Ochin Inc

OREGON HEALTH INFORMATION TECHNOLOGY REGIONAL EXTENSION CENTER (OHITREC)

HEALTH CENTER CONTROLLED NETWORK

HEALTH CENTER CONTROLLED NETWORKS

HEALTH CENTER CONTROLLED NETWORKS

CATALYST (COMMUNITY CLIMATE HEALTH EQUITY RESEARCH CENTER) - SUMMARY. HISTORICALLY MARGINALIZED U.S. COMMUNITIES HAVE INEQUITABLY HIGH RISKS OF EXPERIENCING CLIMATE- INDUCED HEALTH IMPACTS. THE PRIMARY CARE SAFETY NET COMMUNITY HEALTH CENTERS (CHCS) SERVING THESE POPULATIONS ARE UNIQUELY POSITIONED TO PREPARE FOR AND MITIGATE THESE IMPACTS, AS CHCS ARE TRUSTED, CULTURALLY COMPETENT CARE PROVIDERS IN THEIR COMMUNITIES AND HAVE EXPERTISE IN REDUCING HEALTH DISPARITIES. TO INTERVENE SUCCESSFULLY, CHCS NEED TO BE EQUIPPED WITH EVIDENCE ON: (1) HOW EXTREME CLIMATE EVENTS IMPACT HEALTH OUTCOMES IN CHC POPULATIONS (WHICH DIFFER SUBSTANTIALLY FROM THOSE IN OTHER CARE SETTINGS); AND (2) WHAT INTERVENTIONS CHCS CAN ENACT TO EFFECTIVELY PREPARE FOR AND MITIGATE THESE IMPACTS. THE COMMUNITY CATALYST (COMMUNITY CLIMATE HEALTH EQUITY RESEARCH CENTER) CCHRC WILL PROVIDE THIS EVIDENCE AND THE PROPOSED PLANNING PROCESS WILL PREPARE THE CCHRC TO DO SO AS FOLLOWS. OUR ADMINISTRATIVE CORE WILL ASSEMBLE A TRANSDISCIPLINARY TEAM OF EXPERTS IN CLIMATE AND HEALTH, HEALTH EQUITY, SOCIAL RISKS AND RELATED INTERVENTIONS, INTERVENTION DEVELOPMENT AND IMPLEMENTATION / DISSEMINATION, HEALTH POLICY, COMMUNITY-ENGAGED RESEARCH, AND PRIMARY CARE IN CHCS. THE ADMINISTRATIVE CORE WILL ALSO CREATE THE DATA INFRASTRUCTURE NEEDED TO STUDY CLIMATE-INDUCED HEALTH IMPACTS IN CHC POPULATIONS BY LINKING EXISTING, ROBUST, GEOCODED RESEARCH-READY ELECTRONIC HEALTH RECORD DATA FROM THE OCHIN PRACTICE-BASED RESEARCH NETWORK (>1,700 CHC CLINIC SITES IN 36 STATES) WITH EXISTING GRANULAR DATA ON EXTREME HEAT EVENTS AND AIR QUALITY CREATED BY HARVARD’S CONFLUENCE PROJECT. OUR RESEARCH PROGRAM CORE WILL USE THIS DATASET IN NOVEL ANALYSES TO IDENTIFY HOW EXTREME HEAT AND POOR AIR QUALITY IMPACT HYPERTENSION AND ASTHMA INCIDENCE AND EXACERBATION IN CHC PATIENTS, AND THE EFFECT MODIFIERS OF THESE IMPACTS. OUR COMMUNITY ENGAGEMENT CORE WILL CONVENE A LEARNING COMMUNITY OF RESEARCHERS AND DIVERSE REPRESENTATIVES FROM CHCS (LEADERS, STAFF, PATIENTS) AND OTHER RELEVANT COMMUNITY- BASED ORGANIZATIONS (E.G., PUBLIC HEALTH DEPARTMENTS, ENVIRONMENTAL NON-PROFITS). IN A MULTIDIRECTIONAL, ITERATIVE PROCESS, THIS CCHRC LEARNING COMMUNITY WILL IDENTIFY: (1) INTERVENTIONS THAT HAVE POTENTIAL TO MITIGATE PATTERNS OF CLIMATE-INDUCED HEALTH IMPACTS IN CHC POPULATIONS, AND (2) THE RESEARCH NEEDED TO GENERATE EVIDENCE ON SUCH INTERVENTIONS’ EFFECTIVENESS. THE CCHRC WILL THEN BE PREPARED TO IMMEDIATELY BEGIN CONDUCTING RESEARCH THAT IS LED BY COMMUNITY-RESEARCHER PARTNERSHIPS AND DESIGNED TO ADDRESS COMMUNITY-IDENTIFIED EVIDENCE NEEDS ON HOW CHCS CAN PREPARE FOR AND MITIGATE CLIMATE-INDUCED HEALTH IMPACTS IN THEIR POPULATIONS.

