Clinician Perspectives on Electronic Health Records, Communication, and Patient Safety Across Diverse Medical Oncology Practices.

Purpose: We know little about how increased technological sophistication of clinical practices affects safety of chemotherapy delivery in the outpatient setting. This study investigated to what degree electronic health records (EHRs), satisfaction with technology, and quality of clinician-to-clinician communication enable a safety culture.

Methods: We measured actions consistent with a safety culture, satisfaction with practice technology, and quality of clinician communication using validated instruments among 297 oncology nurses and prescribers in a statewide collaborative.

Insuring Good Health: Outcomes and Acceptability of a Participatory Health Insurance Literacy Intervention in Diverse Urban Communities.

Background: The U.S. uninsured rate has dropped significantly since the passage of the Affordable Care Act (ACA), yet insurance coverage remains lower in historically marginalized communities than in the overall population.

The Food & Fitness Community Partnerships: Results From 9 Years of Local Systems and Policy Changes to Increase Equitable Opportunities for Health.

The Food & Fitness (F&F) community partnerships, funded by the W.K. Kellogg Foundation from 2007 to 2016, were established to create community-determined change in the conditions that affect health and health equity in neighborhoods.

Lessons Learned From Food & Fitness About Building Successful Partnerships: Focus, Capacity, and Sustainability.

Approaches undertaken by the Food & Fitness (F&F) community partnerships demonstrate that engaging community residents in the process of creating systems change strengthens the ability of neighborhoods, organizations, and institutions to foster and sustain those changes over time. The F&F partnerships were established to increase access to locally grown food and safe places for physical activity for children and families in communities with inequities across the United States. A critical focus of this initiative has been to use community-determined approaches to create changes in policies, infrastructures, and systems that will lead not only to change but also to sustainable change that positively influences health equity.

Defining and Measuring Sustainability in the Food & Fitness Initiative.

Several frameworks for defining and measuring sustainability in public health have been documented in the literature. For the Food & Fitness Initiative, sustainability was a central aim at the outset and was defined broadly throughout the project. Sustainability included not only funding and resources necessary to support organizational structures but was a core function of how these partnerships were able to focus their work, build capacity, forge lasting relationships, execute the work, and produce systems and policy changes that would endure over time.

Using the Replicating Effective Programs Framework to Adapt a Heart Health Intervention.

Heart disease is the leading cause of death in the United States. African Americans and people of low socioeconomic status suffer disproportionately from heart disease-related morbidity and mortality. In Detroit, Michigan, a primarily African American and low-income urban area, heart disease mortality is at twice the national rate.

Sexual Violence Victimization Among Youth Presenting to an Urban Emergency Department: The Role of Violence Exposure in Predicting Risk.

Sexual violence (SV) is a widespread public health problem among adolescents and emerging adults with significant short- and long-term consequences. Young people living in urban, disadvantaged communities with high rates of violence may be especially at risk for SV victimization. Understanding interconnections between different forms of violence is critical to reducing SV risk among youth.

Measuring the Implementation of Youth Empowerment Solutions.

Scholars have increasingly emphasized the importance of using evidence-based programs to promote health and prevent disease. While theoretically and empirically based programs may be effective in carefully controlled conditions, many fail to achieve desired outcomes when implemented in real-world settings. Ensuring high-quality implementation of health promotion programs is critically important as variation in implementation is closely associated with program effectiveness.

Racial/Ethnic Disparities in Quality of Care for Cardiovascular Disease in Ambulatory Settings: A Review.

Racial and ethnic disparities in cardiovascular disease (CVD) outcomes are widely reported, but research has largely focused on differences in quality of inpatient and urgent care to explain these disparate outcomes. The objective of this review is to synthesize recent evidence on racial and ethnic disparities in management of CVD in the ambulatory setting. Database searches yielded 550 articles of which 25 studies met the inclusion criteria.

Is It Time to Abandon Hospital Accreditation?

Hospitals contracting with the Centers for Medicare & Medicaid Services (CMS) must comply with Conditions of Participation (CoP), enforced by 4 certified independent accrediting organizations (AOs) or individual state survey. Recent work documents that the system fails to achieve consistent clinical outcomes, allowing several-fold variation in mortality and patient safety. Other publicly reported evidence shows weaker clinical performance by state-surveyed hospitals, inexplicable variation in individual state surveys, and recurring disagreement between initial and audit surveyors.

Solutions to Address Diabetes-Related Financial Burden and Cost-Related Nonadherence: Results From a Pilot Study.

Background: Cost-related nonadherence (CRN) to recommended self-management behaviors among adults with chronic conditions such as diabetes is prevalent. Few behavioral interventions to mitigate CRN have been tested and evaluated.

Aims: We developed a financial burden resource tool and examined its acceptability and the preliminary effects on patient-centered outcomes among adults with diabetes or prediabetes seen in a clinical setting.

Do Neighborhood Demographics Modify Walking Group Intervention Effectiveness in Urban Neighborhoods?

Objectives: We assessed the effects of neighborhood composition on effectiveness of the Walk Your Heart to Health (WYHH) intervention in promoting physical activity and reducing cardiovascular risk (CVR) in low-to-moderate-income, predominantly non-Latino Black (NLB) and Latino communities.

Method: Multilevel models assessed modifying effects of neighborhood composition on (1) WYHH adherence/participation at 8 weeks and 32 weeks, (2) associations between participation and steps, and (3) associations between steps and CVR.

Results: Approximately 90% of participants were women.

Linking Spending and Quality Indicators to Measure Value and Efficiency in Health Care.

Policy makers and stakeholders have reached a consensus that both quality and spending or resource use indicators should be jointly measured and prioritized to meet the objectives of our health system. However, the relative merits of alternative approaches that combine quality and spending indicators are not well understood. We conducted a literature review to identify different approaches that combine indicators of quality and spending measures to profile provider efficiency in the context of specific applications in health care.