National Healthcare Quality and Disparities Report
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Topics
- Access to Care (2)
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- (-) Primary Care (34)
- Primary Care: Models of Care (4)
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- Provider: Clinician (1)
- Provider: Pharmacist (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 34 Research Studies DisplayedAckerman SL, Wing H, Acves B
“We were trying to do quality versus quantity”: challenges and opportunities at the intersection of standardized and personalized social care in community health centers.
The purpose of this study was to explore activities to incorporate social risk programs into community health centers (CHCs) providing primary care services in Oregon. CHCs took part in either one or both of two large programs with the goal of incorporating standardized social risk screening and referral processes. The researchers conducted 42 semi-structured interviews with clinicians, managers and staff at 12 clinics affiliated with five CHCs to understand implementation procedures and challenges to those procedures. Thematic analysis utilized the Normalization Process Theory (NPT) to discover the dynamic, interactional nature of activities to integrate a complex sociotechnical intervention. The study found that standardized social care was expected to correspond well with institutional commitments and priorities. However, challenges maintaining support among staff was encountered, affected by competing priorities, staff turnover, and uncertainties about roles and responsibilities. The new tools were frequently altered or abandoned to retain the advantages of existing social care practices. Across clinics, the association between standardized procedures and existing social care activities, had a key role in patterns of adoption, non-adoption and adaptation, with standardized tools frequently experienced as undermining more relational, team-based social care.
AHRQ-funded; HS026435.
Citation: Ackerman SL, Wing H, Acves B .
“We were trying to do quality versus quantity”: challenges and opportunities at the intersection of standardized and personalized social care in community health centers.
SSM Qual Res Health 2023 Jun; 3:100267. doi: 10.1016/j.ssmqr.2023.100267..
Keywords: Community-Based Practice, Social Determinants of Health, Primary Care
Safon CB, Estela MG, Rosenberg J
Implementation of a novel pediatric behavioral health integration initiative.
The purpose of this concurrent, qualitative-dominant mixed methods empirical study was to explore healthcare professionals' perceptions of the impact of behavioral health integration (BHI) on pediatric primary care delivery in community health centers (CHCs). The researchers utilized semi-structured interviews with healthcare professionals at the end of the implementation phase of a 3-year process and surveys administered at three time points. Qualitative themes were mapped onto the Relational Coordination (RC) conceptual framework to triangulate and complement final qualitative results with quantitative results. The researchers round five emergent themes aligning with RC domains. The results of the survey showed that healthcare professionals reported both greater behavioral healthcare integration into clinic practice and greater clinic readiness to address behavioral health needs. The researchers concluded that effective pediatric BHI and care delivery at CHCs may depend on solid professional relationships and communication.
AHRQ-funded; HS022242.
Citation: Safon CB, Estela MG, Rosenberg J .
Implementation of a novel pediatric behavioral health integration initiative.
J Behav Health Serv Res 2023 Jan;50(1):1-17. doi: 10.1007/s11414-022-09803-6..
Keywords: Children/Adolescents, Behavioral Health, Healthcare Delivery, Primary Care, Patient-Centered Healthcare, Community-Based Practice
Beidler LB, Razon N, Lang H
"More than just giving them a piece of paper": interviews with primary care on social needs referrals to community-based organizations.
The purpose of this qualitative study was to describe primary care practice’s referrals to community-based organizations. The researchers utilized semi-structured interviews with 50 healthcare administrators in charge of social care efforts within their organization. Fifty diverse United States healthcare organizations and agencies were included. The study found that social needs referrals were an essential element of administrator’s social care activities. Administrators described the optimal referral program as one which places limited burden on care teams, provides patients with customized referrals, and facilitates closed-loop referrals. The researchers identified three key challenges organizations encounter when trying to implement the optimal referrals program: 1) developing and maintaining resources lists; 2) aligning referrals with patient needs; and 3) measuring the efficacy of referrals. Administrators The study concluded that primary care practice referrals to community-based organizations were used to improve patients' social conditions, but administrators report challenges providing customized and current information to their patients.
