Institute for Family Health

Los Angeles, CA, United States

Institute for Family Health

Los Angeles, CA, United States
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Gagnon M.D.,Institute for Family Health | Waltermaurer E.,State University of New York at New Paltz | Martin A.,Institute for Advanced Medicine | Friedenson C.,University of Pennsylvania | And 2 more authors.
Journal of the American Board of Family Medicine | Year: 2017

Purpose: Nonadherence to medicines contributes to poor health outcomes, especially for patients with complicated medicine regimens. We examined adherence among patients at a family health center and the impact that barriers to getting medicines and negative beliefs about medicines have on adherence. Methods: A survey was administered incorporating the 8-item Morisky Medication Adherence Scale, questions from the Beliefs about Medicine Questionnaire, and questions about patients' external barriers to getting medicines. Low adherence was examined by any external barrier and by higher negative beliefs, adjusting for patient characteristics. Results: The convenience sample of 343 participants is demographically representative of the larger population. Among these patients, 54% report low adherence, 51% have at least 1 barrier to adherence, and 52% report more negative than positive beliefs about medicines. When beliefs and barriers are examined together, patients with negative beliefs are 49% less likely to adhere than those with more positive beliefs, whereas barriers show no significant impact on adherence. Conclusions: Negative beliefs about medicines are as prevalent in this population as external barriers to accessing medicines, but negative beliefs were more significantly associated with adherence than external barriers. Physicians should identify and address patients' negative beliefs about medicines to improve adherence rates.

Eisenberg A.,Drew University | Eisenberg A.,Meridian Health | Rosenthal S.,Jefferson Medical College | Schlussel Y.R.,Institute for Family Health
Academic Medicine | Year: 2015

The authors describe how they came to the realization that theater arts techniques can be useful and effective tools for teaching interpersonal communication skills (ICS) in medical education. After recognizing the outstanding interpersonal skills demonstrated by two actors-turned-doctors, in 2010 the authors began to develop a technique called Facilitated Simulation Education and Evaluation (FSEE) to teach ICS. In FSEE, actors and residents are coached in empathic, and therefore effective, ICS using a novel technique based on lessons learned from theater arts education. Competence in ICS includes the ability to listen actively, observe acutely, and communicate clearly and compassionately, with the ultimate goal of improving medical outcomes. Resident, actor, and faculty perceptions after two years of experience with FSEE have been positive. After describing the FSEE approach, the authors suggest next steps for studying and expanding the role of theater arts in ICS training.

Ravi A.,Beth Israel Residency in Urban Family Practice | Prine L.,Institute for Family Health | Waltermaurer E.,State University of New York at New Paltz | Miller N.,Institute for Family Health | Rubin S.E.,Yeshiva University
Journal of the American Board of Family Medicine | Year: 2014

Background: Federally qualified health centers (FQHCs) can address high rates of unintended pregnancy among adolescents in the United States by increasing access to intrauterine devices (IUDs) in underserved settings. Despite national guidelines endorsing adolescent use of IUDs, some physicians remain concerned about IUD tolerance and safety in adolescents. Therefore we compared adolescents and adults in a family physician staffed FQHC network with regard to (1) IUD postinsertion experience, (2) device discontinuation, and (3) sexually transmitted infection (STI) rates.Methods: We conducted a retrospective cohort study among women < 36 years old who had an IUD inserted in 2011 at a New York City FQHC staffed by family physicians.Results: We included 684 women (27% adolescents, 73% adults). During the 6-month postinsertion period, 59% of adolescents and 43% of adults initiated IUD-related clinical contact after insertion, most commonly for bleeding changes and pelvic or abdominal pain. There were no significant differences between groups in IUD expulsion or removal or STI rates.Conclusions: Urban FQHC providers may anticipate that, compared with their adult IUD users, adolescents will initiate more clinical follow-up visits after insertion. Both groups will, however, have similar clinical concerns about, reasons for, and rate of device discontinuation and low STI rates.

