Better Care at Safety Net Providers?: Utilization of Recommended Standards of Diabetes Care for Rural Latinos in One Midwestern State

2011 ◽  
Vol 22 (3) ◽  
pp. 995-1013 ◽  
Author(s):  
Daniel Sadowski ◽  
Michele Devlin ◽  
Akhtar Hussain
Keyword(s):  
Diabetes Care ◽  
Safety Net ◽  
Safety Net Providers

After the Affordable Care Act: Health Reform and the Safety Net

2016 ◽  
Vol 44 (4) ◽  
pp. 585-588
Author(s):  
Peter Shin ◽  
Marsha Regenstein
Keyword(s):  
Health Care ◽  
Community Health ◽  
Affordable Care Act ◽  
Health Reform ◽  
Community Health Centers ◽  
Safety Net ◽  
Public Hospitals ◽  
Health Centers ◽  
Safety Net Providers ◽  
The Affordable Care Act

Two major safety net providers – community health centers and public hospitals – continue to play a key role in the health care system even in the wake of coverage reform. This article examines the gains and threats they face under the Affordable Care Act.

scholarly journals Medical Home Characteristics and Quality of Diabetes Care in Safety Net Clinics

2016 ◽  
Vol 42 (2) ◽  
pp. 303-311 ◽  
Author(s):  
Kathryn E. Gunter ◽  
Robert S. Nocon ◽  
Yue Gao ◽  
Lawrence P. Casalino ◽  
Marshall H. Chin
Keyword(s):  
Diabetes Care ◽  
Medical Home ◽  
Safety Net ◽  
Safety Net Clinics ◽  
Quality Of Diabetes Care

Characteristics of Primary Care Safety-Net Providers and Their Quality Improvement Attitudes and Activities

2012 ◽  
Vol 28 (2) ◽  
pp. 151-159 ◽  
Author(s):  
Lenny López ◽  
Catherine M. DesRoches ◽  
Christine Vogeli ◽  
Richard W. Grant ◽  
Lisa I. Iezzoni ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Safety Net ◽  
Safety Net Providers

scholarly journals Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial (Preprint)

2017 ◽  
Author(s):  
Shinyi Wu ◽  
Kathleen Ell ◽  
Haomiao Jin ◽  
Irene Vidyanti ◽  
Chih-Ping Chou ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Usual Care ◽  
Diabetes Care ◽  
Functional Disability ◽  
Safety Net ◽  
P Value ◽  
Depression Care ◽  
Care Model

BACKGROUND Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. OBJECTIVE The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. METHODS DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. RESULTS DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). CONCLUSIONS Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality.

scholarly journals Excluding Orphan Drugs from the 340B Drug Discount Program: the Impact on 18 Critical Access Hospitals

2012 ◽  
Vol 3 (1) ◽  
Author(s):  
Madeline Carpinelli Wallack ◽  
Todd Sorensen
Keyword(s):  
Federal Government ◽  
Orphan Drug ◽  
Orphan Drugs ◽  
Safety Net ◽  
Original Research ◽  
Critical Access Hospitals ◽  
Patient Protection ◽  
High Prevalence ◽  
Safety Net Providers ◽  
The Impact

Purpose: The 340B Drug Pricing Program is a federal program designed to reduce the amount that safety net providers spend on outpatient drugs. The Patient Protection and Affordable Health Care Act of 2010 extended eligibility for 340B to critical access hospitals (CAHs) for all drugs except those designated as "orphan." Because this policy is unprecedented, this study quantifies the gross financial impact that this exemption has on a group of CAHs. Methods: Drug spending for 2010 from 18 CAHs in Minnesota and Wisconsin are reviewed to identify the prevalence of orphan drug purchases and to calculate the price differentials between the 340B price and the hospitals' current cost. Results: The 18 CAHs' purchases of orphan drugs comprise an average of 44% of the total annual drug budgets, but only 5% of units purchased, thus representing a very high proportion of their expenditures. In the aggregate, the 18 hospitals would have saved $3.1 million ($171,000 average per hospital) had purchases of drugs with orphan designations been made at the 340B price. Because CAH claims for Medicare are reimbursed on a cost-basis, the Federal government is losing an opportunity for savings. Conclusion: The high prevalence of orphan drug use and considerable potential for cost reduction through the 340B program demonstrate the loss of benefit to the hospitals, Federal government and the states.   Type: Original Research

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