The Nebraska Center for Rural Health Research

Reference Type: Journal Article
Record Number: 80
Year: 1983

Title: Reaching Into the Community-CHC Journal: Frontier Nursing Service Quarterly Bulletin
Volume: 58, Issue: 4, Pages: 1-7

Abstract: A profile on a CHC , Frontier Nursing Service in rural Kentucky. This article describes the community forces that develop and sustain the health care services provided by the CHC. This CHC in particular relies on a large amount of community involvement , but also provides a foundation for other community networks to exist in subsidiary community organizations.

Reference Type: Journal Article
Record Number: 89
Author: Abrams, Rhoda, et al.
Year: 1995

Title: Performance of Community Health Centers Under Managed Care Journal: Journal of Ambulatory Care Management
Volume: 18, Issue: 3, Pages: 77-88
Keywords: community health centers, health maintenance organizations, managed care, performance

Abstract: The Bureau of Primary Health Care, a division of the Health Resources and Services Administration of the Department of Health and Human Services, Public Health Service, commissioned a study to evaluate the performance of community health centers (CHC's) under managed care. This article reports on the findings of the bureau's study, which examined the performance of seven CHC's that contract with health maintenance organizations (HMO's). The experience of these centers can provide valuable insights for other CHC's and the HMO's with which they partner. Policy makers contemplating the role of CHC's in managed care will also benefit from these findings.

Reference Type: Journal Article
Record Number: 76
Author: Advisory Council for the Elimination of Tuberculosis, The Year: 1992
Title: Prevention and Control of Tuberculosis in Migrant Farmworkers: Recommendations of the Advisory Council for the Elimination of Tuberculosis
Journal: Morbidity and Mortality Weekly Report
Volume: 41, Issue: RR-10 (June, 5), Pages: 1-13

Abstract: Farm workers are approximately six times more likely to develop tuberculosis (TB) than the general population of employed adults. These recommendations are presented to assist health-care providers serving migrant and seasonal farm workers. The following services, listed by priority, that should be available for migrant and seasonal farmworkers and their family members are: a) detection and diagnosis of those with current symptoms of active TB; b) appropriate treatment and monitoring for those who have current disease; c) contact investigation and appropriate preventive therapy for those exposed to infectious persons; d) screening and appropriate preventive therapy for asymptomatically infected workers who may be immunosuppressed, such as those with human immunodeficiency virus (HIV) infection; e) screening and appropriate preventive therapy for children of migrant and seasonal farmworkers; f) widespread tuberculin test screening for workers and families with preventive therapy prescribed, as appropriate. Health care providers should immediately perform appropriate diagnostic studies for persons with a productive, prolonged cough, or other symptoms suggestive of tuberculosis. Health departments should be immediately notified when TB is suspected or diagnosed to enable examination of contacts and initiation of other health department diagnostic, preventive, or patient management services.

Reference Type: Journal Article
Record Number: 50
Author: Baer, Roberta
Year: 1996
Title: Health and Mental Health Among Mexican American Migrants: Implications for Survey Research
Journal: Human Organization
Volume: 55, Issue: 1, Pages: 58-66
Keywords: US Census, Mexican Americans, mental health

Abstract: This paper provides an example of the policy implications of the need to understand EMIC categories. As part of research commissioned by the US Census Bureau, in-depth interviewing on the topic of health and mental health was conducted among Mexican and Mexican American migrant workers in Florida. It was found that perceptions of theses topics differ from the biomedical model, but are somewhat similar to the categorization elicited from a sample of white middle class, highly educated urbanites. These results suggest that at least for this domain, standard demographic variables, such as ethnicity, level of education, language, and income seem to be less critical than is the lay/professional distinction. The biomedical categories used in survey research may be inappropriate not only for ethnic minorities, but also for the mainstream population.

Reference Type: Journal Article
Record Number: 33
Author: Barton, J.A., Brown, N.J.,
Year: 1992
Title: Evaluation Study of a Transcultural Discovery Learning Model
Journal: Public Health Nursing
Volume: 9, Issue: 4, Pages: 234-241

Abstract: This qualitative, descriptive study explored the extent to which students' discovery learning centered around cultural understanding and sensitivity occurs in a clinical rotation involving migrant health care. Thirteen nursing students enrolled in this community health clinical rotation were the study sample. Demographically, they were similar to other baccalaureate students in the school of nursing. Characteristics that set them apart were their levels of maturity, motivation, and independence, and their ability to cope with stress and ambiguity. Student journal entries were used to explore changes in cultural understanding and sensitivity over the course of an intensive six-week clinical experience. The method of inquiry was qualitative descriptive. Discovery learning from the perspective of the students was analyzed using domain analysis scheme. Themes that emerged from analysis of the data were personal and professional growth, specialized nursing practice roles with ethnic minorities, and health care system needs and issues for culturally sensitive care. Our findings contribute to faculty understanding of the degree to which student nurses make a transformation in terms of cultural understanding and sensitivity, and the process by which increased cultural understanding and sensitivity result in application of theoretical transcultural concepts.

Reference Type: Journal Article
Record Number: 68
Author: Bechtel, Gregory A.; Mary Anne Shepherd; and Phyllis W. Rogers
Year: 1995
Title: Family, Culture, and Health Practices Among Migrant Farmworkers
Journal: Journal of Community Health Nursing
Volume: 12, Issue: 1, Pages: 15-22

Abstract: Migrant farmworkers and their families have restricted access to health and human services because of their frequent relocation between states, language and cultural barriers, and limited economic and political resources. Living and working in substandard environments, these families are at greater risk for developing chronic and communicable disease. In an assessment of health patterns among 225 migrant workers and their families, using personal observations, unstructured interviews, and individual and state health records, children's immunizations were found to be current, but dental caries and head lice were epidemic. Among adults, almost one third tested positive for tuberculosis exposure. Urinary tract infections were the most common health problem among women. Primary and secondary prevention were almost nonexistent because funds for these services were not readily available. The patriarchal system contributes to these problems by limiting access to family-health and social service needs. Although providing comprehensive health care to migrant communities presents unique challenges, nurses can demonstrate their effectiveness in reducing morbidity through strategic interventions and alternative uses of health delivery systems.

Reference Type: Journal Article
Record Number: 31
Author: Benor, David
Year: 1995
Title: The Federally Supported Health Centers Assistance Act of 1992: an Experiment in Malpractice Coverage
Journal: Public Health Reports
Volume: 110, Issue: 3, Pages: 357-360

Abstract: Based on a claims experience that was extremely low and malpractice insurance rates that remained at "commercial" rates, the Congress concluded in 1992 that coverage of malpractice actions against these grantees and their health care practitioners would be more cost-effective under the Federal Tort Claims Act. This, in turn, would allow the grantees to apply the savings to providing health services to their beneficiaries. The lawmakers thereupon enacted a 3-year experiment in coverage of malpractice actions involving certain Public Health Service grantees. This article describes the background, structure, and administration of this statutory experiment.

Reference Type: Journal Article
Record Number: 55
Author: Bigelow, Barbara; and Melissa Middleton Stone
Year: 1995
Title: Why Don't They Do What We Want? An Exploration of Organizational Responses to Institutional Pressures in Community Health Centers
Journal: Public Administration Review
Volume: 55, Issue: 2, Pages: 183-192

Abstract: Through the use of four comparative case studies, the authors explore the range of factors that influence how community health centers respond to pressures from funders to make substantial cuts to center budgets. Data from these caes suggest that the inter-relationship between internal constellations of power and certain elements in the centers' environment shaped four different responses to institutional pressures. The cases demonstrate that repsonses to institutional pressures are more complex than the complete compliance often expected by funding sources.

Reference Type: Journal Article
Record Number: 27
Author: Blumenthal, Daniel S.; et al
Year: 1993
Title: A Proposal to Provide Care to the Uninsured Through a Network of Community Health Centers
Journal: Journal of Health Care for the Poor and Underserved
Volume: 4, Issue: 3, Pages: 272-279

Abstract: While a national health insurance plan is needed, this alone will not provide access for approximately 30 million persons who face geographic, cultural, language, or health care system barriers, or who live in areas with provider shortages. These barriers often coexist with lack of insurance coverage, but they also affect millions who have public, or even private, coverage. Moreover, large segments of this population suffer from health problems not adequately addressed by the traditional medical model: teenage pregnancy, AIDS, injury, substance abuse, and the like. To provide appropriate care for these underserved persons, we propose to expand the existing network of community health centers over the next 10 years to a total of approximately 3,000. Such an expansion would provide a cost-effective approach to improving provider distribution, increasing consumer input, combining personal health services with health promotion, and removing both financial and nonfinancial barriers to care. This model can be implemented either independent of or in conjunction with other health care system reform efforts.

Reference Type: Journal Article
Record Number: 1
Author: Blumenthal, Daniel; E. Mort, and J. Edwards
Year: 1995
Title: The Efficacy of Primary Care for Vulnerable Population Groups
Journal: Health Services Research
Volume: 30, Issue: 1: part 2, Pages: 253-273
Keywords: efficacy, primary care, vulnerable populations, literature review

Abstract: This article reviews the existing literature on the efficacy of primary care with an emphasis on the evaluation of primary care for vulnerable populations: groups whose demographic, geographic, or economic characteristics impede or prevent their access to health care services. A significant portion of the literature derives from studies of poor and underserved populations. However, to construct a more complete evaluation of primary care services, the authors cite literature that has examined both advantaged and disadvantaged populations. Even then the literature is incomplete, at best. The article describes a definition of primary care suitable for policy analysis and formulation, reviews evidence on the efficacy of care that meets that definition, and concludes that widespread use of primary care services is likely to result in improved patient satisfaction and health status.

Reference Type: Journal Article
Record Number: 16
Author: Brown, N.J., Barton, J.A.
Year: 1992
Title: A Collaborative Effort Between a State Migrant Health Program and a Baccalaureate Nursing Program
Journal: Journal of Community Health Nursing
Volume: 9, Issue: 3, Pages: 151-159

Abstract: This article reports on the way in which a unique collaborative effort between a service agency and a baccalaureate nursing program grew out of the needs of the two separate agencies. The first agency, the Colorado Migrant Health Program, was faced with a budget that was inadequate to meet the health-care needs of the migrant population. The second, a baccalaureate nursing program at the University of Colorado, was finding it increasingly difficult to locate appropriate generalized community health clinical placements with an opportunity for student discovery learning related to transcultural health care. Discussions of a collaborative effort ensued and it became evident that each had something to gain from such an effort. Now, after almost 10 years of cooperation, the commitment to the endeavor on the part of both agencies remains strong as the benefits to each continue to increase. The ultimate beneficiaries, however, are the migrant families receiving care and the students providing care. The way in which the program has evolved over time, a description of the current program, and a discussion of the resources that help to maintain the program are presented. In addition, the curriculum course design, and teaching strategy modifications necessary to facilitate the collaborative program are discussed.

Reference Type: Journal Article
Record Number: 49
Author: Burk, Martha, Peggy Wieser, and Lynn Keegan
Year: 1995
Title: Cultural Beliefs and Health Behaviors of Pregnant Mexican-American Women: Implications for Primary Care
Journal: Advances in Nursing Science
Volume: 17, Issue: 4, Pages: 37-52
Keywords: certified nurse midwife, culturally sensitive primary care, Mexican-american, pregnancy

Abstract: A significant aspect of holistic primary care nursing is that it seeks to assess and understand clients' health beliefs and behaviors in the context of culture. This article examines implications for primary care nursing practice based on the cultural beliefs and health behaviors of pregnant Mexican-American women. Giger and Davidhizar's transcultural assessment model is used to evaluate six cultural phenomena present in all cultural groups. Culturally sensitive primary care by certified nurse-midwives in a community health birth center setting is described.

Reference Type: Journal Article
Record Number: 79
Author: Bushnell, Frances KL; and Tom Cook
Year: 1995
Title: Primary Care to the Underserved Through Community Empowerment
Journal: Nurse Practitioner
Volume: 20, Issue: 8, Pages: 21-23

Abstract: This article describes the need for better acces to primary care. Primary care is defined as not only biomedical care, but also addressing the health of the socioeconomic environment the patient lives in. A program called Community Oriented Primary Care trains nurse practitioners to work with the community to improve the overall health of the community, not just the patients that walk in for health care. The implications of increased dependence on nurse practitioners in the health industry and changes in educational programs are also discussed.

Reference Type: Journal Article
Record Number: 39
Author: Chi, Peter S.K.
Year: 1985
Title: Medical Utilization Patterns of Migrant Farm Workers in Wayne County, New York
Journal: Public Health Reports
Volume: 100, Issue: 5, Pages: 480-490

Abstract: A representative sample of 218 migrant farm workers was randomly drawn in Wayne County, New York, during the summer of 1982. Three distinct migrant groups were identified: immigrants, recent migrants, and long term migrants. Medical utilization patterns, including physician visits and use of medical services in the community health center, were compared among the three migrant groups. The determinants of physician visits were examined in a multiple regression model.The focus was also placed on types of health problems for which medical treatment had been delayed, and the reasons for the delay were clearly identified. Furthermore, this study examined migrants' subjective assessment of quality of health care in the community. The results of this study indicate that the provision of comprehensive health programs, removal of structural barriers in the health delivery system, and a program of migrant health education are the necessary steps to alter the medical utilization behavior of migrant farm workers

Reference Type: Journal Article
Record Number: 53
Author: Chi, Peter S.
Year: 1986
Title: Variation in Subjective Well-being Among Black Migrant Farm Workers in New York.
Journal: Rural Sociolgy
Volume: 51, Issue: 2, Pages: 183-198

Abstract: One purpose of this study is to determine whether the Index of General Well-being is applicable to migrant farm workers, whose values, lifestyles, and health may differ from those of the general population. A second purpose of this research is to compare the level of migrant farmworkers' mental health with that of the general populations and to assess the variation in subjective well-being among them. The results indicate that variation in subjective well-being among this group is a function of lifestyle, social support, housing conditions, and three background variables (age, sex, and education). Policy implications derived from these results are discussed in the paper.