Ancker J.S.,New York Medical College | Barron Y.,New York Medical College | Rockoff M.L.,Columbia University | Hauser D.,Institute for Family Health | And 4 more authors.
Journal of General Internal Medicine | Year: 2011

Background: Electronic patient portals give patients access to information from their electronic health record and the ability to message their providers. These tools are becoming more widely used and are expected to promote patient engagement with health care. Objective: To quantify portal usage and explore potential differences in adoption and use according to patients' socioeconomic and clinical characteristics in a network of federally qualified health centers serving New York City and neighboring counties. Design: Retrospective analysis of data from portal and electronic health records. Participants: 74,368 adult patients seen between April 2008 and April 2010. Main Measures: Odds of receiving an access code to the portal, activating the account, and using the portal more than once Key Results: Over the 2 years of the study, 16% of patients (n=11,903) received an access code. Of these, 60% (n=7138) activated the account, and 49% (n=5791) used the account two or more times. Patients with chronic conditions were more likely to receive an access code and to become repeat users. In addition, the odds of receiving an access code were significantly higher for whites, women, younger patients, English speakers, and the insured. The odds of repeat portal use, among those with activated accounts, increased with white race, English language, and private insurance or Medicaid compared to no insurance. Racial disparities were small but persisted in models that controlled for language, insurance, and health status. Conclusions: We found good early rates of adoption and use of an electronic patient portal during the first 2 years of its deployment among a predominantly low-income population, especially among patients with chronic diseases. Disparities in access to and usage of the portal were evident but were smaller than those reported recently in other populations. Continued efforts will be needed to ensure that portals are usable for and used by disadvantaged groups so that all patients benefit equally from these technologies. © 2011 Society of General Internal Medicine.

Kern L.M.,New York Medical College | Edwards A.M.,New York Medical College | Pichardo M.,Institute for Family Health | Kaushal R.,New York Medical College
Journal of the American Medical Informatics Association : JAMIA | Year: 2015

The longitudinal effects of electronic health records (EHRs) on ambulatory quality are not clear. It is not known whether adoption and meaningful use of EHRs result in a brief period of quality improvement that then plateaus, or whether with ongoing use quality improvement continues. We studied health care quality at six sites of a Federally Qualified Health Center in New York State over 3 years (2008-2010) for 25 290 unique patients. Patients were twice as likely to receive recommended care on a set of 12 quality measures (11 of which are included in Stage 1 Meaningful Use) 3 years post-EHR implementation, compared to 1-year post-implementation (odds ratio 1.97; 95% confidence interval, 1.91-2.03). The magnitude of absolute improvement ranged from 5% to 20% per measure. EHRs were associated with continuing improvement in health care quality for at least 3 years post-implementation in the safety-net setting of a Federally Qualified Health Center. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email:

West B.,Mount Sinai School of Medicine | Parikh P.,University of California at Los Angeles | Arniella G.,Institute for Family Health | Horowitz C.R.,Mount Sinai School of Medicine
Diabetes Educator | Year: 2010

Purpose Community-based diabetes screening is common, but its impact on health outcomes is unclear. Screening protocols may not be standardized nor reflect current clinical practice. A community and clinical team examined the quality and consistency of community-based screening to diagnose hyperglycemic states, and it developed a bilingual screening tool to allow screeners to present accurate, actionable results to participants. Methods The team interviewed providers and community members, analyzed forms and educational materials utilized by screeners, and observed local diabetes screening events. Researchers compared glucose parameters used by screeners to published guidelines and observed finger-stick techniques and protocols for education, referral, and follow-up. Screening was divided into 3 phases: participant assessment before testing, obtainment of a sample, and interpretation of and counsel about results. Results There was a general lack of consistency in diabetes screening practices at the 12 screenings attended and among the 11 screeners interviewed. Assessment rarely included evaluation of diabetes risk factors or recent caloric intake. Obtaining a sample through fingersticks often included practices known to cause discomfort and decrease accuracy of glucose measurements. Criteria used to categorize results as "normal"or "abnormala" rarely followed published guidelines for laboratory-measured glucose values and varied significantly between screeners. No organization mentioned prediabetes in screenings. Postscreening consultation protocols varied widely. Conclusions Inconsistencies and inaccuracies in screening practices may limit the quality and relevance of community-based diabetes screenings. The impact of local screenings may be enhanced by using a tool that includes concrete steps and precise guidelines. © 2010 The Author(s).