ARRA - HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION

COMMUNITY HEALTH WORKER TRAINING PROGRAM - ADDRESS: OCHIN, PO BOX 5426, PORTLAND, OR 97228-5426 PROJECT DIRECTOR NAME: ENGERS FERNANDEZ CONTACT PHONE NUMBER: 503-943-2500 EMAIL ADDRESS: FERNANDEZE@OCHIN.ORG WEBSITE ADDRESS: WWW.OCHIN.ORG REQUEST: $3,000,000 OCHIN, INC. IS PLEASED TO SUBMIT THIS APPLICATION FOR FUNDING TO ESTABLISH A COMMUNITY HEALTH WORKER TRAINING PROGRAM (CHWTP) THAT WILL ENGAGE A NETWORK OF FIVE FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS) IN OREGON. IN OUR PROVEN CAPACITY AS THE LARGEST HRSA-DESIGNATED HEALTH CENTER CONTROLLED NETWORK (HCCN) ON THE UNITED STATES, OCHIN PROPOSES TO LEVERAGE OUR 20 YEARS OF EXPERIENCE TO RAPIDLY RECRUIT, TRAIN, AND PROVIDE CAREER LADDERING OPPORTUNITIES THAT WILL EXTEND AND UPSKILL THE COMMUNITY HEALTH WORKFORCE OVER THREE YEARS, AND MATCH LEARNERS WITH EXPERIENTIAL TRAINING OPPORTUNITIES THROUGH FQHC AND PUBLIC HEALTH FIELD PLACEMENTS. IN ADDITION TO SERVING A PREDOMINATELY LOW-INCOME AND RACIALLY AND ETHNICALLY DIVERSE PATIENT POPULATION, PARTICIPATING HEALTH CENTERS SERVE SPECIAL POPULATIONS, INCLUDING ADOLESCENTS, PEOPLE EXPERIENCING HOMELESSNESS, AGRICULTURAL AND OTHER ESSENTIAL WORKERS AND THEIR FAMILIES, AND RURAL COMMUNITIES. GOALS AND OBJECTIVES: OCHIN AIMS TO TRAIN 80 LEARNERS PER YEAR (240 TOTAL); OF THESE, AT LEAST 60 PER YEAR WILL BE NEW TO THE COMMUNITY HEALTH WORKFORCE (180 TOTAL). CLINICAL PRIORITIES: HEALTH EQUITY PROGRAMS AND ACTIVITIES: OCHIN’S CLOSELY HELD VALUES—ESPECIALLY DIVERSITY, EQUITY, AND INCLUSION—WILL INFORM OUR APPROACH TO BUILDING A COMMUNITY HEALTH WORKFORCE PIPELINE. IF FUNDS ARE RECEIVED, WE WILL WORK WITH OUR PARTNERS TO RECRUIT CANDIDATES FROM THE COMMUNITIES THEY SERVE. WE WILL ENGAGE THE LEARNERS IN TRAINING WITH A FOCUS ON BUILDING PROFESSIONAL SKILLS AND OBTAINING PROFESSIONAL CERTIFICATION. WE WILL EMBED LEARNERS IN COMMUNITY HEALTH WORKFORCE ROLES, WHERE THEY WILL GAIN LOCAL KNOWLEDGE AND PRACTICAL EXPERIENCE IN PRIMARY HEALTH CARE AND PUBLIC HEALTH SETTINGS.