AHRQ-funded; HS024075.
Citation: Beidler LB, Razon N, Lang H .
"More than just giving them a piece of paper": interviews with primary care on social needs referrals to community-based organizations.
J Gen Intern Med 2022 Dec;37(16):4160-67. doi: 10.1007/s11606-022-07531-3..
Keywords: Primary Care, Social Determinants of Health, Community-Based Practice, Healthcare Delivery
White A, Fulda KG, Blythe R
Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety.
The purpose of this narrative review was to further define the nature of collaboration between pharmacists and primary care providers in improving medication safety in community settings, and to describe related barriers and strategies. The researchers searched PubMed studies published between January 2000 and December 2020 using search terms including: "collaboration," "community pharmacy," "patient safety," "medication safety," and "primary care physician." The identified articles were placed into 3 categories: 1) defining collaboration, 2) types of collaboration, and 3) barriers and solutions to collaboration. The authors concluded that medication review and other strategies are a common form of collaboration between pharmacists and primary care providers, and that barriers to that collaboration can include erroneous beliefs regarding roles, variation in access to clinical information, and differences in community pharmacy practice.
AHRQ-funded; HS027277.
Citation: White A, Fulda KG, Blythe R .
Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety.
Expert Opin Drug Saf 2022 Nov;21(11):1357-64. doi: 10.1080/14740338.2022.2147923..
Keywords: Provider: Pharmacist, Primary Care, Medication, Patient Safety, Community-Based Practice
Miller-Rosales C, Rodriguez HP
Interdisciplinary primary care team expertise and diabetes care management.
Researchers examined whether care team role expertise is associated with patients' experiences of chronic care for type 2 diabetes and whether the relationship is stronger for small community health center (CHC) sites. Results of surveys conducted with adults with diabetes that assessed nonphysician team roles involved in managing their chronic care were integrated with clinical and administrative data from 14 CHCs. They found that patients with access to care team expertise in self-management support, including diabetes educators, nutritionists, community health workers, and other general staff report better experiences of chronic care. They concluded that these team roles may reduce barriers to patient self-management and improve patients' overall experiences of chronic care, particularly in small CHC sites.
Citation: Miller-Rosales C, Rodriguez HP .
Interdisciplinary primary care team expertise and diabetes care management.
J Am Board Fam Med 2021 Jan-Feb;34(1):151-61. doi: 10.3122/jabfm.2021.01.200187..
Keywords: Primary Care, Diabetes, Teams, Care Management, Community-Based Practice
Nagykaldi Z, Scheid D, Zhao YD
A sustainable model for preventive services in rural counties: the healthier together study.
The Healthier Together study aimed to implement and evaluate a sustainable, rural community-based patient outreach model for preventive care provided through primary care practices located in 3 rural counties in Oklahoma. Forty-four eligible clinician practices participated in the study. Results showed that, although health care is under-resourced and segmented in many rural counties, when stakeholder partnerships are established, they may be able to achieve and economically sustain community-wide health improvement by creating a win-win situation for all partners.
AHRQ-funded; HS023237.
Citation: Nagykaldi Z, Scheid D, Zhao YD .
A sustainable model for preventive services in rural counties: the healthier together study.
J Am Board Fam Med 2020 Sep-Oct;33(5):698-706. doi: 10.3122/jabfm.2020.05.190357..
Keywords: Rural Health, Prevention, Primary Care: Models of Care, Primary Care, Community-Based Practice
Makelarski JA, DePumpo M, Boyd K
Implementation of systematic community resource referrals at small primary care practices to promote cardiovascular disease self-management.
The purpose of this study was to describe outcomes from implementation of a community resource referral system into small clinical practices to reduce cardiovascular disease risk. HealtheRx-H3, a printed list of resources for patients, was created. It was feasible to create practice-specific HealtheRx-H3s; however, systematic distribution of HealtheRx-H3s using digital electronic health record integration was found to be infeasible. Successful implementation of quality improvement strategies to systematize community resource referral solutions was feasible at small practices, but more research was recommended in order to understand what motivates small practices to participate in implementation of these solutions.
