JOURNAL OF AMBULATORY CARE MANAGEMENT最新文献

{"title":"The Value and Challenges of an Ambulatory Intermediate Care Clinic: A Mixed-Methods Analysis.","authors":"Seung-Yup Lee, Reid M Eagleson, Larry R Hearld, Madeline J Gibson, Allyson Hall, Michael Mugavero, Greer Burkholder, Kimberly L Payne, William M Brown, Lauren M Epp, Laurie Hunter, Corey T Spraberry, Kristine R Hearld","doi":"10.1097/JAC.0000000000000531","DOIUrl":"10.1097/JAC.0000000000000531","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) crowding is a persistent issue in health care, resulting in increased mortality and medical errors. This challenge is particularly pronounced in underserved populations, where a higher prevalence of chronic conditions and ED utilization exacerbates gaps in care. To address this, system-level strategies, including the establishment of intermediate care clinics, are essential. This study evaluates the first three years of a nurse-led ambulatory intermediate care clinic (AICC) in the Southern US, focusing on its role in enhancing care continuity and operational challenges for expansion.</p><p><strong>Methods: </strong>This study, conducted at the University of Alabama at Birmingham Medical Center in Birmingham, Alabama, the United States, used a convergent parallel mixed-methods design, analyzing quantitative data from 3137 AICC appointment records (May 2020-June 2023) and conducting qualitative interviews with AICC staff members. Quantitative data included patient demographics and appointment characteristics. Qualitative data were thematically analyzed to identify common themes around AICC benefits and challenges.</p><p><strong>Results: </strong>Our quantitative analysis showed that the AICC managed an increasing number of patient visits with a stable appointment adherence rate. However, rising clinic-initiated cancellations indicated resource limitations. Qualitative findings provided further context for these quantitative trends. Patients from racial minority groups and those with Medicaid insurance had significantly higher odds of missing appointments. The results highlighted the AICC's value in preventing ED visits but also revealed challenges related to patient acuity level, resource allocation, scheduling complexities, and appointment adherence barriers.</p><p><strong>Conclusions: </strong>Establishing a nurse-led AICC is feasible and beneficial in alleviating the care gap between primary and acute care and reducing ED crowding. Key considerations for sustainable success include determining patient acuity thresholds, streamlining same-day referral processes, and addressing capacity issues. These findings can guide health systems in implementing intermediate care clinics in ambulatory settings, particularly for those serving underserved communities.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"184-196"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991342","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":"A Case Study of CHW Integration in Two Health Departments in Southern Arizona.","authors":"Maia Ingram, Andi Medrano, Dolores Encinas, Lee Itule-Klasen, Gloria Coronado, Maria Esparza, Rodrigo Valenzuela Cordova, Jax Seline, Raleigh C Addington, Ada M Wilkinson-Lee","doi":"10.1097/JAC.0000000000000529","DOIUrl":"10.1097/JAC.0000000000000529","url":null,"abstract":"<p><p>The objective of our participatory case study of community health worker (CHW) integration was to describe the role of CHWs in two local health departments (LHDs). Study partners co-developed an interview guide based on an existing framework. Fourteen staff participated in interviews. CHWs build community trust for LHDs, provide LHD core services, identify community concerns and priorities, and address social determinants of health. Integration barriers include hiring protocols, lack of understanding of the CHW role, inadequate compensation, and sustainable funding. The study identified key factors for an integration process that promotes the effectiveness, wellbeing, and sustainability of the workforce.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"147-158"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987880","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":"Erratum: Characteristics of Persons Using Convenience Clinics for Usual Care in 2022.","authors":"Hannah M Johnson, Bianca K Frogner, Edwin S Wong, Paul A Fishman","doi":"10.1097/JAC.0000000000000528","DOIUrl":"10.1097/JAC.0000000000000528","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 3","pages":"197"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188266","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":"Sustaining Communities and Community Health Workers: Lessons Learned From Community Health Workers' Experience During the COVID-19 Pandemic.","authors":"Alexandra Coritsidis, Guedy Arniella, Timnit Berhane, Devin Madden, Jessica Ruiz, Nita Vangeepuram, Kristin Oliver","doi":"10.1097/JAC.0000000000000532","DOIUrl":"10.1097/JAC.0000000000000532","url":null,"abstract":"<p><p>During the COVID-19 pandemic, community health workers (CHWs) played a significant role in providing health information and addressing health inequities exacerbated by the pandemic. We conducted four focus groups (21 individuals) with New York City CHWs with the aim to learn their perspectives on practices to sustain CHWs work engagement. The following themes emerged through deductive coding: (1) need for mental health support, (2) desire for broader acknowledgment of their value through compensation, and (3) need for continuous training and job growth opportunities. Implementing workplace policies that address these themes could improve CHW well-being and support them to more effectively impact the health of their communities.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"159-168"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121143","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":"Characteristics of Persons Using Convenience Clinics for Usual Care in 2022.","authors":"Hannah M Johnson, Bianca K Frogner, Edwin S Wong, Paul A Fishman","doi":"10.1097/JAC.0000000000000524","DOIUrl":"10.1097/JAC.0000000000000524","url":null,"abstract":"<p><p>Little is known about the characteristics of individuals using urgent care centers or walk-in retail clinics, collectively called convenience clinics (CC), as places of usual care. Using 2022 National Health Interview Survey data and logistic regression, we identified the factors associated with adults using CCs regularly. Among adults with a place of usual care, 7.5% reported receiving usual care at CCs. Individuals who were younger, working, and uninsured were significantly more likely to report CCs as their usual source of care. Understanding the characteristics of CC users is critical to inform policy for this evolving segment of the health care sector.