Reference Type: Journal Article
Record Number: 22
Author: Ciesielski, S.D., Seed, J.R., Esposito, D.H., Hunter, N.
Year: 1991
Title: The Epidemiology of Tuberculosis Among North Carolina Migrant Farm Workers
Journal: JAMA
Volume: 265, Issue: 13, Pages: 1715-1719

Abstract: Although tuberculosis (TB) has been recognized as a significant health problem of migrant farm workers, the nature and extent of the problem have been poorly defined. We report the first population-based study of TB in a random sample of farm workers (n = 543) and the first use of recall antigens in an epidemiologic study of TB. Purified protein derivative positivity ranged from 33% in Hispanics to 54% in US-born blacks and 76% in Haitians. Active tubercular disease occurred in 3.6% of US-born blacks and 0.47% of Hispanics. Among US-born blacks, risk factors associated with farm work were most significant. Blacks born in the United States also had the highest prevalence of anergy. The use of recall antigens made possible a better description of the epidemiology of TB by excluding false negatives and clarifying associations between infection and risk factors. We conclude that TB among farm workers represents a serious public health problem with previously unrecognized risk factors. Additional resources for migrant health care, improvements in health care access, and fundamental changes in the system of migrant labor are all necessary to reduce the transmission of TB.

Notes: [published erratum appears in JAMA 1991 Jul 3;266(1):66]

Reference Type: Journal Article
Record Number: 94
Author: Deprez, Ronald D; Beth-Ellen Pennell; and Mary Anne Libby
Year: 1987
Title: The Substitutibility of Outpatient Primary Care in Rural Community Health Centers for Inpatient Hospital Care
Journal: Health Services Research
Volume: 22, Issue: 2, Pages: 207-233

Abstract: To determine whether outpatient medical care obtained at federally funded rural community health centers (CHCs) in Maine acts primarily as a substitute or as a complement to inpatient care, a study of 36 communities served by CHCs was conducted. The hospital use of CHC users (age- and sex-adjusted admissions, days, and length of stay) was compared with that of nonusers from the same communities in 1980. Statistically lower rates of hospital admissions and days were observed for all CHC patients and for selected groups based on their age, sex, and insurance status (specifically Medicaid or Medicare). Hospital use of CHC community populations was then compared with that of 24 comparison communities without access to CHCs, using multiple linear regression in a pre/post design. The model tested, which included rates of health center use, insurance penetration, poverty, and hospital availability, among other factors, did not detect any differences in hospital use between CHC community and comparison populations. These results and additional data presented on selected hospital diagnoses and insurance coverage suggest that treatment, and hospitalization incentives, of CHC providers may reduce hospitalization. Clinic providers lack the economic, professional, and institutional incentives to hospitalize. Additional study to determine the actual substitutability effect is indicated.

Reference Type: Report
Record Number: 105
Author: Dievler, Anne
Year: 1992
Title: A Lierature Review of Community and Migrant Health Centers: Annotated Bibliography Appendix II
Institution: The George Washington University, Center for Health Policy Research
Date: July 1992

Abstract: This annotated bibliography contains summaries of 55 articles, books and reports concerning community health centers. these articles were published between since the creation of community health centers in 1965, to the present. The summaries emphaisize the aspects of the literature that relate to the effectiveness, the efficiency and the broader role of community health centers. Some of the literature is critical of health centers, and these negative findings have also been included to provide a balanced picture. While this annotated bibliography does not contain all of the articles written about community health centers, it includes a fairly representative sample of the literature.

Reference Type: Journal Article
Record Number: 70
Author: Eng, Eugenia; Marla Salmon; and Fitzhugh Mullan
Year: 1992
Title: Community Empowerment: The Critical Base for Primary Health Care
Journal: Family Community Health
Volume: 15, Issue: 1, Pages: 1-12

Abstract: Primary Health Care research and practice are in an important period of transition with respect to the roles that communities play in the health of people. Both practitioners and educators alike are moving from defining "community" as a physical setting in which care takes place, toward an understanding that a community is a "living" organism with interactive webs or ties among organizations, neighborhoods, families, and friends. As such, the health of this organism is understood to be directly related to the health of the people who are its members. An accompanying understanding is that important determinants of health-related behavior change are embedded in the relationships that tie individuals to organizations, neighborhood, families, and friends in their community. There is now also an additional recognition that control over health solutions cannot be the exclusive prerogative of the health professions, but must be shared with a community, because both have the similar goal of securing the well-being of those they serve.

The purpose of this article is to provide an overview of the theoretical and practice related basis for enabling primary health care programs to enhance health through effecting social change in communitites. Such programs are those that empower a community's various component parts to mobilize internal social change as a basis for enhancing health. We will briefly review the theoretical basis underlying a social change model for community health and empowerment. Both the strategies and expected outcomes that emerge from such a model will be described. Finally, implications of these approaches for primary health care practitioners and managers will be discussed.

Reference Type: Journal Article
Record Number: 97
Author: Eng, Eugenia
Year: 1993
Title: The Save Our Sisters Project: A Social Network Strategy for Reaching Rural Black Women
Journal: Cancer
Volume: 72, Issue: 3 (Supplement), Pages: 1071-1077
Keywords: breast cancer screening, rural, minority, social support

Abstract: Why are older black women screened less for breast cancer? What can be done to narrow the racial gap in mammography screening? These are the questions addressed by the Save Our Sisters (SOS) Project, a pilot demonstration study funded by the National Cancer Institute in a rural county of North Carolina. The target population is 2600 black women 50-74 years of age residing in the county. To assist these women to obtain annual mammograms, SOS has recruited and trained 64 black women who are "natural helpers" to serve as lay health advisors. The lay health advisors reach older black women through their existing kin, friendship, and job networks. Responses from 14 focus group interviews found that when it is a matter of older black women's health concerns, women turn to certain women for social support. Responses revealed factors related to the individual woman and her social network that influence rural black women's seeking breast cancer screening. These results were applied to the Social Change model for designing the training and three network intervention strategies: (1) providing social support (information and referrals, emotional caring, and tangible assistance) through interpersonal counseling with women in their social networks; (2) working as a group, planning and implementing breast cancer control and prevention activities through community-based organizations to which advisors belong (e.g., church groups, civic groups, and social groups); and (3) establishing themselves as a non-profit, community-based SOS Association to sustain project interventions after the funding period. The SOS Community Advisory Group and the advisors developed innovative methods of recruitment, implementation, and follow-up. The community programs they have initiated are: (1) the Adopt-A-Sister Program, which assists black women who cannot afford the cost of a mammogram; (2) a committee on understanding the health care system, which assists women in negotiating regulations and using health care providers; (3) a training committee, which recruits and trains additional advisors; (4) a support group for black women with diagnoses of breast cancer; and (5) a speakers bureau, which has produced a 10-minute video, brochure, and tee-shirts as community education materials.

Reference Type: Journal Article
Record Number: 83
Author: Finkler, Stephen A.; et al.
Year: 1994
Title: Improving the Financial Viability of Primary Care Health Centers
Journal: Hospital and Health Services Administration
Volume: 39, Issue: 1, Pages: 117-131

Abstract: This article presents findings from a national presentation program to improve the long-term financial viability of small not-for-profit primary care health centers. The program initiatives and their implementation are described in some detail. A standard pre/post study design was used to measure the impact of the initiatives on general outcome measures, financial ratios, and the utilization of management techniques. Overall, demonstration centers showed improvement over the study period. Notable short-term improvements inclded significant growth in the volume of patient visits and increased profit. Observed changes also revealed an increased use of sophisticated management techniques, expected to positively affect longer-term financial health. The findings suggest that improving the financial viability of health centers need not be expensive.

Reference Type: Journal Article
Record Number: 107
Author: Frees, N; et al.
Year: 1992
Title: HIV Infection, Syphillis, and Tuberculosis Screening Among Migrant Farm Workers--Florida, 1992
Journal: Morbidity and Mortality Weekly Report
Volume: 41, Issue: 39, Pages: 723-725

Abstract: Migrant farm workers (N=310), ages 16 and over, in fourteen Florida migrant camps were tested for HIV, syphillis, and tuberculosis. Eight per cent tested positive for syphillis, 5% tested positive for HIV, and 44% had a positive tuberculosis skin test. Risk factors were also measured for those tested and those results are discussed. The prevalence of these diseases are compared to the rates found in the surrounding areas or region. Complications involved in testing and treating these types of populations are discussed.

Reference Type: Journal Article
Record Number: 3
Author: Frost, Jennifer J.
Year: 1996
Title: Family Planning Clinic Services in the United States, 1994
Journal: Family Planning Perspectives
Volume: 28, Issue: 3, Pages: 92-100
Keywords: family planning clinics. contraception, Title X funding

Abstract: In 1994, almost 6.6 million women received contraceptive services from more than 7,000 subsidized family planning clinics; these providers were located in 85% of U.S. counties. Health department clinics and Planned Parenthood sites served the largest proportions of these women (32% and 30%, respectively), followed by hospital outpatient sites (16%), independent clinics (13%) and community or migrant health centers (9%). The mix of agency types varied considerably by region and state, and the average annual number of contraceptive clients served per clinic also varied from fewer than 500 at community and migrant health centers to more than 2,000 at Planned Parenthood clinics. Nearly two-thirds of all women served (4.2 million) obtained care at one of the 4,200 clinics receiving funds from the federal Title X family planning program. Health department sites were the most likely to receive Title X funding (78%), followed by independent clinics and Planned Parenthood sites (66% each), hospital clinics (28%) and community and migrant health centers (18%). Overall, clinics receiving Title X funds serve an average of 25% more contraceptive clients than do clinics not receiving such funds.

Reference Type: Journal Article
Record Number: 26
Author: Gardner, Roland J.
Year: 1993
Title: National Health Care Reform and Community and Migrant Health Centers
Journal: Journal of Health Care for the Poor and Underserved
Volume: 4, Issue: 3, Pages: 268-271
Keywords: Community Health Centers, employee health benefit plans, Medicaid

Abstract: Community and migrant health centers (CHCs) have been shown to increase access to health care, improve health status, and reduce health care costs in communities that they serve. Thus CHCs can play an important role in providing for underserved communities under any program of national health care reform whose aim is universal, affordable access. To benefit the poor, such a plan should be federally administered and progressively financed, with comprehensible enrollment procedures, easy paperwork, and clearly delineated limits and benefits.

Reference Type: Journal Article
Record Number: 102
Author: Goldman, Howard H; Barbara J Burns; and Jack D Burke
Year: 1980
Title: Integrating Primary Health Care and Mental Health Services: A Preliminary Report
Journal: Public Health Reports
Volume: 95, Issue: 6, Pages: 535-539

Abstract: Intergrating services and coordinating existing resources have become maor goals in the development of current health and social welfare policy. In the 1970's and thus far in the 1980's recession and inflation have combined with prevailing attitudes of social and fiscal conservatism to produce a social policy characterized by austerity and consolidation. Few large social programs and new service inititatives have been funded. Instead, relatively modest programs have been created to coordinate the activities of existing service units. As a result, service integration and coordination of existing resources have become important strategies for a new social policy for the 1980's.

In this paper we a) outline a theoretical perspective on interorganizational relationships for service integration, based on a framework presented in an earlier paper, b) describe a new service grant program designed to stimulate coordination between primary health care projects (PHCP's) and community mental health centers (CMHC's), and c) pinpoint the problems and prospects of PHCP-CMHC linkage grants in the context of this theoretical perspective on interorganizational relationships.

Reference Type: Journal Article
Record Number: 78
Author: Goldsmith, Marsha
Year: 1989
Title: As Farmwokers Help Keep America Healthy, Illness May Be Their Harvest
Journal: JAMA
Volume: 261, Issue: 22, Pages: 3207-3213

Abstract: An overview of the 12th Annual National Migrant Health Conference, with detailed discussion of the health problems migrant farmworkers have with pesticides. EPA and agricultural agencies have not been diligent in enforcing standards of health and pesticide use in the fields, and there has not been much funding for research about toxicology of agricultural pesticides. Nutrution and disease risks are also discussed within the framwork of this population's behavior and lifestyles that are inherent to migrant and seasonal farmworker life. Lastly, the article discusses the recent development of rural programs targeting not only the health, but social, problems incurred by migrant and seasonal farmworkers.