Prine L.W.,Institute for Family Health | Macnaughton H.,Tufts University
American Family Physician | Year: 2011

The management of early pregnancy loss used to be based largely in the hospital setting, but it has shifted to the outpatient setting, allowing women to remain under the care of their family physician throughout the miscarriage process. Up to 15 percent of recognized pregnancies end in miscarriage, and as many as 80 percent of miscarriages occur in the first trimester, with chromosomal abnormalities as the leading cause. In general, no interventions have been proven to prevent miscarriage; occasionally women can modify their risk factors or receive treatment for relevant medical conditions. Unless products of conception are seen, the diagnosis of miscarriage is made with ultra-sonography and, when ultrasonography is not available or is nondiagnostic, with measurement of beta subunit of human chorionic gonadotropin levels. Management options for early pregnancy loss include expectant management, medical management with misoprostol, and uterine aspiration. Expectant management is highly effective for the treatment of incomplete abortion, whereas misoprostol and uterine aspiration are more effective for the management of anembryonic gestation and embryonic demise. Misoprostol in a dose of 800 mcg administered vaginally is effective and well-tolerated. Compared with dilation and curettage in the operating room, uterine aspiration is the preferred procedure for early pregnancy loss; aspiration is equally safe, quicker to perform, more cost-effective, and amenable to use in the primary care setting. All management options are equally safe; thus, patient preference should guide treatment choice. © 2011 American Academy of Family Physicians.

News Article | March 2, 2017

KINGSTON, N.Y.--(BUSINESS WIRE)--A team from J. Watson Bailey Middle School last night won the 2017 UnitedHealthcare Health Bee in a spirited final round in Kingston, earning the school funding for its health and wellness programs. Twenty-four students from four middle schools in Ulster County competed in the UnitedHealthcare Health Bee, a quiz show-style competition designed to get middle-school students excited about health, fitness and nutrition. UnitedHealthcare and the YMCA of Kingston and Ulster County hosted the competition yesterday at the YMCA in Kingston. Kingston Mayor Steve Noble kicked off the competition and stressed the importance of adopting healthy habits early in life. Mayor Noble was joined on the judge’s panel by Dr. Andrea Littleton of the Institute for Family Health, Ulster County Clerk Nina Postupack, Michael McGuire of UnitedHealthcare, and Heidi Kirschner of the YMCA of Kingston and Ulster County. “Pre-teens are at a critical juncture in their development when they begin to make their own choices about what to eat and how often to exercise,” said McGuire, CEO, UnitedHealthcare of New York. “The UnitedHealthcare Health Bee educates students about their health in a way that’s fun and engaging. By helping kids understand how their choices affect the way their body works and feels, we help set them on a healthy path to adulthood.” State Sen. George Amedore praised the goals of the UnitedHealthcare Health Bee, saying: “Getting young adults engaged and interested in fitness and nutrition helps them make educated choices to develop healthy lifestyles. The UnitedHealthcare Health Bee is a fun and educational experience for our students that will help us build and maintain stronger communities.” UnitedHealthcare awarded the winning team from J. Watson Bailey a $1,000 grand prize, which will support the school’s health and fitness programs. Kingston Catholic Middle School earned second place and a $500 prize, and M. Clifford Middle School took home the school spirit award and a $250 prize. The YMCA of Kingston and Ulster County awarded a one-month free membership to participating students and their families. State Assemblyman Kevin Cahill congratulated the students who participated and thanked UnitedHealthcare for hosting the Bee. “This event is a meaningful way to get young people concerned about health,” he said. “Wellness issues get more challenging to deal with as you get older, and it is important to get students interested in developing a strong foundation on how health decisions will affect their lives. Congratulations to J. Watson Bailey Middle School – they have made their school and community proud.” “The UnitedHealthcare Health Bee lets students celebrate their knowledge of health and wellness, and gives them a head start on the path toward healthy living into adulthood,” said Kirschner, CEO/president, YMCA of Kingston and Ulster County. “We are thrilled to join UnitedHealthcare’s efforts to build healthier communities with a focus on our middle-school students.” UnitedHealthcare serves more than 4 million people in New York with a network of nearly 280 hospitals and more than 91,000 physicians and other care providers statewide. About YMCA of Kingston and Ulster County The YMCA Kingston and Ulster County is a private not-for-profit, community-based organization providing social, health, physical education and recreation services to the residents of Ulster County. YMCA programs includes school-age child care, health enhancement / fitness classes, summer camps, swim lessons for all ages, special scholarship programs for low-income youth and families & physical rehabilitation programs. The YMCA serves all groups from infants to seniors. About UnitedHealthcare UnitedHealthcare is dedicated to helping people nationwide live healthier lives by simplifying the health care experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers, military service members, retirees and their families, and Medicare and Medicaid beneficiaries, and contracts directly with more than 1 million physicians and care professionals, and 6,000 hospitals and other care facilities nationwide. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE: UNH), a diversified Fortune 50 health and well-being company. For more information, visit UnitedHealthcare at or follow @myUHC on Twitter. Click here to subscribe to Mobile Alerts for UnitedHealth Group.

