Urban Community Health Center Research Articles

“There’s always somebody that you can identify with”: a qualitative study of patient perspectives on buprenorphine group medical visits

Abstract Background Buprenorphine (BUP) treatment has been successfully integrated into primary care and other general medical settings; however, potential BUP prescribers frequently report inadequate training and resources to provide psychosocial counseling as barriers to providing care. Group medical visits, which combine psychosocial support and chronic condition management, have been described for BUP treatment, but few studies have explored what is gained and/or lost by offering BUP treatment in groups instead of individual visits. Methods Five focus groups with 3–11 participants each were conducted at an urban community health center that housed a mature office-based BUP treatment program. Participants were persons with opioid use disorder (OUD) who had previously received BUP treatment. A semi-structured interview guide covered the following domains: experience with BUP, experience with group counseling, and preferences for BUP in a group format or individual setting. Qualitative analysis followed a modified grounded theory approach. Results Of 33 participants, 28 were male, median age range was 50–54, 20 identified as Hispanic/Latinx, and 24 reported past experiences with substance use disorder treatment groups. Four main themes were: (1) Groups can address the psychological aspects of addiction; (2) Groups introduce positive peer support; (3) Balancing OUD treatment and management of other chronic conditions; (4) Groups must be voluntary. Conclusions Findings demonstrate that many persons with OUD taking BUP desire assistance with recovery skills, peer support, and learning about the risks and benefits of BUP. Group medical visits can efficiently deliver these services in primary care, but findings also emphasize that group counseling will be best received when voluntary and group members are committed and authentic.

An Explorative Study on Knowledge, Attitudes, and Coronavirus Disease 2019 Vaccine Intention among Parents in India.

India's National COVID Vaccination Program recommended vaccination of children ages 6-12 years in April 2022. This study assessed vaccine acceptance among mothers to better understand potential barriers and facilitators of national acceptance of pediatric coronavirus disease 2019 (COVID-19) vaccination. Qualitative data were collected through three focus group discussions (FGDs) with mothers who had children younger than 12 years of age; FGD-1 was composed of mothers who worked at a tertiary medical center in India, whereas FGD-2 and FGD-3 were composed of mothers who sought care at urban and rural community health centers. Investigators recorded, transcribed, translated, and analyzed FGDs by inductive thematic analysis. Emerging themes related to pediatric COVID-19 vaccination were categorized as knowledge and awareness, attitudes and perception, vaccine intent and facilitators, and future recommendations to promote vaccine uptake. FGD-2 and FGD-3 participants displayed limited knowledge and false beliefs regarding the pediatric COVID-19 vaccine, but mothers in FGD-1 demonstrated adequate knowledge, likely because they are health care providers. Mothers in all three FGDs expressed COVID-19 vaccine hesitancy because of concerns of side effects and low disease prevalence in children. They reported much more fear about giving the vaccine to their children than they felt about receiving it themselves. Overall, education was negatively correlated with vaccine knowledge, but mothers in all groups shared similar hesitancy about their intention to accept the vaccine for their children. Educating parents in India about the COVID-19 vaccine, especially its safety and efficacy in children, is crucial to the success of a national vaccine program.

The equivalent value (EV)-based workload assessment of primary healthcare workers in Beijing, China

BackgroundQuantitative methods for estimating the workload of primary healthcare (PHC) workers are essential for improving the performance of PHC institutions. However, measuring the workload of PHC workers is challenging due to the diverse and complex range of services covered by PHC. This study aims to use an equivalent value (EV)-based approach to assess the workload of PHC workers and inform policymakers about the current workload burden in Beijing, China.MethodsThe EV-based workload assessment system was designed by three main steps: identifying the list of essential PHC service items provided by PHC workers, quantifying the EV of each service item, and calculating the corresponding workload for PHC workers and community health centers (CHCs). The study included 18 CHCs, which were divided into three groups based on population density and topography: Group I (eight urban CHCs), Group II (six CHCs in semi-mountainous areas), and Group III (four CHCs in mountainous areas). Data were collected from local health information system, which automatically collected real-time service volume data for 500 PHC service items at 18 CHCs in the sample district in Beijing from 2017 to 2021.ResultsThis study identified 503 essential PHC service items and defined their EVs. The theoretical full-capacity workload per PHC worker was 6024 EVs, serving as the base workload. The actual annual workload per PHC worker was 7240.0 EVs during 2017–2021. The base workload per budgeted position for the three types of CHCs was 6468.6 EVs for Group I, 5268.5 EVs for Group II, and 5038.7 EVs for Group III. Compared with the actual workload of 7702.3 EVs, 6568.3 EVs, and 5979.0 EVs in each group, respectively, all PHC workers in the sample district were overburdened during the study period.ConclusionsThe EV-based method provides a feasible solution for comprehensively assessing the workload of publicly funded PHC institutions in other regions. This study offers valuable insights to help local policymakers understand the workload burden of PHC workers, objectively evaluate their performance, and guide future health workforce planning.