Reference Type: Journal Article
Record Number: 7
Author: Gordon, Paul R., and Frank Hale
Year: 1993
Title: The Service-Education Linkage: Implications for Family Practice Residency Programs and Community and Migrant Health Centers
Journal: Family Medicine
Volume: 25, Issue: 5, Pages: 16-21
Keywords: C/MHC's, family practice training programs, underserved areas

Abstract: INTRODUCTION: Access to quality primary health care for our country's underserved populations is a challenge for both the government and physicians. The Division of Medicine, through funding priorities and other initiatives, is encouraging family practice educators to train residents and students for work in community and migrant health centers (C/MHCs) in underserved areas. The objective of this research was to study linkages between family practice residency programs and C/MHCs and determine the reasons for affiliation, disadvantages and advantages, predictors of successful linkages, and common errors in the linkage agreement. METHODS: We conducted in-depth telephone interviews with the directors of 13 of the 19 family practice residency programs identified as having linkages with C/MHCs. RESULTS: All interviewees at residency programs indicated that their programs had a mission to serve underserved patients. The most commonly cited constraining factor cited by both residency programs and C/MHCs was financial support for residents, on-site faculty, and support staff. Many programs reported that residents training at the C/MHC were able to gain a community health perspective and practice community-oriented primary care. Finally, financing the relationship involved many different approaches, ranging from the residency paying all of the salaries, to a sharing of salaries by the residency, state, and/or hospital, to C/MHC paying the salaries either through its own funds or through grant support. DISCUSSION: These data provide an assessment of the current issues that family practice residencies must address to implement service-education linkages. They provide an empirical basis to outline the steps involved in forming a linkage between a residency and a C/MHC.

Reference Type: Journal Article
Record Number: 54
Author: Gorin, Sherri Sheinfeld; and Thomas Weirich
Year: 1995
Title: Innovation Use: Performance Assessment in a Community Mental Health Center
Journal: Human Relations
Volume: 48, Issue: 12, Pages: 1427-1453
Keywords: innovation use; performance assessement; mental health innovation

Abstract: This paper discusses the influence of the political economy on the use of performance assessment systems (PAS) in the case of the Community Mental Health Center (CMHC). Performance assessment is defined, and scales for measuring use are discussed. A factor analysis of the influences revealed four separate factors; organizational polity, new money, governmental political-economy, social task, and cultural contexts. Multiple regression analyses of the impacts of these factors on the use of performance assesment showed the organizational polity and new money to be dominant. Implications of organizational determinism and a stage model of innovation use are discussed.

Reference Type: Journal Article
Record Number: 21
Author: Gupta, Gloria C., and Thomas R Konrad
Year: 1992
Title: Allied Health Education in Rural Health Professional Shortage Areas of the United States
Journal: JAMA
Volume: 268, Issue: 9, Pages: 1127-1130

Abstract: Several recent studies have highlighted gross deficiencies in the health status of those living in rural areas of the United States, as well as inequities in the distribution of health resources in such areas. An examination of the distribution and characterisitcs of 2888 allied and health education programs accredited by CAHEA and to determine the extent to which the distribution of rural programs and training sites intersects with geographic areas of need. This project was accomplished by consolidating data collected on CAHEA-accredited allied health education programs with county level sociodemographic and health resources data.

The most important finding, from a health policy perspective, is that counties with a Primary Care HPSA designation also lack allied health training resources. The lack of an association between rural training and Community and Migrant Helath Centers suggests that these centers should be considered as potential sites when rural training locations are established. The lack of allied health training resources in HPSA designated areas supports the premise that targeted expansion of allied health education resources in underserved areas might improve the health care infrastructure by enhancing access to care for the medically underserved. This would make rural HPSAs more attractive as practice locations for physicians and allied health personnel and provide health career opportunities for residents of rural areas.

Reference Type: Journal Article
Record Number: 93
Author: Hedberg, Viking A ; et al.
Year: 1996
Title: The Role of Community Health Centers in Providing Preventive Care to Adolescents
Journal: Archives of Pediatric and Adolescent Medicine Volume: 150, Pages: 603-608

Abstract: OBJECTIVES: To (1) compare preventive health visits by poor and nonpoor adolescents, (2) describe adolescent users of community health centers (CHCs), (3) investigate adolescent preventive visits to CHCs, and (4) determine factors independently associated with timely preventive visits. DESIGN: Analysis of the nationally representative sample of 6635 adolescents aged 11 to 17 years in the Child Health Supplement to the 1988 National Health Interview Survey. RESULTS: Overall, 4% of US adolescents used CHCs for routine health care, and the percentage was higher for poor compared with nonpoor adolescents (11% vs 3%, P < .01). Although CHC users were more likely to be poor (41% vs 10%, P < .001), uninsured (23% vs 10%, P < .001), and to have behavior (16% vs 9%, P = .02) and school problems (56% vs 43%, P < .001), they were as likely to have had timely preventive visits (83% vs 81%, P = .61) as adolescents who used private practices. Using logistic regression, timely adolescent preventive visits were independently associated with having a source for routine care (odds ratio, 4.1; 95% confidence interval, 3.3-5.2), a chronic health condition (odds ratio, 1.2; 95% confidence interval, 1.0-1.5), and the use of seat belts all or most of the time (odds ratio, 1.4; 95% confidence interval, 1.2-1.6), but no independent association was observed between poverty status and timely preventive visits. CONCLUSIONS: Community health centers are an important source of preventive care for impoverished adolescents. Although those who use CHCs have greater psychosocial problems, they seek preventive care as regularly as those using private practices. Thus, periodic comprehensive visits may be an effective strategy for CHCs to provide preventive services to adolescents.

Reference Type: Journal Article
Record Number: 5
Author: Hedgecock, Joan; Maria Castro; and William B. Cruikshank
Year: 1992
Title: Community Health Centers: A Resource for Service and Training
Journal: Henry Ford Hospital Medical Journal
Volume: 40, Pages: 45-49
Keywords: C/MHC's, medically underserved areas, training programs

Abstract: The American Medical Student Association (AMSA) Foundation is assisting the U.S. Public Health Service in increasing the number of primary care physicians trained and committed to practice in medically underserved areas. In collaboration with the American Academy of Family Physicians, the Ambulatory Pediatrics Association, and the Society of General Internal Medicine, AMSA conducted an assessment of federally-funded residency programs to identify and describe their affiliations with federally-funded community and migrant health centers (C/MHCs). Of the 260 programs assessed and the 147 responses, 125 offer community-based training. Of these, 73 offer training in primary care centers and 39 offer training in federally-funded C/MHCs. Residents training in the C/MHCs have positive experiences in both personal and professional development and are frequently hired by the health centers upon graduation. Benefits realized by the affiliations include a community orientation for the residents and enhancement of service and education missions for the collaborating institutions.

Reference Type: Journal Article
Record Number: 51
Author: Henderson, Zorika Petic
Year: 1992
Title: Migrant Program Breaks Down Social Barriers
Journal: Human Ecology Forum
Volume: 20, Issue: Fall, Pages: 28-31

Abstract: The Cornell Migrant Program, started in 1971, is based in teh Department of Human Development and Family Studies in the College of Human Ecology. From its inception, teh program has helped migrant farmworkers in rural New York state with issues related to health care, nutrition, housing education, and immigration. This article gives an overview of the services and programs developed by Cornell, including a child-health voucher system, farmworker health care project, a migrant nutrition program, and an information clearinghouse for issues related to migrant workers needs.

Reference Type: Journal Article
Record Number: 101
Author: Henderson, Tim; and Anne R Markus
Year: 1996
Title: Medicaid Managed Care: How Do Community Health Centers Fit?
Journal: Health Care Financing Review
Volume: 17, Issue: 4, Pages: 135-142

Abstract: Managed care has brought about important changes in how the health care system is financed and services delivered. The authors describe the approaches adopted by community health centers to participate in Medicaid managed care and argue that these providers, commonly referred to as providers of last resort, have a role to play in this system. Many challenges lie ahead for these centers, such as the potential imposition of Medicaid block grants, the increasing number of uninsured persons, and cuts in both Federal grants and State budgets. These various forces may adversely impact health centers, leaving them with more uninsured patients and fewer resources.

Reference Type: Journal Article
Record Number: 14
Author: Hill, Linda; Kevin Patrick; Patricia Avilia
Year: 1996
Title: Training Physicians to Care for the Underserved: Preventive Medicine Residency--Community Health Center Linkages
Journal: American Journal of Preventive Medicine
Volume: 12, Issue: 3, Pages: 156-160

Abstract: The population of uninsured and underinsured individuals in the United States continues to grow, compounding problems of adequate access to medical care. Some of the medical needs of this population are met by community health centers (CHCs). However, CHCs often have difficulty recruiting and retaining physicians, especially those with skills in community medicine. This article describes a general preventive medicine residency program that has been successful in preparing physicians for practice in these settings-what we call training in community-oriented preventive medicine (COPM). At the heart of COPM training are mutually beneficial relationships between CHCs and the residency program. This process has been greatly facilitated through the use of Health Resources and Services Administration (HRSA) federal training grant support to "match" funds provided by CHCs. As of July 1994, 11 residents have entered the COPM track, with eight graduates and three current residents. Thus far, all graduates have remained involved in community-based medical care and preventive medicine activities for medically underserved populations. This training arrangement can serve as a model for other preventive medicine residency programs and for CHCs interested in enhancing physician recruitment and retention. Medical Subject Headings (MeSH): community-oriented preventive medicine, medically uninsured, preventive medicine residency training, community health centers.

Reference Type: Journal Article
Record Number: 4
Author: Holden, David
Year: 1990
Title: Rural Practice Modes
Journal: Academic Medicine
Volume: 65, Issue: Supplement 3, Pages: S32-S40
Keywords: rural practice, health care trends

Abstract: Solo practice is the dominant mode of rural medical care delivery. At the same time, it is the most likely not to succeed, because the solo physician is choosing to leave the rural community. Group family practice is the most stable form of rural practice, is acceptable, and is sought by the majority of family practice residents seeking to establish new practices. Characteristics of successful rural practices include group practice, retention of the same health care providers for more than three years, a community-oriented focus, integration of non-M.D. health care providers, and a commitment to education within the practice. Academic medical centers with area health education centers (AHECs) should consider developing expanded AHECs to provide the education, planning, consultation, and expertise now needed by rural communities. Academic medical centers without AHECs should consider creating offices of rural health to provide the education, planning, consultation, and expertise needed in rural communities.

Reference Type: Journal Article
Record Number: 67
Author: Jezewski, Mary Ann
Year: 1990
Title: Culture Brokering in Migrant Farmworker Health Care
Journal: Western Journal of Nursing Research
Volume: 12, Issue: 4, Pages: 497-513

Abstract: When we perceive ourselves to be ill, many of us elect to enter the orthodox health care system. We have a sense of confidence that we will receive care in this system. When we enter the health care system our expectation is that our illness will be understood, that we will be accepted as a person in need of medical care, and that our illness will be resolved or managed by the health care provider. We possess the economic means to pay for health services, thus giving us the power to choose our providers. Once in the health care system, the system's own network of referrals will facilitate the acquisition of needed services. Migrant farmworkers very often do not possess these health seeking means to enter the orthodox health care system. This article describes a process, culture brokering, used by health care professionals to facilitate the acquisition of health care by migrant farmworkers.

Reference Type: Report
Record Number: 108
Author: Joint Task Force of National Rural Health Association and National Association of Community Health Centers, Inc.
Year: 1995
Title: Reports of the Joint Task Force: October 1991 to August 1995
Date: August 1995

Abstract: The Joint Task Force acts as a mechanism for improving communication fetween these two associations through formalizingan association-level liason to benefit rural community and migrant health centers (C/MHC's), and is empowered to think strategically and make recommendations to the two associations on combined actions necessary to promote the long term growth and sustenance of rural community and migrant health centers.

These reports consists of four sections: a recommended set of basic principles upon which the joint task force believes that NRHA and NACHC should base its future actions regarding health man power issues; Specific recommendations for joint actions by the two associations within teh categories of public relations and information, partnerships, research and legislative and regulatory advocacy; the condensed set of meeting minutes from the testimony received by the task force at its four sessions in October 1991, April 1992, November 1992, and July 1993; conclusions and recommended next steps for deliberations for the joint task force if the associations extend its tenure.

The three major areas of concern for the task force were: man power, financing, and service delivery systems.

Reference Type: Journal Article
Record Number: 10
Author: Jones, Timothy F.; Larry Culpepper; Chris Shea
Year: 1995
Title: Analysis of the Cost of Training Residents in a Community Health Center
Journal: Academic Medicine
Volume: 70, Issue: 6, Pages: 523-531
Keywords: CHC's, teaching programs, training costs

Abstract: BACKGROUND. Currently one federal program funds community health centers (CHCs) to provide services in underserved communities, and a second supports development of primary care teaching programs. Teaching CHCs respond to both program's goals, but their development is hindered by restrictive regulations of the two programs and lack of information regarding cost. METHOD. Spreadsheet software was used to develop a model that allocates cost components of a CHC-based residency. Productivity and staffing data from a teaching CHC program were used to estimate the cost of training and its sensitivity to selected variables. Data from 1992 through 1994 were collected from the family practice residency sponsored by the Brown University School of Medicine, the Memorial Hospital of Rhode Island, and the Blackstone Valley Community Health Center. RESULTS. An educational supplement of $13.21 per visit would be required for the program to be cost-neutral relative to staff. The cost of outpatient training for a resident averaged $13,935 per year. Residents would "break even" if they saw patients at 19% above the average rate recommended by the residency review committee. If staff physicians instead of residents had provided the patient care, the CHC would have saved $6,171 per resident. Additional savings from improved physician recruiting and decreased turnover would increase the value of the program to the CHC. Cost was most sensitive to resident productivity, precepting arrangements, nursing staff support, and staff turnover. CONCLUSION. Developing graduate medical education programs in CHCs can be a cost-effective way of increasing the pool of appropriately trained primary care physicians and increasing health care access for underserved populations. If teaching CHCs are to expand, provisions will need to be made for adequate reimbursement of their costs.