HEALTH CENTER CONTROLLED NETWORKS

DEDICATE: ADVANCING CARE MANAGEMENT ADOPTION IN COMMUNITY HEALTH CENTERS - PROJECT SUMMARY/ABSTRACT LOW-INCOME AND RACIAL/ETHNIC MINORITY POPULATIONS EXPERIENCE DISPARATELY HIGH RATES OF CHRONIC DISEASE INCIDENCE AND POOR DISEASE OUTCOMES, AS WELL AS THE SOCIAL AND CONTEXTUAL RISKS THAT HINDER DISEASE MANAGEMENT. CARE MANAGEMENT IS AN EVIDENCE-BASED STRATEGY FOR CHRONIC DISEASE MANAGEMENT. IT INVOLVES COORDINATING THE NECESSARY, APPROPRIATE CARE FOR AN INDIVIDUAL'S NEEDS, INCLUDING CONNECTING THEM TO COMMUNITY-BASED ORGANIZATIONS (CBOS) TO ADDRESS SOCIAL RISKS. INCREASINGLY, PAYORS (E.G., CMS AND STATE MEDICAID / MANAGED CARE ORGANIZATIONS) ARE REIMBURSING HEALTHCARE PROVIDERS FOR CONDUCTING SOCIAL RISK SCREENING AND MAKING RELATED REFERRALS THAT INVOLVE CLINIC-CBO LINKAGES AS PART OF CARE MANAGEMENT. HOWEVER, IN UNDER-RESOURCED CARE SETTINGS, THE SYSTEMATIC IMPLEMENTATION OF THESE ACTIVITIES IS OFTEN SUBSTANTIALLY HAMPERED BY THE INITIAL INVESTMENT IN TECHNOLOGY AND WORKFLOW REDESIGN NEEDED TO OPERATIONALIZE SUCH TASKS. SUCH BARRIERS TO ESTABLISHING CLINIC-CBO LINKAGES ARE MOST PRONOUNCED IN COMMUNITY HEALTH CENTERS (CHCS), NON-PROFIT PRIMARY CARE SAFETY NET CLINICS SERVING HEALTH DISPARATE POPULATIONS. THERE IS A CLEAR NEED TO IDENTIFY BEST PRACTICES FOR SUPPORTING CHCS' ABILITY TO CONNECT AND MATCH PATIENTS TO AVAILABLE SERVICES USING ELECTRONIC HEALTH RECORD (EHR)-BASED CLINIC-CBO LINKAGE FUNCTIONALITY, AS IMPROVING RECEIPT OF NEEDED SERVICES COULD REDUCE HEALTH DISPARITIES. IN 2022, A NATIONAL NETWORK OF CHCS SHARING ONE EHR MADE AVAILABLE A NEW EHR- INTEGRATED APPLICATION (COMPASS ROSE) THAT IS DESIGNED TO SUPPORT CARE MANAGEMENT, INCLUDING ASSESSING PATIENTS' SOCIAL RISKS, REFERRING THEM TO CBOS, AND TRACKING REFERRAL OUTCOMES . HOWEVER, EXTENSIVE EVIDENCE SHOWS THAT TARGETED IMPLEMENTATION SUPPORT (SUCH AS TRAINING, CHAMPIONSHIP, PRACTICE FACILITATION, AND AUDIT AND FEEDBACK) MAY BE CRITICAL TO ENHANCE CLINICAL ORGANIZATIONS' AND CARE PROVIDERS' ADOPTION OF NEW TECHNOLOGIES. WE WILL PARTNER WITH CHC STAKEHOLDERS TO DEVELOP AND REFINE IMPLEMENTATION STRATEGIES DESIGNED TO SUPPORT THE IMPLEMENTATION AND OPTIMIZATION OF EHR-BASED TOOLS (AND RELATED WORKFLOWS) FOR CHC TEAM COORDINATION AND USE OF CLINIC-CBO LINKAGES. OUR SPECIFIC AIMS ARE TO: 1) IDENTIFY BARRIERS AND FACILITATORS TO CHCS' USE OF EHR-BASED CARE MANAGEMENT FUNCTIONS AS A MEANS TO SYSTEMATIZE (I) REFERRING PATIENTS WITH SOCIAL RISKS TO CBOS AND (II) ASSESSING REFERRED PATIENTS' SERVICE RECEIPT (CLOSED-LOOP REFERRAL); 2) PARTNER WITH COMMUNITY STAKEHOLDERS TO REFINE A SET OF IMPLEMENTATION STRATEGIES TO OPTIMIZE THEIR POTENTIAL TO SUPPORT CHCS' ADOPTION OF LINKAGE FUNCTIONALITY IN COMPASS ROSE; AND 3) CONDUCT A TRIAL OF WHETHER THE REFINED STRATEGIES IMPROVE CLINIC-CBO LINKAGES FOR PATIENTS WITH SOCIAL RISKS. STUDY FINDINGS WILL PROVIDE KNOWLEDGE NEEDED TO SUPPORT CHCS' ADOPTION OF EXISTING TECHNOLOGIES FOR CLINIC-CBO LINKAGES, AS A PRAGMATIC MEANS TO REDUCE HEALTH INEQUITIES. AS THE FIRST TRIAL OF STRATEGIES TO SUPPORT THE IMPLEMENTATION OF CLINIC-CBO LINKAGES VIA ADOPTION OF AN EHR-BASED CARE MANAGEMENT APPLICATION IN THE PRIMARY CARE SAFETY NET SETTING, THE PROPOSED WORK DIRECTLY ADDRESSES NINR'S GOAL OF INCREASING CLINICAL-CBO LINKAGES IN HEALTH DISPARATE POPULATIONS.

