Examining PTSD Prevalence Among Underserved Populations in the Integrated Community Mental Health Setting 2019 to 2022.

Background: The prevalence of Post Traumatic Stress Disorder (PTSD) has been rising since the start of the COVID-19 pandemic, and affects females, sexual and gender minorities, and individuals with social risks at higher rates.

Objective: This study examines if the prevalence of PTSD increased from 2019 to 2022 among patients who received care in a national network of safety-net, community-based health centers with integrated behavioral health programs that serve patients at high risk for PTSD.

Methods: We analyzed electronic health record data from patients with 1 or more behavioral health visits during 2019 to 2022 using repeated cross-sectional data to visualize trends.

Video versus audio telehealth in safety net clinic patients: Changes by rurality and time.

Background: Understanding the mix of video versus audio telehealth modality is critical to informing care for low-income safety net clinic patients. Our study examined whether telehealth modality and continued use of telehealth varied by rurality and whether that changed over time.

Methods: Encounters from adults in the OCHIN national network of primary care safety net clinics were identified by encounter type (in-person vs telehealth) and telehealth modality (video vs audio) from 4/1/2021 to 3/31/2023.

Identifying virtual care modality in electronic health record data.

Background: Virtual care increased dramatically during the COVID-19 pandemic. The specific modality of virtual care (video, audio, eVisits, eConsults, and remote patient monitoring) has important implications for the accessibility and quality of care, but rates of use are relatively unknown. Methods for identifying virtual care modalities, especially in electronic health records (EHR) are inconsistent.

Pandemic-related practice changes and CVD risk management in community clinics.

Objectives: Understanding how the COVID-19 pandemic affected cardiovascular disease (CVD) risk monitoring in primary care may inform new approaches for addressing modifiable CVD risks. This study examined how pandemic-driven changes in primary care delivery affected CVD risk management processes.

Study Design: This retrospective study used electronic health record data from patients at 70 primary care community clinics with scheduled appointments from September 1, 2018, to September 30, 2021.

Cardiovascular disease risk management during COVID-19: in-person vs virtual visits.

Objectives: Limited research has assessed how virtual care (VC) affects cardiovascular disease (CVD) risk management, especially in community clinic settings. This study assessed change in community clinic patients' CVD risk management during the COVID-19 pandemic and CVD risk factor control among patients who had primarily in-person or primarily VC visits.

Study Design: Retrospective interrupted time-series analysis.

Does Clinical Decision Support Increase Appropriate Medication Prescribing for Cardiovascular Risk Reduction?

Purpose: To assess the impact of a clinical decision support (CDS) system's recommendations on prescribing patterns targeting cardiovascular disease (CVD) when the recommendations are prioritized in order from greatest to least benefit toward overall CVD risk reduction.

Methods: Secondary analysis of trial data from September 20, 2018, to March 15, 2020, where 70 community health center clinics were cluster-randomized to the CDS intervention (42 clinics; 8 organizations) or control group (28 clinics; 7 organizations). Included patients were medication-naïve and aged 40 to 75 years with ≥1 uncontrolled cardiovascular disease risk factor, with known diabetes or cardiovascular disease, or ≥10% 10-year reversible CVD risk.

Diabetes and Hypertension Prevention and Control in Community Health Centers: Impact of the Affordable Care Act.

Access to care significantly improved following the implementation of the Patient Protection and Affordable Care Act. Since its implementation, the number of uninsured Americans has significantly decreased. Medicaid expansion played an important role in community health centers, who serve historically marginalized populations, leading to increased clinic revenue, and improved access to care.

The Impact of the Affordable Care Act Medicaid Expansion on Acute Diabetes Complications Among Community Health Center Patients.

Objective: This study evaluates whether patients residing in expansion states have a greater increase in outpatient diagnoses of acute diabetes complications than those living in non-expansion states following the implementation of the Affordable Care Act (ACA).

