Association between distance to community health care facilities and COVID-19-related mortality across U.S. counties in the COVID-19-vaccine era.

OBJECTIVE: COVID-19 has caused tremendous damage to U.S. public health, but COVID vaccines can effectively reduce the risk of COVID-19 infections and related mortality. Our study aimed to quantify the association between proximity to a community healthcare facility and COVID-19 related mortality after COVID vaccines became publicly available and explore how this association varied across racial and ethnic groups. RESULTS: Residents living farther from a facility had higher COVID-19-related mortality across U.S. counties. This increased mortality incidence associated with longer distances was particularly pronounced in counties with higher proportions of Black and Hispanic populations.

Barriers and facilitators to the provision of maternal health services at community health centers during the COVID-19 pandemic: Experiences of midwives in Indonesia.

OBJECTIVE: To explore the experiences of midwives in Indonesia on the provision of maternal health services during the COVID-19 pandemic. DESIGN AND METHODS: A qualitative descriptive study using focus group discussions was undertaken. A conventional content analysis was used to analyze the data. Coding categories were generated from the transcripts. SETTING AND PARTICIPANTS: Twenty-two midwives from five community health centers of three regions in the Province of Jambi, Indonesia were included. FINDINGS: The interviewees shared similar barriers and facilitators in delivering the services, including the unavailability of adequate protective equipment, the limitation of the number of services, and dealing with the new public health measures related to the COVID-19. Overall, midwives demonstrated a continued commitment to provide maternal health services during the pandemic. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Significant changes in service delivery have been made to comply with pandemic related restrictions. Despite the unprecedentedly difficult working environment, the midwives continue to provide adequate services to the community by implementing a strict health protocol. Findings from this study contribute to a better understanding of how the quality of the services changed, as well as how new challenges can be addressed and positive changes can be reinforced.

Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems.

Health care organizations and systems can have a large impact on how extensively telemedicine and virtual visits are used by medical practices and individual clinicians. This supplemental issue of medical care aims to advance evidence about how health care organizations and systems can best support telemedicine and virtual visit implementation. This issue includes 10 empirical studies examining the impact of telemedicine on quality of care, utilization, and/or patient care experiences, of which 6 are studies of Kaiser Permanente patients; 3 are studies of Medicaid, Medicare, and community health center patients; and 1 is a study of PCORnet primary care practices. The Kaiser Permanente studies find that ancillary service orders resulting from telemedicine encounters were not placed as often as in-person encounters for urinary tract infections, neck, and back pain, but there were no significant changes in patient fulfillment of ordered antidepressant medications. Studies focused on diabetes care quality among community health center patients and Medicare and Medicaid beneficiaries highlight that telemedicine helped maintain continuity of primary care and diabetes care quality during the COVID-19 pandemic. The research findings collectively demonstrate high variation in telemedicine implementation across systems and the important role that telemedicine had in maintaining the quality of care and utilization for adults with chronic conditions when in-person care was less accessible.

Telehealth Use, Care Continuity, and Quality: Diabetes and Hypertension Care in Community Health Centers Before and During the COVID-19 Pandemic.

