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Partnering Urban Academic Medical Centers And Rural Primary Care Clinicians To Provide Complex Chronic Disease Care

Published on Jun 1, 2011in Health Affairs5.711
· DOI :10.1377/hlthaff.2011.0278
Sanjeev Arora24
Estimated H-index: 24
(UNM: University of New Mexico),
Summers Kalishman19
Estimated H-index: 19
+ 12 AuthorsSean Yutzy1
Estimated H-index: 1
Abstract
Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of various chronic illnesses and to l...
  • References (8)
  • Citations (136)
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References8
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#1Sanjeev Arora (UNM: University of New Mexico)H-Index: 24
#2Summers Kalishman (UNM: University of New Mexico)H-Index: 19
Last. Wesley Pak (UNM: University of New Mexico)H-Index: 3
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159 CitationsSource
The Patient Protection and Affordable Care Act enables community health centers to serve nearly 20 million new patients while adding an estimated 15,000 providers to their staffs by 2015. Dr. Eli Adashi and colleagues describe the “new” community health centers.
141 CitationsSource
#1S. Abu MouchH-Index: 3
#2Zvi FiremanH-Index: 20
Last. Nimer AssyH-Index: 27
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18 CitationsSource
#1Bonnie M. MillerH-Index: 12
#2Donald E. MooreH-Index: 30
Last. Jeffrey R. BalserH-Index: 41
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AbstractOne hundred years after Flexner wrote his report for the Carnegie Foundation, calls are heard for another “Flexnerian revolution,” a reform movement that would overhaul an approach to medical education that is criticized for its expense and inefficiency, its failure to respond to the health
49 CitationsSource
#1John McWilliamsH-Index: 30
#2Ellen MearaH-Index: 29
Last. John Z. AyanianH-Index: 32
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Background: Efforts to improve the care of cardiovascular disease and diabetes or expand insurance coverage for adults with these conditions may reduce differences in clinical outcomes. Objective: To assess recent national trends in disease control, trends in sociodemographic differences in control, and changes in sociodemographic differences after age 65 years associated with near-universal Medicare coverage. Design: Observational and quasi-experimental analyses of repeated cross-sectional data...
251 CitationsSource
#1Andrew P. Wilper (CHA: Cambridge Health Alliance)H-Index: 11
#2Steffie Woolhandler (CHA: Cambridge Health Alliance)H-Index: 50
Last. David U. Himmelstein (CHA: Cambridge Health Alliance)H-Index: 51
view all 6 authors...
Background: No recent national studies have assessed chronic illness prevalence or access to care among persons without insurance in the United States. Objective: To compare reports of chronic conditions and access to care among U.S. adults, by self-reported insurance status. Design: Population-based survey. Setting: National Health and Nutritional Examination Survey (1999–2004). Participants: 12 486 patients age 18 to 64 years. Measurements: Estimates of national rates of cardiovascular disease...
142 CitationsSource
#1Nakela L. CookH-Index: 14
#2LeRoi S. Hicks (Harvard University)H-Index: 20
Last. Bruce E. Landon (Harvard University)H-Index: 60
view all 6 authors...
Although community health centers (CHCs) provide primary health services to the medically underserved and poor, limited access to off-site specialty services may lead to poorer outcomes among underinsured CHC patients. This study evaluates access to specialty health services for patients receiving care in CHCs, using a survey of medical directors of all federally qualified CHCs in the United States in 2004. Respondents reported that uninsured patients had greater difficulty obtaining access to o...
177 CitationsSource
#1John McWilliamsH-Index: 30
#2Ellen MearaH-Index: 29
Last. John Z. AyanianH-Index: 32
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Background Previously uninsured adults who enroll in the Medicare program at the age of 65 years may have greater morbidity, requiring more intensive and costlier care over subsequent years, than they would if they had been previously insured. Methods We used longitudinal data from the nationally representative Health and Retirement Study to assess self-reported health care use and expenditures from 1992 through 2004 among 5158 adults who were privately insured or uninsured before Medicare cover...
153 CitationsSource
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#1Micah O. Mazurek (UVA: University of Virginia)H-Index: 23
#2Robert A. Parker (Harvard University)H-Index: 57
Last. Kristin Sohl (MU: University of Missouri)H-Index: 6
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Importance The Extension for Community Health Outcomes (ECHO) model is a widely adopted technology-based model for training primary care physicians and practitioners (PCPs) to care for patients with complex conditions. Despite its popularity, to our knowledge, direct effects of ECHO on clinical practice have not been tested in a large-scale study. Objective To test the effectiveness of the ECHO model as applied to primary care for autism and whether it resulted in improved clinical practice, kno...