SEE NOTICE OF AWARD, ATTACHMENT 1 - TERMS AND CONDITIONS, ATTACHMENT D, STATEMENT OF WORK, ABSTRACT

ARRA-COMMUNITY HEALTH APPLIED RESEARCH NETWORK: BUILDING RESEARCH INFRASTRUCTURE TO DEVELOP AND GENERATE COMPARATIVE EFF

REPRODUCTIVE CARE IN THE SAFETY NET: WOMEN'S HEALTH AFTER AFFORDABLE CARE ACT IMPLEMENTATION (EVERYWOMAN)

ARRA - HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION

ELECTRONIC HEALTH RECORD IMPLEMENTATION INITIATIVE

EQUITABLE: EQUITY IN TREATMENT FOR ASTHMA BETWEEN LATINOS AND WHITES - PROJECT SUMMARY/ABSTRACT LATINO-AMERICANS HAVE WORSE ASTHMA OUTCOMES THAN NON-HISPANIC WHITES, BUT THE FACTORS THAT DRIVE THIS DISPARITY MOST HEAVILY ARE POORLY UNDERSTOOD. WHETHER OR NOT LATINO ADULTS UTILIZE OR EXPERIENCE LESS QUALITY PRIMARY CARE FOR ASTHMA IS SIGNIFICANTLY UNDERSTUDIED; THEREFORE, THE CONTRIBUTION OF BASIC ASTHMA CARE SERVICES TO OUTCOMES IS UNKNOWN. SOME EVIDENCE IN THE HEALTH SERVICES LITERATURE SUGGESTS THAT SOCIAL DETERMINANTS OF HEALTH (INDIVIDUAL- AND COMMUNITY-LEVEL ECONOMIC, SOCIAL, AND ENVIRONMENTAL FACTORS) AFFECT UTILIZATION OF ASTHMA CARE. IT IS UNCERTAIN, HOWEVER, WHICH SPECIFIC ASTHMA CARE SERVICES ARE UNDERUSED BY LATINO ADULTS, AND HOW SOCIAL DETERMINANTS MIGHT BE ASSOCIATED WITH THIS GROUP’S UTILIZATION. THE DEARTH OF KNOWLEDGE ABOUT SOCIAL DETERMINANTS AND ASTHMA CARE IN LATINOS IS DUE, AT LEAST IN PART, TO THE LACK OF COMPREHENSIVE DATA ON AMBULATORY HEALTH CARE UTILIZATION LINKED TO DATA ON INDIVIDUAL- AND COMMUNITY- LEVEL SOCIAL DETERMINANTS OF HEALTH. THIS PROJECT WILL ASSESS DISPARITIES IN ASTHMA CARE BETWEEN LATINOS AND NON-HISPANIC WHITES AND IDENTIFY THE FACTORS UNDERLYING THOSE DISPARITIES. TO DO SO, WE WILL LEVERAGE A UNIQUE DATA RESOURCE FROM A LARGE, NATIONAL NETWORK OF COMMUNITY HEALTH CENTERS WITH SHARED ELECTRONIC HEALTH RECORD DATA THAT IS LINKED TO MULTIPLE EXTERNAL DATA SOURCES, INCLUDING COMMUNITY-LEVEL SOCIAL DETERMINANTS OF HEALTH DATA. THIS LARGE, LONGITUDINAL DATASET CONTAINS UNPRECEDENTED DATA LINKAGES WHICH WILL LET US ASSESS DISPARITIES, EVALUATE WHICH SOCIAL DETERMINANTS AFFECT UTILIZATION AND DISPARITIES, AND DETERMINE WHICH OF THESE MAY DO SO MOST SIGNIFICANTLY OVER TIME; IN SO DOING, WE WILL ADDRESS AN IMPORTANT KNOWLEDGE GAP. WE WILL ALSO FURTHER DEVELOP METHODS TO UNDERSTAND SUB GROUP DIFFERENCES (BETWEEN LATINOS OF MEXICAN AND DOMINICAN HERITAGE, FOR INSTANCE) IN ASTHMA CARE UTILIZATION. IDENTIFYING THE FACTORS (INDIVIDUAL OR COMMUNITY) THAT MOST HEAVILY IMPACT ASTHMA CARE IS CRUCIAL TO THE PRIORITIZATION OF POPULATION-BASED INTERVENTIONS TO IMPROVE ASTHMA CARE. UNDERSTANDING THE RELATIVE IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON ASTHMA CARE IN LATINOS WILL ENABLE ACTION/INTERVENTION IN THREE WAYS: 1. IT WILL ENABLE MORE INFORMED POLICY DECISIONS TO IMPROVE PUBLIC HEALTH AND WELLNESS IN LATINO-AMERICANS. 2. IT WILL ALSO FACILITATE STRATEGIC PARTNERSHIPS BETWEEN HEALTHCARE PROVIDERS AND COMMUNITY AGENCIES POISED TO INTERVENE IN SOCIAL FACTORS IN THE LIVES OF LATINO-AMERICANS. 3. IT WILL HELP CLINICAL PROVIDERS UNDERSTAND THEIR PATIENTS’ BARRIERS TO ASTHMA CARE, AND FURTHER POINT-OF-CARE EFFORTS TO ADDRESS THESE BARRIERS THAT INFLUENCE THEIR PATIENTS’ UTILIZATION OF RECOMMENDED SERVICES FOR THIS COMMON CHRONIC DISEASE, ESPECIALLY BECAUSE THIS RESEARCH WILL BE DONE IN A NETWORK ABLE TO RAPIDLY APPLY FINDINGS.

