendations to navigate adverse circumstances.

Self-actuated telematics implementation aimed at insurance covers of fleets

These benefits of the Usages-Based Insurances for the car that covers the overall traditional ratings techniques are also have been examined for writing more than the four decades. Despite these adoption in the insurance the markets act as a moderate. This paper looks to set up the practicality of presenting armada the Telematics based Insurances by the investigating the view of the insurance administrators, following specialist organizations and corporate armada proprietors. At its center, the investigation includes a kind of SWOT-examination to assess the Telematics based Insurances against customary premium rating systems. 25 keys partners in the Malta, a nation with an insurance industry that speaks to others in microcosm, were met to build up our investigation. Everyone affirm so that neighborhood back up plans have interests in such insurance conspires as upgraded armada the board and observing convert into an improved insurance hazard. The discoveries introduced here have suggestions for all partners as this is contend for telematics upgradation of armada board, TBI improves risk administration for back up plans and appropriation of this innovation is subject to telematics suppliers expanding the apparent control by safety net providers over dealing with this innovation.

How the Trump Administration's Pandemic Health Care Response Failed Racial Health Equity: Case Studies of Structural Racism and a Call for Equity Mindfulness in Federal Health Policy Making

The racial health equity implications of the Trump administration's response to the COVID-19 pandemic. We focus on four key health care policy decisions made by the administration in response to the public health emergency: rejecting a special Marketplace enrollment period, failing to use its full powers to enhance state Medicaid emergency options, refusing to suspend the public charge rule, and failing to target provider relief funds to providers serving the uninsured. In each case, the administration's policy choices intensified, rather than mitigated, racial health inequality. Its choices had a disproportionate adverse impact on minority populations and patients who are more likely to depend on public programs, be poor, experience pandemic-related job loss, lack insurance, rely on health care safety net providers, and be exposed to public charge sanctions. Ending structural racism in health care and promoting racial health care equity demands an equity-mindful approach to the pursuit of policies that enhance-rather than undermine-health care accessibility and effectiveness and resources for the poorest communities and the providers that serve them.

Implementing blockchain technologies for health insurance claim processing in hospitals

Blockchain is getting expanding consideration from academy and industry, since it is viewed as an achievement innovation that could bring advantages to a wide range of divisions. Insurance is one of the sectors that started to investigate the possibilities of blockchain. It can be utilized over the protection esteem bind because of its capacity to offer longvital advantages, for example, lower operational expenses as decreased duplication of procedures, diminished counter party dangers, expanded robotization of procedures, and secure and decentralized exchanges. Medical coverage: A blockchain that interfaces clinics, doctors, lab merchants and safety net providers could empower a consistent stream of well being data for improved endorsing and approving of cases. The protection business is vigorously reliant on numerous procedures between executing parties for starting, keeping up and shutting differing sort of arrangements. The major concerns involved in executing the claims are the time involved for processing and settlement and also security. The objective of our paper is to develop a blockchain based on health insurance claim processing system which will help insurance companies build a secure network which is free from tampering. It also aims to build the structure of an effective methodology for handling protection relevant exchanges dependent on a blockchain-empowered stage.

Telehealth in a Washington, DC African American Religious Community at the Onset of COVID-19: Showcasing a Virtual Health Ministry Project

ABSTRACT The COVID-19 pandemic, with its disproportionate health and social-economic effects on the African American community, mandates bold new models to ensure that vulnerable communities receive maximum support and services. This article highlights a social work practice innovation model adapted from a traditional social work casework model. A group of multidisciplinary leaders strategized about ways to meet the needs of older African-American adults as many traditional government agencies were not sending staff into the community due to COVID-19. The result birthed a faith-based virtual health ministry. Using a faith-based virtual health ministry, church lay leaders and other professionals partnered with Master of Social Work (MSW) level social workers using a telehealth platform with technology tools to assist shut-in older adults in Washington, DC. The project uses a structured, coordinated care telehealth support model for a marginalized population. Telehealth within the rubric of healthcare models has not been demonstrated in African American communities, particularly older adults. Meeting the needs of shut-in older adults and marginalized groups within the COVID-19 pandemic may show innovation that can be translational for local governments and traditional safety net providers within a social work milieu.

Changing Safety Net Healthcare Systems to Age-Friendly Healthcare Systems: Lessons Learned

Federally Qualified Health Centers (FQHC) are important safety net providers in disadvantaged communities. As outpatient clinics in these areas, they qualify for specific reimbursement systems under Medicare and Medicaid. Age-friendly health care is an urgent need to be able to provide quality healthcare to more than 46 million Americans age 65 and older, with that number projected to double to more than 98 million by 2060. Friendly healthcare systems require a focus on the 4Ms framework and is focused on improving the health of people at every life stage and in every community across the country. The 4Ms are as follows: 1) What Matters: Aligning care with each older adult’s specific health outcome goals and care preferences; 2) Medications: If medications are necessary, use age-friendly medications that do not interfere with What Matters, Mentation or Mobility; 3) Mentation: Prevent, identify, treat and manage depression, dementia and delirium across settings of care and 4) Mobility: Ensure that older adults move safely every day in order to maintain function and do What Matters. An age-friendly health system is one in which every older adult’s care is guided by these evidence-based practices (the 4Ms), where the care causes no harms, and where the care is consistent with what matters to older adults and their families. In this symposium five Geriatric Workforce Enhancement Programs at five diverse universities will share their experiences with supporting FQHC in their areas to become age-friendly healthcare systems. The unique lessons learned at these different sites will be shared.