“Round Peg in a Square Hole”: Lessons from Community Health Promotion Practice on Dynamics of Accountability, Reporting and Evaluation, and Governance

This paper presents results from a small-scale institutional ethnography study of reporting requirements and evaluation practices in two urban community health centers (CHCs), as a sample of community-based nonprofit organizations that focus on social justice and health equity. The study illuminated complex relationships among accountability, reporting and evaluation, and governance. Among the CHCs, reporting and evaluation practices consistent with goals of obtaining social justice and health equity were undermined by an imbalance toward funder-oriented functional accountability. Analysis of accountability and reporting practices as systemic factors shaping knowledge production, decision-making, and action revealed notable consequences for CHCs’ health promotion practice. This paper proposes a wholistic accountability model to encourage equitable power relations in evaluation, enable participatory methods, and better align CHC knowledge production and governance systems with their health promotion goals. This study further adds to the growing literature supporting critical attention to nonprofit accountability in the context of systems change work.

Abstract P316: Beyond the Cuff: Revolutionizing Hypertension Care through Human-Centered Design and Tech-Driven Solutions in an Urban Community Health Center

Community Health Centers serve populations burdened with cardiovascular disease due to social determinants of health, necessitating innovative solutions in resource-limited environments. Wi-Fi/Bluetooth-enabled home blood pressure monitors have emerged as clinical tools for diagnosing, monitoring, and managing hypertension. The real time data enables timely interventions by care teams of patients being monitored. A multifaceted approach beyond clinic settings, supported by digital tools, can help reduce healthcare costs by preventing avoidable emergency room visits. We posited that implementing a self-monitored blood pressure (SMBP) program, supplemented by holistic, human-centered patient coaching and feedback, in a community health center setting would enhance patient engagement, medication adherence, and hypertension control. We designed and piloted a small SMBP program using Bluetooth-enabled blood pressure devices, targeting adult patients with documented uncontrolled blood pressure seen in our health centers in a 6- month window. This was further augmented by a holistic, human-centered individual and group-level coaching session. Patients enrolled in the SMBP program received comprehensive education on hypertension, including medication management and lifestyle changes, as well as data-driven feedback on their blood pressure profiles during virtual group and individual outreach sessions. The program's goals were to increase patient engagement in their care, adherence to interventions, leading to better blood pressure control. Results were significant: 22 of 32 participants graduated, achieving improved blood pressure control with medication and lifestyle changes. Average reductions of 17 mmHg in systolic and 6 mmHg in diastolic blood pressure were noted after being in the program for an average of three months. Among the graduates, 50% required medication intensification, and 60% adopted lifestyle changes, indicating the program's effectiveness. Our pilot affirmed the efficacy of utilizing digital solutions and integrated strategies to improve hypertension control and empower patients to make timely changes with data feedback. The key findings from our pilot led to the expansion of the SMBP program to serve a larger cohort of patients in our clinic. This underscores the critical role of patient engagement, technology integration, and an integrated approach to care in improving hypertension management, particularly in underserved communities.

Early Infant Male Circumcision Decisions in Zambia: Demographic and Familial Influences

Public health initiatives in Zambia encourage the uptake of early infant male circumcision (EIMC) as an HIV prevention strategy. This study assessed EIMC parental decision-making during perinatal care in Lusaka, Zambia, focusing on the influence of sociodemographic factors, family, and friends. A longitudinal pilot perinatal intervention, Like Father Like Son (LFLS), was implemented among 300 couples attending antenatal clinics in four urban community health centers. Participants were assessed postpartum regarding subsequent EIMC decisions. Partners, religion, and marital status were associated with the EIMC decision-making. Large scale EIMC promotion interventions that target both parents during perinatal care should be explored.

