Publications by authors named "Kaytura Felix Aaron"

12 Publications

  • Page 1 of 1

Health center financial performance: national trends and state variation, 1998-2004.

J Public Health Manag Pract 2007 Mar-Apr;13(2):133-50

Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, Maryland 21205, USA.

For four decades, health centers have provided quality, cost-effective primary healthcare to underserved populations. Using the Uniform Data System, this study analyzes national trends in health center patients, providers, and financial performance for 1998-2004, and state-specific data for 2004. Between 1998 and 2004, health centers served increasing numbers of underserved patients, which included patients who were uninsured or on Medicaid, minorities, and patients at or below poverty level. Even though the number of health center providers and patients increased, patient-to-provider ratios did not change significantly. Medicaid remained the single largest source of health center revenue, accounting for 36.4 percent of total revenue in 2004. Compared with Medicare, private insurance, and self-pay, Medicaid consistently reimbursed health centers at the highest rate per patient. Federal and nonfederal grants to support care for the uninsured as well as enabling services such as transportation, translation, and other support systems is one of many important sources of revenue. Financial challenges for health centers included increasing costs and varied or declining rates of reimbursement for services rendered. However, health centers became more self-sufficient over time, average net revenues increased, and operating margins were predominantly positive. Data on individual states, with different numbers and types of health centers, varied widely in all of these categories. In conclusion, health centers rely on federal and nonfederal grant support in concert with the Medicaid program as major funding sources and continued financial stability will be contingent upon health centers' ability to balance revenues with the cost of managing the vulnerable populations that they serve.
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http://dx.doi.org/10.1097/00124784-200703000-00009DOI Listing
May 2007

Building a research agenda for community health centers and the medically underserved: meeting proceedings.

Prog Community Health Partnersh 2007 ;1(1):67-73

National Association of Community Health Centers, USA.

The Problem: Community, migrant, and homeless health centers (CHCs) are an integral component of the nation's safety net with a proven record of success in access, quality, and cost effectiveness. Still, as CHCs face rising numbers of vulnerable patients and shrinking resources, they must continue to improve quality of care to further narrow health disparities, as well as demonstrate their cost effectiveness and value to policymakers.

Purpose: CHCs, researchers, national partners, and others met in December 2005 to produce a consensus-driven research agenda that lays out research priorities for CHCs and the medically underserved. This article details the meeting process and resulting research agenda.

Key Points: The meeting focused on three domains that touch on community need: health information technology (HIT), quality improvement, and cost effectiveness and value. Community representatives helped to drive research priorities.

Conclusions: CHCs must continually demonstrate their efficiency and effectiveness. Accordingly, the research agenda must be continually revisited through a collaborative process.
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http://dx.doi.org/10.1353/cpr.0.0006DOI Listing
April 2010

Variation in quality of men's health care by race/ethnicity and social class.

Med Care 2005 Mar;43(3 Suppl):I72-81

Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, MD 20587, USA.

Background: Until recently, minority and poor men have been characterized as "an invisible population," overlooked by public and private efforts to improve the health status of women, children, and the elderly.

Objective: This study compares the health care experiences of racial and ethnic minority men with that of white men, and low socioeconomic status with those of higher status. MEASURES/SUBJECTS: Quality-of-care measures in multiple clinical domains are evaluated. The authors use data from several databases, including the National Health Interview Survey, Medical Expenditure Panel Survey, and Health Care Cost and Utilization Project State Inpatient Database. The relative difference between each racial/ethnic and socioeconomic group and a fixed reference group is used to assess differences in use of services. Statistical significance is assessed using z tests.

Results: Hispanic men were much less likely to receive colorectal cancer screening (relative risk [RR] range, 0.61-0.69), cardiovascular risk factor screening and management (RR, 0.84-0.88), and vaccinations (RR, 0.47-0.94). Black and Asian men were significantly less likely to have received selected preventive services (adult immunization and colorectal cancer screening). The differences in end-stage renal disease care that black and white men received were statistically significant (RR, 0.39-0.97), with black men consistently receiving worse care. For some measures of management of end-stage renal disease, Asian men received care that was similar to or better than that received by non-Hispanic whites.

Conclusion: Minority men are at a markedly elevated risk for the receipt of poor health care quality. However, generalizations about "minority" men are likely to be misleading and incomplete. There is a considerable variation in the magnitude, direction, and significance of these risks.
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http://dx.doi.org/10.1097/00005650-200503001-00011DOI Listing
March 2005

African American church participation and health care practices.

J Gen Intern Med 2003 Nov;18(11):908-13

Center of Primary Care Research, Agency of Healthcare Research and Quality, Rockville, MD 20850, USA.

Background: While religious involvement is associated with improvements in health, little is known about the relationship between church participation and health care practices.

Objectives: To determine 1) the prevalence of church participation; 2) whether church participation influences positive health care practices; and 3) whether gender, age, insurance status, and levels of comorbidity modified these relationships.

Design: A cross-sectional analysis using survey data from 2196 residents of a low-income, African-American neighborhood.