THIS AWARD FUNDS THE APPROVED 2022?23 PUBLIC HEALTH AMERICORPSPROGRAM. NO MEMBER MAY ENROLL PRIOR TO THE APPROVED START DATE OF THE MEMBER ENROLLMENT PERIOD. YOUR 2022?23 REGULATORY MATCH IS 0%. OCHIN, A NONPROFIT HEALTH INFORMATION TECHNOLOGY (HIT) COLLABORATIVE, PROPOSES TO HAVE 20 FULL-TIME AMERICORPS MEMBERS WHO WILL LEARN IT AND PATIENT ENGAGEMENT SKILLS TO HELP CLINICIANS REDUCE THE IMPACT OF COVID-19 AND SUPPORT PUBLIC HEALTH DEPARTMENTS AND FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS) ACROSS 6 STATES (MA, MN, NC, OH, OR, WI). AT THE END OF THE FIRST PROGRAM YEAR, AMERICORPS MEMBERS WILL BE RESPONSIBLE FOR CAPACITY-BUILDING AND ACTIVE SERVICE TO PATIENTS (E.G., TELEHEALTH TECH SUPPORT, IMMUNIZATION OUTREACH) TO IMPROVE HEALTH OUTCOMES AND SUPPORT COLLECTION OF CRITICAL DISEASE CONTROL AND CLINICAL QUALITY DATA. IN ADDITION, AMERICORPS MEMBERS WILL LEVERAGE 20 OCHIN-EMPLOYED VOLUNTEERS WHO WILL BE ENGAGED IN MENTORING/ADVISING THE AMERICORPS MEMBERS THROUGHOUT THE SERVICE YEAR. AFTER THEIR YEAR OF SERVICE, AT LEAST 10 AMERICORPS MEMBERS WILL PURSUE FUTURE ENGAGEMENT IN THE PUBLIC HEALTH SECTOR.