BACKGROUND: Community health centers (CHCs) pivoted to using telehealth to deliver chronic care during the coronavirus COVID-19 pandemic. While care continuity can improve care quality and patients' experiences, it is unclear whether telehealth supported this relationship. OBJECTIVE: We examine the association of care continuity with diabetes and hypertension care quality in CHCs before and during COVID-19 and the mediating effect of telehealth. RESEARCH DESIGN: This was a cohort study. PARTICIPANTS: Electronic health record data from 166 CHCs with n=20,792 patients with diabetes and/or hypertension with ≥2 encounters/year during 2019 and 2020. METHODS: Multivariable logistic regression models estimated the association of care continuity (Modified Modified Continuity Index; MMCI) with telehealth use and care processes. Generalized linear regression models estimated the association of MMCI and intermediate outcomes. Formal mediation analyses assessed whether telehealth mediated the association of MMCI with A1c testing during 2020. RESULTS: MMCI [2019: odds ratio (OR)=1.98, marginal effect=0.69, z=165.50, P<0.001; 2020: OR=1.50, marginal effect=0.63, z=147.73, P<0.001] and telehealth use (2019: OR=1.50, marginal effect=0.85, z=122.87, P<0.001; 2020: OR=10.00, marginal effect=0.90, z=155.57, P<0.001) were associated with higher odds of A1c testing. MMCI was associated with lower systolic (ß=-2.90, P<0.001) and diastolic blood pressure (ß=-1.44, P<0.001) in 2020, and lower A1c values (2019: ß=-0.57, P=0.007; 2020: ß=-0.45, P=0.008) in both years. In 2020, telehealth use mediated 38.7% of the relationship between MMCI and A1c testing. CONCLUSIONS: Higher care continuity is associated with telehealth use and A1c testing, and lower A1c and blood pressure. Telehealth use mediates the association of care continuity and A1c testing. Care continuity may facilitate telehealth use and resilient performance on process measures.

TAIBU Community Health Centre's Proportionate Response to a Disproportionate Pandemic.

Data from the City of Toronto indicate that the majority of COVID-19 cases and hospitalizations as of December 2021 were among individuals who identified with a racialized group. In this paper, we summarize how TAIBU Community Health Centre, an organization mandated to serve the Black and Francophone communities in the Greater Toronto Area, prioritized and embedded race-based data collection in order to highlight the specific experiences of Black and racialized communities during the COVID-19 pandemic. Lessons learned from this work can be used to help support race-based data collection.

Impact of COVID-19 Pandemic on Assessing Tobacco Status in Community Health Centers.

Few have studied the COVID-19 pandemic's impact on tobacco use status assessment and cessation counseling. Electronic health record data from 217 primary care clinics were examined from January 1, 2019 to July 31, 2021. Data included telehealth and in-person visits for 759,138 adult patients (aged ≥18 years). Monthly rates of tobacco assessment per 1,000 patients were calculated. From March 2020 to May 2020, tobacco assessment monthly rates declined by 50% and increased from June 2020 to May 2021 but remained 33.5% lower than pre-pandemic levels. Rates of tobacco cessation assistance changed less, but remain low. These findings are significant given the relevance of tobacco use to increased severity of COVID-19.

Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers.

BACKGROUND: Uncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient's BP is assumed uncontrolled. METHODS: To examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP). RESULTS: The percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021). CONCLUSIONS: The transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes.

The preparedness of disaster among nurses in community health centers in rural areas during the COVID-19 pandemic in Malang City.

Positive COVID-19 cases in Malang City, Indonesia continue to increase. Until 04 August 2021, the COVID-19 update shows 3301 positive cases with 7754 cured and 832 deaths. This study aims to identify nurses preparedness in rural area community health centers during the COVID-19 pandemic in Malang for self-control to implement health protocol. This study intends to provide insights on controlling COVID-19 spread in Malang, Indonesia. This research is a quantitative study with correlative analytic observational design and a cross-sectional approach involving 120 nurses from 16 primary health centers. The results of the bivariate analysis using gamma correlation test are: knowledge factors (p = 0.005; r = 0.35), attitude (p = 0.000; r = 0.46), means of infrastructure (p = 0.000; r = 0.54), and self-control (p = 0.000; r = 0.52) for the quarantined COVID-19 patients. Knowledge, attitude, infrastructure, and safe house factors can influence self-control for COVID-19. In rural areas, health education-as education and empowerment for patient self-control-is an effort to encourage them to obey health protocol during the pandemic. Nurse readiness and preparedness during the pandemic is crucial for strengthening the assertive behavior commitment through self-control. This ensures the community's awareness of the importance of complying with health protocols for the common good. Mental nursing intervention needs to be added as a part of psychosocial therapy for the community's social problems, primarily in reducing the pressure due to the social distancing enforcement to control and prevent COVID-19 spread.