Measurements: Our independent variable measured the frequency of church attendance. Dependent variables were: 1) Pap smear; 2) mammogram; and 3) dental visit-all taking place within 2 years; 4) blood pressure measurement within 1 year, 5) having a regular source of care, and 6) no perceived delays in care in the previous year. We controlled for socioeconomic factors and the number of comorbid conditions and also tested for interactions.

Results: Thirty-seven percent of community members went to church at least monthly. Church attendance was associated with increased likelihood of positive health care practices by 20% to 80%. In multivariate analyses, church attendance was related to dental visits (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.3 to 1.9) and blood pressure measurements (OR, 1.6; 95% CI, 1.2 to 2.1). Insurance status and number of comorbid conditions modified the relationship between church attendance and Pap smear, with increased practices noted for the uninsured (OR, 2.3; 95% CI, 1.2 to 4.1) and for women with 2 or more comorbid conditions (OR, 1.9; 95% CI, 1.1 to 3.5).

Conclusion: Church attendance is an important correlate of positive health care practices, especially for the most vulnerable subgroups, the uninsured and chronically ill. Community- and faith-based organizations present additional opportunities to improve the health of low-income and minority populations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494942PMC
http://dx.doi.org/10.1046/j.1525-1497.2003.20936.xDOI Listing
November 2003

Beyond rhetoric: what we need to know to eliminate disparities.

Ethn Dis 2003 ;13(3 Suppl 3):S3-9-11

Office of Priority Populations Research, Agency for Healthcare Research and Quality, Rockville, Maryland 20852, USA.

Racial and ethnic disparities in health care are well documented and can be discussed in 3 broad categories: health system factors, patient-level factors, and patient/provider interaction. Clinicians and others working in health care and related fields are knowledgeable about disparities in health, but the general US population is not. Racial/ethnic disparities are most striking in life expectancy, infant mortality, and lack of health insurance. The inaugural edition of the National Healthcare Disparities Report, due out in 2003, will provide valuable insights into the state of health care in America, including a comprehensive view of disparities in health care. The Agency for Healthcare Research and Quality is conducting and supporting research, data collection, and other initiatives aimed at reducing racial/ethnic disparities in health care. The documented disparities in health care represent a critical opportunity for quality improvement that requires input from all sectors, including policymakers, providers, community leaders, and patients.
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February 2004

The effectiveness of a community/academic health center partnership in decreasing the level of blood pressure in an urban African-American population.

Ethn Dis 2003 ;13(3):354-61

Sandtown-Winchester High Blood Pressure Control Program, The Johns Hopkins Schools of Medicine, Public Health and Nursing, Baltimore, Maryland 21205, USA.

This study investigated the effectiveness of a community-academic health center partnership, utilizing nurse-supervised indigenous community health workers, in decreasing the blood pressure in an urban African-American population. A four-year randomized clinical trial was conducted in the Sandtown-Winchester community, which has an excess prevalence of high blood pressure, in order to test the effectiveness of 2 different levels of intervention intensity on increasing the control of high blood pressure. Community health workers were trained and certified in blood pressure management, monitoring, education and counseling, social support mobilization, and community outreach and follow up. The primary results were a significant decrease in mean systolic and diastolic pressures after both levels of intervention, and a significant increase in the percentage of individuals with controlled high blood pressure. Surprisingly, no differences in results were observed between the 2 levels of intervention intensity. This study supports the use of community-based partnership efforts, and the utilization of indigenous health workers, to enhance the control of high blood pressure in a high-risk, African-American urban population.
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November 2003

Using participant information to develop a tool for the evaluation of community health worker outreach services.

Ethn Dis 2002 ;12(1):87-96

Agency of Healthcare Research and Quality, Rockville, MD 20852, USA.

Objective: Because there is no instrument that measures how clients judge community health worker (CHW) services, we sought to develop such a questionnaire. We report how we used client information to develop a brief questionnaire evaluating CHW services.

Design: We conducted and content-analyzed 18 in-depth semi-structured interviews of clients receiving CHW services to determine aspects of care salient to clients. Based on the results of these analyses, we developed and administered an in-person survey measuring the importance of 57 aspects of CHW services to 84 clients in 3 programs using CHWs to help control hypertension or diabetes.

Results: Clients perceived a broad array of aspects of CHW care including CHW attributes, services, benefits or outcomes of service and service arrangements. The 15 aspects ranking highest included: 1) CHW knows job; 2) CHW keeps client alive; 3) CHW gives information on high blood pressure; 4) CHW shows respect; 5) blood pressure is lowered; 6) CHW pays attention; 7) client gets better medical care; 8) CHW speaks understandably; and 9) client gets needed care.

Conclusion: We used client information to generate and determine the relative importance of a pool of aspects that we and others can use to construct brief questionnaires to measure clients' judgments of CHW services. Such questionnaires are needed for ongoing evaluation as more providers and managed care organizations increase their use of CHWs for outreach programs.
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August 2002
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