Activity

The cornerstone of ambulatory care training for internal medicine residents is the continuity clinic, which often serves medically and psychosocially complex patients. We conducted and evaluated a population-oriented redesign to improve care for “high-needs” patients and the resident experience at a hospital-based safety net primary care internal medicine practice in the Southeastern U.S. A Define, Measure, Analyze, Implement, Control (DMAIC) framework was adapted to identify and develop three main interventions to address major unmet needs of patients and trainees (1) a behavioral health-focused team care model; (2) a formalized hospital discharge transitions workflow; and (3) the creation of larger “firms” of smaller resident practice partnerships. We constructed a financial model to justify investments, with metrics to track progress. Over three years, sustained reductions in hospitalizations and ED visits (mean annual changes of -11.6% and -16.9%, respectively) were achieved. Resident primary care provider (PCP)-to-patient continuity and satisfaction also improved.

To analyze the association between social vulnerability and emotional distress in older adults (OAs) visiting health centers in Mexico City, to describe the strategies and services used by OAs when they experience emotional distress, and to determine whether emotional distress is addressed in these primary care settings.

A sequential exploratory mixed method. In the first phase, qualitative information was collected through semi-structured interviews with 17 OAs. The information obtained was used to construct the instrument used in the second phase, which obtained quantitative data from 61 OAs.

The main causes of emotional distress were feelings of loneliness, unemployment, and problems with children. The main actions used to address this distress were seeking support from family and friends, “hanging on,” and engaging in religious practices. A total of 29.5% indicated that their doctor asked about emotional distress; 23% said they were referred to a psychologist, but few took this advice.

The presence of emotional distress in OAs is not an individual health problem but rather the result of their living conditions and environment.

The presence of emotional distress in OAs is not an individual health problem but rather the result of their living conditions and environment.Equitable dental care across U.S. populations remains a national concern. Previously reported predictors of dental student altruism include student and school characteristics. This study additionally considered the effect of educational experiences on dental students’ anticipation of providing care to medically underserved populations, areas, or facilities at some point during their careers. Data from 2014-2017 graduating student surveys (response rate 62%) assessed the relationship between students’ intention to provide care to the underserved and student sociodemographic, clinical, non-clinical, faculty-interaction, research, and organizational experience during dental education. Respondents were 52% female and 18% underrepresented minorities. Positive intention ranged from 51% for “working in a practice that accepts Medicaid” to 25% for “practicing in an underserved rural community” with 45% intending to “work in a community health clinic.” Higher levels of intention were significantly correlated with student diversity, maturity, and involvement with non-clinical faculty and activities.Incidence of HIV infection remains high in New York City and, while considerable attention has been paid to the scale-up of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP) plays an important role in the HIV prevention continuum. We conducted a retrospective analysis of clinical and demographic characteristics of individuals receiving HIV post-exposure prophylaxis at a large academic medical center in northern Manhattan. Post-exposure prophylaxis users were predominantly Latinx (52.8%) and/or African American (33.7%) men who have sex with men (72%), representing the underserved groups at highest risk of HIV infection. Many individuals (20%) requiring PEP presented to their clinician seeking initiation of PrEP. Frequent PEP users may be good candidates for PrEP but psychosocial barriers such as home environment and recreational drug use must be addressed for successful transitions. Zavondemstat Patient counseling for at-risk groups should involve both PEP and PrEP screening and must be sensitized to the needs and cultures of the communities they serve.

Mobile health clinics often deliver care in medically underserved communities and train student volunteers to support service delivery, but little is known about how these clinics affect trainees.

We conducted a qualitative analysis of over 100 trainees’ experiences volunteering with a mobile health clinic, to explore the training experience’s impact on personal and professional development.

Volunteers’ training experiences involved learning how to deliver compassionate, non-judgmental health care. They developed competencies necessary to deliver effective, understandable, and respectful care. Their understanding of the health care system and patient-provider relationships deepened, and they expressed stronger empathy for people different from themselves. Over time, trainees progressed from initial apprehension towards confidence and competence, mediated by practice and staff expertise.

Mobile clinics should support trainees in understanding community-based services for clients, in addition to cultivating patient-care skills.

Mobile clinics should support trainees in understanding community-based services for clients, in addition to cultivating patient-care skills.Hospitals’ approaches to increased value may include taking part in payment programs, such as those relating to accountable care organizations (ACOs), and addressing social determinants of health. We conduct a cross-sectional study using 2017 American Hospital Association Annual Survey and Area Health Resource File data to examine hospitals that are in ACOs and offer Meals on Wheels. Of 3,992 hospitals in 2017, 27.4% took part in only ACOs, 8.4% took part in Meals on Wheels only, and 11.2% were part of both. In adjusted models, hospitals in ACOs had 1.94 higher odds of having Meals on Wheels programs compared with hospitals not in ACOs (95% CI 1.58-2.38). In an exploratory analysis, we found no associations between 30-day inpatient Medicare costs and ACO status or Meals on Wheels. Some hospital strategies to increase value may extend beyond traditional medical care to social services.