The reliability and feasibility of teledermatology to diagnose patients referred from the emergency department to outpatient dermatology

The reliability and feasibility of teledermatology to diagnose patients referred from the emergency department to outpatient dermatology

Real-World Utilization and Outcomes of the Veterans Health Administration's Smoking Cessation Text Message Program.

Smoking cessation mobile health (mHealth) programs are effective and have been recommended for integration into health care services but have not been evaluated in real-world health care settings. The Veterans Health Administration, a safety net health care provider, provides health care for 9 million US military veterans. Veterans Health Administration implemented the SmokefreeVET text message program in 2013. A retrospective evaluation of 6153 SmokefreeVET subscribers was conducted. The primary outcome was 30-day self-reported abstinence at 6 months. Secondary outcomes included percentage of opt outs, program completers, and 30-day self-reported abstinence at 3 months. SmokefreeVET subscribers were on average 47.5 years old and 71.4% male. Smoking cessation medication use was reported by 11.5% of subscribers at the start of their quit attempt and subscribers enrolled in the program for an average of 29 days. Subscribers who were younger, female, and heavier smokers were more likely to opt out of the six-week program early. The abstinence rate for the primary outcome, self-reported 30-day abstinence at 6 months among all subscribers was 3.7%. SmokefreeVET enrolled a younger and more female population of subscribers than other studies of veterans interested in tobacco treatment. The mHealth program was generally acceptable to veterans, yet strategies to increase retention may improve completion rates and outcomes. In this real-world setting, nearly half of the mHealth program subscribers combined use of the text program with smoking cessation medication. Further study of the optimal combination of mHealth with smoking cessation treatments is needed. mHealth smoking cessation programs can be effectively implemented within real-world health care settings, even in those serving disadvantaged populations. Further research to improve mHealth program efficacy and integration into clinical settings will increase the population-level impact of these effective smoking cessation programs.

Quality of Diabetes and Hypertension Management at the DAWN (Dedicated to Aurora's Wellness and Needs) Student-Run Free Clinic.

IntroductionStudent-Run Free Clinics (SRFCs) are part of the safety-net healthcare system. Given variable settings and models, relatively little is known about the quality of care in these settings.MethodsA mixed-methods evaluation of diabetes and hypertension management was conducted for patients initiating care from March 1, 2015, to September 31, 2016, at the DAWN (Dedicated to Aurora’s Wellness and Needs) SRFC. Retrospective chart review assessed whether patients received recommended screening tests (process outcomes) and achieved disease control (short-term outcomes). These outcomes were compared to a local community health center (CHC), a local federally qualified health center (FQHC) network, and Colorado Medicaid (CoM) using one proportion t-tests. In-depth case studies of randomly selected individuals with good and poor disease control identified targets for quality improvement through nominal group technique.ResultsDiabetic patients (n=30) were recommended screening, including HbA1c (93.3%) (vs. 77.8% with CoM, p=0.04), nephropathy care (70%) (vs. 85.4% with CoM, p=0.02), retinopathy examination (30%) (vs. 40.47% with CoM, p=0.24). Diabetic short-term outcomes showed 46.6% with poor control (vs. 61.1% at the CHC, p=0.10; vs. 30.62% at the FQHC, p=0.06; vs. 55% with CoM, p=0.10). Patients with hypertension (n=75) 33.3% had controlled (<140/90) blood pressure (vs. 49.2% at the CHC, p<0.01; vs. 61.1% at the FQHC, p<0.01; vs. 58.9% with CoM, p<0.01). Themes for quality improvement included improving follow-up, documentation and data collection, clinic processes, and addressing barriers to care.DiscussionDAWN outcomes were comparable to other safety-net providers for diabetes, similar to findings in evaluations conducted by other SRFCs. However, DAWN did not have equivalent outcomes for hypertension in contrast to other published findings from SRFCs. Poor access to care and baseline chronic disease control among DAWN patients may have contributed to these findings.ConclusionsWhile this study is not directly generalizable to all SRFC models and communities, these results contribute to the growing body of data around SRFCs and chronic disease management and indicate that SRFCs may have a role in the safety-net healthcare system. However, more study is needed to ensure that SRFCs can provide high-quality care because otherwise efforts should focus on other strategies to expand access within the safety-net system.

An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net

BackgroundPatients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal.ObjectiveBecause safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net.MethodsWe conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes.ResultsOf the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement.ConclusionsProviders recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.