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Background The Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE) is a nationally recognized standardized protocol that goes beyond medical acuity to account for patients' social determinants of health (SDH). Aims We described the magnitude of patient SDH barriers at health centers. Methods Health centers across three PRAPARE implementation cohorts collected and submitted PRAPARE data using a standardized data reporting template. We analyzed the scope and intensity of SDH barriers across the cohorts. Results Nationally, patients faced an average of 7.2 out of 22 social risks. The most common SDH risks among all three cohorts were limited English proficiency, less than high school education, lack of insurance, experiencing high to medium-high stress, and unemployment. Conclusions Findings demonstrated a high prevalence of SDH risks among health center patients that can be critical for informing social interventions and upstream transformation to improve health equity for underserved populations.

Background Hepatitis B virus (HBV) infection is a major health disparity between Asian Americans, Native Hawaiians, and Pacific Islanders compared with other racial/ethnic groups in the U.S. Aims Our aims were to determine the effectiveness of an electronic health record (EHR) data-driven clinical intervention to improve HBV screening and vaccination rates at a community health center primarily serving Asian American patients. Methods Using a community-engaged approach, we conducted a study to compare the differences in screening and vaccination rates for 6,429 patient encounters before and after implementation of the EHR intervention. A multivariable logistic regression analysis was conducted to estimate the effect of the intervention. Results Analyses indicated that patients who visited the clinic after implementing the EHR intervention were more likely to be screened (OR=1.8, pl.001) and vaccinated (OR=2.8, pl.001) for hepatitis B. Conclusions Electronic health record interventions implemented using a community-engaged approach may improve delivery of appropriate care to patients at risk for hepatitis B in a community health setting.

Objective: Recent research demonstrates an increased need to understand the contribution of social determinants of health (SDHs) in shaping an individual9s health status and outcomes. We studied patients with diabetes in safety-net centers and evaluated associations of their disease complexity, demographic characteristics, comorbidities, insurance status, and primary language with their HbA1c level over time. Methods: Adult patients with diabetes with at least 3 distinct primary care visits between January 1, 2006, and December 31, 2013, were identified in the CHARN data warehouse. These patients were categorized into 4 groups: those without a diagnosis of cardiovascular disease (CVD) or depression; those with CVD but not depression; those with depression but not CVD; and those with CVD and depression. Charlson score; demographic characteristics such as age, sex, and race/ethnicity; and SDHs such as primary language and insurance status were used as predictors. The outcome measure was HbA1c. Hypothesis testing was conducted using 3-level hierarchical linear models. Results: Baseline HbA1c differed significantly across the 4 diabetes groups and by race/ethnicity. The amount of HbA1c change over time differed by insurance status. Patients who were continuously insured tended to have lower baseline HbA1c and a smaller increase. Chinese-speaking patients tended to have lower baseline HbA1c but a larger increase over time compared with English speakers. There were various unexpected associations: compared with the diabetes-only group, mean HbA1c tended to be lower among the other more complex groups at baseline; women tended to have lower measures at baseline; older age and higher Charlson scores were associated with lower HbA1c. Conclusions: There is still unexplained variability relating to both baseline HbA1c values and change over time in the model. SDHs, such as insurance status and primary language, are associated with HbA1c, and results suggest that these relationships vary with disease status among patients with diabetes in safety-net centers. It is important to recognize that there are complex relationships among demographic and SDH measures in complex patients, and there is work to be done in correctly modeling and understanding these relationships. We also recommend prioritizing the collection of SDH and enabling services data for safety-net patients that would be instrumental in conducting a more comprehensive study.

Research conducted to benefit communities is often done without community involvement, threatening its relevance for the groups the studies purport to serve. A great need exists for education of both researchers and community members on how research can be more appropriately conducted in partnership with community members. This paper presents Community Criteria for Research Participation developed by community health centers (CHCs) with input from academic partners to support CHCs' capacity to conduct research of community significance.

