Article Figures & Data
Figures
- Figure 1.
Comparison of the percentage of quality measures met at baseline and at the end of the intervention period for patients in the expanded medical home (Ypsilanti Health Center [YHC]/Regional Alliance for Healthy Schools [RAHS]) versus those seen only at their primary care physician's office (YHC only).
Tables
- Table 1.
Consolidated Framework for Implementation Research Constructs Describing Domains That Influence the Success of Implementing an Intervention
Domain Definition and Examples of Included Constructs Intervention characteristics Describes the characteristics of the intervention being implemented into a particular organization; for example: ∙ if the intervention is developed internally or externally
∙ if the intervention can be adapted to meet local needs
∙ perceived complexity of the intervention
Outer setting Consists of the economic, political, and social context outside of or encompassing the organization implementing change; for example: ∙ how well the organization understands and prioritizes patient needs, including barriers and facilitators to meet those needs
∙ external pressures on the organization, such as a need to meet external mandates, recommendations, and guidelines; pay-for-performance; and/or public or benchmark reporting
Inner setting Includes the structural, political, and cultural contexts of the organization that may influence the implementation process; for example: ∙ the organization's capacity for change, which includes individuals' receptivity to the intervention and the extent that the organization rewards, expects, and supports the intervention
∙ the organization's readiness to change, which is affected by leadership engagement, resources available, and clear understanding of the intervention
Characteristics of individuals Describes the characteristics of the individuals involved with the intervention and/or implementation process; for example: ∙ individuals' attitudes toward and value placed on the intervention
∙ individuals' perception of, relationship with, and commitment to the organization
Process Describes components of the process, from planning to evaluation; for example: ∙ the degree and quality of planning of the tasks needed to implement the intervention
∙ involvement of key individuals in the implementation, such as opinion leaders, formal leaders, champions, and change agents
Data from refs. 12 and 13.
- Table 2.
Summary of Patient* Demographics and Services Provided by the Regional Alliance of Healthy Schools School-Based Clinics from July 2014 to June 2015
At-risk youth seen (n) 2200 Total visits (n) 9338 Payer (%) Medicaid 45 Uninsured 30 Private insurance 25 Sex (%) Male 53 Female 47 Race (%) Black 47 White 33 Unknown/unreported/refused to answer 11 American Indian 3 Asian 3 Multiple Races 3 Families assisted with insurance enrollment (n) 407 Families provided with assistance in meeting tangible needs (food, housing, utilities, cash assistance) (n) 1500 Youth receiving free vision services, including glasses (n) 355 Youth receiving free dental care (n) 297 Data are percentages unless otherwise indicated.
↵* The patients analyzed in this study are a subset of this group.
- Table 3.
Comparison of Proportions of Quality Measures Met at Baseline and During the Intervention Period Between Those Seen in the Expanded Medical Home (Ypsilanti Health Center/Regional Alliance for Healthy Schools) versus Those Seen Only at Their Primary Care Physician's Office (Ypsilanti Health Center Only)*
Quality Measure Baseline (September 1, 2013, through August 31, 2014) Intervention (September 1, 2014, through June 30, 2015) Differences in Improvements Between Groups,† % (P Value) YHC/RAHS YHC Only Difference in Patients Meeting Metric, % (P Value) YHC/RAHS YHC Only Difference in Patients Meeting Metric, % (P Value) Asthma Action Plan 65.0 (13/20) 46.0 (46/100) 19 (.19) 92.3 (24/26) 77.2 (71/92) 15.1 (.10)‡ −3.9 (.78) Influenza vaccination Patients with asthma 58.6 (17/29) 62.0 (93/150) −3.4 (.89) 73.5 (25/34) 55.6 (69/124) 17.9 (.09) 21.3 (.11) All patients 57.8 (111/192) 48.4 (619/1279) 9.4% (.02) 58.8 (141/240) 49.4 (511/1035) 9.4 (.01) 0 (.99) Nutrition/physical activity counseling§ 48.5 (50/103) 14.8 (75/508) 33.7 (<.001) 53.8 (63/117) 19.1 (74/387) 34.7 (<.001) 1 (.90) Spirometry for patients with asthma 48.3 (14/29) 46.0 (69/150) 2.3 (.98) 61.8 (21/34) 43.5 (54/124) 18.3 (.09) 16 (.25) Well-child visit 71.4 (137/192) 65.6 (839/1279) 5.8 (.14) 77.1 (185/240) 69.9 (723/1035) 7.2 (.03) 1.4 (.75) Data are % (n/N) unless otherwise indicate. Bold values indicate statistically significant difference.
↵* The baseline time period was 12 months and the intervention time period was 10 months. Comparisons are made using the χ2 test unless otherwise stated.
↵† Difference in between-group differences was determined using a z-test. An overall measure of the effect that the expanded medical home had on the likelihood of receiving the recommended services was evaluated through logistic regression with a binary indicator for receiving the service as the outcome and group (Ypsilanti Health Center [YHC]/Regional Alliance for Healthy Schools [RAHS] vs YHC only), time, and service type as covariates. Patients seen in the expanded medical home had a higher likelihood of receiving quality metric services than patients seen in the YHC only (odds ratio, 1.8; 95% confidence interval, 1.57–2.05) across all measures.
↵‡ Comparison via Fisher exact test.
↵§ For patients with a body mass index within or above the 85th percentile.