AHRQ-funded; HS023921.
Citation: Makelarski JA, DePumpo M, Boyd K .
Implementation of systematic community resource referrals at small primary care practices to promote cardiovascular disease self-management.
J Healthc Qual 2020 Sep/Oct;42(5):278-86. doi: 10.1097/jhq.0000000000000234..
Keywords: Cardiovascular Conditions, Risk, Community-Based Practice, Patient Self-Management, Education: Patient and Caregiver, Primary Care, Implementation, Lifestyle Changes
Loo S, Grasso C, Glushkina J
Capturing relevant patient data in clinical encounters through integration of an electronic patient-reported outcome system into routine primary care in a Boston Community Health Center: development and implementation study.
This study’s goal was to implement an electronic patient-reported outcome (ePRO) system that administers key health questionnaires in an urban community health center in Boston, Massachusetts. The system was integrated with the EHR so that medical providers could review and arbitrate patient responses in during the patient’s visit. Findings showed that this program demonstrated that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care.
AHRQ-funded; HS026154.
Citation: Loo S, Grasso C, Glushkina J .
Capturing relevant patient data in clinical encounters through integration of an electronic patient-reported outcome system into routine primary care in a Boston Community Health Center: development and implementation study.
J Med Internet Res 2020 Aug 19;22(8):e16778. doi: 10.2196/16778..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Community-Based Practice, Implementation
Islam N, Rogers ES, Schoenthaler EA
A cross-cutting workforce solution for implementing community-clinical linkage models.
This article discusses the use of employing community health workers (CHWs) in primary care practices to create community-clinical linkage models to address the underlying role of social determinants of health and achieve health equity. Federal initiatives such as EvidenceNOW and Million Hearts have supported a renewed focus on small, independently owned practices. These initiatives emphasize the role of practice facilitation. The authors drew from the literature and propose that small, independently owned practices strategically employ practice facilitators to help integrate CHWs into their primary care teams. These facilitators help provide a “population health management” infrastructure to develop effective partnerships. Several ways that practice facilitation can help do this is outlined in this paper.
AHRQ-funded; HS023922.
Citation: Islam N, Rogers ES, Schoenthaler EA .
A cross-cutting workforce solution for implementing community-clinical linkage models.
Am J Public Health 2020 Jul;110(S2):S191-s93. doi: 10.2105/ajph.2020.305692..
Keywords: Community-Based Practice, Primary Care, Workforce, Primary Care: Models of Care, Healthcare Delivery
Fiori KP, Rehm CD, Sanderson D
Integrating social needs screening and community health workers in primary care: the community linkage to care program.
This study used logistic regression to identify factors associated with successful social service uptake in an urban pediatric practice. Out of 4948 households screened for social needs from December 2017 to November 2018, 20% self-reported at least one factor. Only 43% of the 287 households with unmet needs reported social service uptake. Greater than 4 outreach encounters were significantly associated with successful referrals. This study suggests the need for additional research and an opportunity for further program optimization.
AHRQ-funded; HS026396.
Citation: Fiori KP, Rehm CD, Sanderson D .
Integrating social needs screening and community health workers in primary care: the community linkage to care program.
Clin Pediatr 2020 Jun;59(6):547-56. doi: 10.1177/0009922820908589..
Keywords: Children/Adolescents, Community-Based Practice, Primary Care, Social Determinants of Health, Implementation, Low-Income
Cohen DJ, Wyte-Lake T, Dorr DA
Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs.
The authors sought to identify the unmet information needs of clinical teams delivering care to patients with complex medical, social, and economic needs, and to propose principles for redesigning electronic health records (EHR) to address these needs. They concluded that developing EHR tools that are simple, accessible, easy to use, and able to be updated by a range of professionals is critical. They recommended that the identified information needs and design principles inform developers and implementers working in community health centers and other settings where complex patients receive care.
AHRQ-funded; HS023324.
Citation: Cohen DJ, Wyte-Lake T, Dorr DA .
Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs.
