Koeniggroth9717

Organizations that approach CHW program implementation with a deliberate focus on recruitment and training and career pipelines/pathways, and adequately prepare their organization for CHWs will realize the benefits this unique workforce has to offer. Our experiences have demonstrated that if you hire the right people, train them effectively, and provide appropriate supervision, CHWs are transformative to health care delivery. We discuss our solutions in these areas within the context of integrating CHWs into our health care system to work with our most medically and socially complex patients.Telehealth became a crucial vehicle for health care delivery in the United States during the COVID-19 pandemic. However, little research exists on inequities in telehealth utilization among the pediatric population. This study examines disparities in telehealth utilization in a population of publicly insured children. This observational, retrospective study used administrative data from Alabama's stand-alone Children's Health Insurance Program, ALL Kids. Rates of any telehealth use for March to December 2020 were examined. In addition-to capture lack of health care utilization-rates of having no medical claims were examined and compared with March to December 2019 and 2018. Multinomial logit models were estimated to investigate how telehealth use and having no medical claims (reference category having medical claims but no telehealth) were associated with race/ethnicity, rural-urban residence, and family income. Of the 106,478 enrollees over March to December 2020, 13.4% had any telehealth use and 24.7% had no medical claims. The latter was greater than no medical claims in 2019 (19.5%) and 2018 (20.7%). Black and Hispanic children had lower odds of any telehealth use (odds ratio [OR] 0.81, P  less then  0.01; OR 0.68, P  less then  0.01) and higher odds of no medical claims (OR 1.11, P  less then  0.05; OR 1.73, P  less then  0.05) than non-Hispanic White children. Rural residents had lower odds of telehealth use than urban residents. Those in the highest family income-based fee group had higher odds of telehealth use than the lowest family income-based fee group. As telehealth will likely continue to play an important role in health care delivery, additional efforts/investments are required to ensure telehealth does not further exacerbate inequities in pediatric health care access.Psychiatric and medical comorbidities are common among adults in the United States. Due to the complex interplay between medical and psychiatric illness, comorbidities result in substantial disparities in morbidity, mortality, and health care costs. There is, thus, both an ethical and fiscal imperative to develop care management programs to address the needs of individuals with comorbid conditions. Although there is substantial evidence supporting the use of care management for improving health outcomes for patients with chronic diseases, the majority of interventions described in the literature are condition-specific. Given the prevalence of comorbidities, the authors of this article reviewed the literature and drew on their clinical expertise to guide the development of future multimorbidity care management programs. Their review yielded one study of multimorbidity care management and two studies of multimorbidity collaborative care. The authors supplemented their findings by describing three key pillars of effective care management, as well as specific interventions to offer patients based on their psychiatric diagnoses and illness severity. The authors proposed short-, medium-, and long-term indicators to measure and track the impact of care management programs on disparities in care. Future studies are needed to identify which elements of existing multimorbidity collaborative care models are active ingredients, as well as which of the suggested supplemental interventions offer the greatest value.Despite changes brought about by the 2010 Affordable Care Act (ACA), millions of individuals are still unable to access health care in the United States. Mobile medical clinics have been an invisible force of care delivery for vulnerable and marginalized populations for decades; however, little is known about their impact post-ACA. Guided by the Anderson Behavioral Model, the purpose of this article was to review and critique the state of the current literature about mobile medical clinics in the United States since 2010. Following Whittemore and Knafl's integrative review methodology, the search was conducted in 6 databases and delivered 1934 results; 341 articles were removed as duplicates. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, 2 independent reviewers screened and adjudicated the remaining titles, abstracts, and full-texts, yielding 12 articles in the final review. The Mixed Methods Appraisal Tool (MMAT) was used to evaluate the quality of the articles. Studies revealed variation in quality, study design, and location; and diversity of chronic diseases and populations addressed (eg, children with asthma, complementary alternative medicine use with children, adults with diabetes and hypertension, patients with chronic disease with an emphasis on the patient experience, utilization patterns in migrant farmers). Selleckchem VH298 Mobile medical clinics provide care for the prevention, treatment, and management of chronic illness and their wide geographic spread confirms their broad use across the United States. They provide a return on investment through emergency room avoidance, decreasing hospital length of stay, and improving chronic disease management.Frameworks for identifying and assessing social determinants of health (SDOH) are effective for developing long-term societal policies to promote health and well-being, but may be less applicable in clinical settings. The authors compared the