Calman N.S.,Institute for Family Health | Hauser D.,Institute for Family Health | Chokshi D.A.,Harvard University
Archives of Internal Medicine | Year: 2012

The Affordable Care Act made admirable strides toward the "triple aim" of reducing health care costs, increasing health care quality, and improving the health of the community at large. A key element of reform is the accountable care organization (ACO), which restructures health care delivery such that networks of providers are held responsible for a group of patients they serve. The recently announced Medicare ACO program lays the foundation for 2 of its 3 major goals by allowing ACOs to share in any cost savings, provided they meet quality criteria. Yet it seems that the public health goals of accountable care - arguably the most important of the 3 - have been left behind. To better address public health goals, we propose a novel method for quality reporting within ACOs: introducing an "expanded denominator" that attributes patients to a health system if they have ever been seen within the system. An expanded denominator would ensure that ACOs are held accountable not only for patients already engaged in primary care but also for patients with fragmented care and high-risk community members not receiving adequate care. Ultimately, payment reform in Medicare, and potentially Medicaid, must support this new approach to quality measurement for it to have lasting ramifications. ©2012 American Medical Association. All rights reserved.

Calman N.S.,Mount Sinai School of Medicine | Calman N.S.,Institute for Family Health | Golub M.,Institute for Family Health | Shuman S.,Institute for Family Health
Mount Sinai Journal of Medicine | Year: 2012

Skyrocketing health care costs are burdening our people and our economy, yet health care indicators show how little we are achieving with the money we spend. Federal and state governments, along with public-health experts and policymakers, are proposing a host of new initiatives to find solutions. The Patient Protection and Affordable Care Act is designed to address both the quality and accessibility of health care, while reducing its cost. This article provides an overview of models supported by the Affordable Care Act that address one or more goals of the "Triple Aim": better health care for individuals, better health outcomes in the community, and lower health care costs. The models described below rely on the core principles of primary care: comprehensive, coordinated and continuous primary care; preventive care; and the sophisticated implementation of health information technology designed to promote communication between health care providers, enhance coordination of care, minimize duplication of services, and permit reporting on quality. These models will support better health care and reduced costs for people who access health care services but will not address health outcomes in the community at large. Health care professionals, working in concert with community-based organizations and advocates, must also address conditions that influence health in the broadest sense to truly improve the health of our communities and reduce health care costs. Mt Sinai J Med 79:527-534, 2012. © 2012 Mount Sinai School of Medicine © 2012 Mount Sinai School of Medicine.

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