Association between state payment parity policies and telehealth usage at community health centers during COVID-19.

OBJECTIVE: We study the association between payment parity policies and telehealth utilization at community health centers (CHCs) before, during, and after the onset of the pandemic. MATERIALS AND METHODS: We use aggregated, de-identified data from FAIR Health for privately insured patients at CHC sites. Descriptive statistics and time trends are calculated. Logistic regression models were used to quantify the factors associated with telehealth utilization for each of our time periods: 1) pre-pandemic (March-June 2019), 2) immediate pandemic response (March-June 2020), and 3) sustained pandemic response (March-June 2021). RESULTS: Telehealth usage rates at CHC sites surged to approximately 61% in April 2020. By April 2021, only 29% of CHC sites in states without payment parity policies used telehealth versus 42% in states without. Controlling for other characteristics, we find that CHC sites in states with payment parity were more likely to utilize telehealth one year after the onset of the pandemic (OR:1.740, p<0.001) than states without, but did not find this association in 2019 or 2020. DISCUSSION: The public health emergency drove widespread use of telehealth, making the virtual care environment inherently different in 2021 than in 2019. Due to the unique fiscal constraints facing CHCs, the financial sustainability of telehealth may be highly relevant to the relationship between telehealth utilization and payment parity we find in this paper. CONCLUSION: Supportive payment policy and continued investments in broadband availability in rural and undeserved communities should enable CHCs to offer telehealth services to populations in these areas.

Addressing Inequities in SARS-CoV-2 Vaccine Uptake: The Boston Medical Center Health System Experience.

Academic medical centers could play an important role in increasing access to and uptake of SARS-CoV-2 vaccines, especially in Black and Latino communities that have been disproportionately affected by the pandemic. This article describes the vaccination program developed by the Boston Medical Center (BMC) health system (New England's largest safety-net health system), its affiliated community health centers (CHCs), and community partners. The program was based on a conceptual framework for community interventions and aimed to increase equitable access to vaccination in the hardest-hit communities through community-based sites in churches and community centers, mobile vaccination events, and vaccination on the BMC campus. Key strategies included a communication campaign featuring trusted messengers, a focus on health equity, established partnerships with community leaders and CHCs, and strong collaboration with local health departments and the Commonwealth of Massachusetts to ensure equitable allocation of the vaccine supply. Process factors involved the use of robust analytics relying on the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI). The vaccination program administered 109 938 first doses, with 94 703 (86%) given at community sites and 2466 (2%) given at mobile sites. Mobile vaccination events were key in reaching younger people living in locations with the highest SVIs. Challenges included the need for a robust operational infrastructure and mistrust of the health system given the long history of economic disinvestment in the surrounding community. The BMC model could serve as a blueprint for other medical centers interested in implementing programs aimed at increasing vaccine uptake during a pandemic and in developing an infrastructure to address other health-related disparities.

COVID-19 Sero-Prevalence and Risk Factors in a Sample of Community Health Center Employees in New York State.

OBJECTIVE: To document COVID-19 sero-prevalence, prior testing, symptom experiences, and risk factors in a sample of community health center (CHC) workers. METHODS: Descriptive statistics and log-binomial regression were used to analyze an electronic employee survey linked with COVID-19 antibody results. The sample included 378 employees who completed the survey; 325 had complete lab data. RESULTS: The sero-positivity rate was 15.4%. One third of sero-positive participants had no previous COVID-19 symptoms or were unsure. Working on-site only and/or with direct patient contact was not associated with sero-positivity. Employees in their 20s were more likely to test positive than employees ages 50+, controlling for sex, race, and region (PR = 2.96; P < 0.05). CONCLUSIONS: With CHCs central to COVID-19 response and vaccination efforts, public health messaging should remind CHC workers, especially younger employees, of their risks of community-based exposure.