Reference Type: Journal Article
Record Number: 61
Author: Kerekes, Jon J.; Melinda Jenkins; and Donna Torrisi
Year: 1996
Title: Nurse-Managed Primary Care
Journal: Nursing Management
Volume: 27, Issue: 2, Pages: 44-47

Abstract: A nurse-managed primary care community health center, Abbottsford Community Health Center (ACHC), provides highly accessible, quality, cost-effective care to the residents of the Abbottsford Community. Data revealed that, in comparison to the aggregate family practices in an HMO, ACHC has achieved better outcomes in areas such as emergency department visits, inpatient days and client care costs. The nurse manager's roles and responsibility are critical in achieving this success.

Reference Type: Journal Article
Record Number: 66
Author: Kindig, David A.
Year: 1995
Title: Residency Training in Community Health Centers-An Unfulfilled Opportunity
Journal: Public Health Reports
Volume: 110, Issue: 3, Pages: 300-301

Abstract: Dr. Kindig endorses residency training in community health centers, and gives additonal information to support his rationale. His training was in an inner city community health center.

Notes: A response article to John Zweifler's article in the same issue of Public Health Reports.

Reference Type: Journal Article
Record Number: 43
Author: Koday, Mark, David Rosenstein, Gloriana Lopez
Year: 1990
Title: Dental Decay Rates Among Children of Migrant Workers in Yakima, WA
Journal: Public Health Reports
Volume: 105, Issue: 5, Pages: 530-533

Abstract: The literature documents a significant decline in the prevalence of dental caries among children. Unfortunately, dental decay rates of children of migrant workers remain high. This study collected data from 885 migrant children in central Washington. This community is in the west coast migrant stream. The area is served by a health center funded through the community and migrant health center program. There is an active dental program provided through the health center. The children were found to have a high rate of dental decay. However, there was a high rate of treatment of this decay and a rate of sealants (a preventive measure) nearly three times the rate in the general population. Although dental decay remains a serious problem in the migrant community, the migrant health centers appear to be making a positive impact on the dental health of the children.

Reference Type: Journal Article
Record Number: 28
Author: Kolimaga, Jane T.; Thomas Konrad; Thomas C. Ricketts
Year: 1994
Title: Does Subsidizing Rural Community Health Centers Hurt Private Practice Physicians?
Journal: Journal of Health Care for the Poor and Underserved
Volume: 5, Issue: 2, Pages: 124-141

Abstract: One reason for the shortage of primary care physicians in rural areas may be these physicians' reluctance to compete for patients with federally subsidized Community Health Centers (CHCs). Yet little is known about the relationship between private practice physicians and physicians in federally subsidized practices who share service areas. We used surveys from a two-state subset of a nationally representative sample to compare practice characteristics of three types of physicians: those who work in CHCs; those in private practice within CHC service areas; and private practice physicians in other rural areas. We found that rural physicians who compete with CHCs earn incomes comparable to physicians in rural areas who do not compete with CHCs, and that the percentage of Medicaid and uninsured patients seen in private physician practices does not increase when a CHC is not in the county. We conclude that CHCs do not provide competitive barriers to physicians in private practice, although we do not know if the presence of a CHC inhibits new private physicians from entering practices in these communities.

Reference Type: Journal Article
Record Number: 46
Author: Lamb, Gerri
Year: 1995
Title: Early Lessons From a Capitated Community-Based Nursing Model
Journal: Nursing Administration Quarterly
Volume: 19, Issue: 3, Pages: 18-26
Keywords: capitation, community health care, managed care

Abstract: The community nursing organization (CNO) demonstration is a three-year Medicare program to develop, manage, and evaluate a new capitated, nurse-managed system of community and ambulatory care. Since February 1994, four national sites have started CNOs. The CNO at Carondelet Health Care in Tucson, Arizona, shares early experiences in designing and implementing an exciting new community practice model.

Reference Type: Journal Article
Record Number: 23
Author: Lambrew, Jeanne M.; Thomas C. Ricketts; and Joseph P. Morrissey
Year: 1993
Title: Case Study of the Integration of a Local Health Department and a Community Health Center
Journal: Public Health Reports
Volume: 108, Issue: 1, Pages: 19-29

Abstract: As rural communities struggle to sustain health services locally, innovative alternatives to traditional programs are being developed. A significant adaptation is the rural health network or alliance that links local health departments and community health centers. The authors describe how a rural local health department and community health center, the core organizations in publicly sponsored primary care, came to share a building and administrative and service activities. Both the details of this alliance and its development are examined. The case history reveals that circumstance and State involvement were the catalysts for service integration, more so than the need for or the benefits of the arrangement. The closure of a county-owned hospital created a situation in which State officials were able to broker a cooperative agreement between the two agencies. This case study suggests two hypotheses: that need for integrated services alone may not be sufficient to catalyze the development of primary care alliances and that strong policy support may override any local and internal resistance to integration.

Reference Type: Journal Article
Record Number: 12
Author: Larson, Oscar W. III; John Doris; and William Alvarez
Year: 1990
Title: Migrants and Maltreatment: Comparative Evidence from Central Register Data
Journal: Child Abuse & Neglect
Volume: 14, Pages: 375-385

Abstract: This paper reports the results of a series of studies on the abuse and neglect of migrant farmworker children. These investigations were conducted between 1983 and 1985 in the states of New York, New Jersey, Pennsylvania, Florida, and Texas. Names of approximately 24,000 migrant children obtained from annual migrant education censuses were individually cross-referenced with the appropriate state data bases to determine if they had been involved in a confirmed incident of maltreatment. The information acquired was converted to incidence estimates that were contrasted with the rates for all children in the respective states and were decomposed to identify high-risk cohorts within the migrant population. One finding common to all five assessments was that migrant children were significantly more likely to be maltreated than other children, although these incidence rates varied appreciably from one state to another. The emphasis of this paper is on the unique methodology employed in the research, issues pertaining to provisions for accessing central registers and protecting confidentiality of subjects, the generalizability of the findings, and cross-state incidence differentials for both migrants and children from nonmigrant families.

Reference Type: Journal Article
Record Number: 41
Author: Lee, C. Virginia, Suzanne McDermott, and Carl Elliott
Year: 1990
Title: The Delayed Immunization of Children of Migrant Farm Workers in South Carolina
Journal: Public Health Reports
Volume: 105, Issue: 3, Pages: 317-320

Abstract: A study was conducted to evaluate the immunization status of migrant farm worker children in South Carolina. Results of this study indicate that the children receive their immunizations at times which are significantly later than the recommended schedule. The first, second, third, and fourth oral poliomyelitis vaccine doses are being given at approximately 10, 15, 23, and 32 months late, respectively. Diptheria, pertussis, tetanus vaccine is likewise late with the first, second, third and fourth doses occurring 9, 14, 20, and 26 months late. The fifth booster shot in both series was timed properly. The mumps, measles, rubella vaccine is approximately 28 momths late, on average. An evaluation of antibody status of 41 migrant farm worker children (5-10 years old) revealed that, even with aberrant patterns of administration, all children had adequate antibody titers. These data indicate that, although, adequate levels of protection are reached with the pattern of immunization that migrant farm worker children have, there are large groups of children that are unprotected early in life when they are most suseptible to these diseases.

Reference Type: Report
Record Number: 103
Author: Lewin-VHI, Inc. and MDS Associates
Year: 1994
Title: Community Health Centers' Performance Under Managed Care
Institution: Bureau of Primary Care
Date: December, 1994
Type of Work: Executive Summary of Report

Abstract: This study examines the managed care experiences and performance of seven community health centers (CHC's). The policies and practices of the CHC's included in this study--and the lessons they have learned-- can provide valuable insights for other CHC's and the HMO's with which they partner. Policy makers contemplating the role of CHC's in managed care will also benefit from these findings.

This study explores the effects of managed care on CHC's, shedding light on such issues as: how managed care affects health centers' capacity planning and their ability to recruit and retain health professionals; the different operational impacts of mandatory versus voluntary Medicaid enrollment; the role of clinicians in managerial decision-making under managed care; the impact of managed care on clinical practice within the health center; and how managed care alters access to specialty care. The study also compares the performance of CHC's to other primary care providers participating in the same managed care delivery networks.

Reference Type: Journal Article
Record Number: 52
Author: Littlefield, Carla; and Charles Stout
Year: 1987
Title: A Survey of Colorado's Migrant Farmworkers: Access to Health Care
Journal: International Migration Review
Volume: 21, Issue: Fall, Pages: 688-708

Abstract: This report utilizes data collected in a sample survey of Colorado's migrant farmworker population to determine their health care needs, health services utilization, and overall access to care. Health needs include selected indices of medical, dental, nutrition and reproductive health. The conclusions and recommendations of the report address pertinent issues in the funding and delivery of health care services to the migrant farmworker population.

Reference Type: Journal Article
Record Number: 74
Author: Margolis, Carmi Z.; et al.
Year: 1984
Title: Increase in Relevant Data After Introduction of a Problem-Oriented Record System in Primary Pediatric Care
Journal: American Journal of Public Health
Volume: 74, Issue: 12, Pages: 1410-1412

Abstract: We determined the effect of the problem list and standard data base components of the problem-oriented record (POR) on kibbutz clinic care. We compared quantity and type of data collected and number of problems identified before and after POR implementation at an experimental clinic with the same variables measured at a similar clinic. Family history, prenatal, natal, nutritional, immunization, environment, review of systems, psychosocial and total data collected, as well as number of chronic problems identified, increased significantly after POR implementation.

Notes: Although the setting for this article is Israel, the application of the information may be useful for US community health centers

Reference Type: Journal Article
Record Number: 73
Author: Margolis, Carmi Z.; et al.
Year: 1992
Title: Computerized Algorithms and Pediatricians' Management of Common Problems in a Community Clinic
Journal: Academic Medicine
Volume: 67, Issue: 4, Pages: 282-284

Abstract: In 1987, a microcomputer clinical algorithm (CA) system for constructing and using CAs for patient care was designed and implemented for six common primary care pediatrics problems. Six community clinic pediatricians agreed to use the system for several months. Length of patient's visit, completeness of data collection, antibiotic use, and appropriateness of clinical plan were measured before the computers were introduced (without CAs) and after the computers were introduced (both with and without CAs). All performance measures improved after the introduction of CAs. However, CA implementation had to be discontinued after five weeks because the CAs were too tedious for the physicians to follow during routine care. The authors conclude that CAs cannot be successfully sustained with physicians for common problems, even though their design and use can significantly improve the process of care.

Notes: This article was chosen for its possible comparitive value for community centers in the US

Reference Type: Journal Article
Record Number: 90
Author: Martaus, Therese M.
Year: 1986
Title: The Health-seeking Process of Mexican-American Migrant Farmworkers
Journal: Home Healthcare Nurse
Volume: 4, Issue: 5, Pages: 32-38

Abstract: In order to render effective health care to any minority group, the community health nurse needs to understand the beliefs and value systems of that group, especially as they relate to illness and treatment modalities.

Reference Type: Journal Article
Record Number: 18
Author: McDermott, Suzanne; C. Virginia Lee
Year: 1990
Title: Injury Among Male Migrant Farm Workers in South Carolina
Journal: Journal of Community Health
Volume: 15, Issue: 5, Pages: 297-305

Abstract: A record review and interview survey were carried out to determine the impact of injury on the health of male migrant workers in the Ridge area of South Carolina. Thirteen percent of the men's visits to the Rural Migrant Clinic were for injuries. A larger number, sixty percent, of men's visits to the local Emergency Room were due to injuries. Documentation of alcohol and drug use or the circumstances of the injury was more complete on the Emergency Room records than on the Clinic records. Interviews with 116 migrant workers were carried out in the camps during the summers of 1986 and 1987. Male migrant workers had similar rates of work related accidents as other hired farm workers in the United States. However, male migrant workers have more episodes of personal violence than black males living in other types of rural settings. Heavy drinking was associated with these violent episodes. Over 83 percent of the episodes of personal violence occurred in the camps after dark. It is suggested that camp conditions with poor sanitation, crowding, lack of recreational outlets, and high presence of available alcohol contributes to the high rates of injury in this group of men.

Reference Type: Journal Article
Record Number: 71
Author: Milburn, Lonna T; Rose Hall; and Marsha Brandon
Year: 1992
Title: Networking to Extend the Health Industry Into Underserved Communities
Journal: Family Community Health Volume: 15, Issue: 3, Pages: 49-61

Abstract: Intense competition within the health care industry can minimize effective communication between health care providers and consumers. Yet, when diverse health care providers and consumers come together for a common purpose, the enhanced communication results in more awareness of a need and a cooperative effort to extend services into the area of need.

The results of such an effort were envisioned as the Texas Cancer Council sought to implement its Texas Cancer Plan to Year 2000. To address the need for reducing cancer in at-risk populations, the Texas Cancer Council funded the Texas Cancer Network at the Lyndon B. Johnson School of Public Affairs, The University of Texas at Austin, to determine if the burden of cancer could be reduced by interconnecting the many cancer related resources available in a network.

Previous studies have measured the effects of networks largely through qualitative data rather than from quantitative data obtained through controlled studies. Overall, these studies indicate that networks facilitate health care delivery. This study goes beyond these network projects because it quantitatively measures the network's effects on consumers. During a 15-month period the Texas Cancer Network Project was designed (3months), implemented (9 months), and evaluated (3 months) in a six-county area of central Texas to determine the impact of a community based cancer network on consumers. This report presents consumers' reactions to network activities.

