JOURNAL OF AMBULATORY CARE MANAGEMENT最新文献

{"title":"Relationship of Medical Home Components With Health Care Utilization and Unmet Needs in Children and Youth With Special Health Care Needs.","authors":"Suman Kanti Chowdhury, Jennifer Marshall, Beth Boone, Russell S Kirby","doi":"10.1097/JAC.0000000000000543","DOIUrl":"10.1097/JAC.0000000000000543","url":null,"abstract":"<p><strong>Background and objective: </strong>The medical home is a primary care model that offers comprehensive, uninterrupted, and family-centered care to children regardless of their special health care needs. Although the overall contribution of medical home is well-studied, the differential influence of its components on health care utilization and unmet needs, particularly for children and youth with special health care needs (CYSHCN) remains insufficiently understood. This study examined the medical home component(s) that can best predict emergency and preventive visits, and unmet needs in CYSHCN.</p><p><strong>Methods: </strong>This study analyzed 2016-2022 National Survey of Children's Health data from 64 553 caregivers of CYSHCN aged 0-17 years using the Rao-Scott Chi-square test and multivariable logistic regression.</p><p><strong>Results: </strong>Findings show that receiving care within an overall medical home was associated with lower odds of emergency visits [adjusted odds ratio (aOR): 0.77 (95% confidence interval: 0.70-0.84)] and unmet needs [aOR = 0.29 (0.24-0.34)], and higher odds of preventive dental visits [aOR = 1.40 (1.25-1.57)]. Having a usual source for sick care and receiving effective care coordination was associated with reduced odds of emergency visits (aOR = 0.74 [0.64-0.84] and aOR = 0.85 [0.77-0.95], respectively). Receiving family-centered care [aOR = 0.45 (0.38-0.54)], no problems getting needed referral [aOR = 0.58 (0.47-0.72)], and getting effective care coordination when needed [aOR = 0.32 (0.26-0.39)] were associated with lower odds of unmet needs. The odds of utilizing preventive medical and dental visits was higher with having a personal doctor or nurse [aOR = 1.42(1.12-1.80) and aOR = 1.41 (1.20-1.65), respectively] and receiving family-centered care [aOR = 1.59 (1.18-2.12) and aOR = 1.44 (1.22-1.71), respectively].</p><p><strong>Conclusions: </strong>The study highlights the importance of considering the differential contribution of medical home components for reducing emergency visits, addressing unmet needs, and improving preventive care, providing insights to enhance health care delivery for CYSHCN.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"49 1","pages":"E14-E30"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655900","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":"Perceived Benefit and Impact of a Health Care-Based Food Pantry: \"One Stop Shop\".","authors":"Laura M Plencner, Katiana Kelty, Sabrina Demaestri, Molly Krager, Patricia Marein, Georgi Erbert, Jeffrey D Colvin","doi":"10.1097/JAC.0000000000000544","DOIUrl":"10.1097/JAC.0000000000000544","url":null,"abstract":"<p><strong>Background and objective: </strong>Health care systems are increasingly implementing interventions such as health care-based food pantries to mitigate the harmful health impacts of food insecurity. Our urban children's hospital established an on-site food pantry within the primary care building. This study seeks to identify the perceived benefits and impact of a health care-based food pantry on health, diet, and family finances.</p><p><strong>Methods: </strong>In this qualitative study, semi-structured interviews were conducted with English- and Spanish-speaking caregivers utilizing a pediatric health care-based food pantry. Interview questions explored the impact of the pantry on health, diet, and family finances. Interviews were conducted until thematic saturation was reached. Transcripts were coded and thematically analyzed. Participants also completed surveys to enhance data obtained from the semi-structured interviews. Survey data included health-related social needs (including food insecurity), financial tradeoffs made between food and other necessities, and other utilized food resources.</p><p><strong>Results: </strong>Of the 23 participants, interview themes included a positive impact on household budget with money saved on food utilized for other expenses. However, participants reported limited impact on diet and health due to the similarity of the food to their usual diet. Additional themes included the perceived benefit of food pantries within health care as a \"one stop shop\" and the importance of language concordance and being treated respectfully within the pantry. Most participants were food insecure (12, 52.2%) and had ≥1 unmet social need (13, 56.5%). Financial tradeoffs made for food were common with half reporting ≥1 tradeoff (13, 56.5%) in the past 12 months.