Attitude of health professionals towards COVID-19 vaccination and associated factors among health professionals, Western Ethiopia: A cross-sectional survey.

INTRODUCTION: Even though people of the world were eagerly waiting for the hope of vaccine development, vaccine hesitancy is becoming the top concern in both developed and developing countries. However, there is no adequate evidence regarding the attitude and perception of health professionals towards the COVID 19 vaccine in resource-limited settings like Ethiopia. The aim of this study was to assess health professionals' attitudes and perceptions towards COVID 19 vaccine in Western Ethiopia. METHODS: An institution-based cross-sectional study was conducted among health care workers found in Nekemte town from April 14-21, 2021. A total of 439 health professionals present on duty during the study period was included in the study. The data were collected by using self-administered questionnaire. Epidata version 3.2 was used for data entry, and STATA version 14 was used for data analysis. The binary logistic regression model was employed to determine factors associated with the attitude towards COVID-19 vaccination. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared at a 5% level (p-value < 0.05). RESULT: A total of 431 health professionals participated in the study yielding a response rate of 98.1%. The results indicated that 51.28% (95%CI: 45.12%, 57.34%) of health professionals had a favorable attitude towards COVID-19 vaccination. Having good knowledge about the COVID-19 vaccine (AOR = 0.38, 95%CI: 0.22, 0.64, P-value <0.001) was negatively associated with unfavorable attitude towards COVID-19 vaccine, whereas age less than 30 years (AOR = 2.14, 95%CI:1.25,3.67, P-value <0.001), working in a private clinic (AOR = 7.77, 95% CI: 2.19, 27.58, P-value <0.001) and health center (AOR = 2.45, 95%CI: 1.01, 5.92, P-value = 0.045) were positively associated with unfavorable attitude towards COVID-19 vaccine. CONCLUSION AND RECOMMENDATION: In general, the attitude and perception of health care professionals toward the COVID-19 vaccine in the study area were unsatisfactory. Knowledge about the COVID-19 vaccine, age of health care workers, and place of work are the factors which affects attitude towards COVID-19 vaccine. Thus, we recommend the media outlets and concerned bodies to work to develop trust among the public by disseminating accurate and consistent information about the vaccine.

Beyond Primary Care: Renewing the Community Health Center Vision for Today's Health Crisis.

United States community health centers address socioeconomic and environmental conditions and provide comprehensive primary care despite market forces that reinforce a medical model. Collaborating with 14 health center organizations, the RCHN Community Health Foundation promoted the original and broader health center vision of health, launching its population health management initiative in 2015. Although participating organizations were recognized as patient-centered medical homes and achieved rewards for quality, most identified gaps in their capacity for population health management. These challenges, addressed through peer learning and local initiatives, included engaging target populations, care coordination, socioeconomic and clinical data collection, and working with nontraditional local organizations. With relatively small funding, the zeal and enthusiasm for population health was revitalized among health center staff. The current pandemic and growing national concern for health disparities represents an opportunity to expand this broader vision of population health and to sustain it as the COVID-19 pandemic eventually subsides.

Colorectal Cancer Screening with Mailed Fecal Immunochemical Tests and Telephone Outreach at a Community Health Center during the COVID-19 Pandemic.

Colorectal cancer (CRC) is a common cause of cancer death and disproportionately affects non-Hispanic Black patients. Routine screening with the fecal immunochemical test (FIT) decreases CRC incidence and mortality, and previous literature suggests pairing FIT with live outreach. Screening delays due to the COVID-19 pandemic will likely increase CRC incidence and mortality, especially in underserved communities. We implemented a quality improvement (QI) project at an urban community health center (CHC) in which FIT was paired with live telephone outreach. The intervention increased CRC screening at the CHC by five percentage points. Fecal immunochemical test completion rates significantly increased with successful contact (24.6% for at least one vs. 3.0% for none, p < .0001) and ordering a FIT kit during a patient interaction (28.4% vs. 15.7%, p < .001). This intervention addressed disparities in CRC screening, and the report may have general implications for addressing systemic racism in preventive medicine.