Reference Type: Journal Article
Record Number: 29
Author: Mobed, Ketty; Ellen B. Gold; Marc B. Schenker
Year: 1992
Title: Cross-cultural Medicine- A decade Later: Occupational Health Problems Among Migrant and Seasonal Farm Workers
Journal: Western Journal of Medicine
Volume: 157, Pages: 367-373

Abstract: Migrant and seasonal farm workers are one of the most underserved and understudied populations in the United States. The total US population of such farm workers has been estimated at 5 million, of whom about 20% live or work in California. Farm workers perform strenuous tasks and are exposed to a wide variety of occupational risks and hazards. Low socioeconomic status and poor access to health care also contribute to existing health problems in this population. Potential farm work-related health problems include accidents, pesticide-related illnesses, musculoskeletal and soft-tissue disorders, dermatitis, noninfectious respiratory conditions, reproductive health problems, health problems of children of farm workers, climate-caused illnesses, communicable diseases, bladder and kidney disorders, and eye and ear problems. Few epidemiologic studies exist of these occupational health problems. No comprehensive epidemiologic studies have assessed the magnitude of occupational health problems among migrant and seasonal farm workers and their dependents. Although the migratory nature of this population makes long-term studies difficult, the development of standardized data collection instruments for health consequences and scientific assessment of farm work exposures and working conditions are vital to characterize and reduce the occupational health risks in farm workers.

Reference Type: Journal Article
Record Number: 100
Author: Moidu, K.; O. Wigetz; and E. Trell
Year: 1991
Title: A Multicenter Study of Data Collection and Communication at Primary Health Care Centers
Journal: Journal of Medical Systems
Volume: 15, Issue: 3, Pages: 205-220

Abstract: Health care delivery is information intensive. As computer applications make information available to the decision maker with speed and accuracy, informatics applications will strengthen the infrastructure. This paper is the second part of a multicenter systems analysis study to design a common application software to support primary health care focused on information flow. We present the questionnaire analysis and observations from a field study of a district health site. Analyses using contingency tables revealed differences, some statistically significant. The field study confirmed that minor differences exist even within a district health site. Development of a common application software on the basis of information flow studies is feasible. However, to make optimum use of computer implementation, revision of the health information systems was recommended. It was suggested that application software be developed with the core data set required by the care providers to deliver and administrators to manage a vertical health program.

Reference Type: Conference Proceedings
Record Number: 56
Author: Moran, William P.; et al.
Year: 1994
Title: Implementing Computerized Tracking System at a Community Health Center: Challenges and Solutions
Conference Name: Eighteenth Annual Symposium on Computer Applications in Medical Care
Volume: 18, Pages: 139-143
Series Title: Proceedings From the Annual Symposiums on Computer Applications in Medical Care

Abstract: A computerized tracking system for both preventive care and chronic disease tracking was implemented at a community health center, using a PC based local area network interfaced with a mainframe scheduling and billing system. Initial database construction used downloads of historical billing data, but ongoing database maintenance is accomplished by using an optical mark-sense scanner to construct both billing and clinical tracking files from custom-designed encounter forms. In this way, expanded clinical data is collected with an actual reduction in manually keyed data, reducing the ongoing cost of the system.

Reference Type: Report
Record Number: 109
Author: Nadel, Mark V; et al.
Year: 1995
Title: Community Health Centers: Challenges in Transitioning to Prepaid Managed Care
Institution: National and Public Health Issues
Date: May 4, 1995
Type of Work: GAO Report fo the Chair of the Committee on Labor and Human Resources
Report Number: GAO/HEHS-95-138

Abstract: In 1989, the Congress mandated that state Medicaid programs reimburse health centers for the cost of services that the centers provide to their beneficiaries. The more recent change from cost-based reimbursement to a monthly per capita amount for health centers particpating in prepaid managed care has raised concerns about teh ability of thses centers to continue to provide their communities with both medical and enabling services.

This report focuses on the following: Have centers in prepaid managed care been able to continue providing the medical and enabling services needed in their communities without threatening their financial position? What lessons can be learned from health center experiences in prepaid managed care? How does the Bureau of Primary Health Care help centers prepare for operating under prepaid managed care systems?

The report discusses the findings from detailed reviews of 10 centers in four states- Arizona, Florida, Massachusetts, and Pennsylvania- that have had Medicaid prepaid managed care programs since the mid-1980's. At each health center, data was collected program and financial for fiscal years 1989 through 1993. Interviews include: health center and state Medicaid prgram officials and BPHC officials with responsibility for providing guidance and overseeing the Community and Migrant Health Center Program. In addition, we visited state Medicaid offices and health centers in Tennessee and Washington to learn about recent changes in ther Medicaid programs and the responses of health centers to these changes.

Reference Type: Journal Article
Record Number: 98
Author: O'Connor, Patrick J; et al.
Year: 1990
Title: Hypertension Control in a Rural Community: An Assessment of Community-Oriented Primary Care
Journal: Journal of Family Practice
Volume: 30, Pages: 420-424

Abstract: To determine the effectiveness of a community-oriented primary care approach for the detection, treatment, and control of hypertension, data were analyzed from a survey of all 3094 adults living in a geographically well-defined rural community. Among the 2939 (96.1%) persons who completed the survey, 587 (20%) were found to meet study criteria for the diagnosis of hypertension. Hypertensive adults who identified a neighborhood health center with a community-oriented primary care philosophy as their source of care were more likely to have their disease detected, treated, and controlled than were hypertensive adults who identified other sources of care. The improved control was most evident for men and for blacks, but in every race-sex stratum, hypertensive patients of the neighborhood health center were more likely to be under control. Even when controlling in logistic models for age, race, and sex, identification of the neighborhood health center was associated with better control of hypertension (beta = 0.591, P = .004). In this rural community, community-oriented primary care delivered through a neighborhood health center appears to be associated with increased likelihood of detection, treatment, and control of hypertension.

Reference Type: Journal Article
Record Number: 17
Author: O'Malley, Ann S.; Christopher B. Forrest
Year: 1996
Title: Continuity of Care and Delivery of Ambulatory Services to Children in Community Health Clinics
Journal: Journal of Community Health
Volume: 21, Issue: 3, Pages: 159-173

Abstract: This study assesses how continuity of care influences receipt of preventive care and overall levels of ambulatory care among children and adolescents in community health clinics (CHCs). It is a secondary data analysis of the 1988 Child Health Supplement to the National Health Interview Survey. Of 17,110 children in the sample population, the 1465 who identified CHCs as their routine source of care formed the study population. Continuity of site was defined as identification of a CHC as a source of both routine and sick care, and continuity with a clinician was defined as identification of a specific clinician for sick visits. In bivariate analyses both continuity with the CHC and with a specific clinician were associated with increased levels of preventive care and overall ambulatory care. In logistic regression models, continuity of care was associated with nearly a two-fold increase in the odds of receiving age-appropriate preventive care. Alternatively, insurance status was a better predictor of receipt of overall levels of ambulatory care. We conclude that expanding financial access alone is unlikely to sufficiently improve low-income children's access to Community Health Clinics. Additional emphasis on localizing the delivery of both routine and sick care services in a single site or with a specific clinician may be needed to achieve higher levels of both preventive care and overall ambulatory care.

Reference Type: Journal Article
Record Number: 99
Author: Okada, Louise M; and Thomas T H Wan
Year: 1980
Title: Impact of Community Health Centers and Medicaid on the Use of Health Services
Journal: Public Helath Reports
Volume: 95, Issue: 6, Pages: 520-534

Abstract: The impact of improved access to health care through the Federal community health center (CHC) and Medicaid programs was examined in five urban low-income areas. Data on access to care and physician, hospital, and dental services utilization were collected by baseline and followup health surveys in the CHCs' services areas. There was a shift in use from hospital clinics to CHCs. Followup surveys indicated that 23 percent of the population reported CHCs as usual source of care. Travel time to source of care was reduced for users of CHCs. Medicaid coverage of the population in the survey areas increased from 16 to 37 percent between the baseline and followup surveys, an interval of 4 to 7 years. Increases occurred in the use of physicians and dental care between the baseline and followup surveys, but the rates scarcely kept pace with the national rates. Respondents who reported CHCs as their usual source of care, however, had a higher rate of physician visits and a lower rate of hospitalization compared with those using private physicians or hospital clinics as the usual source of care. Respondents with Medicaid coverage usually had higher physician and hospital use, irrespective of usual source of care. Both CHC and Medicaid programs contributed to increased use of dental care by providing financial and dental care resources. Although these two programs greatly facilitated the use of health services, disparity in physician and dental utilization remains between the five low-income areas and the averages for the nation.

Reference Type: Journal Article
Record Number: 30
Author: Palerm, Juan V.
Year: 1992
Title: Cross-cultural Medicine- A Decade Later: A Season in the Life of a Migrant Farm Worker in California
Journal: Western Journal of Medicine
Volume: 157, Pages: 362-366

Abstract: There is an erroneous but widespread belief that in the past few decades California agriculture has become increasingly mechanized and reduced its need for migrant labor. Steeply increasing demand, however, for specialty fruit and vegetable crops, which are labor-intensive, has actually increased the need for migrant workers, who come mainly from Mexico. A case study of a young migrant describes the dismal work, economic, and living conditions such workers typically endure and the possible health consequences of those conditions.

Reference Type: Journal Article
Record Number: 20
Author: Pathman, Donald E.; Thomas R Konrad; Thomas C Ricketts III
Year: 1992
Title: The Comparative Retention of National Health Service Corps and Other Rural Physicians
Journal: JAMA
Volume: 268, Issue: 12, Pages: 1552-1558

Abstract: OBJECTIVE--To contrast the retention of physicians serving National Health Service Corps (NHSC) Scholarship Program obligations in rural settings to that of non-NHSC physicians working in the same or similar practices, and to identify promising retention-enhancing strategies. DESIGN--Cohort study. PARTICIPANTS--Four hundred twelve primary care physicians initially identified during an earlier study as working in a national stratified random sample of 178 externally subsidized rural clinics in 1981. Thirty-six percent were serving obligations to the NHSC, nearly all through the NHSC's Scholarship Program. The NHSC and non-NHSC inception cohorts (those first coming to their 1981 [or "index"] practices from May 1979 through December 1981) were created from within the entire group for use in most analyses. INTERVENTION--In 1990, physicians were resurveyed to learn of their backgrounds, experiences in their index practices, and their subsequent career moves. RESULTS--By 1984 and in each year thereafter, fewer NHSC than non-NHSC physicians of the entire respondent cohort remained (1) in their index practices, (2) in their index communities, and (3) in practice in any rural county (P less than .001). In the inception cohort, fewer NHSC than non-NHSC physicians were retained within all three settings by the third year after their initial dates of employment (P less than or equal to .01). After 8 years of employment, group retention rates for NHSC and non-NHSC inception cohort physicians were 12% vs 39% in the index practice and 29% vs 52% in nonmetropolitan practice. Physicians in both NHSC and non-NHSC groups who left their index practices generally left rural practice altogether. CONCLUSIONS--When compared to non-NHSC physicians working in comparable rural settings, the retention of rural NHSC physicians is seen to be poor and only partially explained by fixed physician, practice, or community variables. Long-term retention of NHSC providers is now receiving much needed attention at the federal level.

Reference Type: Journal Article
Record Number: 45
Author: Pathman, Donald, and Thomas Konrad
Year: 1996
Title: Minority Physicians Serving in Rural Natioanl Health Service Corps Sites
Journal: Medical Care
Volume: 34, Issue: 5, Pages: 439-4554
Keywords: minority groups, blacks, hispanics, Native Americans, National Health Service Corps, rural primary care physicians

Abstract: Providing National Health Service Corps (NHSC) scholarships to under-represented minorities has been an important federal mechanism to bolster the numbers of minority physicians. Little is known about how minorities fare during their NHSC commitment periods. In 1991, questionnaires were mailed to all primary care physicians placed in rural communities from 1987 through 1990 in the NHSC scholarship program, in a retrospective cohort study. One hundred and twenty-two of the 398 eligible NHSC physician respondents (31%) indicated they were minorities. National Health Service Corps physicians were found to be well matched by race to the sites where they served, and minority NHSC physicians worked in counties and practices with greater proportions of minority inhabitants and patients. Minorities among rural NHSC physicians were less likely to have been raised in rural areas and were less interested in rural practice during medical school and when placed in their rural NHSC sites. The relative urban preferences of minority physicians in large part explains why this group was more dissatisfied with their work and personal lives while serving their obligations. Minority physicians also reported lower satisfaction for their families. Minority and nonminority NHSC physicians reported comparable acceptance by their communities, and demonstrated similarly low retention rates. The NHSC plays a significant role in the careers of many young minority physicians and in promoting the temporary availability of minority physicians for rural health professional shortage areas. However, as of 1991, many minority NHSC physicians placed in rural areas would have preferred urban sites, which resulted in their lower satisfaction.

Reference Type: Journal Article
Record Number: 64
Author: Penney, Naomi E.; Barbara Gibbons; and Angeline Bushey
Year: 1996
Title: Partners in Distance Learning: Project Outreach
Journal: Journal of Nursing Administration
Volume: 26, Issue: 7/8, Pages: 27-36

Abstract: Distance learning refers to any educational experience in which the instructor (teacher) is separated from the student (learner) by geographic distance. Partnerships are being established between institutions of higher education and healthcare organizations to achieve a mutual goal, that of educating employees to work in a rapidly changing workplace environment. The authors describe one such partnership and the common issues confronted by both the academic and service institutions in implementing an outreach education program. The authors propose that these partnerships can be effective in implementing distance learning programs that meet the ongoing educational needs of nurses living and working in rural and underserved environments.