relative contribution of a specific set of SDOH indicators with several measures of health status among patients served by health centers (HCs). The 2014 Health Center Patient Survey was used to identify a sample of HC patient adults 18 years and older that reported the HC as their usual source of care (n = 5024). The authors examined the relationship between SDOH indicators organized in categories (health behaviors, access and utilization, social factors, economic factors, quality of care, physical environment) with health status measures (fair or poor health, diabetes, hypertension, cardiovascular disease, depression, or anxiety) using logistic regressions and predicted probabilities. Findings indicated that access to care and utilization indicators had the greatest relative contribution to all health status measures, but the relative contribution of other SDOH indicators varied. For example, access indicators had the highest predicted probability in the model with fair or poor health as the dependent variable (72.4%) and the model with hypertension as the dependent variable (47.4%). However, the second highest predicted probability was for social indicators (54.1%) in the former model and physical environment (44.7%) indicators in the latter model. These findings have implications for HCs that serve as the primary point of access to medical care in underserved communities and to mitigate SDOH particularly for patients with diabetes, depression, or anxiety.Greater investment in the social determinants of health (SDOH) is positively associated with improved health outcomes of both individuals and their communities, which in turn may help to bend the health care cost curve and reduce health care spending. The purpose of this study was to examine the relationship between local governments' spending on the SDOH and the health care costs of privately insured nonelderly adults. Annual spending by local governments on the SDOH for the years 2007-2017 was obtained from the Census of Governments. Annual health care costs for privately insured nonelderly adults for the years 2013-2017 was obtained from the Health Care Cost Institute. Bivariate and multivariate regression analyses were performed to examine the association between county-level local governments' per capita spending on the SDOH and the per member health care costs of privately insured adults living in these counties controlling for community characteristics. All analyses were conducted in 2021. For near-elderly adults ages 55-64, health care costs were significantly higher in counties with the lowest levels of local governmental spending on the SDOH. For adults ages 18-54, in contrast, health care costs were unrelated to local governmental spending. Investments of local governments in the SDOH may have rather limited potential to yield meaningful savings in health care costs for privately insured nonelderly adults at the population level, especially once such investments exceed a minimum threshold.Mammography screening rates are typically lower in those with less economic advantage (EA). This study, conducted at an integrated health care system covering a mixed rurality population, assessed the ability of interventions (text messages linking to a Web microsite, digital health care workers, and a community health fair) to affect mammography screening rates and disparity in those rates among different EA populations. Payor type served as a proxy for greater (commercially insured) versus lower (Medicaid insured) EA. 4,342 subjects were included across the preintervention ("Pre") and postintervention ("Post") periods. Interventions were prospectively applied to all Medicaid subjects and randomly selected commercial subjects. Applying interventions only to lower EA subjects reversed the screening rate disparity (2.6% Pre vs. -3.7% Post, odds ratio [OR] 2.4 P  less then  0.01). When intervention arms ("Least," "More," "Most") were equally applied, screening rates in both EA groups significantly increased in the More arm (Medicaid OR = 2.04 P = 0.04, Commercial OR = 3.08 P  less then  0.01) and Most arm (Medicaid OR 2.57 P  less then  0.01, Commercial OR 2.33 P  less then  0.01), but not in the Least (text-only) arm (Medicaid OR 1.83 P = 0.11, Commercial OR 1.72 P = 0.09), although this text-only arm was inadequately powered to detect a difference. In summary, targeting interventions to those with lower EA reversed screening rate disparities, text messaging combined with other interventions improved screening rates in both groups, and future research is needed to determine whether interventions can simultaneously improve screening rates for all without worsening the disparity.Objectives To evaluate perioperative and functional outcomes of clampless laparoscopic tumor enucleation for completely endophytic renal tumors with the guide of intraoperative ultrasonography. Methods We analyzed patients with clinically completely endophytic tumors, renal tumors, who underwent clampless three-dimensional (3D) retroperitoneoscopic laparoscopic tumor enucleation between January 2012 and January 2021. Patients with exophytic tumors were excluded. Intraoperative ultrasonography was used to map out the mass in all surgeries. Results Overall, 57 patients underwent clampless 3D retroperitoneoscopic laparoscopic tumor enucleation. Mean surgical time was 131 minutes, and mean estimated blood loss was 202 mL. Mean hospital stay was 4.7 days. Major and minor postoperative complications occurred, respectively, in 3 and 10 cases. Only a patient had a positive surgical margin. One-year renal function did not differ from baseline. Conclusion Our study showed that clampless laparoscopic enucleation guided by laparoscopic ultrasonography ensured satisfactory outcomes for completely intrarenal tumors, with excellent renal function preservation 1 year after surgery.