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#1Claire T. Than (UCLA: University of California, Los Angeles)H-Index: 7
#2Emmeline Chuang (UCLA: University of California, Los Angeles)H-Index: 15
Last. Elizabeth M. Yano (UCLA: University of California, Los Angeles)H-Index: 41
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Abstract Background Gender sensitivity of providers and staff has assumed increasing importance in closing historical gender disparities in health care quality and outcomes. The Department of Veterans Affairs (VA) has implemented several initiatives intended to improve gender sensitivity of its health care workforce. The current study examines practice- and individual-level characteristics associated with gender sensitivity of primary care providers (PCPs) and staff. Methods We surveyed PCPs and...
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#1Kimberley H. Geissler (UMass: University of Massachusetts Amherst)H-Index: 7
OBJECTIVE: To examine differences in referral patterns in a nationally representative sample between primary care physicians (PCP) practicing in rural vs nonrural areas and changes over time. STUDY DESIGN: Using the 2005-2016 National Ambulatory Medical Care Survey and multivariate logit regression models, I compare referral patterns of PCPs in rural vs nonrural areas. DATA COLLECTION: Multiple years of data were combined. PRINCIPAL FINDINGS: A PCP visit was 1.9 percentage points (95% confidence...
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#1Joanna G. Katzman (UNM: University of New Mexico)H-Index: 8
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#1Kristin N. Ray (University of Pittsburgh)H-Index: 9
#2Jeremy M. Kahn (University of Pittsburgh)H-Index: 44
Abstract Nearly a quarter of families of children with need of subspecialty care report difficulty accessing that care. Telehealth is a method to overcome barriers to subspecialty care. However, improving access to subspecialty care through telehealth requires granular identification of specific subspecialty barriers and recognition of the strengths and limitations of each telehealth strategy for addressing identified barriers. Focusing on each sequential step in subspecialty referrals and poten...
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#1Miriam Komaromy (BMC: Boston Medical Center)H-Index: 1
#2Judy Bartlett (UNM: University of New Mexico)H-Index: 1
Last. Sanjeev Arora (UNM: University of New Mexico)H-Index: 24
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Background Programs for high-need, high-cost (HNHC) patients can improve care and reduce costs. However, it may be challenging to implement these programs in rural and underserved areas, in part due to limited access to specialty consultation.
Source
#1Erin L. Winstanley (WVU: West Virginia University)H-Index: 2
#2Laura R. Lander (WVU: West Virginia University)H-Index: 6
Last. Marc W. HautH-Index: 19
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Abstract West Virginia (WV) is situated at the epicenter of the opioid epidemic with the highest rates of overdose deaths and some of the lowest rates of access to life saving evidence-based medication assisted treatment (MAT) for patients with opioid use disorder (OUD). WV used a modified hub-and-spoke model to build organizational capacity for facilities to use buprenorphine to treat patients with OUD and to provide ongoing case consultation. The purpose of this study is to 1) describe the gro...
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#1Miriam Komaromy (BMC: Boston Medical Center)H-Index: 1
#1Miriam KomaromyH-Index: 10
Last. Sanjeev AroraH-Index: 24
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Background A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes.
1 CitationsSource
#1E. Michael Lewiecki (UNM: University of New Mexico)H-Index: 47
Last. Rachelle Rochelle (UNM: University of New Mexico)H-Index: 2
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Purpose of Review This review describes the global development of a model of technology-enabled collaborative learning for healthcare professionals called Project ECHO (Extension for Community Healthcare Outcomes) and its applications for the management of patients with skeletal diseases.
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#1Tamara T. Perry (University of Arkansas for Medical Sciences)H-Index: 22
#2Jessica H. Turner (University of Arkansas for Medical Sciences)H-Index: 1
Asthma affects 10% of school-age children in the United States. These numbers nearly double in high-risk populations such as low-income and minority populations. Patients in these populations frequently live in communities that are medically underserved, with limited resources to implement comprehensive asthma interventions. It is important for researchers and clinicians to explore avenues to reduce the burden of illness in this population. Incorporating innovative strategies such as school-base...
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