Implementing expanded COVID-19 testing in Massachusetts community health centers through community partnerships: Protocol for an interrupted time series and stepped wedge study design.

BACKGROUND: Community Health Centers (CHCs) are a critical source of care for low-income and non-privately insured populations. During the pandemic, CHCs have leveraged their infrastructure and role as a trusted source of care to engage the communities they serve in COVID-19 testing. METHODS: To directly address the impact that COVID-19 has had on historically marginalized populations in Massachusetts, we designed a study of community-engaged COVID-19 testing expansion: (1) leveraging existing partnerships to accelerate COVID-19 testing and rapidly disseminate effective implementation strategies; (2) incorporating efforts to address key barriers to testing participation in communities at increased risk for COVID-19; (3) further developing partnerships between communities and CHCs to address testing access and disparities; (4) grounding the study in the development of a shared ethical framework for advancing equity in situations of scarcity; and (5) developing mechanisms for communication and science translation to support community outreach. We use a controlled interrupted time series design, comparing number of COVID-19 tests overall and among people identified as members of high-risk groups served by intervention CHCs compared with six matched control CHCs in Massachusetts, followed by a stepped wedge design to pilot test strategies for tailored outreach by CHCs. CONCLUSIONS: Here, we describe a community-partnered strategy to accelerate COVID-19 testing in historically marginalized populations that provides ongoing resources to CHCs for addressing testing needs in their communities. The study aligns with principles of community-engaged research including shared leadership, adequate resources for community partners, and the flexibility to respond to changing needs over time.

Willingness to use community health centres for initial diagnosis: the role of policy incentives among Chinese patients.

The aim of the study is to investigate the effect of policy incentives on residents' willingness to use community health centres for initial diagnosis. A cross-sectional survey with specific multiple price-list experiments was conducted in Guizhou, China. We were able to use in-depth individual interviews with a total of 422 participants. Our results showed that both financial and non-financial policy incentives can facilitate the utilisation of the community health centres. Approximately 60% of the respondents reported an increase in their willingness to use community health centres after the presentation of the financial policy, whereas 50% of respondents expressed an increase in their willingness to use community health centres with the non-financial policy. However, to some specific subgroups, such as residents with low trust, residents without chronic disease, residents with less healthcare visits and risk-averters, the impact of policy incentives were limited. The policy incentives are useful tools to attract more visitors to community health centres for initial diagnosis; however, their incentive effects vary in different subgroups. Thus, to change patients' perceptions regarding healthcare provider choice for initial diagnosis, policymakers should consider the heterogeneous responses of patients to policy incentives and focus their efforts on key cohorts.

Operation and management of a community treatment center using telemedicine for foreign patients with mild COVID-19 symptoms.

ABSTRACT: South Korean studies on coronavirus disease-2019 (COVID-19) treatment have described the use of community treatment centers (CTCs), which combine elements of the home and hospital, to isolate and treat mild COVID-19 patients. While the number of South Koreans diagnosed with COVID-19 cases has varied greatly by season, the number of confirmed cases in foreign nationals has shown no seasonality, with an average of around 25 to 30 per day. For foreign patients, accommodation arrangements and travel routes may be difficult; they may also have difficulty accessing medical care, so require careful management.We discuss our experience in operating and managing a CTC for foreign COVID-19 patients arriving in South Korea with mild symptoms. We also propose guidelines for efficient use of resources with respect to treating these patients in CTCs.We present the clinical findings of patients treated at the CTC between 7 October and 22 November 2020, and make some recommendations. We quarantined and treated foreign patients with mild symptoms of COVID-19 at the Ansan CTC. Discharge is determined based on clinical symptoms rather than polymerase chain reaction results. Medical and administrative staff use building A, while building B is used for isolating patients. Medical rounds are in the form of twice-daily video calls. Three kinds of foods with medication are served according to the patient's country of origin.In total, 315 patients were admitted to the Ansan CTC between 7 October and 22 November 2020; 145 of them were discharged from the CTC and 26 were transferred to other hospitals.To utilize medical resources efficiently during the pandemic, it is desirable to reserve CTCs exclusively for foreign patients.

