JOURNAL OF AMBULATORY CARE MANAGEMENT最新文献

{"title":"Diabetes MESSAGES: A Learning Collaborative to Support Community Health Centers in Implementing and Sustaining Group Visits.","authors":"Erin M Staab, Amanda Campbell, Cynthia T Schaefer, Michael T Quinn, Jefferine Li, Mengqi Zhu, Wen Wan, Arshiya A Baig","doi":"10.1097/JAC.0000000000000536","DOIUrl":"10.1097/JAC.0000000000000536","url":null,"abstract":"<p><p>The goal of the Diabetes MESSAGES study was to support community health centers (CHCs) in implementing diabetes group visits (GVs). In this paper, we describe the training and technical assistance provided and evaluate implementation and sustainability. CHC teams attended in-person learning sessions and regular web-based check-ins, implemented a 6-month GV program, and completed surveys and reports. We analyzed changes in staff knowledge and attitudes from pre- to post-training. We measured adoption, engagement, fidelity, tailoring, staff satisfaction, and barriers and facilitators to implementation. Using a mixed-methods multi-site case study approach, we identified factors related to sustainability. All 7 CHC teams successfully implemented GVs for 6 months; 4 continued GVs after the study period. Teams adapted the GV model to their local contexts while retaining the core elements of individual medical care, group education, goal setting, and social support. Staff enjoyed GVs and thought they benefited patients. Key factors that differed between sites that continued GVs and sites that did not were team cohesiveness, experience, and stability; success in operationalizing GV model components; ongoing adaptation and improvement; and ability to demonstrate benefits and address concerns regarding the organizational impact of GVs. The Diabetes MESSAGES learning collaborative offered a flexible GV model, a roadmap for implementation, expert coaching, and co-learning with other CHCs. CHCs succeeded in implementing diabetes GVs despite barriers. Lessons learned may be useful for others hoping to establish and maintain their own GV programs.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 4","pages":"215-227"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three Strategies for Healthcare Systems to Address Barriers to Care and Reduce Avoidable Spending for Children With Complex Medical Conditions.","authors":"Michele D Nelson, Victoria Liou-Johnson, Terry Platchek, Nirav R Shah, Stephanie Peters","doi":"10.1097/JAC.0000000000000537","DOIUrl":"10.1097/JAC.0000000000000537","url":null,"abstract":"<p><p>Children with complex medical conditions (CCMC) face substantial health challenges, high health care utilization and costs, and an elevated risk of adverse events. CCMC families experience barriers to optimal care, including financial difficulties, unmet medical needs, a lack of care coordination, and limited access to mental health services. This paper explores key systemic challenges in delivering high-quality, cost-effective care to CCMC and proposes 3 targeted strategies to improve care delivery and reduce avoidable spending: (1) bridging clinical care by ensuring 24/7 access to clinicians familiar with the child's needs, (2) using technology such as telehealth, mobile apps, and referral platforms to improve care coordination and access, and (3) prioritizing mental health through partnering with family-centered behavioral health services. While comprehensive policy reforms remain essential, this paper highlights pragmatic solutions that health care systems, government services, and technology companies can implement collaboratively to address the unmet care demands, improve patient outcomes, and enhance cost efficiency.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 4","pages":"228-239"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keep On Keeping On: An Examination of the Sustainability Capacity of a Heart Health Improvement Program in Primary Care Clinics.","authors":"Larry R Hearld, Nathan W Carroll, Kimberly A Smith, Holly Resuehr, Sharon Parker, Elizabeth A Jackson, Andrea Cherrington","doi":"10.1097/JAC.0000000000000538","DOIUrl":"10.1097/JAC.0000000000000538","url":null,"abstract":"<p><strong>Objective: </strong>Sustaining evidence-based interventions in health care delivery organizations are a well-known challenge. Failure to sustain evidence-based interventions wastes resources, diminishes access to high-quality care for patients and negatively affects quality outcomes, and leaves a residue of disillusionment among organizational members that hinder future efforts to implement other evidence-based interventions. The purpose of this study was to identify characteristics associated with sustainability capacity in a group of primary care clinics implementing the evidence-based heart health improvement program (HHIP).</p><p><strong>Methods: </strong>We used mixed methods that included validated cross-sectional surveys and semi-structured interviews administered throughout 2023-2024 among 23 primary care clinics. Univariate and ordinary least squares regression models were used to describe the level of capacity across seven different dimensions of sustainability and their relationship with organizational characteristics. Quantitative relationships were considered statistically significant at P ≤ .05. A framework-guided analysis was applied to 6 interviews with clinic leaders and staff to identify thematic barriers to sustainability.</p><p><strong>Results: </strong>Study participants reported relatively high levels of capacity to sustain the HHIP (range of 5.46-6.00, on a scale of 1-7), with the outcomes and effectiveness dimension rated highest and engaged staff rated lowest. The baseline level of organizational readiness to implement change was most consistently and positively related to sustainability capacity (5 of 7 dimensions). FQHCs (relative to non-FQHCs) and clinic leaders (relative to clinicians and clinic staff) were associated with higher ratings of 3 operationally focused dimensions of sustainability capacity (implementation and training, monitoring and evaluation, and outcomes and effectiveness).</p><p><strong>Conclusions: </strong>Despite generally positive perceptions of clinic capacity to sustain the HHIP, our analysis highlights general opportunities to build capacity to sustain evidence-based practices in primary care settings (cultivate readiness to change among clinic members) and places where focused efforts may do the same (target organizational-cultural dimensions of sustainability capacity, non-FQHCs).