Metabolomics analysis reveals resembling metabolites between humanized γδ TCR mice and human plasma.

Gamma delta (γδ) T cells, which reside in mucosal and epithelial tissues, are integral to immune responses and are involved in various cancers, autoimmune, and infectious diseases. To study human γδ T cells to a translational level, we developed γδ humanized TCR-T1 (HuTCR-T1) mice using our TruHumanization platform. We compared the metabolomic profiles from plasma samples of wild-type (WT), γδ HuTCR-T1 mice, and humans using UHPLC-MS/MS.

Factors associated with smoking cessation attempts in a public, safety-net primary care system.

Smoking cessation rates are low in safety-net settings. We conducted a retrospective analysis using electronic health record (EHR) data on adults with at least three primary care visits from 2016 to 2019 in the San Francisco Health Network (SFHN), a network of clinics serving publicly insured and uninsured San Francisco residents. We used multivariable regression to identify factors associated with 1) any cessation attempt, defined as smoking status change from "current smoker" at the index visit to "former smoker" at visit 2 or 3, and 2) a sustained cessation attempt, defined as smoking status change from "current smoker" at the index visit to "former smoker" at visits 2 and 3.

Increased Colorectal Cancer Screening Sustained with Mailed Fecal Immunochemical Test Outreach.

Background & Aims: Reports of mailed fecal immunochemical test (FIT) outreach effectiveness over time are minimal. We aimed to better evaluate a mailed FIT program with longitudinal metrics.

Methods: A total of 10,771 patients aged 50 to 75 years not up-to-date with colorectal cancer screening were randomized to intervention or usual care.

Standardized Workflows Improve Colonoscopy Follow-Up After Abnormal Fecal Immunochemical Tests in a Safety-Net System.

Background: How clinical teams function varies across sites and may affect follow-up of abnormal fecal immunochemical test (FIT) results.

Aims: This study aimed to identify the characteristics of clinical practices associated with higher diagnostic colonoscopy completion after an abnormal FIT result in a multi-site integrated safety-net system.

Methods: We distributed survey questionnaires about tracking and follow-up of abnormal FIT results to primary care team members across 11 safety-net clinics from January 2017 to April 2017.

Recent cessation attempts and receipt of cessation services among a diverse primary care population - A mixed methods study.

Smoking rates are high among low-income populations who seek care in safety-net clinics. While most safety-net clinics screen for cigarette smoking, there are substantial disparities in the delivery of smoking cessation counseling in these systems. We conducted a mixed method study between July 2016 and April 2017 to examine receipt of smoking cessation counseling and estimate recent cessation attempts among primary care patients in four safety-net clinics in San Francisco.

Effectiveness and Cost of Organized Outreach for Colorectal Cancer Screening: A Randomized, Controlled Trial.

Background: Colorectal cancer (CRC) screening remains underused, especially in safety-net systems. The objective of this study was to determine the effectiveness, costs, and cost-effectiveness of organized outreach using fecal immunochemical tests (FITs) compared with usual care.

Methods: Patients age 50-75 years eligible for CRC screening from eight participating primary care safety-net clinics were randomly assigned to outreach intervention with usual care vs usual care alone.

Adapting and Evaluating a Health System Intervention From Kaiser Permanente to Improve Hypertension Management and Control in a Large Network of Safety-Net Clinics.

Background: Nearly half of Americans with diagnosed hypertension have uncontrolled blood pressure (BP) while some integrated healthcare systems, such as Kaiser Permanente Northern California, have achieved control rates upwards 90%.

Methods And Results: We adapted Kaiser Permanente's evidence-based treatment protocols in a racially and ethnically diverse population at 12 safety-net clinics in the San Francisco Health Network. The intervention consisted of 4 elements: a hypertension registry, a simplified treatment intensification protocol that included fixed-dose combination medications containing diuretics, standardized BP measurement protocol, and BP check visits led by registered nurse and pharmacist staff.

Inadequate Utilization of Diagnostic Colonoscopy Following Abnormal FIT Results in an Integrated Safety-Net System.

Objectives: The effectiveness of stool-based colorectal cancer (CRC) screening is contingent on colonoscopy completion in patients with an abnormal fecal immunochemical test (FIT). Understanding system and patient factors affecting follow-up of abnormal screening tests is essential to optimize care for high-risk cohorts.

Methods: This retrospective cohort study was conducted in an integrated safety-net system comprised of 11 primary-care clinics and one Gastroenterology referral unit and included patients 50-75 years, with a positive FIT between April 2012 and February 2015.

Costs for a health coaching intervention for chronic care management.

Objectives: Health coaches can help patients gain knowledge, skills, and confidence to manage their chronic conditions. Coaches may be particularly valuable in resource-poor settings, but they are not typically reimbursed by insurance, raising questions about their budgetary impact.

Study Design: The Health Coaching in Primary Care (HCPC) study was a randomized controlled trial that showed health coaches were effective at helping low-income patients improve control of their type 2 diabetes, hypertension, and/or hyperlipidemia at 12 months compared with usual care.

Health coaching by medical assistants improves patients' chronic care experience.

Objectives: We sought to test the hypothesis that training medical assistants to provide health coaching would improve patients' experience of care received and overall satisfaction with their clinic.