AMERICAN RESCUE PLAN ACT FUNDING FOR HEALTH CENTER CONTROLLED NETWORKS

HEALTHCARE UTILIZATION AND OUTCOMES ACROSS THE CANCER CARE CONTINUUM: UNDERSTANDING THE IMPACT OF SOCIAL RISK FACTORS AND SCREENING AMONG LATINO PATIENTS - PROJECT SUMMARY/ABSTRACT IN THE UNITED STATES (US), NEARLY HALF OF PATIENTS WITH A HISTORY OF CANCER REPORT EXPERIENCING SOCIAL RISKS INCLUDING FINANCIAL HARDSHIP, FOOD INSECURITY, UNSTABLE HOUSING, AND TRANSPORTATION DIFFICULTIES. SOCIAL RISKS MAY HAVE NEGATIVE IMPACTS ON HEALTHCARE USE AND OUTCOMES, SUCH AS DELAYED OR FORGONE MEDICAL CARE, POOR QUALITY OF LIFE AND INCREASED MORTALITY. HOWEVER, RESEARCH ON THE ASSOCIATIONS BETWEEN SOCIAL RISKS AND HEALTHCARE USE ACROSS THE CANCER CARE CONTINUUM IS LIMITED. LATINOS EXPERIENCE MORE SOCIAL RISKS, HAVE LOWER USE OF MANY CANCER SERVICES, AND SUFFER WORSE CANCER OUTCOMES ACROSS NUMEROUS CANCER TYPES THAN NON-LATINO WHITES. THE LACK OF DATA ON SOCIAL RISKS AMONG LATINOS SUGGESTS THAT THE EXTENT AND MAGNITUDE OF THE BURDEN OF UNMET SOCIAL RISKS ARE NOT WELL DEFINED, NOR IS THE ASSOCIATION BETWEEN SOCIAL RISKS AND CANCER HEALTH AND HEALTHCARE OUTCOMES. TO FILL THIS GAP, WE PROPOSE A LONGITUDINAL, MULTI-LEVEL STUDY OF THE ASSOCIATIONS BETWEEN SOCIAL RISK SCREENING, SOCIAL RISK, AND CANCER OUTCOMES USING DATA FROM A COMMUNITY HEALTH CENTER (CHC) NETWORK (WHERE LATINO PATIENTS DISPROPORTIONATELY RECEIVE CARE IN THE US) ACROSS MORE THAN 40 STATES AND INCLUDING OVER 2 MILLION LATINO PATIENTS. THIS ROBUST AND UNIQUE ELECTRONIC HEALTH RECORD (EHR)-BASED DATASET WILL INCLUDE CLINICAL, UTILIZATION, MULTI-LEVEL SOCIAL DETERMINANTS OF HEALTH, TUMOR REGISTRY, AND DEATH DATA. SPECIFICALLY, WE AIM TO (1) DEFINE THE USE, AND VARIATION, OF SOCIAL RISK SCREENING IN LATINOS (OVERALL AND BY PLACE OF BIRTH) COMPARED TO NON-LATINO WHITES; (2) DETERMINE THE PREVALENCE AND TYPE OF SOCIAL RISKS, AND THE ASSOCIATIONS WITH THE RECEIPT OF RECOMMENDED CANCER PREVENTIVE SCREENING SERVICES, COMPARED TO NON-LATINO WHITES; AND (3) USING NOVEL CHC NETWORK DATA LINKED TO CANCER REGISTRY DATA FROM OREGON, WASHINGTON, AND CALIFORNIA, DETERMINE WHETHER SOCIAL RISK SCREENING, AND THE SOCIAL RISKS IDENTIFIED, ARE ASSOCIATED WITH STAGE AT CANCER DIAGNOSIS, TREATMENT INITIATION, AND CANCER MORTALITY, COMPARING LATINOS (OVERALL AND BY PLACE OF BIRTH) TO NON-LATINO WHITE PATIENTS. FINDINGS WILL BE DISSEMINATED ACROSS MULTIPLE PATIENT AND PROVIDER NETWORKS, AND HELP INFORM PATIENTS, COMMUNITY PRACTICES, PROVIDERS, AND POLICY MAKERS ABOUT THE EXTENT TO WHICH SOCIAL RISKS SERVE AS BARRIERS TO RECEIPT OF QUALITY CANCER CARE IN LATINOS, AS WELL AS THE IMPORTANCE OF INTEGRATING SOCIAL RISK SCREENING WITHIN THE HEALTHCARE SETTING TO IMPROVE CANCER OUTCOMES.

