检索结果-南通市图书馆

Family Medicine and Community Health 2016年第4期4卷 63-67页

作者： Jennifer DeVoe Heather Angier Megan Hoopes Rachel Gold Oregon Health and Science University PortlandORUSA ochin IncPortlandORUSA Kaiser Permanente Center for Health Research NorthwestRegion PortlandORUSA

Maintaining continuous health insurance coverage is important.With recent expansions in access to coverage in the United States after“Obamacare,”primary care teams have a new role in helping to track and improve coverage rates and to provide outreach to patients.We describe efforts to longitudinally track health insurance rates using data from the electronic health record(EHR)of a primary care network and to use these data to support practice-based insurance outreach and assistance.Although we highlight a few examples from one network,we believe there is great potential for doing this type of work in a broad range of family medicine and community health clinics that provide continuity of care.By partnering with researchers through practice-based research networks and other similar collaboratives,primary care practices can greatly expand the use of EHR data and EHR-based tools targeting improvements in health insurance and quality health care.

关键词： Insurance,health Affordable Care Act electronic health records

Comparison of associations of household-level and neighbourhood-level poverty markers with paediatric asthma care utilisation by race/ethnicity in an open cohort of community health centre patients

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Family Medicine and Community Health 2023年第3期11卷 86-101页

作者： Jennifer A Lucas Miguel Marino Steffani R Bailey Audree Hsu Roopradha Datta Erika Cottrell Ye Ji Kim Shakira F Suglia Andrew Bazemore John Heintzman Department of Family Medicine Oregon Health&Science UniversityPortlandOregonUSA California University of Science and Medicine ColtonCaliforniaUSA ochin Inc PortlandOregonUSA Department of Epidemiology Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA American Board of Family Medicine LexingtonKentuckyUSA

Objective The objective of this research was to examine how different measurements of poverty(household-level and neighborhood-level)were associated with asthma care utilisation outcomes in a community health centre setting among Latino,non-Latino black and non-Latino white children.Design,setting and participants We used 2012–2017 electronic health record data of an open cohort of children agedochin,Inc.network.Independent variables included household-level and neighborhood-level poverty using income as a percent of federal poverty level(FPL).Covariate-adjusted generalised estimating equations logistic and negative binomial regression were used to model three outcomes:(1)≥2 asthma visits/year,(2)albuterol prescription orders and(3)prescription of inhaled corticosteroids over the total study period.Results The full sample(n=30196)was 46%Latino,26%non-Latino black,31%aged 6–10 years at first clinic visit.Most patients had household FPL200%FPL(55%).Overall,neighbourhood poverty(<100%FPL)was associated with more asthma visits(covariate-adjusted OR 1.26,95%CI 1.12 to 1.41),and living in a low-income neighbourhood(≥100%to<200%FPL)was associated with more albuterol prescriptions(covariate-adjusted rate ratio 1.07,95%CI 1.02 to 1.13).When stratified by race/ethnicity,we saw differences in both directions in associations of household/neighbourhood income and care outcomes between groups.Conclusions This study enhances understanding of measurements of race/ethnicity differences in asthma care utilisation by income,revealing different associations of living in low-income neighbourhoods and households for Latino,non-Latino white and non-Latino black children with asthma.This implies that markers of family and community poverty may both need to be considered when evaluating the association between economic status and healthcare utilisation.Tools to measure both kinds of poverty(family and community)may already exist within clinics,and

关键词： prescription income Latin

Answering calls for rigorous health equity research:a cross-sectional study leveraging electronic health records for data disaggregation in Latinos

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Family Medicine and Community Health 2023年第2期11卷 9-17页

作者： John Heintzman Dang Dinh Jennifer A Lucas Elena Byhoff Danielle M Crookes Ayana April-Sanders Jorge Kaufmann Dave Boston Audree Hsu Sophia Giebultowicz Miguel Marino Family Medicine Oregon Health&Science UniversityPortlandOregonUSA Department of Medicine University of MassachusettsBostonMassachusettsUSA College of Social Sciences and Humanities Northeastern UniversityBostonMassachusettsUSA Rutgers School of Public Health PiscatawayNew JerseyUSA ochin PortlandOregonUSA California University of Science and Medicine ColtonCaliforniaUSA