Study Design: Randomized controlled trial.

Methods: Low-income English- or Spanish-speaking patients aged 18 to 75 years with poorly controlled type 2 diabetes, hypertension, and/or hyperlipidemia were randomized to receive either a health coach or usual care for 12 months.

Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial.

Purpose: Health coaching by medical assistants could be a financially viable model for providing self-management support in primary care if its effectiveness were demonstrated. We investigated whether in-clinic health coaching by medical assistants improves control of cardiovascular and metabolic risk factors when compared with usual care.

Methods: We conducted a 12-month randomized controlled trial of 441 patients at 2 safety net primary care clinics in San Francisco, California.

The impact of health coaching on medication adherence in patients with poorly controlled diabetes, hypertension, and/or hyperlipidemia: a randomized controlled trial.

Background: Lack of concordance between medications listed in the medical record and taken by the patient contributes to poor outcomes. We sought to determine whether patients who received health coaching by medical assistants improved their medication concordance and adherence.

Methods: This was a nonblinded, randomized, controlled, pragmatic intervention trial.

Does health coaching change patients' trust in their primary care provider?

Objective: To assess the impact of health coaching on patients' in their primary care provider.

Methods: Randomized controlled trial comparing health coaching with usual care.

Participants: Low-income English or Spanish speaking patients age 18-75 with poorly controlled type 2 diabetes, hypertension and/or hyperlipidemia.

Impact of peer health coaching on glycemic control in low-income patients with diabetes: a randomized controlled trial.

Purpose: Peer health coaches offer a potential model for extending the capacity of primary care practices to provide self-management support for patients with diabetes. We conducted a randomized controlled trial to test whether clinic-based peer health coaching, compared with usual care, improves glycemic control for low-income patients who have poorly controlled diabetes.

Method: We undertook a randomized controlled trial enrolling patients from 6 public health clinics in San Francisco.

The effectiveness of medical assistant health coaching for low-income patients with uncontrolled diabetes, hypertension, and hyperlipidemia: protocol for a randomized controlled trial and baseline characteristics of the study population.

Background: Many patients with chronic disease do not reach goals for management of their conditions. Self-management support provided by medical assistant health coaches within the clinical setting may help to improve clinical outcomes, but most studies to date lack statistical power or methodological rigor. Barriers to large scale implementation of the medical assistant coach model include lack of clinician buy-in and the absence of a business model that will make medical assistant health coaching sustainable.

The myth of the lone physician: toward a collaborative alternative.

Cultural values and beliefs about the primary care physician bolster the myth of the lone physician: a competent professional who is esteemed by colleagues and patients for his or her willingness to sacrifice self, accept complete responsibility for care, maintain continuity and accessibility, and assume the role of lone decision maker in clinical care. Yet the reality of current primary care models is often fragmented, impersonal care for patients and isolation and burnout for many primary care physicians. An alternative to the mythological lone physician would require a paradigm shift that places the primary care physician within the context of a highly functioning health care team.

The effects of Tai Chi on the balance control of elderly persons with visual impairment: a randomised clinical trial.

Background: balance control is a major problem for older individuals with poor vision. There are limitations, however, for visually impaired elderly persons wishing to participate in exercise programmes. The benefits of Tai Chi for balance control, muscle strength and preventing falls have been demonstrated with sighted elderly subjects.

Building teams in primary care: what do nonlicensed allied health workers want?

Introduction: Nonlicensed allied health workers are becoming increasingly important in collaborative team care, yet we know little about their experiences while filling these roles. To explore their perceptions of working as health coaches in a chronic-disease collaborative team, the teamlet model, we conducted a qualitative study to understand the nature and dynamics of this emerging role.

Methods: During semistructured interviews, 11 health coaches reflected on their yearlong experience in the teamlet model at an urban underserved primary care clinic.

Balance control in very old adults with and without visual impairment.

Good balance, an important ability in controlling body movement, declines with age. Also, balance appears to decrease when visual input is restricted, while this has been poorly investigated among visually impaired very old adults. The objective of this study is thus to explore whether the balance control of the very old differs with varying degrees of visual impairment.

The effectiveness of peer health coaching in improving glycemic control among low-income patients with diabetes: protocol for a randomized controlled trial.

Background: Although self-management support improves diabetes outcomes, it is not consistently provided in health care settings strained for time and resources. One proposed solution to personnel and funding shortages is to utilize peer coaches, patients trained to provide diabetes education and support to other patients. Coaches share similar experiences about living with diabetes and are able to reach patients within and beyond the health care setting.

Using the Teamlet Model to improve chronic care in an academic primary care practice.

Background: Team care can improve management of chronic conditions, but implementing a team approach in an academic primary care clinic presents unique challenges.

Objectives: To implement and evaluate the Teamlet Model, which uses health coaches working with primary care physicians to improve care for patients with diabetes and/or hypertension in an academic practice.

Design: Process and outcome measures were compared before and during the intervention in patients seen with the Teamlet Model and in a comparison patient group.

Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job?

The U.S. chronic illness burden is increasing and is felt more strongly in minority and low-income populations: in 2005, 133 million Americans had at least one chronic condition.