ARRA - HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

ACCESS: ADVANCING CONTRACEPTIVE EQUITY AND SERVICE UPTAKE THROUGH TELEMEDICINE IN THE US SAFETY-NET, 2019-2025 - PROJECT SUMMARY ACCESS: ADVANCING CONTRACEPTIVE EQUITY AND SERVICE UPTAKE THROUGH TELEMEDICINE IN THE US SAFETY-NET, 2019-2025 UNINTENDED PREGNANCY IS A KEY INDICATOR OF HEALTH INEQUITY IN THE US. UNINTENDED PREGNANCY RATES ARE DECREASING OVERALL IN THE US, BUT DISPARITIES ARE WIDENING, WITH UNINTENDED PREGNANCY BECOMING MORE CONCENTRATED AMONG ADOLESCENTS, WOMEN OF COLOR, AND WOMEN LIVING IN POVERTY. ACCESS TO CONTRACEPTIVE SERVICES FOR LOW-INCOME AND OTHER MARGINALIZED IDENTITIES IS CENTRAL TO REDUCING INEQUITIES IN UNINTENDED PREGNANCY. TELEMEDICINE (TM), HAS THE POTENTIAL TO EXPAND ACCESS TO CARE, BUT WIDESPREAD USE OF TM FOR CONTRACEPTIVE CARE WAS LIMITED PRIOR TO THE COVID19 PANDEMIC. THE PUBLICLY FUNDED FAMILY PLANNING “SAFETY NET” SYSTEM OF COMMUNITY HEALTH CENTERS (CHCS) IS A CRITICAL PROVIDER OF FAMILY PLANNING SERVICES TO HISTORICALLY MARGINALIZED POPULATIONS; HOWEVER, EXISTING EVIDENCE ABOUT USE OF TM FOR CONTRACEPTIVE SERVICES IN THE US SAFETY NET SYSTEM IS LIMITED. THIS PROPOSAL DIRECTLY ADDRESSES THIS GAP. WE LEVERAGE INDIVIDUAL-LEVEL CLINICAL DATA - REAL WORLD HEALTH IT - FROM A COMMON ELECTRONIC HEALTH RECORD ACROSS A NATIONAL NETWORK OF CHCS AND RIGOROUS MULTILEVEL ANALYTIC METHODS TO DOCUMENT USE OF TM COMPARED WITH FACE-TO-FACE VISITS FOR CONTRACEPTIVE SERVICES. AIM 1. ASSESS WHETHER THERE IS A DIFFERENTIAL UPTAKE OF THE USE OF TM FOR CONTRACEPTIVE SERVICES ACROSS COMMUNITY HEALTH CENTERS (CHCS). WE WILL FOCUS ON KEY POPULATIONS (E.G., ADOLESCENTS, UNINSURED, LATINAS, BLACK WOMEN, RURAL), CLINIC CHARACTERISTICS (E.G., TITLE X STATUS), COMMUNITY-LEVEL SDH FACTORS (E.G., SOCIAL AND ECONOMIC CONDITIONS, COMPUTER AND BROADBAND ACCESS), AND STATE FACTORS (E.G., MEDICAID EXPANSION) TO IDENTIFY DIFFERENTIAL UPTAKE IN THE USE OF TM (VERSUS FACE-TO-FACE VISITS) FOR CONTRACEPTIVE SERVICES FOR LOW-INCOME POPULATIONS. AIM 2. QUANTIFY INEQUITIES OR UNINTENDED CONSEQUENCES OF TM UTILIZATION FOR INDIVIDUALS AND THE HEALTH SYSTEM. WE WILL IDENTIFY DISPARITIES IN USE OF LONG-ACTING REVERSIBLE CONTRACEPTION (LARC) METHODS (WHICH REQUIRE AN IN-CLINIC VISIT), METHOD SWITCHING AT ONE YEAR, AND NO-SHOW RATES AND CANCELLATIONS BY VISIT MODALITY (TM VERSUS IN-PERSON). AIM 3. UNDERSTAND PATIENT EXPERIENCE OF CARE AND PREFERENCES FOR CONTRACEPTIVE SERVICES VIA TM VERSUS IN-PERSON. WE WILL CONDUCT SEMI-STRUCTURED INTERVIEWS WITH PATIENTS WHO RECEIVE CONTRACEPTIVE CARE AT CHCS TO UNDERSTAND THEIR EXPERIENCES WITH TM, BARRIERS AND FACILITATORS TO RECEIVING CONTRACEPTIVE SERVICES THROUGH TM VERSUS IN-PERSON CARE, AND CONTEXTUAL FACTORS THAT IMPACT THEIR ABILITY TO ACCESS CONTRACEPTION THROUGH TM VERSUS IN-PERSON CARE.