Reference Type: Journal Article
Record Number: 77
Author: Poss, Jane E.
Year: 1994
Title: Meeting the Health Care Needs of Migrant Farmworkers: The Experience of the Niagara County Migrant Clinic
Journal: Journal of Community Health Nursing
Volume: 11, Issue: 4, Pages:219-228

Abstract: The Niagara County Migrant and Rural Ministry Clinic (Migrant Clinic) in northwestern New York State is an example of how the health care needs of migrant farmworkers can be met with limited assistance and funding from federal, state, or local agencies. This article relates the history of the Migrant Clinic and describes how various sources of funding and personnel are utilized to operate the clinic. In addition, several case examples from the clinic are presented to illustrate how nurses and outreach workers face in obtaining health care services. By relating the experiences of this clinic, we hope to provide others who offer health care to migrant farmworkers with ideas about establishing and managing a clinic to serve this population.

Reference Type: Journal Article
Record Number: 8
Author: Potts, Michael
Year: 1994
Title: Rural Community Health Agencies as Primary Care Clerkship Sites for Medical Students
Journal: Family Medicine
Volume: 26, Issue: 10, Pages: 632-37
Keywords: rural health care, community health care agencies, primary care training

Abstract: BACKGROUND AND OBJECTIVES: This study describes a student-centered third-year clerkship involving student choice and on-site investigation of rural community health care agencies. The objective of the clerkship was student understanding of how to explore and use community agencies to enhance the care of patients. METHODS: The course was evaluated through pre- and postcourse surveys of attitudes about primary care, care of the socially disadvantaged, knowledge of social agencies, and specialty orientation. Also analyzed were student clerkship evaluation forms, student performance evaluations, and review by external consultants. RESULTS: Students reported statistically significant increases in knowledge about social agencies (P = .0001). Attitudes of social responsibility for health care and greater concern about patients' social well-being were reported but were not statistically significant. While students agreed with the philosophy of the experience, they felt the course would have been more valuable later in their training. Student performance exceeded faculty expectations in all cases. External evaluators felt the community agency contacts were crucial experiences for future caregivers. CONCLUSIONS: A student-centered clerkship using community-based agencies can provide a valid educational experience, even in remote rural areas. Students develop facility in contacting and using community resources. Participation can give new perspectives on patient care not achievable in other sites. The long-term benefits of this early community exposure remain to be investigated.

Reference Type: Journal Article
Record Number: 37
Author: Roemer, Milton
Year: 1988
Title: Resistance to Innovation: The Case of the Community Health Center
Journal: American Journal of Public Health
Volume: 78, Issue: 9, Pages: 1234-1239

Abstract: The Community Health Center has historically encountered much resistance throughout history from the medical status quo. Those against institutional change and/or health care for the poor have objected to its philosophy and application since its inception in the 1600's. Now, the community health center model is a conventional facility which allows the provision of health care that is sensitive to the needs of people throughout the developed and undeveloped world.

Reference Type: Journal Article
Record Number: 9
Author: Rust, G.S.
Year: 1990
Title: Health Status of Migrant Farmworkers: A Literature Review and Commentary
Journal: American Journal of Public Health
Volume: 80, Issue: 10, Pages: 1213-1217
Keywords: migrant farmworkers, literature review, research trends

Abstract: I made a computerized search of MEDLINE files from 1966 through October 1989 followed by a review of this literature. Four hundred eighty-five articles were scanned; 152 were found specifically related to migrant families, while another 51 articles addressed the health of agricultural workers or farmers in general. Solid data exist on dental health, nutrition and, to a lesser extent, childhood health. Data also were prominent in several disease categories including certain infectious diseases, pesticide exposures, occupational dermatoses, and lead levels in children. Estimates of the size of the migrant and seasonal farmworker population vary widely. Basic health status indicators such as age-related death rates are unknown. Prevalence rates of the most common cause of death in the United States have yet to be studied. More research is needed into the health problems and health status of migrant and seasonal farmworker families.

Reference Type: Journal Article
Record Number: 87
Author: Sakala, C.
Year: 1987
Title: Migrant and Seasonal Farmworkers in the United States: A Review of Health Standards, Status, and Policy
Journal: International Migration Review
Volume: 21, Issue: 3, Pages: 659-687
Keywords: Although the occupation and associated living conditions of migrant and seasonal farmworkers in the US pose exceptional health hazards to the workers and their dependents, relatively few occupational health professionals have been involved with this group. This article examines the basis for this neglect and proposes a definition of the population that should be considered in farmworker health policy. It then reviews existing evidence regarding hazards of four major occupational exposures- pesticides, the sun, injuries, and poor field sanitation- and policies that have been developed to address these hazards. The extremely negative health consequences of farmworker living conditions, which are indirect occupational hazards, are also summarized. Numerous policy, planning, and research recommendations are made. Adequate solutions for this impoverished and powerless group, however, will require significant sociopolitical advances, such as are developing with unionization and other forms of political organization.

Reference Type: Journal Article
Record Number: 15
Author: Schauffler, Helen H.; Jessica Wolin
Year: 1996
Title: Community Health Clinics Under Managed Competition: Navigating Unchartered Waters
Journal: Journal of Health Politics, Policy and Law
Volume: 21, Issue: 3, Pages: 462-488

Abstract: In this article, we consider how major changes in the health care system, both real and proposed, may affect the future of community health clinics (CHCs) in the United States and their ability to continue to provide comprehensive care to underserved populations. We discuss the constraints and opportunities that CHCs face in a health care system that is rapidly moving away from fee-for-service medical care toward a model of managed competition. We describe the role that the National Association of Community Health Centers has played in advocating for CHCs in Congress and the role state primary care associations are playing in spear-heading the development of statewide CHC-sponsored health maintenance organizations. We also analyze CHC reactions to the changes in federal policies that were proposed in the major health care reform bills of the 103d Congress, as well as the prospects for CHCs under Medicaid managed care as it sweeps rapidly across the nation. As a case study, we examine California's policies that mandate that Medicaid recipients enroll in either a private managed care plan or a newly created public plan, which compete against each other within each county. CHCs are vulnerable during the transition to managed care and managed competition, and they have neither the resources nor the ability to integrate or compete successfully with private health maintenance organizations without safeguards, new sources of funding, technical assistance, improved infrastructure, and vigorous monitoring and oversight from federal and state governments, as well as the continued education, training, and policy advocacy provided by the National Association of Community Health Centers and state primary care associations.

Reference Type: Journal Article
Record Number: 96
Author: Schenker, Marc B; Stephen A McCurdy
Year: 1990
Title: Occupational Health Among Migrant and Seasonal Farmworkers: The Specific Case of Dermatitis
Journal: American Journal of Industrial Medicine
Volume: 18, Pages: 345-351
Keywords: farmers, agriculture, farmworkers, migrant workers, dermatitis, bias in census data

Abstract: Occupational health studies of agricultural workers have generally excluded migrant and seasonal farmworkers, and this population experiences a high degree of health risk from agricultural exposures. A survey of dermatologic disorders among migrant and seasonal farmworkers will be used to illustrate this point. Data from a recent field study are presented to illustrate epidemiologic approaches to studying dermatologic disorders in farmworkers and risk factors for dermatitis. This study suggests there is generally a high health risk to agricultural workers and this study also suggests methods to investigate other acute and chronic diseases among agricultural workers.

Reference Type: Journal Article
Record Number: 38
Author: Sherraden, Margaret, and Steven Wallace
Year: 1992
Title: Innovation in Primary Care: Community Health Services in Mexico and the United States
Journal: Social Science Medicine
Volume: 35, Issue: 12, Pages: 1433-1443
Keywords: primary care, Mexico, underserved, community health centers, health policy, rural health

Abstract: Providing adequate health care to a nation's citizens is a challenge in every country. Despite large differences in wealth, health care organizations, and health politics, both Mexico and the United States undertook similar efforts to expand primary care to previously underserved populations during the past 30 years. This study analyzes common antecedents, contexts of change, elements of the innovations, problems with entrenched interests, and resources that have allowed both programs to survive in difficult environments. We show that new forms of primary health care can face similar problems and prospects in very different countries because of similar political, bureaucratic, and economic limitations.

Reference Type: Journal Article
Record Number: 63
Author: Shi, Leiyu; et al.
Year: 1993
Title: The Determinants of Utilization of Nonphysician Providers in Rural Community and Migrant Health Centers
Journal: Journal of Rural Health
Volume: 9, Issue: 1, Pages: 27-39

Abstract: The use of nonphysician providers, such as nurse practitioners, physician assistants, and certified nurse midwives, in rural areas is critically important due to the continued primary care access problems. This study examines the major factors influencing the use of nonphysician providers in rural community and migrant health centers based on a 1991 national survey of the centers. This study demonstrates that the employment of nonphysician providers in rural community and migrant health centers is significantly influenced by both supply and demand factors. Among supply factors, there is a significant and positive relationship between the number of physicians and the number of nonphysician providers employed, indicating nonphysician providers primarily serve as substitutes for physicians in rural community and migrant health centers. The supply of nonphysician providers, as measured by the number of affliated training programs, is significantly related to the employment of nonphysician providers. The demand variable, geographic location, and the centers' staffing policies are also significant determinants of the use of nonphysician providers.

Reference Type: Journal Article
Record Number: 44
Author: Shi, Leiyu; Michael Samuels; Thomas Ricketts;and Thomas Konrad
Year: 1994
Title: A Rural-urban Comparitive Study of Nonphysician Providers in Community and Migrant Health Centers
Journal: Public Health Reports
Volume: 109, Issue: 6, Pages: 809-815

Abstract: This is a study of the employment of nonphysician providers--nurse practitioners, physician assistants, and certified nurse midwives--in both rural and urban Community and Migrant Health Centers and of factors associated with their employment, based on a 1991 national survey of 383 Centers. Results of the survey suggest that nonphysician providers, in particular nurse practitioners and certified nurse midwives, primarily serve as physician substitutes, and are more likely to be employed by Centers that are larger and have affiliations with nonphysician provider training programs. Rural or urban location is not significantly related to the employment of nonphysician providers after controlling for center size. The fact that rural centers employ fewer nonphysician providers than urban centers can primarily be accounted for by their relatively small size, rather than a lack of interest. These findings demonstrate that the use of nonphysician providers is an important way both to achieve cost containment and improve access to primary care for those residing in medically underserved areas.

Reference Type: Journal Article
Record Number: 47
Author: Siantz, Mary Lou de Leon
Year: 1994
Title: The Mexican-American Family: Mental Health Issues
Journal: Mental Health Nursing
Volume: 29, Issue: 1, Pages: 65-72

Abstract: This article introduced the Hispanic population of the United States. Three major subgroups were identified: Mexican-American, Cuban, and Puerto Rican. While the relative size and geographic location of each group was identified, the Mexican-American population was considered in greater detail and included the sociopolitical history and culture. The Mexican-American or Chicano migrant farmworker family was next introduced. Their lifestyle, problems, strengths, and needs were discussed. The importance of social support among the mothers was emphasized. Cultural characteristics that influence family life were considered, including religion, familism, male dominance, machismo, the role of the female and children. Culturally sensitive assessment should include evaluation of health, education, income, degree of acculturation, level of participation in traditional culture, length of time in the United States, ethnic identity access to social support, and risk for depression. The need for cultural sensitivity during this process was emphasized, especially the establishment of linguistic abilities and preferences. Finally, successful intervention strategies were introduced. These included nonjudgmental communication and the ability to convey confidence, respect, and genuine affection for the family.

Reference Type: Journal Article
Record Number: 2
Author: Slesinger, D.P., Ofstead, C.
Year: 1996
Title: Using a Voucher System to Extend Health Services to Migrant Farmworkers
Journal: Public Health Reports
Volume: 111, Issue: 1, Pages: 57-62
Keywords: migrant health center, rural health care, voucher system

Abstract: FAMILY HEALTH/LA CLINICA de los Campesinos, Inc., is a federally funded migrant health clinic in the heart of Wisconsin's farmland that has offered outpatient health care since 1973 and an accompanying "voucher" program since 1988. The charges for outpatient care are based on the ability to pay. The clinic issues vouchers not only to migrant workers living and working in remote parts of the State but also to patients needing services the clinic does not offer. Between 1 April 1992 and 30 March 1993, 677 participants submitted 1,794 vouchers that provided for $83,833 in partial health care payments. La Clinica paid a median amount of $22 for each voucher, its reimbursement value ranging from $1 to $979. Hospitals received the highest median payment and pharmacies the lowest. Voucher payments generally covered 60% of the bill, but dentists commanded a higher percentage(70%) and clinics and medical groups a lower one (42%). Most vouchers paid for procedures and services La Clinica could not provide. This program shows how a health care provider in one location, with a patient population scattered throughout a sizeable geographic area, can coordinate services not offered at its facility. With the national spotlight on health care reform, the concept of vouchers for people in outlying or underserved regions deserves further investigation.

Reference Type: Journal Article
Record Number: 40
Author: Sleslinger, Doris; Bruce Christenson; and Elanor Cautley
Year: 1986
Title: Health and Mortality of Migrant Farm Children
Journal: Social Science Medicine
Volume: 23, Issue: 1, Pages: 65-74
Keywords: migrants and health, childhood mortality

Abstract: This research examines preventive medical care, morbidity and mortality among children of migrant agricultural workers using a representative sample of migrant families in Wisconsin. Our findings support the view that this group is at substantially greater risk of health problem and early mortality than the general population. Fewer than half of migrant children under age 16 had received an annual dental checkup compared to 50% of children in the total population. A rough comparison between levels of chronic health conditions for migrant children and those reported for children in a national survey suggest that the incidence of chronic conditions is several times greater among migrant children. Childhood mortality appears to be 1.6 times higher than in the U.S. population.