J Am Med Inform Assoc 2020 May;27(5):690-99. doi: 10.1093/jamia/ocaa010..
Keywords: Healthcare Delivery, Teams, Electronic Health Records (EHRs), Health Information Technology (HIT), Social Determinants of Health, Community-Based Practice, Primary Care
Kaufman A, Dickinson WP, Fagnan LJ
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
The states of New Mexico, Oklahoma, Oregon, Colorado, and Washington stand out in stretching the boundaries of health extension; their stories reveal lessons learned regarding the successes and challenges. All states saw the need for long-term, sustained fundraising beyond grants in an environment expecting a short-term return on investment, and they were challenged operating in a shifting health system landscape where the creativity and personal relationships built with small primary care practices was hindered when these practices were purchased by larger health delivery systems.
AHRQ-funded; HS020890; HS020972; HS23904; HS023908.
Citation: Kaufman A, Dickinson WP, Fagnan LJ .
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S67-s72. doi: 10.1370/afm.2409..
Keywords: Community-Based Practice, Health Services Research (HSR), Healthcare Delivery, Organizational Change, Primary Care, Social Determinants of Health, Practice Improvement
Fiori K, Patel M, Sanderson D
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
The authors described their experience implementing a novel social needs screening program at an academic pediatric clinic. They found that, on average, 76% of providers had their patients screened on more than half of eligible well-child visits. Their experience suggested that screening for social needs at well-child visits is feasible as part of routine primary care. They recommended that success would best be achieved by leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.
AHRQ-funded; HS026396.
Citation: Fiori K, Patel M, Sanderson D .
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719899207. doi: 10.1177/2150132719899207..
Keywords: Children/Adolescents, Community-Based Practice, Healthcare Delivery, Implementation, Screening, Social Determinants of Health, Urban Health, Workflow, Primary Care
Herrera CN, Brochier A, Pellicer M
Implementing social determinants of health screening at community health centers: clinician and staff perspectives.
Screening for social determinants of health (SDOH) during primary care office visits is recommended by pediatric and internal medicine professional guidelines. Less is known about how SDOH screening and service referral can be successfully integrated into clinical practice. SDOH screening and referral care models can help support the mission of community health centers by identifying unmet material needs. Additional support for SDOH models might include piloting the SDOH screening model workflow and formalizing the workflow before implementation, including the specific roles for clinicians, staff, and patient navigators.
AHRQ-funded; HS022242.
Citation: Herrera CN, Brochier A, Pellicer M .
Implementing social determinants of health screening at community health centers: clinician and staff perspectives.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719887260. doi: 10.1177/2150132719887260..
Keywords: Social Determinants of Health, Screening, Community-Based Practice, Primary Care, Provider: Clinician, Provider
Davis MM, Gunn R, Gowen LK
A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: more similar than different.
In this study, the authors examined, using qualitative methods, patients' experiences of care in integrated settings. The study included 24 patients receiving care across five practices participating in Advancing Care Together (ACT)-a 4-year demonstration project (2010-2014) of primary care and community mental health centers (CMHCs) integrating care. The investigators found that patients in both primary care and CMHCs perceived similar benefits from integrated care related to personal growth, improved quality, and access to care.
AHRQ-funded; HS022981.
Citation: Davis MM, Gunn R, Gowen LK .
A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: more similar than different.
Transl Behav Med 2018 Sep 8;8(5):649-59. doi: 10.1093/tbm/ibx001..
Keywords: Community-Based Practice, Healthcare Delivery, Behavioral Health, Patient Experience, Primary Care
Cole MB, Wright B, Wilson IB
Medicaid expansion and community health centers: care quality and service use increased for rural patients.
Investigators studied the impact of Medicaid expansion in rural areas. Data from 2011-2015 found that there was an 11.4% decline in uninsured patients and a 13.5% increase in Medicaid patients at community health centers (CHCs). Relative improvements were shown in patients with chronic conditions such as asthma and hypertension; and an increase in visits for mammograms and substance abuse disorders.
AHRQ-funded; HS024652.
Citation: Cole MB, Wright B, Wilson IB .
