Effects of the COVID-19 Pandemic on Patient Navigation for Health-Related Social Needs: Reflections From the Accountable Health Communities Model.

BACKGROUND AND OBJECTIVES: This paper uses data from the Center for Medicare & Medicaid Innovation's Accountable Health Communities (AHC) Model to assess the effects of the COVID-19 pandemic on patient navigation (PN) for health-related social needs. METHODS: We analyzed evaluation data from 28 organizations implementing the Center for Medicare & Medicaid Innovation's AHC Model. We first distilled themes from 81 stakeholder interviews conducted in 2021. We then analyzed quantitative beneficiary-level data on acceptance of navigation among 133,173 unique Medicare and Medicaid beneficiaries who were eligible for navigation between January 2019 and March 2021. RESULTS: During the pandemic, interview participants described greater complexity of patients' cases and uncertainty regarding community service availability. Changes to navigation staffing and mode led to improvements in navigation quality and efficiency, but also challenges such as reduced rapport with patients. The pandemic increased navigator stress and burnout but also deepened appreciation for navigation among navigators and their patients. Beneficiaries were more likely to accept navigation during the pandemic than before the pandemic ( P < .05). CONCLUSIONS: Changes in PN during the pandemic were perceived as both good and bad. Future work is needed to assess the long-term implications of pandemic-related changes to navigation for patients and navigators.

U.S. Food System Working Conditions as an Issue of Food Safety.

Food workers' health and hygiene are common pathways to foodborne disease outbreaks. Improving food system jobs is important to food safety because working conditions impact workers' health, hygiene, and safe food handling. Stakeholders from key industries have advanced working conditions as an issue of public safety in the United States. Yet, for the food industry, stakeholder engagement with this topic is seemingly limited. To understand this lack of action, we interviewed key informants from organizations recognized for their agenda-setting role on food-worker issues. Findings suggest that participants recognize the work standards/food safety connection, yet perceived barriers limit adoption of a food safety frame, including more pressing priorities (e.g., occupational safety); poor fit with organizational strategies and mission; and questionable utility, including potential negative consequences. Using these findings, we consider how public health advocates may connect food working conditions to food and public safety and elevate it to the public policy agenda.

Listening to food workers: Factors that impact proper health and hygiene practice in food service.

BACKGROUND: Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers' improper health and hygiene practice. OBJECTIVE: To investigate food workers' perceptions of factors that impact proper food safety practice. METHOD: Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior. RESULTS: Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies. CONCLUSION: Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers' social and structural context, that impact food safety practice.

The role of partnerships in U.S. Food Policy Council policy activities.

Food Policy Councils (FPC) help to identify and address the priorities of local, state, and regional food systems with the goal of improving food systems through policy. There is limited research describing FPCs' strategies for accomplishing this goal. As part of a larger study examining FPC policy efforts, this paper investigates the role of partnerships in food systems policy change. We conducted interviews with representatives from 12 purposefully selected FPCs in the United States and 6 policy experts identified by the selected FPC representatives to document and describe their policy work. One theme that emerged from those interviews was the role of partners. Interviewees described a range of partners (e.g., stakeholders from government, business, and education) and credited FPC partnerships with advancing their policy goals by increasing the visibility and credibility of FPCs, focusing their policy agenda, connecting FPCs to key policy inputs (e.g., local food community knowledge and priorities), and obtaining stakeholder buy-in for policy initiatives. Partnerships were also described as barriers to policy progress when partners were less engaged or had either disproportionate or little influence in a given food sector. Despite these challenges, partnerships were found to be valuable for FPCs efforts to effectively engage in the food policy arena.