Methods: This retrospective cohort study uses electronic health records (EHR) from 10,665 non-pregnant patients, aged 19 to 64 years old who were diagnosed with diabetes in 2012 or 2013 from 347 community health centers (CHCs) across 16 states (11 expansion and 5 non-expansion states). Patients included had ≥1 outpatient ambulatory visit in each of these periods: pre-ACA: 2012 to 2013, post-ACA: 2014 to 2016, and post-ACA: 2017 to 2019.

Adoption of shared decision-making and clinical decision support for reducing cardiovascular disease risk in community health centers.

Objective: Electronic health record (EHR)-based shared decision-making (SDM) and clinical decision support (CDS) systems can improve cardiovascular disease (CVD) care quality and risk factor management. Use of the CV Wizard system showed a beneficial effect on high-risk community health center (CHC) patients' CVD risk within an effectiveness trial, but system adoption was low overall. We assessed which multi-level characteristics were associated with system use.

Before and During Pandemic Telemedicine Use: An Analysis of Rural and Urban Safety-Net Clinics.

Introduction: Differences in face-to-face and telemedicine visits before and during the COVID-19 pandemic among rural and urban safety-net clinic patients were evaluated. In addition, this study investigated whether rural patients were as likely to utilize telemedicine for primary care during the pandemic as urban patients.

Methods: Using electronic health record data from safety-net clinics, patients aged ≥18 years with ≥1 visit before or during the COVID-19 pandemic, March 1, 2019-March 31, 2021, were identified, and trends in face-to-face and telemedicine (phone and video) visits for patients by rurality using Rural‒Urban Commuting Area codes were characterized.

High Blood Pressure Reduction, Health Insurance Status, and Social Deprivation Index in U.S. Community Health Centers.

Introduction: Lack of health insurance is a risk factor for uncontrolled hypertension, but it is unknown whether health insurance or neighborhood-level social deprivation is associated with greater reductions in blood pressure over time.

Methods: We estimated the association of health insurance and social deprivation index on blood pressure reduction over time using electronic health record data from 2012 to 2017. We included patients aged 19-64 years with an initial systolic blood pressure ≥150 mmHg or diastolic blood pressure ≥100 mmHg and ≥1 additional visit from 93 community health centers in states that expanded Medicaid in 2014.

Primary and mental health service use in community health center patients before and after cancer diagnosis.

Background: Cancer survivors face increased risk for chronic diseases resulting from cancer, preexisting conditions, and cancer treatment. Having an established primary care clinic or health insurance may influence patients' receipt of recommended preventive care necessary to manage, treat, or diagnose new conditions. This study sought to understand receipt of healthcare in community health centers (CHCs) before and after cancer diagnosis among cancer survivors.

Effect of Clinical Decision Support at Community Health Centers on the Risk of Cardiovascular Disease: A Cluster Randomized Clinical Trial.

Importance: Management of cardiovascular disease (CVD) risk in socioeconomically vulnerable patients is suboptimal; better risk factor control could improve CVD outcomes.

Objective: To evaluate the impact of a clinical decision support system (CDSS) targeting CVD risk in community health centers (CHCs).

Design, Setting, And Participants: This cluster randomized clinical trial included 70 CHC clinics randomized to an intervention group (42 clinics; 8 organizations) or a control group that received no intervention (28 clinics; 7 organizations) from September 20, 2018, to March 15, 2020.

Geographic, racial/ethnic, and socioeconomic inequities in broadband access.

Introduction: Broadband access is a "super determinant of health." Understanding the spatial distribution and predictors of access may help target government programs and telehealth applications. Our aim was to examine broadband access across geography and sociodemographic characteristics using American Community Survey (ACS) data.

Understanding Health Need and Services Received by Youth in Foster Care in Community Safety-Net Health Centers in Oregon.

Youth in foster care have significant unmet health needs. We assessed health needs and health service use among youth in foster care in Oregon using electronic health record data from 258 community health centers and Medicaid enrollment data from 2014-2016. We identified 2,140 youth in foster care and a matched comparison group of 6,304 youth from the same clinics who were not in foster care, and compared the groups on demographic characteristics, health needs, and health service use.