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"95-107"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441843","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":"A Welcome to an Expanded Editorial Board at the Journal of Ambulatory Care Management.","authors":"Megan B Cole Brahim","doi":"10.1097/JAC.0000000000000522","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000522","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 2","pages":"71-72"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114716","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":"Frontline Clinic Administrator Perspectives on Extreme Weather Events, Clinic Operations, and Climate Resilience.","authors":"Tess Wiskel, Nathaniel Matthews-Trigg, Kristin Stevens, Thomas T Miles, Caleb Dresser, Aaron Bernstein","doi":"10.1097/JAC.0000000000000519","DOIUrl":"10.1097/JAC.0000000000000519","url":null,"abstract":"<p><p>Climate-sensitive extreme weather events are increasingly impacting frontline clinic operations. We conducted a national, cross-sectional survey of 284 self-identified administrators and other staff at frontline clinics determining their attitudes toward climate change and the impacts, resilience, and preparedness of clinics for extreme weather events. Most respondents (80.2%) reported that humans are causing climate change, and nearly half (45.9%) reported concerns about extreme weather impacting their job, with barriers to preparedness including financing and knowledge and resources. Over a third (41.8%) of respondents reported taking steps to protect their clinic infrastructure from extreme weather, including by addressing power and improving ventilation.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"73-83"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013822","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":"Methodology of a Social Network Survey in Primary Care Practices With Medical Home Attributes.","authors":"Justinna Dixon, Eleanor Turi, Madeline Pollifrone, Kyle Featherston, Jianfang Liu, Grant Martsolf, Lusine Poghosyan","doi":"10.1097/JAC.0000000000000520","DOIUrl":"10.1097/JAC.0000000000000520","url":null,"abstract":"<p><strong>Objective: </strong>To provide an overview of the methods of a social network survey used to collect data in primary care practices on team structures, compositions, and social networks (eg, support, communication).</p><p><strong>Methods: </strong>A cross-sectional sociometric social network survey in 23 primary care practices with medical home attributes in New York and Pennsylvania was conducted. All primary care providers (ie, physicians, nurse practitioners, physician assistants), clinical staff (eg, registered nurses, social workers, and nutritionists, etc), and administrative staff (eg, practice managers, office assistants, etc) in each practice were eligible to participate in the online survey. All practice members received an online survey asking them to identify who they work with during a typical week. Data were collected about the characteristics of respondent's relationships with each identified team member, perceived team effectiveness, and respondent-level job satisfaction, intent to leave, burnout, and demographics. We calculated the overall response rate and compared it among practices with different practice sizes and respondent roles using chi-square tests and independent samples t-tests.</p><p><strong>Results: </strong>The survey yielded an average response rate of 51.8%, with a range between 21.8% and 82.3% across the practices. Three hundred ninety-four primary care providers, 222 clinical staff, and 173 administrative staff responded to the survey. Respondents (n = 792) were more likely to be from smaller practices and be administrative or clinical staff rather than providers.</p><p><strong>Conclusion: </strong>This social network survey of primary care providers and staff used innovative approaches to collect data on team structures beyond traditional methods. Despite declining response rates in healthcare provider surveys, our survey reached high response rates in several practices. Future studies should find ways to engage primary care providers and staff in survey research.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"84-94"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving Beyond Viral Suppression: Strengthening the Community HIV Workforce to Improve Empowerment and Reduce Stigma in the Memphis Transitional Grant Area.","authors":"Serena Rajabiun, Noelle Wiggins, Abigail Smack, Xiyuan Zhang, Brandon Bernard Williams, Robin Lennon-Dearing","doi":"10.1097/JAC.0000000000000521","DOIUrl":"10.1097/JAC.0000000000000521","url":null,"abstract":"<p><p>Community health worker (CHW) integration into the health care team has been identified as an important strategy for engaging people living with HIV in care and treatment. The content and methodology for training influences the way CHWs work with clients. Our study describes the impact of a community-driven CHW and supervisor training program on client viral suppression, retention in care, and psychosocial outcomes. We conducted a single arm, pretest-posttest study of 45 clients of CHWs who participated in a training intervention from 2021 to 2022 in eight counties in the southern United States. We found significant improvements in viral suppression and empowerment, and reductions in stigma and unmet service needs. Providing training to CHWs and supervisors, using a participatory methodology and content designed to enhance integration in the care team can improve psychosocial outcomes for clients, including increased empowerment and reduced stigma.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":" ","pages":"108-122"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441893","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":"E Lee Rosenthal, Megan B Cole Brahim, Durrell J Fox","doi":"10.1097/JAC.0000000000000525","DOIUrl":"10.1097/JAC.0000000000000525","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"48 2","pages":"69-70"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494203","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}