In analyzing variation in preventive care for migrant children, younger children are more likely to receive checkups, while older children are more likely to receive immunizations. In interpreting this finding, we suggest distinguishing between two types of preventive care: one under direct control of the family, and the other controlled by the schools. Since immunizations are given to migrant children in schools, the older or school-age children are more likely to be immunized.

The analysis of childhood mortality shows the level of mortality to be proportionally lower among women who spoke English, and higher among those who gave birth to low birth weight child. But surprisingly, the most important characteristic related to loss of children ws whether or not a mother smoked. Using smoking as one example of high risk behavior, we suggest that future studies should give closer attention to the impact of parental risk-taking behaviors on childhood morbidity and mortality experiences.

Reference Type: Journal Article
Record Number: 48
Author: St. Martin, Evelyn
Year: 1996
Title: Community Health Centers and Quality of Care: A Goal to Provide Effective Health Care to the Community
Journal: Journal of Community Health Nursing
Volume: 13, Issue: 2, Pages: 83-92

Abstract: The uniqueness of community health centers provides for a sound environment for total quality management (TQM). Structure, process, and outcome are valued equally under TQM. With strong management leadership and a framework for quality of care, community health care specialists (e.g., advanced practice nurses) can easily incorporate the TQM measurement criteria in their daily practice routines. By applying the principles of TQM, the community health center will advance toward its goal of enhancing the effectiveness of health care delivery to a community and its members in partnership with the community.

Reference Type: Journal Article
Record Number: 19
Author: Starfield, Barbara; et al.
Year: 1994
Title: Costs vs Quality in Different Types of Primary Care Settings
Journal: JAMA
Volume: 272, Issue: 24, Pages: 1903-1908

Abstract: OBJECTIVE--To determine the relationship between efficiency in use of resources and quality of care provided by physicians serving as the usual source of care for patients in a state Medicaid program. DESIGN--Retrospective quality-of-care review of 2024 outpatient medical records of 135 providers sampled from system-wide Medicaid claims data in Maryland. SUBJECTS--Providers in three types of practice settings (hospital outpatient clinic, community health center, and physician's office) were stratified into three case mix-adjusted resource use groups (high, medium, and low). A sample of patients with the diagnoses of diabetes, hypertension, asthma, well-child care, or otitis media were identified from Medicaid claims forms from visits during 1988. Case mix was controlled by the application of the ambulatory care groups, a method that characterizes populations according to their burden of morbidity. MAIN OUTCOME MEASURES--Nurses from the local peer review organization audited medical records using explicit criteria for quality of care in several categories: evidence of impaired access, evidence of compromised technical quality, evidence of inappropriate care, outcome of care, and several generic indicators of quality. Well-adult care was assessed for patients with the adult diagnoses. RESULTS--Although there were some systematic differences by type of facility in some aspects of quality of care (more access problems for patients in hospital clinics and more technical quality problems for patients in office-based practice), there were no consistent differences in quality of care overall for patients in different types of settings and no consistent relationships between cost-efficiency and quality of care. However, patients in medium-cost community health centers had the best or second best scores for most of the 21 comparisons of type of quality assessed. CONCLUSIONS--Quality of care provided for common conditions in primary care is not associated with costs generated by providers. Policies directed toward the choice of low-cost vs high-cost providers will not necessarily lead to a deterioration in the quality of care. States can both improve quality and lower costs by consistent monitoring of programs over time. The finding of generally higher quality of care for patients in medium-cost community health centers deserves further study.

Reference Type: Journal Article
Record Number: 92
Author: Stein, Lea M La Plante
Year: 1993
Title: Health Care Delivery to Farmworkers in the Southwest: An Innovative Nursing Clinic
Journal: Journal of the American Academy of Nurse Practitioners
Volume: 5, Issue: 3, Pages: 119-124

Abstract: The migrant and seasonal farmworkers of the United States constitute a medically underserved population with many health care needs. Barriers to health care among farmworker families include financial constraints, cultural factors, restrictive labor practices, and absence of accessible clinics in rural areas. The Migrant Health Outreach Program is a federally funded mobile nursing clinic created to deliver health care to farmworkers where they live and work. The Migrant Health Outreach Team, composed of family nurse practitioners, registered nurses, and health care workers, offers primary care including health care maintenance and treatment of acute and chronic illness. The mobile nursing clinic serves the target population of farmworkers as a successful alternative to a traditional medical clinic.

Reference Type: Journal Article
Record Number: 24
Author: Stoskopf, Carleen H.; Michael E Samuels; and James R Ciesla
Year: 1993
Title: Findings from a Demonstration Outreach Project at a Community Health Center
Journal: Journal of Health Care for the Poor and Underserved Volume: 4, Issue: 1, Pages: 51-64

Abstract: Outreach using personal contact was a cornerstone of the federally funded Community Health Center (CHC) movement of the 1960s. Funding cuts and changes in federal policy have led to the discontinuation of this activity in most CHCs. This paper assesses aspects of a demonstration outreach project designed to encourage use of a CHC in Orangeburg, South Carolina. The evaluation shows that this type of outreach effort, which includes door-to-door canvassing, can identify specific needs for primary health care services in a poor underserved community, and can enhance community access to Medicaid, although the financial impact of bringing poor patients into CHCs by means of this type of outreach is relatively low.

Reference Type: Journal Article
Record Number: 25
Author: Strobino, Donna M.; Louise L Wulff; and Donald A Cornely
Year: 1992
Title: Follow-up of the Use of Local Health Department Clinics for Preventive Care Among Young Children
Journal: American Journal of Preventive Medicine
Volume: 8, Issue: 3, Pages: 178-181

Abstract: We followed 18,490 infants from their first visit to a county child health clinic (CHC) in Maryland through visits through their third year of age to investigate whether their continued use of the CHCs was related to their characteristics or to the services they were provided as an infant. We classified as provided services immunization, an Early and Periodic Screening, Diagnosis, and Treatment Program (EPSDT) recommended screening, and number of visits. Immunization was associated with an increased percentage of infants who returned to the CHCs at two and three years of age. Half of the children, on the other hand, never returned to the clinics if they were not immunized as infants. These findings persisted, regardless of race, Medicaid status, completion of a screening, or number of visits in the first year of life. One-fifth of infants did not receive an immunization during one or more visits to CHCs in their first year. Failure to administer an immunization to infants appears to impede subsequent use of public health clinics for well child care.

Reference Type: Journal Article
Record Number: 86
Author: Stuart, Mary E., and Donald Steinwachs
Year: 1993
Title: Patient Mix Differences Among Providers and Their Effects on Utilization and Payments for Maryland Medicaid Users
Journal: Medical Care
Volume: 31, Issue: 12, Pages: 1119-1137

Abstract: Characteristics of the usual source of care (e.g. specialty, organizational type) are known to be related to utilization and cost levels. This study assesses the degree to which variations in utilization and cost are attributable to differences in patient mix (i.e. demographic and diagnostic characteristics). Comparisons are made with Medicaid payments with and without patient-mix adjustment among users of hospital outpatient departments, emergency rooms, Federally Qualified Health Centers and office-based physicians. The study builds upon previous work by including a well-developed set of ambulatory case-mix controls, a variety of provider types, a large number of providers, and a relatively comprehensive resource utilization component. Findings confirm significant differences in patient demographic and diagnostic characteristics among users of different types of providers. Controlling for these patient-mix characteristics explains 44% of the variation in ambulatory use, 21% in hospital admissions, and 13% in total Medicaid payments. The considerable remaining variation suggests differences in provider efficiency. For example, even after patient mix adjustment, 18% of those who rely on outpatient departments are hospitalized annually compared to 10% for users of office-based physicians. Overall findings indicate that patient-mix characteristics, as well as differences in provider efficiency, should be considered when developing and evaluating managed care and preferred provider initiatives for ambulatory care.

Reference Type: Journal Article
Record Number: 85
Author: Stuart, Mary E., et al
Year: 1995
Title: Improving Medicaid Pediatric Care
Journal: Journal of Public Health Mangement
Volume: 1, Issue: 2, Pages: 31-38
Keywords: claims data, provider variation, well-child visits

Abstract: This article uses Medicaid claims data to examine the adequacy of well-child being care provided by different ambulatory care providers for selected children enrolled in Maryland Medicaid. Considerable provider variation was observed. The majority of the nearly one-quarter of the children with no well-child visits during the year appeared to have had no regular primary care source. Results contributed to the development of a managed care program designed to increase care accessability and continuity and improve provider practices. Advantages and disadvantages of using claims data to investigate this public health issue are discussed.

Reference Type: Journal Article
Record Number: 106
Author: Sweeney, Mary Anne; and Claire Gulino
Year: 1988
Title: Interactive Video in Health Care: Blending Patient Care, Computer Technology , and Research Results
Journal: Journal of Biocommunication
Volume: 15, Issue: 4, Pages: 6-11

Abstract: This article illustrates one method of combining research results and computer technology to produce a "high-tech" patient-education program that has demonstrated its applicability in clinical practice. A videodisc entitled The Story of Maria was produced as part of a large primary care research project along the southwestern U.S.-Mexico border. A needs assessment of approximately 200 Hispanic mothers preceded the scripting of the videodisc. The paper presents an overview of the production process, as well as a description of some special technological features, including the bilingual soundtrack, touchscreen control, and careful design of instructions to eliminate the need for literacy. Pilot testing of the interactive video program in two community health centers in the U.S.-Mexico border area indicates that the program is not only fulfilling its purpose, but also being enthusiastically received by the patients.

Reference Type: Journal Article
Record Number: 82
Author: Thompson, Theodis
Year: 1981
Title: Community Health Centers: A Vanguard in the Community Control of Cancer
Journal: Family and Community Health
Volume: 4, Issue: 4, Pages: 67-73

Abstract: Community Health Centers are the vanguard of health services for the poor, and are often the only means of meeting the medical needs of this segment of the population. If there is to be a sincere effort to achieve a shared community responsibility in the implementation of a national cancer screening program, community health centers must play an active role. This article briefly describes the history of the development of CHC's, the achievements, and the problems incurred during the past 30 years. Although there are no regular screening program for the detection of cancer at most CHC's, they are in an excellent position to participate in cancer screening programs, especially for high risk populations.

Reference Type: Journal Article
Record Number: 72
Author: Thompson, Mark S.; et al.
Year: 1984
Title: Resource Requirements for Evaluating Ambulatory Health Care
Journal: American Journal of Public Health
Volume: 74, Issue: 11, Pages: 1244-1248

Abstract: We implemented the most frequently used form of quality assurance activity: abstracting information on the quality of patient care from medical records and communicating findings to providers in 16 ambulatory care groups. Site providers accepted the evaluation criteria, agreed that deficiencies in care were detected, and, for some medical tasks, effected improvements in care. Direct costs in 1980 dollars for the quality assurance cycle including data system development were $46 per evaluated case. Per-case costs varied considerably among tasks, decreased with larger numbers of cases and as experience grew, and were reduced through computerization. Measured costs were high due to: a demanding research design; our extended accounting of direct, indirect, and induced costs; and the substantial resource requirements of rigorously performed evaluations.

Reference Type: Report
Record Number: 104
Author: Travers, Karen; and Robert Ellis
Year: 1992
Title: Comparison of the Rural Health Clinic and Federally Qualified Health Center Programs
Institution: National Association of Community Health Centers for the Office of Rural Health Policy
Date: December 1992

Abstract: A comparitive description of the Rural Health Clinic Program (RHC) and the Federally Qualified Health Center Program (FQHC). These programs present a very real opportunity for enhancing access to health care in underserved areas. Recent federal legislation has dramatically expanded these programs. The following information will provide a basic description of the programs, including some complexities and unique aspects of each. Practices in underserved areas need to understand these programs, and the opportunities they provide, to be able to determine which program best meets their needs.

Reference Type: Journal Article
Record Number: 81
Author: Trute, Barry; and Robb Tonn
Year: 1982
Title: Privacy and Computerized Health Information in Communtiy Health Centers and District Health Agencies
Journal: Medical Care
Volume: 20, Issue: 2, Pages: 202-215

Abstract: Computers play an important role in health care delivery. Electronic data systems have been extensively applied in health settings to facilitate treatment procedures, to serve as program management aids, and to serve cost-control and billing functions. Underlying this expanding application of computer technology is the issue of privacy as it applies to the collection, storage and retrieval of personal health information. To appreciate the complexity of this issue, one must attend to the use of health data for patient-specific treatment tasks as differentiated from their use in aggregated management, statistical and research tasks. The key factor in this regard is the identification of information that can be linked to a specific person. This article focuses on the basic privacy issues that emerge from the use of computers and how they relate to policy in regard to the use of health information. Differential approaches in the collection and storage of health details must be resolved, including which information should be considered confidential, who should have access to data banks and what intersystem linkages should be permitted. Salient concerns in regard to patient rights emerge, such as the need for informed consent and the access of individuals to their personal medical files. Essentially, the overriding question is who controls what aspects of health information, to what extent and under what circumstances. Consideration is given to the Candian model in which small district health centers share computer hardware, while maintainig independent control over their individual management information files. The key to the protection of patient information in this shared system is the absence within the computer banks of any personal information that would allow individual patient identification.

Reference Type: Conference Proceedings
Record Number: 57
Author: Urkin, Jacob; et al.
Year: 1992
Title: A Computerized Medical Record With Direct Data Entry for Community Clinics in Israel
Conference Name: Sixteenth Annual Symposium on Computer Applications in Medical Care
Volume: 16, Pages: 838-842
Series Title: Proceedings From the Annual Symposiums on Computer Applications in Medical Care

Abstract: CLINIC is a computerized medical record system currently being used in two primary care clinics in Israel. CLINIC features direct coded data-entry by the medical personnel via a system based on categories of problems and complaints with common signs and symptoms.

