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The purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease "inappropriate" or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six emergency departments and six federally qualified health centers were evaluated. Secondary data over a three-year time period were abstracted from patient and organizational records at the hospitals and federally qualified health centers. The utilization data from the emergency departments and health centers were compared. The analysis revealed a significant change in the number of non-urgent visits by self-pay patients at the emergency departments when the health centers expanded. A 32.2 percent decrease in utilization of the emergency departments by self-pay patients was found. Non-parametric tests demonstrated significant differences in the population seen at the emergency departments and the clinics over the three-year study period. Regression analysis demonstrated a statistically significant decrease in non-urgent, self-pay visits at the emergency departments as a result of the increase in self-pay visits at the federally qualified health centers. Further analysis includes forecasting the impact of future federally qualified health centers on emergency department utilization. Recommendations for future research include evaluation of the increased numbers of non-urgent transports from the local emergency medical system by self-pay patients as well as the design of a pilot study to look at the effectiveness of transporting these patients to the federally qualified health centers for care instead of to the local emergency departments.

Using a logistic regression model, this dissertation employed a macro level Gateway Provider Model to explore eight factors that may influence community health center HIV testing approach. The logistic regression model indicated that three variables related to community health center HIV testing approach. First, all else equal, the odds of offering routine HIV testing for community health centers that perceived their patients and community to be at average risk for HIV were 3.676 times the odds for those centers that perceived their patients and community to be at low or no risk for HIV. Further, the odds of offering routine HIV testing for community health centers that perceived their patients and community to be at high risk for HIV were 4.693 times the odds for those centers that perceived the community to be at low or no HIV risk. Second, all else equal, the odds of offering routine HIV testing for community health centers in which an HIV testing policy exists were 2.202 times the odds for those centers in which an HIV testing policy does not exist. Third, all else equal, the odds of offering routine HIV testing for community health centers that received funding specifically for HIV testing were 2.938 times the odds for those centers that did not receive such funding. No other individual predictor variables in the model were related to community health center HIV testing approach.

Effective doctor-patient communication is critical to improving health outcomes. Good communication improves emotional health, symptom resolution, functional and physiologic status, and pain control. Conversely, ineffective communication leads to misdiagnosis, inappropriate treatment poor adherence, misuse of health services, and high patient stress. In the U.S., Hispanics are the fastest growing minority. Despite the high burden of illness among this population, Hispanics are less likely than other minorities to regularly see a health professional. This is explained in part because Hispanics navigate a health system designed for the majority, experience a mismatch between cultural values and health beliefs, and have limited English proficiency. These communication challenges contribute to health disparities among the Hispanic population living in the U.S. Despite the importance of doctor-patient communication, few communication interventions that focus on improving patient skills have been tested in this population. Therefore, the purpose of this study was to evaluate whether a patient communication intervention tailored for female Hispanic patients could be practically implemented in a practice setting. The first aim focused on adapting existing communication skills training tools for a Hispanic population. The second aim assessed the feasibility of implementing the training tool in a federally qualified health center in a US-Mexico border community. The third aim explored the extent to which trained patients were able to integrate the information provided. Results indicate that it is feasible to implement communication training when delivered by clinical staff. Patient follow-up revealed that patients valued training on how to communicate with their doctor the most. Moreover, it is feasible to sustain the intervention when it is aligned with the priorities of the clinical site. Patient communication training in medically underserved rural areas could improve barriers to improved health outcomes in communities with a high prevalence of Hispanic patients. Future funding is needed to further test, dissemination of communication training programs.

The Johnson City Community Health Center is one of over 1200 community health centers serving over 22 million patients across the United States. Community health centers primarily serve patients with low income or without health insurance, but most serve all the members of their communities. These centers provide many services and treat health problems in a holistic manner in order to improve the health of their communities and also allow the members of those communities to progress. The Johnson City Community Health Center is compared to successful CHCs from across the nation to determine if it has characteristics to be successful in this community. A SWOT Analysis is conducted by evaluating the Marketing Mix, or the Product, Price, Placement, and Promotion, of the center and also by examining the Political, Economic, Social, and Technological environments it operates in. This research determines the internal Strengths and Weaknesses and external Opportunities and Threats of the Johnson City Community Health Center and concludes that it does have the characteristics needed to be successful in the community. This research can be used by center management to improve services, but it can also be used by other researchers to continue evaluations of community health centers across the nation.

No description available.