Study protocol: ACCESS: (Advancing Contraceptive Equity and Service Uptake through Telemedicine in the US Safety-Net).

Access to desired contraceptive care is a critical component of reproductive autonomy. Telemedicine (TM), or the remote provision of clinical services via technology, in community-based health centers has the potential to expand access to family planning services, potentially enhancing both reproductive autonomy and equity. However, little is known about which patient populations use TM for contraceptive services in the US " safety net" (community-based health centers), if there are inequities in access to TM care, or patient preferences for TM contraceptive care.

Trends in Days in Accounts Receivables Across Safety-Net Health Centers, 2019-2023.

Community-based health centers play a crucial role in delivering care to medically under-resourced communities but operate in a state of financial instability exacerbated by the COVID-19 pandemic. To improve understanding of the pandemic on health centers we assessed monthly and annual accounts receivables (AR) data over 5 years (2019-2023) for 81 health centers. Between 2019 and 2023, health centers improved their Days in AR, decreasing from 49.

Using a Modified Delphi Process to Develop an Intervention to Support Care Coordination of Patient Social Needs in Primary Care.

Aims: To identify implementation strategies that effectively facilitate the adoption of social needs care coordination activities using enabling technologies among care management teams serving patients in community-based health centres.

Design: Modified Delphi process.

Methods: Discrete, feasible implementation strategies were identified through literature review and semi-structured interviews with care management staff and subject matter experts in clinical informatics, workflow redesign, and product engineering.

An analysis of primary care safety-nets' preventive service provision with a new composite reporting measure.

Background: The 2024 Final Rule for physician fee schedule under the Medicare Prospective Centers for Medicare & Medicaid Services (CMS) has sunset and combined seven screening and quality measures for traditional Medicare Merit-Based Incentive Payment System (MIPS) reporting with a single composite clinical quality process measure, Preventive Care and Wellness (PCW). While composites offer benefits including statistical efficiency and increased stability over time, the contextless nature of composite scores may result in disadvantaging low-resource primary care health centers ("health centers") serving medically underserved communities that face healthcare access and outcome challenges.

Objective: Evaluate the CMS composite score metric in health centers to identify characteristics that are associated with higher versus lower composite scores.

Long COVID after SARS-CoV-2 during pregnancy in the United States.

Pregnancy alters immune responses and clinical manifestations of COVID-19, but its impact on Long COVID remains uncertain. This study investigated Long COVID risk in individuals with SARS-CoV-2 infection during pregnancy compared to reproductive-age females infected outside of pregnancy. A retrospective analysis of two U.

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.

Implementation strategies to improve adoption of unmet social needs screening and referrals in care management using enabling technologies: study protocol for a cluster randomized trial.

Background: Adverse social determinants of health contribute to health inequities. Practice guidelines now recommend incorporating patient unmet social needs into patient care, and payors increasingly reimburse for screening and providing related referrals to community organizations. Emergent electronic health record (EHR)-based tools can enable clinical-community linkages, but their adoption commonly faces workflow and infrastructure barriers.

Finding Long-COVID: temporal topic modeling of electronic health records from the N3C and RECOVER programs.

Post-Acute Sequelae of SARS-CoV-2 infection (PASC), also known as Long-COVID, encompasses a variety of complex and varied outcomes following COVID-19 infection that are still poorly understood. We clustered over 600 million condition diagnoses from 14 million patients available through the National COVID Cohort Collaborative (N3C), generating hundreds of highly detailed clinical phenotypes. Assessing patient clinical trajectories using these clusters allowed us to identify individual conditions and phenotypes strongly increased after acute infection.

Capturing the care of complex community-based health center patients: A comparison of multimorbidity indices and clinical classification software.

Objective: To compare morbidity burden captured from multimorbidity indices and aggregated measures of clinically meaningful categories captured in primary care community-based health center (CBHC) patients.

Data Sources And Study Setting: Electronic health records of patients seen in 2019 in OCHIN's national network of CBHCs serving patients in rural and underserved communities.

Study Design: Age-stratified analyses comparing the most common conditions captured by the Charlson, Elixhauser, and Multimorbidity Weighted (MWI) indices, and Classification Software Refined (CCSR) and Chronic Condition Indicator (CCI) algorithms.

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.