</p><p><strong>Conclusions: </strong>We identified a positive financial impact on household finances and perceived benefits of a food pantry's location within health care. The limited impact on diet and perceived health may be due to the intentional offering of foods desired by pantry users.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"49 1","pages":"E4-E13"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655957","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":"Durrell J Fox, Megan B Cole Brahim, E Lee Rosenthal","doi":"10.1097/JAC.0000000000000548","DOIUrl":"https://doi.org/10.1097/JAC.0000000000000548","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"49 1","pages":"E1"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120581","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":"Empowering Medical Assistants Through Organizational Policy Change: Reporting Normal Labs in Team-Based Ambulatory Care.","authors":"Candice Halinski, Mark A Talamini, Maureen T White, Marianna Karavolias","doi":"10.1097/JAC.0000000000000542","DOIUrl":"10.1097/JAC.0000000000000542","url":null,"abstract":"<p><strong>Objective: </strong>As the ambulatory care landscape shifts due to advances in medical technology and a rise in medically complex patients, health care systems must evolve by optimizing team-based care models and scope-of-practice utilization. This case study describes Northwell Health Physician Partners' policy-level initiative to expand the role of medical assistants (MAs) by permitting them to communicate normal laboratory results to patients.</p><p><strong>Methods: </strong>A structured, multiphase approach was used to evaluate and implement the policy change. This included a comprehensive review of clinical workflows, stakeholder engagement, assessment of patient safety implications, and alignment with regulatory and compliance standards. The initiative prioritized maintaining the integrity of the MA role while enhancing care delivery efficiency. Training, documentation protocols, and communication standards were developed to support safe execution of this expanded task.</p><p><strong>Results: </strong>Following implementation, the organization observed improved care team efficiency and enhanced patient communication workflows. Clinicians reported a reduction in administrative burden, particularly in managing normal test results. MAs were successfully integrated into follow-up communication workflows, freeing licensed staff to focus on higher-acuity needs. This scope-of-practice enhancement not only empowered MAs but also fostered greater operational synergy across the care team, enabling more efficient task distribution among clinicians, registered Nurses, and MAs and improved overall workflow. This shift facilitated optimal utilization of licensed professionals within their scope of practice allowing them to fully leverage their training and expertise. No adverse events related to the expanded task were reported during the observation period.</p><p><strong>Conclusions and action steps: </strong>Expanding MA responsibilities to include the communication of normal laboratory results demonstrates how institutional flexibility in scope-of-practice policy can strengthen team-based care in ambulatory settings. Key lessons include the importance of stakeholder consensus, standardized training, and clear documentation protocols. This case highlights a replicable approach for other health systems seeking to address workforce challenges while ensuring patient safety and satisfaction. Future steps include ongoing evaluation of patient outcomes, expanded metrics tracking, and exploration of additional opportunities to optimize support staff roles across the ambulatory enterprise.</p>","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"49 1","pages":"E49-E60"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655862","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 Tribute to Graham Atkinson.","authors":"Robert Murray, Jack C Keane, Norbert Goldfield","doi":"10.1097/JAC.0000000000000547","DOIUrl":"10.1097/JAC.0000000000000547","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"49 1","pages":"E2-E3"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655868","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":"War Is Afoot.","authors":"Zhaohui Su","doi":"10.1097/JAC.0000000000000545","DOIUrl":"10.1097/JAC.0000000000000545","url":null,"abstract":"","PeriodicalId":46654,"journal":{"name":"JOURNAL OF AMBULATORY CARE MANAGEMENT","volume":"49 1","pages":"E39"},"PeriodicalIF":1.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655872","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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973934","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":"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}