Introduction Country of birth/nativity information may be crucial to understanding health equity in Latino populations and is routinely called for in health services literature assessing cardiovascular disease and risk,but is not thought to co-occur with longitudinal,objective health information such as that found in electronic health records(EHRs).Methods We used a multistate network of community health centres to describe the extent to which country of birth is recorded in EHRs in Latinos,and to describe demographic features and cardiovascular risk profiles by country of birth.We compared geographical/demographic/clinical characteristics,from 2012 to 2020(9 years of data),of 914495 Latinos recorded as US-born,non-US-born and without a country of birth recorded.We also described the state in which these data were collected.Results Country of birth was collected for 127138 Latinos in 782 clinics in 22 states.Compared with those with a country of birth recorded,Latinos without this record were more often uninsured and less often preferred Spanish.While covariate adjusted prevalence of heart disease and risk factors were similar between the three groups,when results were disaggregated to five specific Latin countries(Mexico,Guatemala,Dominican Republic,Cuba,El Salvador),significant variation was observed,especially in diabetes,hypertension and hyperlipidaemia.Conclusions In a multistate network,thousands of non-US-born,US-born and patients without a country of birth recorded had differing demographic characteristics,but clinical variation was not observed until data was disaggregated into specific country of origin.State policies that enhance the safety of immigrant populations may enhance the collection of health equity related data.Rigorous and effective health equity research using Latino country of birth information paired with longitudinal healthcare information found in EHRs might have significant potential for aiding clinical and public health practice,but it depends on increased,widespread and accurate avai

关键词： Latin rigorous sectional

New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Family Medicine and Community Health 2020年第4期8卷 84-89页

作者： Heather Angier Nathalie Huguet David Ezekiel-Herrera Miguel Marino Teresa Schmidt Beverly B Green Jennifer E DeVoe Family Medicine Oregon Health&Science UniversityPortlandOregonUSA Biostatistics Group Oregon Health&Science University-Portland State University School of Public HealthPortlandOregonUSA Research OCHINPortlandOregonUSA Kaiser Permanente Washington Health Research Institute SeattleWashingtonUSA

Objective To assess the Affordable Care Act(ACA)Medicaid expansion’s impact on new hypertension and diabetes diagnoses in community health centres(CHCs).Design Rates of new hypertension and diabetes diagnoses were computed using generalised estimating equation Poisson models and we tested the difference-in difference(DID)pre-ACA versus post-ACA in states that expanded Medicaid compared with those that did not.Setting We used electronic health record data(pre-ACA:1 January 2012-31 December 2013-post-ACA:1 January 2014-31 December 2016)from the Accelerating Data Value Across a National Community Health Center Network clinical data network.We included clinics with≥50 patients contributing to person-time at risk in each study year.Participants Patients aged 19-64 with≥1 ambulatory visit in the study period were included.We then excluded patients who were pregnant during the study period(N=127530).For the hypertension outcome,we excluded individuals with a diagnosis of hypertension prior to the start of the study period,those who had a hypertension diagnosis on their first visit to a clinic or their first visit after 3 years without a visit,and those who had a diagnosis more than 3 years after their last visit(pre-ACA non-expansion N=130973;expansion N=193198;post-ACA non-expansion N=186341;expansion N=251015).For the diabetes analysis,we excluded patients with a diabetes diagnosis prior to study start,on their first visit or first visit after inactive patient status,and diagnosis while not an active patient(pre-ACA non-expansion N=145435;expansion N=198558;post-ACA non-expansion N=215039;expansion N=264644).Results In non-expansion states,adjusted hypertension diagnosis rates saw a relative decrease of 6%,while in expansion states,the adjusted rates saw a relative increase of 7%(DID 1.14,95%CI 1.11 to 1.18).For diabetes diagnosis,adjusted rates in non-expansion states experienced a significant relative increase of 28%and in expansion states the relative increase was 25%;yet these differences were not significant pre-

关键词： diagnosis hypertension expansion

家庭医学：加速患者与人群健康提升的突破性革新

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

中国全科医学 2016年第28期19卷 3392-3393页

作者： Glen Stream Jennifer E.DeVoe Lauren S.Hughes Robert L.Phillips 本刊编辑部(译) Family Medicine for America's Health Leawood KS the Department of Family Medicine Oregon Health & Science University Portland OR ochin Inc. Port - land the Pennsylvania Department of Health Harrisburg PA the American Board of Family Medicine Lexington KY 不详