</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 4","pages":"201-214"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Sustaining the Community Health Center Model: Urgency of Primary Care Investment.","authors":"Peter Shin, Joe Dunn","doi":"10.1097/JAC.0000000000000535","DOIUrl":"10.1097/JAC.0000000000000535","url":null,"abstract":"<p><p>Community Health Centers (CHCs) provide care to 32.5 million low-income patients across high need areas, forming the largest primary care network in the US. CHCs consistently improve outcomes and lower costs, yet face growing financial stress. Rising demand, workforce shortages, and uncompensated care costs are stretching limited budgets at CHCs, while Medicaid payments and federal funding do not reflect the true cost of care. Many CHCs lack financial reserves to modernize or join new payment models. This article argues for long-term investments to maintain access to affordable and comprehensive primary care.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"240-243"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144745437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the Editors.","authors":"Megan B Cole Brahim, E Lee Rosenthal, Durrell J Fox","doi":"10.1097/JAC.0000000000000539","DOIUrl":"10.1097/JAC.0000000000000539","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 4","pages":"199-200"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: A Community Organizing Model for Advancing CHW Workforce Sustainability.","authors":"Lesley Wolf, Sherri Ohly, Lisa Renee Holderby-Fox, Sara Elise Bristol, Ashley Wennerstrom","doi":"10.1097/JAC.0000000000000540","DOIUrl":"10.1097/JAC.0000000000000540","url":null,"abstract":"<p><p>Community health workers (CHWs) play a vital role in advancing health equity, improving health outcomes, and addressing the social determinants of health. However, funding for CHW positions and supportive policy infrastructure to sustain a thriving CHW workforce remain elusive. This commentary provides a definition of CHW workforce sustainability and an overview of how a CHW-led national training and technical assistance center used a community organizing framework to build the capacity of CHWs and their allies to advance local sustainability efforts. The model includes four key objectives: (1) grow CHW leadership and policy capacity, (2) build strong relationships and partnerships, (3) establish supportive systems and policies, and (4) implement diverse financing mechanisms. It also offers a conceptual model to illustrate the steps CHWs can take to lead local efforts to advance CHW workforce sustainability.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 4","pages":"244-251"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the Editors.","authors":"Megan B Cole Brahim, E Lee Rosenthal, Durrell J Fox","doi":"10.1097/JAC.0000000000000534","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000534","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 3","pages":"135"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the Ability of Primary Care Practices to Report on Age-Friendly Quality of Care Measures: A Novel Approach.","authors":"Ashley A Park, Elizabeth A Phelan, Katherine A Bennett, Barbara B Cochrane, Michael V Vitiello, Aimee M Verrall, Allison M Cole","doi":"10.1097/JAC.0000000000000533","DOIUrl":"10.1097/JAC.0000000000000533","url":null,"abstract":"<p><p>Health systems are mandated to report on quality of care provided to older patients. However, reporting on quality of care remains challenging. The coordinating center for a practice-based research network collaborated with primary care practices to develop tools to facilitate data collection and reporting of age-friendly quality-of-care measures. Three practices informed design of the toolkit. Six additional practices (9 practices total) used the toolkit to report measurement data with technical assistance. All practices reported that quality-of-care assessment using the toolkit was feasible and acceptable. Providing tools and technical assistance are effective strategies for enabling primary care practices to report age-friendly quality metrics.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"169-183"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Health Centers' Response to COVID-19 and Serving the Community: This Feeling of Never Being Enough and Never Doing Enough.","authors":"Cecilia Hurtado, James D Harrison, Susan L Ivey, Mark D Fleming, Michael B Potter, Gena Lewis, Stutee Khandelwal, Tung Nguyen, David Ofman, Lali Moheno, Maria Carbajal, Maria Echaveste, Kerrington Osborne, Gary Bossier, Nynikka R Palmer","doi":"10.1097/JAC.0000000000000530","DOIUrl":"10.1097/JAC.0000000000000530","url":null,"abstract":"<p><strong>Objective: </strong>Community health centers (CHCs) are a vital safety net for under-resourced and medically underserved patients. As few studies have explored how they implemented broad-based organizational changes throughout the COVID-19 pandemic, we aimed to qualitatively examine CHCs' longitudinal, comprehensive pandemic response through the perspectives of staff, administrators, and researchers working in CHCs.</p><p><strong>Methods: </strong>25 clinic leaders, staff, and researchers from three CHC networks and two academic medical centers in Northern California and the Central Valley of California participated in 18 focus groups and interviews between April and October 2022. We used thematic content analysis to identify key themes.</p><p><strong>Results: </strong>Key themes emerged for three pandemic phases: shutdown, pivot, and recovery. During the shutdown, CHCs paused non-urgent services and in-person outreach while facing increased strain on staff capacity. Although CHCs were traditionally siloed, the pivot phase yielded efforts to build trust through information dissemination, partnerships with other health care organizations, and unprecedented innovations in care delivery. During recovery, CHCs re-prioritized preventive care but continued to face poor access to specialty care and socioeconomic resources for their patients.</p><p><strong>Conclusions: </strong>The COVID-19 pandemic magnified extant barriers within CHCs, including limitations in funding, staff capacity, and infrastructure for collaboration. CHC constituents highlight lessons learned through organization-wide adaptations and opportunities for the continuation and expansion of pandemic-related changes (e.g., investments in CHCs' workforce, care delivery infrastructure, and avenues for multidisciplinary collaboration) to better serve their communities in the post-COVID era.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"136-146"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the Editors.","authors":"","doi":"10.1097/JAC.0000000000000534","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000534","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 3","pages":"135"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}