As a chronic disease, asthma presents a significant public health challenge nationally and in Georgia. In 2007, over 22 million people, including over 9 million children, had asthma in the United States. In Georgia, 230,000, or 10% of children have asthma, which is more prevalent among children less than 18 years of age than among adults. While asthma affects people of all ages and socioeconomic status, low income and minority populations have the highest asthma morbidity. This has proven to be the case with residents of Neighborhood Planning Unit V (NPU-V), a low-income minority community located in southeast Atlanta. Children comprise 35% of NPU-V's population, and over half of them live below the poverty line. Among other concerns, children with asthma have higher rates of hospitalization and absenteeism from school than their peers. The hospitalization rates for children with asthma in South Atlanta aged 0-17 years of age is almost five times the rate of North Fulton County. The Georgia State University Institute of Public Health received grant funding for the planning and implementation of the Accountable Communities: Healthy Together-Asthma (ACHT-A) program to help address the problems associated with asthma in NPU-V and among patients of Southside Medical Center (SMC). The capstone project involved development of an evaluation plan for future determinations about the program’s effectiveness in achieving desired outcomes. The evaluation process included development of a logic model and putting systems in place to track and measure specific indicators. The project culminated in a preliminary assessment of selected program activities to establish baseline information for the program, its participants, and SMC staff.

No description available.

Federally Qualified Health Center (FQHC) organizations, which provide health care services to low-income, underserved patients, are underfunded. From 2000 to 2007, the cost of treating an FQHC patient increased by $146, while federal compensation to FQHCs increased by only $44 per patient. One FQHC organization in rural Alabama experienced financial losses from the fiscal year 2011 through 2014, jeopardizing services to approximately 6,000 low-income patients. The purpose of this qualitative case study was to analyze the subject organization and discover opportunities to improve financial performance. The research question pertained to the opportunities for improving profitability at the subject organization. The conceptual framework was the systems thinking model. Along with data from the literature review, reviews of the organization's archived data containing employee feedback and feedback from unstructured interviews of four of the 14 FQHC chief executive officers in Alabama were used to develop the profitability model. No employees were interviewed or surveyed during this study, however, a review of archived documents revealed information provided by employees that was helpful in developing the profitability model. To help determine the subject organization's performance, data from independent auditors, technical assistants, FQHC performance reports, the organization's electronic health record system, accounting system, meeting minutes and performance reports were coded, classified, and analyzed. Data from these sources was compared to the profitability model and a gap analysis was used to identify the areas and causes of poor performance. The results indicated that the rural environment impacted the organization's financial performance. The subject FQHC organization may be able to use the results of this study to improve profitability. This study contributes to positive social change by providing a profitability model that other FQHC organizations may use to improve their financial viability and expand services to underserved patients throughout the United States.

Between 2013 and 2016, 8.1% of U.S. adults 20 years and older suffered from depression, but only 29% of them sought help. This project addressed the low depression screening rate in a Federally Qualified Health Center (FQHC) that supported integrated care. The purpose of the project was to evaluate the integration of behavioral health into primary care in an FQHC through the rate of depression screenings. Two theoretical frameworks, the find-organize-clarify-understand-select/plan-do-study-act model and the Centers for Disease Control and Prevention's framework for program evaluation in public health were combined into a list of questions and data validity tests that were used to conduct the evaluation. This quality improvement (QI) project evaluated an existing QI initiative. Findings revealed that 75% of the patients seen, and not the initially reported 53%, received depression screenings, which indicated an improved outcome. Other findings were inadequate use of theoretical frameworks, poor data quality, and suboptimal effectiveness of QI team processes. The strategies and tools recommended in this project could be used by organizational leaders and QI teams to evaluate and improve QI initiatives. The project's contribution to awareness about depression through integrated care could increase patients' access to care, quality of life, and life expectancy, and positively impact social change.

BACKGROUND: Despite large investments in maternity care services, perinatal health outcomes in the U.S. are among the worst compared to other industrialized countries, with documented perinatal health disparities disproportionately impacting racial and ethnic minorities. Midwifery-led freestanding birth centers (FSBC) have emerged as an underutilized model for the safe and cost-effective care of women with low-risk pregnancies. Despite approximately 85% of all US pregnancies being considered low-risk, only 0.5% of all US births occurred in a FSBC in 2016. The goal of the study is to elucidate strategies used to develop and sustain freestanding birth centers (FSBCs) that are seeking to serve high proportions of publicly-insured women and women of color. METHODS: I conducted an embedded unit case study, including semi-structured in-depth interviews and focus groups with 49 stakeholders from three exemplary FSBCs. Supplemental interviews were led with five key informants from three additional FSBCs and a relevant national membership organization. Additional data sources used to complete this case study include, where relevant and permitted, observations of maternity care settings, patient-provider encounters, management meetings, community events, and review of pertinent documents. Qualitative analysis methods were used to identify common themes and variations. FINDINGS: Midwifery-led birth center care can improve the experience and outcomes of maternity care among publicly insured women of color. The study revealed persistent multi-level challenges, as well as the use of common approaches to overcome these organizational, financial, and cultural barriers, resulting in greater, yet still fragile, access to family-centered intrapartum care within the communities in which these FSBCs operate. CONCLUSIONS: The careful integration of FSBCs into health systems such as a Federally Qualified Health Center (FQHC) may contribute to the broad scale-up of this underutilized model of care. While integrating FSBCs into FQHCs may be helpful in expanding equitable access to birth center care, it is not necessary, and also not sufficient. Expansion efforts should include additional deliberate processes and strategies to ensure equitable uptake and sustainability of birth center care. / 2020-10-23T00:00:00Z