Factors contributing to differences in cervical cancer screening in rural and urban community health centers.

Community health centers (CHCs) provide historically marginalized populations with primary care, including cancer screening. Previous studies have reported that women living in rural areas are less likely to be up to date with cervical cancer screening than women living in urban areas. However, little is known about rural-urban differences in cervical cancer screening in CHCs and the contributing factors, and whether such differences changed during the COVID-19 pandemic. Using 8-year pooled Uniform Data System (2014-2021) data and Oaxaca-Blinder decomposition, the extent to which CHC- and catchment area-level characteristics explained rural-urban differences in up-to-date cervical cancer screening was estimated. Up-to-date cervical cancer screening was lower in rural CHCs than urban CHCs (38.2% vs 43.0% during 2014-2019), and this difference increased during the pandemic (43.5% vs 49.0%). The rural-urban difference in cervical cancer screening in 2014-2019 was mostly explained by differences in CHC-level proportions of patients with limited English proficiency (55.9%) or income below the poverty level (12.3%) and females aged 21 to 64years (9.8%), and catchment area-level's unemployment (3.4%) and primary care physician density (3.2%). However, Medicaid (-48.5%) or no insurance (-19.6%) counterbalanced the differences between rural-urban CHCs. The contribution of these factors to rural-urban differences in cervical cancer screening generally increased in 2020-2021. Rural-urban differences in cervical cancer screening were mostly explained by multiple CHC-level and catchment area-level characteristics. The findings call for tailored interventions, such as providing resources and language services, to improve cancer screening utilization among uninsured, Medicaid, and patients with limited English proficiencyin rural CHCs.

Organizational Learning and Primary Care Nurses’ Work Performance and Well‐Being: A Multilevel Linear Analysis in a Developing Country

Aim. This study aims to investigate the level of organizational learning within urban Chinese Community Health Centres and reveal its potential association with primary care nurses’ work performance and well‐being. Background. Globally, there is a push to establish learning healthcare systems for complex health reform challenges. Existing studies on organizational learning mainly focus on North American and European hospital settings, offering limited insights into primary care environments, particularly in developing countries. Design. Cross‐sectional study. Methods. We recruited 175 nurses from 38 community health centres in four Chinese cities (Shanghai, Shenzhen, Tianjin, and Jinan) using convenience sampling. Trained research assistants conducted face‐to‐face surveys, measuring organizational learning with the Learning Orientation Scale. Nurse‐level outcomes included self‐directed learning, quality of care, organizational commitment, and work stress. Data analysis employed multilevel linear modelling. Results. The 38 community health centres displayed a relatively high level of organizational learning, and there was a positive and significant association between organizational learning within community health centres and nurses’ self‐directed learning as well as the quality of care. However, there was no significant association between organizational learning and nurses’ organizational commitment or work stress. Conclusion. This study demonstrates a high‐level organizational learning capacity in urban community health centres in China. It provides a new perspective on the potential relationship between CHCs’ organizational learning and primary care nurses’ well‐being and work performance. Further research is needed to clarify unexpected findings and identify factors promoting organizational learning in primary care settings. Implications for Nursing Management. In China’s evolving primary care system, nurses play a vital role amidst physician shortages. Policy should prioritize internal management reform alongside structural changes. This study highlights the importance of fostering organizational learning in primary care settings. Strategic interventions should promote a learning culture in CHCs, which may enhance nurses’ self‐directed learning and improve the quality of care.

Maximizing the impact of reach out and read literacy promotion:anticipatory guidance and modeling.

