Integration of the Registered Nurse Care Coordinator Role in a Federally Qualified Health Center.

The purpose of this 1-group, retrospective case study was to analyze the expanded role of registered nurse care coordination (RNCC) on health outcomes in a primary care setting in its real-life context. The convenience sample consisted of 244 adults diagnosed with uncontrolled diabetes mellitus and/or hypertension. Secondary data entered into the electronic health record by the health care team during patient visits pre- and post-implementation of the RNCC program were analyzed. Clinical findings suggest that RNCC may provide a valuable service. Additionally, financial analysis demonstrated that the cost of the RNCC position was both self-sustaining and revenue producing.

Evaluation of a Web-Based Training Model for Family Peer Advocates in Children's Mental Health.

OBJECTIVE: The aim of this study was to compare knowledge gains from a new online training program with gains from an existing in-person training program for family peer advocates. METHODS: Data were used from a pre-post study of individuals who enrolled in the Web-based Parent Empowerment Program training; 144 participants completed the training and pre-post tests, and 140 were admitted to the analyses. Knowledge was assessed with 34 questions, 29 of which were common to the online and in-person trainings. Pre-post knowledge scores were available from the in-person training. RESULTS: Statistically significant gains in knowledge were found with both the 34 questions and the 29 questions common to both trainings. Knowledge gains across the two training models did not differ. CONCLUSIONS: Data on knowledge gains from this accessible, affordable online model show promise for training the growing and important workforce of family peer advocates.

Using health coaches to help patients manage chronic disease.

This exploratory pilot study analyzed the transition to a new patient-centered care team model at three separate clinical sites of an urban community health center. The findings provide insights from both providers and health coaches on benefits and barriers of this new model.

A cost consequence analysis of outreach strategies for high risk pregnant women.

This retrospective, cost consequence analysis examined three distinct outreach strategies used by a community-based public health agency to enroll uninsured, low-income pregnant women in perinatal health care services. The three strategies included outreach workers, liaison workers, and case managers. Data analysis revealed that costs per enrollee by strategy were: outreach workers: $429; liaison workers: $98; and case managers: $187. Cost per strategy must be considered cautiously, however, because outreach and enrollment strategies at this agency are not mutually exclusive. Data analysis also revealed that the number of low and very low birth weight babies born to women enrolled in the study agency was half that of the general population, even though less than half the participants were enrolled in prenatal care during the first trimester of pregnancy. Findings from this study support the use of outreach and enrollment strategies to reduce barriers to access to health care and reduce health disparities of low-income, vulnerable populations.

Community health changes under welfare reform.

This comparative case study examined changes in community health under New Jersey welfare reform policy implementation (1994-2001). The boundaries of these case descriptions were directed by Milii's ecological framework for policy studies. The separate cases consist of descriptions of changes in social climate and health indicators within Camden, Essex, and Hudson counties in New Jersey. Data analysis revealed a greater public health challenge in these counties than the state as a whole. A large increase in the numbers of low income and uninsured in the population may begin in 2004, 2 years following the 5-year lifetime limit of the receipt of welfare benefits. A growing uninsured population would place additional burdens on the abilities of safety net providers to meet health care needs of vulnerable populations. If left unchanged, these wider effects of the New Jersey welfare reform policy would have negative implications for improving quality of care.

Organizational and community health changes under welfare reform.

This article comments on changes made by health-related organizations and in community health during the first years of New Jersey's welfare reform policy implementation in Camden, Essex, and Hudson counties (1992-1998). Throughout these years, county welfare agencies made organizational changes that shifted their focus from supporting family well-being to encouraging work. Health care provider organizations now are beginning to make organizational changes in response to the ripple effects of welfare reform policy. Specific actions to initiate and influence healthy welfare policy reformulation are presented.

Community-based health workers: head start or false start towards health for all?

Health service delivery programs using minimally-trained community-based health workers (CHWs) have been estabished in many developing countries in recent years. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. The reported experience with these programs has been mixed, raising questions about whether the community health worker is an optimal vehicle for extending primary health care. This review of six large-scale community-based worker programs suggests that they have succeeded in some of their objectives but not in others. CHWs increase the coverage and equity of service delivery at low cost compared with alternative modes of service organization. However, they do not consistently provide services likely to have substantial health impact and the quality of services they provide is sometimes poor. Large-scale CHW systems require substantial increases in support for training, management, supervision, and logistics. The evidence suggests that, in general, their potential has not been achieved in large routine programs. Further development of these programs is needed to reinforced their successes and assure that they are adequately supported as an integral component of the basic health system.(AU)