ARRA - HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION

THE EFFECT OF RURALITY AND THE COVID-19 PANDEMIC ON TELEMEDICINE AND PREVENTIVE HEALTHCARE USE - PROJECT SUMMARY THIS RESUBMISSION IS RESPONDING TO SPECIAL EMPHASIS NOTICES NOT-HS-21-014 HEALTH SERVICES RESEARCH TO ADVANCE HEALTH EQUITY AND NOT-HS-22-002 SUPPORTING PRIMARY CARE RESEARCH CAREER DEVELOPMENT AWARDS. RESIDENTS IN RURAL AREAS HAVE HIGHER RATES OF CHRONIC DISEASES, INFANT MORTALITY, DISABILITY, AMBULATORY CARE SENSITIVE HOSPITALIZATIONS, AND AGE-ADJUSTED MORTALITY THAN THEIR URBAN COUNTERPARTS. PEOPLE LIVING IN RURAL AREAS, PARTICULARLY THOSE WITH FEWER FINANCIAL RESOURCES, ALSO FACE MANY CHALLENGES ACCESSING PRIMARY CARE. TO DATE, LITTLE IS KNOWN ABOUT THE ACUTE AND INTERMEDIATE EFFECTS OF THE COVID-19 PANDEMIC ON PRIMARY CARE UTILIZATION AND QUALITY OF CARE AMONG RURAL PATIENTS. THE RAPID AND WIDE-SCALE ADOPTION OF TELEMEDICINE (TM) RESULTING FROM THE COVID-19 PANDEMIC PROVIDES A UNIQUE OPPORTUNITY TO UNDERSTAND IF TM CAN IMPROVE UTILIZATION OR QUALITY OF PREVENTIVE HEALTHCARE FOR RURAL PATIENTS. RESEARCH IS CRITICALLY NEEDED TO EXAMINE WHETHER DIFFERENCES IN PREVENTIVE CARE UTILIZATION AMONG RURAL/URBAN PATIENTS IS INCREASING AND WHETHER TM HAS IMPROVED OR WORSENED DISPARITIES IN PREVENTIVE CARE USE AND QUALITY OF CARE. TO MEET THIS NEED WE PROPOSE TO ADDRESS THE FOLLOWING AIMS: (1) ASSESS CHANGES IN FREQUENCY OF PREVENTIVE CARE VISITS AND METHOD OF PREVENTIVE CARE RECEIVED (E.G., IN-PERSON, VIDEO, PHONE, PATIENT PORTAL) AMONG RURAL AND URBAN PATIENTS AS A RESULT OF THE COVID-19 PANDEMIC; (2) EXAMINE DIFFERENCES IN THE USE OF TM AND THE TYPE OF PRIMARY CARE FOR WHICH TM WAS USED AMONG RURAL AND URBAN PATIENTS AS A RESULT OF THE COVID-19 PANDEMIC; AND (3) EVALUATE THE EFFECT OF TM USE ON THE QUALITY AND EQUITY OF CARE FOR CHRONIC PHYSICAL AND MENTAL HEALTH CONDITIONS AMONG RURAL AND URBAN PATIENTS AS A RESULT OF THE COVID-19 PANDEMIC. WE WILL USE ELECTRONIC HEALTH RECORD (EHR) DATA FROM A NETWORK OF 800+ COMMUNITY HEALTH CENTERS IN 20 STATES THAT ARE HOSTED AND STANDARDIZED BY OCHIN. THE EHR DATA ARE GEOCODED TO PATIENT ADDRESSES AND LINKED TO US CENSUS AND USDA RURAL URBAN COMMUTING AREA DATA. THESE UNIQUE FEATURES WILL ALLOW USE OF COMMUNITY- LEVEL DATA AND GEOSPATIAL ANALYSIS TO IDENTIFY COMMUNITIES WITH UNMET NEEDS AND HELP IDENTIFY CONTEXTUAL FACTORS AFFECTING USE OF PRIMARY CARE AND OUTCOMES FOR UNDERSERVED, RURAL PATIENTS. USE OF THIS DATA ALSO REPRESENTS A SIGNIFICANT ADVANCEMENT IN THE STUDY OF RURAL POPULATIONS BECAUSE DATA ON PATIENTS WITHOUT INSURANCE OR LAPSES IN INSURANCE, OF WHICH RURAL PATIENTS ARE OVERREPRESENTED, ARE MISSING FROM CLAIMS DATA OFTEN USED IN HEALTH SERVICES RESEARCH. RURAL POPULATIONS ARE A PRIORITY FOR AHRQ, AND HEALTHY PEOPLE 2020 AND THE NATIONAL INSTITUTE OF HEALTH IDENTIFIED RURAL HEALTH DISPARITIES AND THE LACK OF RESEARCH ON RURAL HEALTH AS TOP PRIORITIES. FINDINGS FROM THIS RESEARCH WILL ADVANCE KNOWLEDGE ON THE IMPACT OF THE COVID-19 PANDEMIC ON LOW-INCOME, RURAL POPULATIONS AND THE EFFECT OF TM ON USE AND QUALITY OF PRIMARY CARE. THIS INNOVATIVE RESEARCH PROJECT HAS THE POTENTIAL TO IMPROVE HEALTHCARE ACCESS AND QUALITY OF CARE FOR LOW-INCOME, RURAL PATIENTS.

ARRA - HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION

OREGON COMMUNITY HEALTH INTEGRATED DATA SYSTEM PROJECT

CHARN DIPEX FEASIBILITY STUDY

THE PROJECT WILL BUILD THE CAPACITY OF THE PARTICIPANTS (500 YOUTH AT-RISK) TO PREVENT AND RESPOND TO THREATS OF CYBERSECURITY.

HIRE AND EDUCATIONUSA ADVISER TO SUPPORT EDUCATION ADVISING SERVICES IN KENYA.