Publications and Resources

Shared Decision Making

Shared Decision Making: Innovation in Implementation and Practice Symposium. Proceedings


Authors: Danielle Lazar, AM
Date: May 2018
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In December 2017, nearly 50 experts, innovators and providers gathered at the ACCESS Center for Discovery and Learning to exchange ideas and practices for incorporating shared decision making into patient care.  ACCESS’ innovative approach to incorporating shared decision making as a system wide practice is highlighted as well as key takeaways from the two-year collaboration between ACCESS, Dartmouth Institute for Health Policy & Clinical Practice and the American Institutes for Research.  ACCESS has provided training on the approach to all providers, including providing 70 plus providers with 1:1 coaching on shared decision making.  As of November 2017, the use of shared decision making was documented more than 20,000 in ACCESS’ electronic health record. Keynote and panelists included: Gregory Makoul, PhD, MS; Danielle Lazar, AM; Glyn Elwyn, MD; Jairo Mejia, MD; Colleen McLoughlin, MPH; Mark Stolspart, ANP. 

 

Patient-Centered Medical Home (PCMH)

A Multipronged Initiative to Improve Productivity and Patient Access in a Federally Qualified Health Center Network


Authors: Heriberto “Eddie” Cruz, MBA, FACHE; Janie Gawrys, MS, RN, CPHQ; Donna Thompson, MS,RN; Jairo Mejia, MD; Linda Rosul, BA; Danielle Lazar, AM
Date: July-September 2018
Journal:  Journal of Ambulatory Care Management, Volume 41, Number 3, pp. 225-237
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In 2012, Access Community Health Network, a Federally Qualified Health Center (FQHC) network with 36 health centers serving the greater Chicago area, embarked on a 3-year initiative to improve patient access. “Dramatic Performance Improvement” (DPITM) included the adoption of modified open access scheduling and practice changes designed to improve capacity and the ability to balance supply and demand. This article describes DPITM implementation, strategies, and associated outcomes, including a 20% decrease in no-show rate, a 33% drop in time to the third next available appointment (TNAA), a 37% decrease in cycle time, and a 13% increase in patient satisfaction. (Journal of Ambulatory Care Management, Volume 41, Number 3, pp. 225-237)    

 

Social Determinants of Health

Building Systems to Evaluate Food Insecurity Screening and Diabetes in an FQHC


Authors:  Danielle Lazar, AM; Kathleen Gregory, MBA; Jonathan Blitstein, PhD
Date: April 23, 2018
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Access Community Health Network (ACCESS) has incorporated screening for food insecurity throughout its network of federally qualified health centers.  In this webinar, sponsored by ACCESS, N2-PBRN and the Clinical Directors Network, Inc.(CDN), ACCESS’ approach to food insecurity is described as well as the key learnings from initiating a system wide evaluation of the food insecurity program and its impact on diabetes. The webinar describes the practice innovation to address food insecurity within a community health network, the methodology and process for developing systems for evaluation within community health systems and shares lessons as to what it takes to build a culture of research and evaluation within a community health network. ACCESS has recruited nearly 1,000 patients to participate in the evaluation study, which will be completed in January 2019 and is funded by the Robert Woods Johnson Foundation. 

 

Health Disparities

House Parties: An Innovative Model for Outreach and Community-Based Health Education


Authors: Timika Anderson-Reeves, Jacqueline Goodman, Brian Bragg, Chelsey Leruth
Date: November 22, 2017
Journal: Maternal and Child Health Journal (2017) 21 (Suppl 1): S75-S80
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ACCESS and partners in Westside Healthy Start developed a house party model as a community based workshop approach to health education. Key elements included use of community health workers as facilitators, multiple collaborations across community based organizations, referrals to local services and interactive activities that encouraged ongoing engagement in education.  The article describes the intervention and results. Evaluation showed improvement by participants in knowledge for several areas important to maternal and child health including causes or signs of preterm labor (50 percent were able to identify causes prior to the house parties and 80 percent after).  The authors conclude that house parties are a promising intervention for increasing knowledge in hard-to-reach populations and about resources in the community.  

 

A Multilevel Approach to Breastfeeding Promotion: Using Healthy Start to Deliver Individual Support and Drive Collective Impact


Authors: Chelsey Leruth, Jacqueline Goodman, Brian Bragg, Dara Gray
Date: November 22, 2017
Journal:  Maternal and Child Health Journal (2017) 21 (Suppl 1): S4-S10
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Westside Healthy Start, a collaborative led by Access Community Health Network, to improve maternal and child health outcomes on the Westside of Chicago, developed a multilevel approach to breastfeeding promotion that targeted low-income and African-American women who typically have lower breast feeding initiation rates, despite the benefits of breastfeeding.  Key elements included individual education and counseling from pregnancy to 6 months postpartum and partnership with a local safety net hospital.  Results showed that in the year the model was implemented, 44.6 percent of prenatal patients planned to breastfeed and 67 percent of delivered participants initiated breastfeeding.  At 6 moths, 10.5 percent were still breastfeeding. The article discusses the initiative as a promising intervention to improve breastfeeding initiation, with recommendations for additional evaluation to understand barriers to continuing breastfeeding past 6 months. 

 

EHR-Based Medication Support and Nurse-Led Medication Management: Rationale and Design for a Three-Arm Clinic Randomized Trial


Authors:  Stephen D Persell, MD, MPH; Elisha M Friesma, CCRP; Milton “Mickey” Eder, PhD; Corinne Connor, RN, BSN,CIC; Alfred Rademaker, PhD; Dustin French, PhD; Jennifer King, MPH; Michael Wolf, MA, MPH, PhD
Date: October 24, 2013
Journal: Journal of the American Heart Association 2(5):
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Access Community Health Network (ACCESS) and Northwestern University conducted a three-arm randomized clinical trial (Northwestern and Access Community Health Network Medication Education Study or NAMES) to compare the incorporation of nurse-led medication therapy management and electronic-health record tools to the use of electronic-health record tools for medication management alone or usual care. EHR tools included printed medication list to prompt review of medications at each visit as well as printing of medication information in the after visit summary to encourage proper medication use.  The nurse-led intervention included one-on-one counseling by a registered nurse about medication regimens including reviewing concerns about medication, clarifying how to take medication and overall adherence. The study was designed to understand the impact of these different medication management interventions on patients with uncontrolled hypertension, with a primary outcome of systolic blood pressure after 1 year. This article describes the rationale and design of the study, which was completed in early 2017. NCT: NCT01578577   

 

Stand Against Cancer: Evaluating a Breast and Cervical Cancer Screening Program for Uninsured Patients


Authors: Milton “Mickey” Eder, PhD; Charles Firke
Date: Spring 2015
Journal: Progress in Community Health Partnerships: Research, Education and Action, Volume 9, Issue 1, Spring 2015, pp. 129-134
Publication Link


ACCESS’ Stand Against Cancer (SAC) program addressed breast and cervical cancer disparities by making free cancer screening accessible to uninsured women and connecting them to nurse case management in case of abnormal screening results.  This article describes the results of an evaluation of ACCESS’ SAC program.  Results showed that over 5 years, more than 10,000 women received SAC supported screening at ACCESS and 90 percent of women with abnormal results received results through nurse case management and were linked with appropriate services.