Medicaid expansion and community health centers: care quality and service use increased for rural patients.
Health Aff 2018 Jun;37(6):900-07. doi: 10.1377/hlthaff.2017.1542..
Keywords: Medicaid, Community-Based Practice, Rural Health, Access to Care, Quality of Care, Healthcare Utilization, Primary Care
Gao YN, Nocon RS, Sharma R
What factors are associated with Medicaid patients' use of health centers?.
This study identified patient and neighborhood factors associated with health center (HC) use. Dually eligible patients and those with high chronic disease burden had lower odds of HC use. Temporary Assistance for Needy Families participants and Hispanic beneficiaries had higher odds. Local HC presence predicted higher HC use.
AHRQ-funded; HS000084.
Citation: Gao YN, Nocon RS, Sharma R .
What factors are associated with Medicaid patients' use of health centers?.
J Prim Care Community Health 2017 Jul;8(3):141-46. doi: 10.1177/2150131916687919.
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Keywords: Community-Based Practice, Healthcare Utilization, Medicaid, Primary Care, Social Determinants of Health
Fontil V, Bibbins-Domingo K, Nguyen OK
Management of hypertension in primary care safety-net clinics in the United States: a comparison of community health centers and private physicians' offices.
The researchers examined adherence to guideline-concordant hypertension treatment practices at community health centers (CHCs) compared with private physicians' offices.: Medicaid patients at CHCs were as likely as privately insured individuals to receive a new medication for uncontrolled hypertension, whereas Medicaid patients at private physicians' offices were less likely to receive a new medication.
AHRQ-funded; HS018090.
Citation: Fontil V, Bibbins-Domingo K, Nguyen OK .
Management of hypertension in primary care safety-net clinics in the United States: a comparison of community health centers and private physicians' offices.
Health Serv Res 2017 Apr;52(2):807-25. doi: 10.1111/1475-6773.12516.
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Keywords: Blood Pressure, Primary Care, Community-Based Practice, Guidelines, Evidence-Based Practice
Angier H, O'Malley JP, Marino M
Evaluating community health centers' adoption of a new global capitation payment (eCHANGE) study protocol.
This protocol paper describes the evaluation of an Alternative Payment Methodology (APM) implemented in a subset of Oregon community health centers (CHCs), using a prospective matched observational design. The researchers will implement a difference-in-difference analytic approach to evaluate pre-post APM changes between intervention and control groups.
AHRQ-funded; HS022651.
Citation: Angier H, O'Malley JP, Marino M .
Evaluating community health centers' adoption of a new global capitation payment (eCHANGE) study protocol.
Contemp Clin Trials 2017 Jan;52:35-38. doi: 10.1016/j.cct.2016.11.001.
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Keywords: Community-Based Practice, Payment, Patient-Centered Healthcare, Primary Care
Komaromy M, Duhigg D, Metcalf A
Project ECHO (Extension for Community Healthcare Outcomes): a new model for educating primary care providers about treatment of substance use disorders.
ECHO is a distance education model that connects specialists with numerous PCPs via simultaneous video link for the purpose of facilitating case-based learning. This article describes a teleECHO clinic that is focused on treatment of substance use disorders (SUDs) and behavioral health disorders. It concluded that the ECHO model can promote expansion of access to treatment for opioid use disorder and other SUDs, particularly in underserved areas.
AHRQ-funded; HS016510.
Citation: Komaromy M, Duhigg D, Metcalf A .
Project ECHO (Extension for Community Healthcare Outcomes): a new model for educating primary care providers about treatment of substance use disorders.
Subst Abus 2016;37(1):20-4. doi: 10.1080/08897077.2015.1129388.
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Keywords: Community-Based Practice, Primary Care, Substance Abuse, Training, Health Information Technology (HIT)
Fulford D, Tuot DS, Mangurian C
Electronic psychiatric consultation in primary care in the safety net.