Reach Out and Read (ROR) is a multi-component pediatric literacy promotion intervention. However, few studies link ROR components to outcomes. We examine associations between receipt of (1) multiple ROR components and (2) clinician modeling, a potential best practice, with enhanced home literacy environments (EHLEs) among Latino families. We conducted secondary analyses of cross-sectional enrollment data from a randomized clinical trial at three urban community health centers between November 2020 and June 2023. Latino parents with infants 6-<9 months old were surveyed about ROR component receipt (children's book, anticipatory guidance, modeling) and EHLE (StimQ2- Infant Read Scale). We used mixed models with clinician as a random effect, adjusting for covariates. 440 Latino parent-infant dyads were included. With no components as the reference category, receipt of 1 component was not associated with EHLE. Receipt of 2 components (standardized beta = 0.27; 95%CI: 0.12-0.42) and 3 components (standardized beta = 0.33; 95% CI: 0.19-0.47) were associated with EHLE. In separate analyses, modeling was associated with EHLE (standardized beta = 0.16; 95%CI: 0.06-0.26). Findings support modeling as a core ROR component. Programs seeking to enhance equity by promoting EHLE should utilize such strategies as anticipatory guidance and clinician modeling in addition to book distribution. Reach Out and Read, a multi-component literacy promotion intervention, leverages primary care to promote equity in children's early language experiences. However, few studies link Reach Out and Read components to outcomes. Among Latino parent-infant dyads, we found that implementation of two and three components, compared to none, was associated with enhanced home literacy environments, following a dose response pattern. Parent report of clinician modeling was associated with enhanced home literacy environments. Literacy promotion programs seeking to enhance equity by promoting enhanced home literacy environments should utilize strategies in addition to book distribution, including anticipatory guidance and modeling, to maximize impact.

Psychometric Properties and Clinical Utility of CBCL and P-GBI Sleep Items in Children and Adolescents

ABSTRACT Objective Sleep is crucial to overall health, playing a complex role in a wide range of mental health concerns in children and adults. Nevertheless, clinicians may not routinely assess sleep problems due to lack of awareness or limitations such as cost or time. Scoring sleep-related items embedded on broader scales may help clinicians get more out of tools they are already using. The current study explores evidence of reliability, validity, and clinical utility of sleep-related items embedded on two caregiver-report tools: the Child Behavior Checklist (CBCL) and Parent General Behavior Inventory (P-GBI). Method Youth aged 5–18 years and their parents were recruited from both an academic medical center (N = 759) and an urban community health center (N = 618). Caregivers completed the CBCL and P-GBI as part of a more comprehensive outpatient evaluation. Exploratory factor analyses, multi-group confirmatory factor analyses, and graded response models evaluated dimensionality, reliability, and invariance across samples. Correlations and receiver operating characteristic curve analyses probed associations with diagnostic and demographic variables. Results Two subscales emerged for each itemset. Across both samples, P-GBI sleep subscales were more reliable and consistent than CBCL sleep subscales, showed greater coverage of sleepiness and insomnia constructs, were better at discriminating individuals within a wider range of sleep complaints, and showed significant correlation with mood disorder diagnoses. Conclusions The P-GBI sleep items provide a brief, reliable measure for assessing distinct dimensions of sleep complaints and detecting mood symptoms or diagnoses related to the youth’s sleep functioning, making them a useful addition to clinical practice.

Exploring gender euphoria in a sample of transgender and gender diverse patients at two U.S. urban community health centers

Transgender and gender diverse (TGD) people are affected by mental health inequities. Gender euphoria—positive emotions or joy in gender—may be associated with positive mental health. Between February 2019–July 2021, we surveyed 2,165 adult TGD patients (median age = 28 years; 29.2 % people of color; 29.6 % nonbinary; 81.0 % taking hormones) evaluating gender euphoria and mental health. Overall, 35.0 % self-reported gender euphoria, 50.9 % gender dysphoria, 23.5 % alcohol misuse, and 44.5 % resilience. Gender euphoria differed by race, gender, insurance, and hormone use, and was associated with reduced gender dysphoria (adjusted Odds Ratio[aOR] = 0.58; 95 % confidence interval [95 %CI] = 0.47–0.72) and alcohol misuse (aOR = 0.75; 95 %CI = 0.60–0.95), and increased resilience (aOR = 1.31; 95 %CI = 1.07–1.61). The construct of gender euphoria may be a promising mental health target.

Nurse Standing Orders for Buprenorphine Follow-Up Care in a Community Health Center Network.