Notes: The information in this article may be of comparitive use for U.S. community health centers.

Reference Type: Conference Proceedings
Record Number: 59
Author: Wald, Jonathan S.; et al.
Year: 1995
Title: Patient Entries in the Electronic Medical Record: An Interactive Interview Used in Primary Care
Conference Name: Nineteenth Annual Symposium on Computer Applications in Medical Care
Volume: 19, Pages: 147-151
Series Title: Proceedings From the Annual Symposium on Computer Applications in Medical Care

Abstract: We describe the development, implementation, and use of a computer-administered patient interview, the Health History Interview, by over 300 new patients in a primary care practice at Boston's Beth Israel Hospital. The interview has been well accepted by patients and rated positively by providers. It electronically captures clinical information directly from patients for use during their initial encounter with a provider. It facilitates aggregate analysis of clinical data for quality improvement efforts, such as aiming preventive medicine interventions at identified problem areas within the clinic. Expectations management has been an important task throughout the project. Increasing use of the interview beyond the 30-40% of new patients who have taken it will require greater communication with patients, greater convenience to patients and providers, and more evidence of the clinical, administrative, and research benefits of the technique. Most important, full implementation will require fundamental changes in physician practice habits and patterns of communication between patients and the health care system, as well as clearly demonstrated cost-benefit improvements through the use of these tools.

Reference Type: Journal Article
Record Number: 13
Author: Waldman, H. Barry
Year: 1994
Title: Invisible Children: The Children of Migrant Farm Workers
Journal: Journal of Dentistry for Children
Volume: 218, Pages: 218-221

Abstract: This article describes the socioeconomic status and living conditions of seasonal and migrant farmworkers and how this effects their childrens health; more specifically dental health. The dental health of migrant and seasonal farmworker children has always been lacking or non-existent in comparison with the general population. Data is provided for rates of caries and decay for the migrant children. The author makes an appeal to the dental community for more concern and involvement in providing care to this underserved population.

Reference Type: Journal Article
Record Number: 42
Author: Watkins, Elizabeth; Kim Larson; Christina Harlan; and Suzanna Young
Year: 1990
Title: A Model Program for Providing Health Services for Migrant Farmworker Mothers and Children
Journal: Public Health Reports
Volume: 105, Issue: 6, Pages: 567-575

Abstract: A bilingual, multidisciplinary team of health professionals collaborated with a migrant health center in North Carolina to develop a model program to deliver primary health care services to migrant farmworker women and children. The program included case finding and outreach, coordination of maternal and child health services locally as well as interstate, and innovative health education programming. Data were collected on the health status of 359 pregnant migrant farmworker women and 560 children, ages birth to 5 years, the majority of Mexican descent, who received primary care services at the center. The mean age of the women was 23.1 years and their mean gravidity was 2.9. Dietary assessments showed that the protein intakes of most met or exceeded the U.S. Recommended Dietary Allowances, but their consumption of foods in the milk-dairy group and the fruit-vegetable group was below recommended standards. Low hematocrit was a common problem among the women (43 percent) and, to a lesser extent, among the children (26 percent). Among the infants and children, 18 percent were obese. Black American women had the highest proportion of low birth weight infants. The project emphasized coordinated services for migrant farmworker mothers and children, such as transportation services, language translation, followup, and advocacy. An outreach strategy involved case finding, home visits, and services by lay health advisors. By the third year of the project, there were increases in the average number of prenatal visits, the proportion of women entering prenatal care in their first trimester, and in the use of well-child services.

Reference Type: Journal Article
Record Number: 6
Author: Weinreb, L.inda; and Mary Walsh
Year: 1990
Title: Health and Psychosocial Needs of Homeless Families: A Pilot Education and Research Program
Journal: Family Medicine
Volume: 22, Issue: 1, Pages: 58-59
Keywords: homeless families, primary care training, community medicine

Abstract: Family homelessness is increasing and poses unique clinical challenges to physicians who provide health services to this population. Curricula designed to prepare health professionals to effectively care for homeless families is lacking. This report describes a pilot education and research program for family practice residents based at the University of Massachusetts' community health center training site. In addition to providing critical health services to Worcester area homeless families, the program prepares residents to provide continuous, comprehensive, and context-sensitive care to families. The program also familiarizes residents with methods to conduct clinical research with an underserved population.

Reference Type: Journal Article
Record Number: 75
Author: Weinstein, Philip; et al
Year: 1992
Title: Mexian-American Parents With Children At Risk for Baby Bottle Tooth Decay: Pilot Study at a Migrant Farmworkers Clinic
Journal: Journal of Dentistry for Children
Volume: 59, Issue: 5, Pages: 376-383

Abstract: Treatment of severe BBTD in very young children often requires the use of general anesthetic. In 1987, the cost was estimated at $700-$1,000; add another $1,000, if hospitalization is needed. Informal surveys of dentists across the country indicate that in 1991-1992, the cost of treatment has increased substantially.

Reference Type: Journal Article
Record Number: 95
Author: Wilk, Valerie A
Year: 1993
Title: Health Hazards to Children in Agriculture
Journal: American Journal of Industrial Medicine
Volume: 24, Pages: 283-290
Keywords: child labor, agriculture, migrant farmworkers, farm machinery, pesticides, labor law reform , OSHA, EPA

Abstract: Children comprise a significant portion of the agricultural workforce and are exposed to many workplace hazards, including farm machinery, pesticides, poor field sanitation, unsafe transportation, and fatigue from doing physically demanding work for long periods. Migrant farmworker children face the additional hazard of substandard or nonexistent housing in the fields. Children account for a disproportionate share of agricultural workplace fatalities and disabling injuries, with more than 300 deaths and 27,000 injuries per year. The most common cause of fatal and nonfatal injury among children in agriculture is farm machinery, with tractors accounting for the greatest number. Remedies to the problems of child labor must take into account family economics and the need for child care. Labor law reform and rigorous enforcement of existing laws and of workplace health and safety requirements are vital to better protect the children and adults working in agriculture.

Reference Type: Journal Article
Record Number: 69
Author: Wright, Richard A.
Year: 1993
Title: Community Oriented Primary Care: The Cornerstone of Health Care Reform
Journal: JAMA
Volume: 269, Issue: 19, Pages: 2544-2547

Abstract: The current high-cost health care delivery system, which places greater emphasis on acute hospital care than on community-based primary and preventive care, is no longer viewed by policymakers, politicians, and the American public as the ideal model for organizing and providing health care services. Americans want change; however, politicians are responding with a barrage of disjointed finance and cost-containment proposals that fail to address the organization and provision of health care services. Nevertheless, to adequately address problems of cost, access, and quality, reform proposals will need to consider delivery models that create a balance between medical care and health care, between public health and personal health services, and between curative and preventive care. The community-oriented primary care model and the discipline of community and socially responsive medicine is a process for making a health care system more rational, accountable, appropriate, and socially relevant to the public. Consequently, this model, which is now at a pivotal point in its evolution, may serve as a paradigm for reforming the organization and provision of health care services in America.

Reference Type: Journal Article
Record Number: 32
Author: Yeatts, Dale E.; et al.
Year: 1991
Title: Financing Geriatric Programs in Community Health Centers
Journal: Public Health Reports
Volume: 106, Issue: 4, Pages: 375-383

Abstract: There are approximately 600 Community and Migrant Health Centers (C/MHCs) providing preventive and primary health care services principally to medically underserved rural and urban areas across the United States. The need to develop geriatric programs within C/MHCs is clear. Less clear is how and under what circumstances a comprehensive geriatric program can be adequately financed. The Health Resources and Services Administration of the Public Health Service contracted with La Jolla Management Corporation and Duke University Center on Aging to identify successful techniques for obtaining funding by examining 10 "good practice" C/MHC geriatric programs. The results from this study indicated that effective techniques included using a variety of funding sources, maintaining accurate cost-per-user information, developing a marketing strategy and user incentives, collaborating with the area agency on aging and other community organizations, and developing special services for the elderly. Developing cost-per-user information allowed for identifying appropriate "drawing card" services, negotiating sound reimbursement rates and contracts with other providers, and assessing the financial impact of changing service mixes. A marketing strategy was used to enhance the ability of the centers to provide a comprehensive package of services. Collaboration with the area agency on aging and other community organizations and volunteers in the aging network was found to help establish referral networks and subsequently increase the number of elderly patients served. Finally, development of special services for the elderly, such as adult day care, case management, and health education, was found to increase program visibility, opportunities to work with the network of services for the aging, and clinical utilization.

Reference Type: Journal Article
Record Number: 36
Author: Young, Suzanna; and Mildred Kaufman
Year: 1988
Title: Promoting Breastfeeding at a Migrant Health Center
Journal: American Journal of Public Health
Volume: 78, Issue: 5, Pages: 523-525

Abstract: A program to promote breastfeeding was introduced at a migrant health center in North Carolina. Strategies for promoting breastfeeding as a feeding method particularly suited to the migrant lifestyle were identified and implemented. Donated layettes were used to encourage attendance of prenatal patients at a class on breastfeeding. Women planning to breastfeed were given cards to alert the delivering hospital of their intention. These hospitals were provided with bilingual flipcharts to use in communicating with non-English speaking patients. Of the 158 women who came to the center for one or more prenatal visits, 101 attended a class or received individual counseling on breastfeeding; during this 13 month period , 52 percent of 64 women were breastfeeding at time of their hospital discharge (Mexican-Amrican 60%, Black Americans 44%). In a comparison of similar ethnic distribution, the corresponding rate was 10%.

Reference Type: Journal Article
Record Number: 84
Author: Zuvekas, Ann
Year: 1990
Title: Community and Migrant Health Centers: An Overview
Journal: Journal of Ambulatory Care Management
Volume: 13, Issue: 4, Pages: 1-12

Abstract: As of 1990 approximately 540 organizations operate 1,800 health centers on a $1 billion budget. these centers provide primary care for 5.8 million people, or about one fourth of the nation's medically indigent. They employ 2,600 physicians and an additional 1,200 nurse practioners, physician's assistants, and nurse midwives. In this issue we will be exploring the various aspects of C/MHC's: what they are, where they came from, their relationships with other parts of the system [especially hospitals and health maintneance organizations (HMO's)], their financing, and their use of health status data to measure the need for primary care and plan for its delivery. As C/MHC's have grown in number and geographic spread, and as concern about the uninsured has increased, C/MHC's are being carefully examined by policymakers looking for cost-effective solutions to the problems of medical indigency. The quarter century mark demands a reexamination of their usefulness in the 1990's. Are they an anachronistic social experiment, or do they fit a much changed health care and financing world? This article and those that follow will seek to answer these questions.

Reference Type: Journal Article
Record Number: 11
Author: Zweifler, John
Year: 1993
Title: Balancing Service and Education: Linking Community Health Centers and Family Practice Residency Programs
Journal: Family Medicine
Volume: 25, Issue: 5, Pages: 306-311
Keywords: C/MHC's. family practice residency programs, ambulatory care training

Abstract: Many medical educators are calling for an increased emphasis on ambulatory care training, but financial constraints are often cited as impediments to developing ambulatory care training sites. A growing number of family practice residency programs (FPRPs) are affiliating with community and migrant health centers (C/MHCs). This movement has the potential to strengthen community-based ambulatory care training, while addressing some of the financial concerns noted above. This article illustrates how FPRPs can establish mutually beneficial linkages with C/MHCs, while operating within the policy parameters established by the Residency Review Committee (RRC) and the Bureau of Health Care Delivery and Assistance (BHCDA). For this to occur, BHCDA and C/MHCs need to calculate the time required for attending physicians to supervise family practice residents and to contribute to the legitimate educational and teaching needs of the FPRP. Conversely, FPRPs must work closely with C/MHCs to ensure that family practice residents maintain acceptable levels of productivity. The RRC can make it more feasible to have pathways at smaller C/MHCs by allowing those attending physicians supervising family practice residents to see a reduced patient load, determined by the number of residents working at the C/MHC.

Reference Type: Journal Article
Record Number: 65
Author: Zweifler, John
Year: 1995
Title: Family Practice Residencies in Community Health Centers- an Approach to Cost and Access Concerns
Journal: Public Health Reports
Volume: 110, Issue: 3, Pages: 312-318

Abstract: An inadequate number of trained primary care clinicians limits access to care at Community Health Centers. If family practice residents working in these centers can provide care to patients at a cost that is comparable to the center's hiring its own physicians, then expansion of Family Practice Residency Programs into community centers can address both cost and access concerns. A cost-benefit analysis of the Family Practice Residency Program at the Fresno, CA, community center was performed; the community center is affiliated with the University of California at San Francisco. Costs included (a) residents' salaries, (b) supervision of the family practice residents, (c) family practice program costs for educational activities apart from supervision at the community center, and (d) administrative costs attributable to family practice residents in the community center. Benefits were based on the number of patients that residents saw in the community center. Using this approach, a cost of $7,700 per resident per year was calculated. This cost is modest compared with the cost of training residents in inpatient settings. The added costs attributable to training residents in community health centers can be shared with agencies that are concerned with medical education, providing physicians to underserved communities, and increasing the supply of primary care physicians. Redirecting graduate medical education funding from hospitals to selected ambulatory care training centers of excellence would facilitate placing residents in community centers. This change would have the dual advantage of addressing the current imbalance between training in ambulatory care and hospital sites and increasing the capacity of community health centers to meet the health care needs of underserved populations.