The authors examined the feasibility and acceptability of implementing a psychiatric eReferral program in a publicly funded, community-based primary care clinic in San Francisco staffed by eight primary care practitioners (PCPs). They found feasibility and acceptability of implementing an integrated electronic psychiatry consultation and referral service in a community-based primary care clinic and recommended future trials designed to examine the impact of this type of service on the delivery of high-quality mental health care and its cost-effectiveness in a safety-net health care system.
AHRQ-funded; HS021700.
Citation: Fulford D, Tuot DS, Mangurian C .
Electronic psychiatric consultation in primary care in the safety net.
Psychiatr Serv 2016 Oct;67(10):1160-61. doi: 10.1176/appi.ps.671003.
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Keywords: Community-Based Practice, Electronic Health Records (EHRs), Behavioral Health, Primary Care, Health Information Technology (HIT)
Gao Y, Nocon RS, Gunter KE
AHRQ Author: Ngo-Metzger Q
Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis.
The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. The researchers identified characteristics associated with HCs' PCMH capability. EHR adoption likely played a role in HCs' improvement in PCMH capability. Other factors include a greater number of types of financial performance incentives, more types of hospital-HC affiliations, and state-level support and payment for PCMH activities.
AHRQ-authored; AHRQ-funded; HS000084.
Citation: Gao Y, Nocon RS, Gunter KE .
Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis.
J Gen Intern Med 2016 Sep;31(9):1041-51. doi: 10.1007/s11606-016-3729-8.
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Keywords: Patient-Centered Healthcare, Electronic Health Records (EHRs), Primary Care, Community-Based Practice, Vulnerable Populations
Hernandez SE, Taylor L, Grembowski D
A first look at PCMH implementation for minority veterans: room for improvement.
The researchers sought to determine if the degree of Patient Aligned Care Teams (a patient-centered medical home model), implementation at Veterans Health Administration hospital-based and community-based primary care facilities varied with the percentage of minority veteran patients at each facility. They found that overall implementation of the care teams varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having lower implementation scores.
AHRQ-funded; HS013853; HS023376.
Citation: Hernandez SE, Taylor L, Grembowski D .
A first look at PCMH implementation for minority veterans: room for improvement.
Med Care 2016 Mar;54(3):253-61. doi: 10.1097/mlr.0000000000000512.
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Keywords: Patient-Centered Healthcare, Racial and Ethnic Minorities, Community-Based Practice, Primary Care
Patel SR, Gorritz M, Olfson M
Training community-based primary care physicians in the screening and management of mental health disorders among Latino primary care patients.
The researchers evaluated a quality improvement intervention to improve the screening and management (e.g., referral to psychiatric care) of common mental disorders in small independent Latino primary care practices. They concluded that improving the quality of mental health care in low-resourced primary care settings may require academic detailing and consultation/liaison psychiatric intervention supplemented with staff outreach to achieve meaningful improvement in the processes of care.
AHRQ-funded; HS021112.
Citation: Patel SR, Gorritz M, Olfson M .
Training community-based primary care physicians in the screening and management of mental health disorders among Latino primary care patients.
Gen Hosp Psychiatry 2016 Jan-Feb;38:71-8. doi: 10.1016/j.genhosppsych.2015.09.006.
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Keywords: Community-Based Practice, Primary Care, Behavioral Health, Racial and Ethnic Minorities, Quality Improvement
Davis MM, Balasubramanian BA, Cifuentes M
Clinician staffing, scheduling, and engagement strategies among primary care practices delivering integrated care.
This study examined the interrelationship among behavioral health clinician staffing, scheduling, and a primary care practice's approach to delivering integrated care. It concluded that practices' approaches to staffing by primary care clinicians and behavioral health clinicians, scheduling, and delivery of integrated care mutually influenced each other and were shaped by the local context.
AHRQ-funded; HS022981.
Citation: Davis MM, Balasubramanian BA, Cifuentes M .
Clinician staffing, scheduling, and engagement strategies among primary care practices delivering integrated care.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S32-40. doi: 10.3122/jabfm.2015.S1.150087.
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Keywords: Behavioral Health, Patient-Centered Healthcare, Healthcare Delivery, Primary Care: Models of Care, Primary Care, Community-Based Practice