Less than 20% of individuals with opioid use disorder (OUD) are receiving a medication treatment for OUD in the United States. Though nurses can assume critical roles in outpatient models of OUD care, there are no published reports of buprenorphine standing orders for nurses that guide a nuanced response for patients returning as expected versus those re-engaging after a treatment lapse, without requiring real-time prescriber consultation. Standing orders for buprenorphine were created with multiple stakeholders within an urban community health center that includes traditional clinics as well as non-traditional homeless care sites. After more than two years of use, an anonymous survey assessed staff perception of usability and safety of the standing orders using the validated system usability scale (SUS) and a 5-item Likert scale. Patient retention rates at 12 and 18 months were compared for sites that were early- and late-adopters of the standing orders. Of 24 clinicians and 7 nurses who responded to the survey, 46% had used the standing orders. More than 85% reported a perception that the standing orders improved team-based care and increased access to buprenorphine refills. None reported any safety concerns. The median SUS score was 75.0 (SD 15.4), rated as "excellent". There was no statistically significant difference in 12- or 18-month retention rates between early- and late-adopter sites of the standing orders. Nurse standing orders for buprenorphine follow-up and re-engagement care are feasible, usable and perceived as safe in varied community health center settings.

Disparities in lung cancer screening in a diverse urban population and the impact of a community-based navigational program.

6555 Background: Lung cancer (LC) is the leading cause of cancer death in the US in both men and women; causing 25% of all cancer deaths. Annual lung cancer screening (LCS) with a low-dose CT (LDCT) in high-risk individuals (aged 50-80 with a &gt;20 pack-year smoking history) decreases LC deaths by 20% and is recommended by USPSTF. Despite the efficacy, uptake of LDCT remains low at 6% nationally, and 13% in Rhode Island. Patient (pt) and provider perceived barriers, along with racial, ethnic and socioeconomic disparities widen the gap. We evaluated the implementation of a LCS navigation program at an urban community health center (CHC) with a multiethnic, socioeconomically underserved population. Methods: A bilingual (English and Spanish speaking) pt navigator was integrated into routine clinic practice at a large primary care CHC group, across 4 sites, starting in January 2022. The navigator’s role was to assess pt and provider awareness of the LCS process, assess for systemic barriers, and provide navigational support for the LDCT process. Pts eligible for LCS at the CHC from 1/2022 to 12/2022 were retrospective examined; 50 to 80 years and a &gt;20 pack-year smoking history. The navigator administered a questionnaire to assess barriers to LDCT and demographic variables. Results: A total of 360 eligible pts were seen across the CHC practice in 2022, of which 149 (41.4%) agreed to undergo LDCT after counseling and shared decision making and 28% of these (n 101) completed LDCTs. 153 of the eligible pts completed the survey questionnaire. Of these, 50% were females; 40% were Hispanic/Latinx, 40% were non-Hispanic/Latinx and 22% declined to answer. Majority, 61% were white, 10% African American/Black and 28% declined to answer. A sizeable proportion were non-English speaking (34%) and resided in cities with Rhode Island’s lowest per-capita incomes (Pawtucket 48%), Central Falls (32%) and North Providence/Providence (10%). In assessing barriers to LCS, 46% of pts were not aware of the LCS process and 44% were unaware that LCS was covered by health insurance; 58% of eligible pts did not recall their PCP discussing LCS. Of the LDCTs resulted available at the time of analysis, 84% were Lung RADS-1 and 16% Lung RADS-4 category. Conclusions: Our study highlights the unique barriers to LCS in an urban multiethnic community. While access to LCS remains an issue, pt awareness of the lung cancer screening process was the major barrier. A patient navigation program is critical to the success of LCS in a community, by providing education to patients and providers and the necessary logistical support needed in the LDCT process. With a community based navigational program, we demonstrate a significant increase in lung cancer screening rates in our population to 28% as compared to the state LCS rate of 13%. (Supported by the Robert A. Winn Diversity in Clinical Trials Career Development Award).

Palliative Care in an Urban Community Health Center Setting: A Needs Assessment (QI118)

Palliative Care in an Urban Community Health Center Setting: A Needs Assessment (QI118)

Gestational glucose intolerance (GGI) and gestational diabetes mellitus (GDM) among antenatal women attending urban community health centers of Lucknow: A cross-sectional study.