Collective Weakness and Fluidity in Weakness Status Associated With Basic Self-Care Limitations in Older Americans.

Aims: To examine the associations of 1) absolute and normalized weakness cut-points, 2) collective weakness categories, and 3) changes in weakness status on future activities of daily living (ADL) limitations in older Americans.

Methods: The analytic sample included 11,656 participants aged ≥65-years from the 2006-2018 waves of the Health and Retirement Study. ADL were self-reported.

Care Quality and Equity in Health Centers During and After the COVID-19 Pandemic.

Introduction: Federally Qualified Community Health Centers (FQHCs) are on the frontline of efforts to improve healthcare equity and reduce disparities exacerbated by the COVID-19 pandemic. This study assesses the provision and equity of preventive care and chronic disease management by FQHCs before, during, and after the pandemic.

Methods: Using electronic health record data from 210 FQHCs nationwide and employing segmented regression in an interrupted time series design, preventive screening and chronic disease management were assessed for 939,053 patients from 2019 to 2022.

Weakness Thresholds Are Differentially Linked to Cognitive Function by Obesity Status in Older Americans.

Background: Weakness can be operationalized with several thresholds, which in turn, could impact associations with cognitive impairment when considering obesity status.

Objective: We examined the associations of absolute, normalized, and collective weakness thresholds on future cognitive impairment by obesity status in older adults.

Methods: We performed a secondary data analysis on the 2006-2018 waves of the Health and Retirement Study.

Collective Weakness Is Associated With Time to Mortality in Americans.

McGrath, R, McGrath, BM, Jurivich, D, Knutson, P, Mastrud, M, Singh, B, and Tomkinson, GR. Collective weakness is associated with time to mortality in Americans. J Strength Cond Res 38(7): e398-e404, 2024-Using new weakness cutpoints individually may help estimate time to mortality, but their collective use could improve value.

Variation in multimorbidity by sociodemographics and social drivers of health among patients seen at community-based health centers.

Purpose: Understanding variation in multimorbidity across sociodemographics and social drivers of health is critical to reducing health inequities.

Methods: From the multi-state OCHIN network of community-based health centers (CBHCs), we identified a cross-sectional cohort of adult (> 25 years old) patients who had a visit between 2019-2021. We used generalized linear models to examine the relationship between the Multimorbidity Weighted Index (MWI) and sociodemographics and social drivers of health (Area Deprivation Index [ADI] and social risks [e.

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.

Area-level social determinants of health and individual-level social risks: Assessing predictive ability and biases in social risk screening.

Introduction: Area-level social determinants of health (SDoH) and individual-level social risks are different, yet area-level measures are frequently used as proxies for individual-level social risks. This study assessed whether demographic factors were associated with patients being screened for individual-level social risks, the percentage who screened positive for social risks, and the association between SDoH and patient-reported social risks in a nationwide network of community-based health centers.

Methods: Electronic health record data from 1,330,201 patients with health center visits in 2021 were analyzed using multilevel logistic regression.

Impact of Reducing Time-to-Antibiotics on Sepsis Mortality, Antibiotic Use, and Adverse Events.

Shorter time-to-antibiotics is lifesaving in sepsis, but programs to hasten antibiotic delivery may increase unnecessary antibiotic use and adverse events. We sought to estimate both the benefits and harms of shortening time-to-antibiotics for sepsis. We conducted a simulation study using a cohort of 1,559,523 hospitalized patients admitted through the emergency department with meeting two or more systemic inflammatory response syndrome criteria (2013-2018).

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022).

Introduction: Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery.

Objective: To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE).

Antibiotic Prescribing Practices for Upper Respiratory Tract Infections Among Primary Care Providers: A Descriptive Study.

Background: Most antibiotics are prescribed in the ambulatory setting with estimates that up to 50% of use is inappropriate. Understanding factors associated with antibiotic misuse is essential to advancing better stewardship in this setting. We sought to assess the frequency of unnecessary antibiotic use for upper respiratory infections (URIs) among primary care providers and identify patient and provider characteristics associated with misuse.

Interpretability, credibility, and usability of hospital-specific template matching versus regression-based hospital performance assessments; a multiple methods study.

Background: Hospital-specific template matching (HS-TM) is a newer method of hospital performance assessment.

Objective: To assess the interpretability, credibility, and usability of HS-TM-based vs. regression-based performance assessments.