Leveraging Health IT to Reduce Disparities in Three Underserved Beacon Communities.

Using health information technology (IT) can potentially address health disparities by increasing access to care, delivering higher-quality care, improving patient-provider communication, and enhancing patient safety. It describes challenges encountered by three underserved Beacon Communities that implemented health IT interventions, including inadequate connectivity infrastructure, technical support, expertise, and financial resources; provider shortages and staff turnover; and equipment theft.

Patient Engagement and Activation in Three Underserved Beacon Communities.

Whether the setting is urban, rural, or somewhere in between, engagement strategies for the underserved require a great deal of flexibility and sensitivity to the socioeconomic, cultural, and geographic conditions of the patient population. The following report details how three unique communities designed specific strategies to engage underserved populations in the management of their chronic conditions.

Transforming primary care practices in a Hawai'i Island clinic: obtaining patient perceptions on patient centered medical home.

Health care access is a significant problem for residents of Hawai'i Island who are experiencing a healthcare provider shortage crisis. Many residents must travel far for routine medical care, and in some cases to other islands. Hamakua Health Center, Inc., which operates from two clinical sites (Honokaa and Kapaau), is transitioning towards a Patient-Centered Medical Home care model. Through focus groups, a qualitative study was completed to obtain patient perceptions on Patient-Centered Medical Home. The Hamakua and Kohala Family Health Center staff were asked to recommend a list of patients from their respective health centers for focus group participation. In this sample (N=18), 67% of participants were female of various ethnicities. The participants' mean age was 62.2 (SD =14.3) years. Questions asked by the moderator were based on the American College of Providers' Patient-Centered Medical Home Assessment Tool. The three universal themes generated by the focus groups included quality care, provider and health services accessibility, and communication and coordination. Health information technology was a topic that was explored in the focus groups, and encompasses all three themes. Communication is regarded as a key to receiving quality care. Participants suggested having a rotation of specialists flown-in regularly from O'ahu to improve care quality. Technology is appreciated as it can streamline the information exchange process, and increase the patient's access to health services. There is unanimous concern regarding confidentiality and privacy. It is imperative that the health centers keep patients informed as they make their transition.

Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study.

UNLABELLED: Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study. OBJECTIVE: To evaluate the feasibility and gait stability and balance outcomes of a 4-month individualized home exercise program for women with arthritis. DESIGN: Pre-post interventional study. SETTING: General community. PARTICIPANTS: Women (N=49) (volunteers) with lower-limb osteoarthritis or lower-limb rheumatoid arthritis were enrolled. Only 39 subjects were eligible and completed the study. INTERVENTION: After completion of the initial assessment, all participants received home balance exercises from an experienced physiotherapist based on assessment findings and exercises available from commercially available kits. All measures were repeated 4 months later. MAIN OUTCOME MEASURES: Falls risk (Falls Risk of Older People-Community Setting) and balance measures. RESULTS: Thirty-nine women (mean age, 69.3y; 95% confidence interval, 65.7-72.9) completed the 4-month program. At baseline, 64% of participants reported falling in the preceding 12 months, and the average falls risk (Falls Risk of Older People-Community Setting) score was 14.5, with 42% rated as moderate risk (16-23). Participants achieved improved performance on most balance and related measures after the exercise program, including falls risk (P=.01), activity levels (P=.015), fear of falling (P=.022), functional reach test (P=.001), rising index for sit to stand (P=.001), step width in walking (P=.001), and body mass index (P=.006). CONCLUSIONS: An individualized balance training home exercise program is feasible for older women with osteoarthritis or rheumatoid arthritis and may improve stability during walking and other functional activities.