Gestational diabetes mellitus (GDM) is an emerging public health concern in India, which has detrimental effects on both the mother and the baby. The data on prevalence of GDM was unavailable at secondary urban health facilities, from where a majority of pregnant women seek antenatal services, and the following study identifies this burden. A cross-sectional study was conducted from May 2019 to June 2020 among pregnant women attending the antenatal outpatient department (OPD) at secondary level health facilities in urban Lucknow. A semi-structured interview schedule was administered to the study subjects for collecting the relevant information and 75 g of oral glucose tolerance test was performed irrespective of the meal. The cut-off points taken for the diagnosis of GDM and gestational glucose intolerance (GGI) was as per the guidelines of the Ministry of Health and Family Welfare for diagnosis of GGI/GDM. The overall prevalence of GDM and GGI in the study was 11.6% and 16.8%, respectively. Three-fourth of the women (22/29) were diagnosed with GDM in the second trimester of pregnancy. The prevalence of GDM (16.7%) was significantly higher in pregnant women aged more than 25 years and in those who were overweight. Mean birth weight (3.2 ± 8.1 kg) of the babies was significantly higher in the women with GDM. Among the fetal complications was respiratory distress observed among 28 pregnant women and 31% of them had GDM and this was statistically significant. The prevalence of GGI and GDM was found 16.8% and 11.6%, respectively. Gestational age, pre-pregnancy weight, pre-pregnancy BMI, weight gain during the pregnancy, family history of diabetes. PCOS, macrosomia and GDM in prior pregnancies was found to significant with GDM in the study.

Knowledge, Attitude, and Practice Towards Sexually Transmitted Infections Among Women of Reproductive Age in an Urban Community Health Centre in Indonesia

Introduction: Sexually transmitted infections (STIs), an emerging public health burden, are increasing due to a lack of understanding about their prevention. Objective: To understand the association between STI-related knowledge, attitudes, and practices (KAP) among women of reproductive age in an urban community health centre in Jakarta, Indonesia. Material and Methods: A cross-sectional study and consecutive sampling technique were employed on 50 women using a structured, self-administered questionnaire. All data were analysed using Spearman’s rank correlation, χ2, or Fisher’s exact test to test the hypothesis. Results: Encountered women had an average age of 26.80 ± 4.64 years, were married (74%), primiparous (46%), and with a high level of education (88%). The median scores for attitude and knowledge were 76.90 and 79.20, respectively, and there was a moderate correlation between these scores (ρ=0.482, p&lt;0.001). Overall, 84% of individuals had good knowledge, and 88% of respondents had a positive attitude. Practical insight was moderate, with the rate of abstinence, using condoms, suggesting condoms, and stigmatising persons with HIV/AIDS being 54%, 32%, 2%, and 36%, respectively. Education level was a significant predictor of knowledge, and women’s attitudes toward STIs were associated with their knowledge (OR 7.80, p=0.044). There was no relationship between socio-demographic profiles and the KAP of STIs. Knowledge and attitude did not contribute significantly towards abstinence, using condoms, suggesting condoms, and HIV/AIDS-related stigmatisation due to the complexity of practice actualisation related to theories of planned behaviour. Conclusion: STI-related knowledge and attitude correlate well, but this study found that neither predicts STI-related practice.

Correlation between input on public health services and work motivation among primary health workers in China

BackgroundThe integration of public health services into primary health care has been advocated and practiced worldwide for better management of preventable diseases. Health policy makers in China have started the reforms to better integrate public health services and clinical services, but public health services in China still remained neglected in primary health system. This study aimed to explore the input of Chinese primary health workers on delivering public health services and its association with their intrinsic working motivation in China.MethodsData were collected from a cross-sectional survey conducted in 2019. Participants in this survey included 803 primary health workers in 75 primary health institutions in China. Questions about the input on clinical and public health services delivery and intrinsic working motivation were asked. A multiple linear regression model was adopted to investigate the correlation between intrinsic working motivation and the time input on public health service. The robustness of this model was checked with a generalized linear model.ResultsIntrinsic motivation was found to have negative association with health workers’ input on public health (β: -1.01, p < 0.05), with the robustness checked with a generalized linear model. The significance of this association differed in the group of urban community health centers and rural township health center. Other factors that had significant relationship with the input on public health services include the being nurses instead of doctors (p < 0.01), being a member of family doctor team (p < 0.01), recognition on relative importance of clinical services (p < 0.01), and perception on better exterior support (p < 0.01).ConclusionWith higher intrinsic working motivation, primary health workers tended to spend less time on public health services. It reflected that doctors and nurses in primary healthcare institutions still perceived clinical treatment services as their main work responsibility and source of career recognition. Organizational level supports and system level policies should guide the primary health workers to increase their awareness on the importance of public health services and to cultivate their internal interests on public health services, in order to ensure sustainable input and performance improvement on public health services in primary health system in China.

Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Settings for an Underserved Population: A Feasibility Pilot Study.

Acupuncture and yoga have both been shown to be effective in chronic pain. Underrepresented populations have poorer pain outcomes with less access to effective pain care. To assess the feasibility of bundling group acupuncture with yoga therapy for chronic neck, back or osteoarthritis pain in safety net settings. This was a feasibility pilot in Bronx and Harlem primary care community health centers. Participants with chronic neck, back or osteoarthritis pain received acupuncture and yoga therapy over a 10-week period. Participants received 10weekly acupuncture treatments in group setting; with Yoga therapy sessions beginning immediately following the 3rd session. Primary outcome was pain interference and pain intensity on the Brief Pain Inventory (BPI); Outcomes were measured at baseline, 10-week close of intervention, and 24-week follow-up. 93 patients were determined to be eligible and completed the baseline interview. The majority of participants were non-White and Medicaid recipients. 78 (84%) completed the intervention and 10-week survey, and 58 (62%) completed the 24-week post intervention survey. Participants received an average number of 6.5 acupuncture sessions (out of a possible 10), and 4 yoga sessions (out of a possible 8) over the 10-week intervention. Patients showed statistically significant improvements in pain at the close of the intervention and at a somewhat lesser rate, at 24-weeks post intervention. Challenges included telephone outreach and site coordination integrating acupuncture with yoga therapy. The trial also had to be stopped early due to the COVID-19 pandemic. Bundling acupuncture therapy and yoga therapy is feasible for an underrepresented population with chronic pain in urban community health centers with preliminary indications of acceptability and benefit to participants.

Evaluation of an Academic Detailing Program to Improve Blood Pressure Measurement and Hypertension Treatment in Urban Community Health Centers.

Hypertension is estimated at a prevalence of 30 to 50% in the United States. Only 54% of patients with hypertension have their condition adequately controlled. This study aimed to use academic detailing (AD) to improve practice team knowledge and confidence in blood pressure (BP) management, specifically in low-income, underresourced patient populations. AD was developed for five practices that care for high percentages of Medicaid-eligible patients. A needs assessment was administered to each site's practice champion to determine high-yield AD sessions for their team. Presession and postsession evaluations were completed by practice team members. Fifty providers and eight staff member participants completed evaluations over nine sessions for two AD topics at four practice sites. Statistical significance was found for several items within sessions including accurately choosing cuff sizes and identifying barriers to home BP monitoring. AD is a potentially financially efficient model to improve knowledge and confidence in hypertension care at the practice level. Tailoring session content to specific needs of a practice site, along with an identified practice champion, facilitated implementation of the program. This replicable model is one way to deliver evidence-based information to those who serve Medicaid-eligible patients.

Building Practical Risk Prediction Models for Nasopharyngeal Carcinoma Screening with Patient Graph Analysis and Machine Learning.

To expand nasopharyngeal carcinoma (NPC) screening to larger populations, more practical NPC risk prediction models independent of Epstein-Barr virus (EBV) and other lab tests are necessary. Patient data before diagnosis of NPC were collected from hospital electronic medical records (EMR) and used to develop machine learning (ML) models for NPC risk prediction using XGBoost. NPC risk factor distributions were generated through connection delta ratio (CDR) analysis of patient graphs. By combining EMR-wide ML with patient graph analysis, the number of variables in these risk models was reduced, allowing for more practical NPC risk prediction ML models. Using data collected from 1,357 patients with NPC and 1,448 patients with control, an optimal set of 100 variables (ov100) was determined for building NPC risk prediction ML models that had, the following performance metrics: 0.93-0.96 recall, 0.80-0.92 precision, and 0.83-0.94 AUC. Aided by the analysis of top CDR-ranked risk factors, the models were further refined to contain only 20 practical variables (pv20), excluding EBV. The pv20 NPC risk XGBoost model achieved 0.79 recall, 0.94 precision, 0.96 specificity, and 0.87 AUC. This study demonstrated the feasibility of developing practical NPC risk prediction models using EMR-wide ML and patient graph CDR analysis, without requiring EBV data. These models could enable broader implementation of NPC risk evaluation and screening recommendations for larger populations in urban community health centers and rural clinics. These more practical NPC risk models could help increase NPC screening rate and identify more patients with early-stage NPC.