Building capacity of community health centers to overcome data challenges with the development of an agile COVID-19 public health registry: a multistate quality improvement effort.

OBJECTIVE: During the coronavirus disease 2019 (COVID-19) pandemic, federally qualified health centers rapidly mobilized to provide SARS-CoV-2 testing, COVID-19 care, and vaccination to populations at increased risk for COVID-19 morbidity and mortality. We describe the development of a reusable public health data analytics system for reuse of clinical data to evaluate the health burden, disparities, and impact of COVID-19 on populations served by health centers. MATERIALS AND METHODS: The Multistate Data Strategy engaged project partners to assess public health readiness and COVID-19 data challenges. An infrastructure for data capture and sharing procedures between health centers and public health agencies was developed to support existing capabilities and data capacities to respond to the pandemic. RESULTS: Between August 2020 and March 2021, project partners evaluated their data capture and sharing capabilities and reported challenges and preliminary data. Major interoperability challenges included poorly aligned federal, state, and local reporting requirements, lack of unique patient identifiers, lack of access to pharmacy, claims and laboratory data, missing data, and proprietary data standards and extraction methods. DISCUSSION: Efforts to access and align project partners' existing health systems data infrastructure in the context of the pandemic highlighted complex interoperability challenges. These challenges remain significant barriers to real-time data analytics and efforts to improve health outcomes and mitigate inequities through data-driven responses. CONCLUSION: The reusable public health data analytics system created in the Multistate Data Strategy can be adapted and scaled for other health center networks to facilitate data aggregation and dashboards for public health, organizational planning, and quality improvement and can inform local, state, and national COVID-19 response efforts.

Early Data on Predictors of COVID-19 Treatment Frequency at Community Health Centers.

INTRODUCTION: Federally-funded community health centers (CHCs) serve on the front lines of the COVID-19 pandemic, providing essential COVID-19 testing and care for vulnerable patient populations. Overlooked in the scholarly literature is a description of how different characteristics and vulnerabilities shaped COVID-19 care delivery at CHCs in the first year of the pandemic. Our research objective was to identify organization- and state-level factors associated with more or fewer COVID-19 care and testing visits at CHCs in 2020. METHODS: Multilevel random intercept regression models examined associations among organization and state-level predictor variables and the frequency of COVID-19 care and testing visits at CHCs in 2020. The study sample included 1267 CHCs across the 50 states and the District of Columbia. RESULTS: The average CHC provided 932 patient visits for COVID-19-related care in 2020. Yet, the CHC's role in delivering COVID-19 services proved as diverse as the populations and localities CHCs serve. For example, after adjusting for other factors, each percentage-point increase in a CHC's Hispanic patient population size was associated with a 1.3% increase in the frequency of patient visits for COVID-19 care in 2020 (P < .001). Serving a predominantly rural patient population was associated with providing significantly fewer COVID-19-related care visits (P = .002). Operating in a state that enacted a mask-wearing policy in 2020 was associated with a 26.2% lower frequency of COVID-19 testing visits at CHCs in 2020, compared to CHCs operating in states without mask-wearing policies (P = .055). CONCLUSIONS: In response to the pandemic, the federal government legislated funding to help CHCs address challenges associated with COVID-19 and provide services to medically-underserved patient populations. Policymakers will likely need to provide additional support to help CHCs address population-specific vulnerabilities affecting COVID-19 care and testing delivery, especially as highly contagious COVID-19 variants proliferate (eg, Delta and Omicron).