本文由参加第4届G.Gayle Stephens研讨会的作者于会后撰写,这些作者同时也是家庭医学与美国健康(FMAHealth)委员会的成员。文章将现阶段FMAHealth所做的战略与沟通工作的志向与会议得出的理念进行了关联。FMAHealth项目由8个国家家庭医... 详细信息

本文由参加第4届G.Gayle Stephens研讨会的作者于会后撰写,这些作者同时也是家庭医学与美国健康(FMAHealth)委员会的成员。文章将现阶段FMAHealth所做的战略与沟通工作的志向与会议得出的理念进行了关联。FMAHealth项目由8个国家家庭医学机构赞助,力图在最初的家庭医学未来项目的基础上进行开展。此项目的目标之一是使实力充足的家庭医生队伍在持续改善的医疗之家模式中工作,并且由足够维持医疗之家和私人医生与患者保持联系的综合付费模式支持。

关键词：医治家庭医学家庭医生医疗卫生提供私人医生人口健康基层医疗职业化社会公正

Mobility and social deprivation on primary care utilisation among paediatric patients with asthma

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Family Medicine and Community Health 2021年第3期9卷 47-53页

作者： Jennifer A Lucas Miguel Marino Sophia Giebultowicz Katie Fankhauser Shakira F Suglia Steffani R Bailey Andrew Bazemore John Heintzman Department of Family Medicine Oregon Health&Science UniversityPortlandOregonUSA ochin Inc PortlandOregonUSA Department of Epidemiology Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA American Board of Family Medicine LexingtonKentuckyUSA Center for Professionalism&Value in Health Care WashingtonDCUSA

Objective Asthma care is negatively impacted by neighbourhood social and environmental factors,and moving is associated with undesirable asthma outcomes.However,little is known about how movement into and living in areas of high deprivation relate to primary care use.We examined associations between neighbourhood characteristics,mobility and primary care utilisation of children with asthma to explore the relevance of these social factors in a primary care setting.Design In this cohort study,we conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination.All models were adjusted for patient-level covariates.Setting We used data from community health centres in 15 ochin states.Participants The sample included 23773 children with asthma aged 3-17 across neighbourhoods with different levels of social deprivation from 2012 to 2017.We conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination.All models were adjusted for patient-level covariates.Results Clinic visit rates were higher among children living in or moving to areas with higher deprivation than those living in areas with low deprivation(rate ratio(RR)1.09,95%CI 1.02 to 1.17;RR 1.05,95%CI 1.00 to 1.11).Children moving across neighbourhoods with similarly high levels of deprivation had increased RRs of influenza vaccination(RR 1.13,95%CI 1.03 to 1.23)than those who moved but stayed in neighbourhoods of low deprivation.Conclusions Movement into and living within areas of high deprivation is associated with more primary care use,and presumably greater opportunity to reduce undesirable asthma outcomes.These results highlight the need to attend to patient movement in primary care visits,and increase neighbourhood-targeted population management to improve equity and care for children with asthma.

关键词： deprivation asthma vaccination

健康的社会决定因素在初级卫生保健中的融入路径

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

中国全科医学 2016年第22期19卷 2617-2618页

作者： Jennifer E.DeVoe Andrew W.Bazemore Erika K.Cottrell Sonja Likumahuwa-Ackman Jené Grandmont Natalie Spach Rachel Gold 杨文俄勒冈医科大学家庭医学学院美国俄勒冈州波特兰市 ochin有限公司 Robert Graham中心华盛顿特区 HealthLandscape 俄亥俄州辛辛那提市 Kaiser Permanente健康研究中心俄勒冈州波特兰市中国全科医学杂志社

健康的社会决定因素（SDH）指非临床上的可以影响患者健康的因素,如社会地位、经济状况及邻里资源等。WHO将其定义为人们出生、成长、工作、生活、衰老的环境,以及广义上的塑造这些日常生活条件的力量和系统。SDH与疾病发病率、死亡率... 详细信息

健康的社会决定因素（SDH）指非临床上的可以影响患者健康的因素,如社会地位、经济状况及邻里资源等。WHO将其定义为人们出生、成长、工作、生活、衰老的环境,以及广义上的塑造这些日常生活条件的力量和系统。SDH与疾病发病率、死亡率及其他健康指标相关,且其对人群健康的影响大于医疗服务。

关键词：健康的社会决定因素初级卫生保健人口特征医学信息学数据收集