In 2010, the Health Resources and Services Administration (HRSA) established the Community Health Applied Research Net- work (CHARN) to build research infrastructure and capacity at community health centers (CHCs) and to promote comparative effectiveness research in these safety-net settings. A data warehouse with standardized data was created to capture, manage, and share patient-level data with all eighteen participating CHCs, including four CHCs primarily serving Asian American, Native Hawaiian, and Other Pacific Islanders (AANHOPI). AANHOPI patients face unique health risks, yet these large and diverse populations are historically understudied. The CHARN data warehouse provides important opportunities for understanding the health needs of this heterogeneous population.

Pay for performance (P4P) and health information technology (HIT) have been used to improve health care quality, but few studies examine interventions combining P4P with HIT support at federally qualified health centers (FQHCs). An intervention comparison, pre-post study was conducted to determine the effect of a P4P+HIT intervention on emergency department (ED) visits and hospitalizations. While ED utilization decreased in both intervention and comparison groups, there were no significant differences in ED or hospital utilization between intervention and comparison groups. Additional time or support above and beyond P4P+HIT may be necessary to improve the health care provided by FQHCs to underserved communities in Hawai‘i.

Background: Understanding and enhancing change capabilities, including Practice Adaptive Reserve (PAR), of Community Health Centers (CHCs) may mitigate cancer-related health disparities. Materials and Methods: Using stratified random sampling, we recruited 232 staff from seven CHCs serving Asian Pacific Islander communities to complete a self-administered survey. We performed multilevel regression analyses to examine PAR composite scores by CHC, position type, and number of years worked at their clinic. Results: The mean PAR score was 0.7 (s.d. 0.14). Higher scores were associated with a greater perceived likelihood that clinic staff would participate in an evidence-based intervention (EBI). Constructs such as communication, clinic flow, sensemaking, change valence, and resource availability were positively associated with EBI implementation or trended toward significance. Conclusions: PAR scores are positively associated with perceived likelihood of clinic staff participation in cancer screening EBI. Future research is needed to determine PAR levels most conducive to implementing change and to developing interventions that enhance Adaptive Reserve.

Background. Type 2 diabetes is a growing concern among medically underserved Chinese Americans. However, very few interventions have been developed or adapted for Chinese Americans with diabetes. Objective. To use a participatory research approach to evaluate the effectiveness of a culturally tailored, linguistically appropriate model for diabetes care employing health coaches to improve A1C levels among Chinese-American patients in a federally qualified health center setting. Methods. We compared change in A1C between intervention participants (n = 46), who received a health coaching intervention, and control participants (n = 46), who received usual care over a period of ~ 6 months. Results. Intervention participants showed a decrease in mean A1C at follow-up (−0.40%) compared to control subjects (+0.04%), although this difference was not statistically significant. At the 6-month follow-up, a significantly higher percentage of intervention participants (45.7%) had well-controlled A1C levels compared to control subjects (23.9%) (P = 0.048). Conclusions. It is feasible to implement a culturally tailored, linguistically appropriate teamlet model of care for Chinese Americans with type 2 diabetes. Such a model may be helpful in reducing A1C levels. Given trends in A1C improvement during a 6-month pilot, future randomized trials with a larger sample capable of providing adequate statistical power to detect improvements are warranted.

Introduction. A needs assessment was conducted of hepatitis B education, screening, vaccination, and care within community health centers (CHCs) serving Asian Americans, Native Hawaiians, and Pacific Islanders. Methods . Written surveys were administered to health education directors from 13 CHCs and 75 medical providers from 14 CHCs in the U.S. and affiliated Pacific Islands. Results . Although hepatitis B is within the mission of CHCs and clients are screened regardless of insurance status, little financial or staffing resources are dedicated to hepatitis B services. Lack of funding is considered the greatest barrier. Better coordination between HBV prevention and primary and specialty medical services is needed. Discussion . HBV cross-training for providers and allied staff, particularly around identification and screening of high risk groups and case management, would greatly enhance services along with additional funding. Findings support national hepatitis B strategy recommendations made by the Institute of Medicine and Office of Minority Health.

Functionally, many CBPR projects operate through a model of academic partners providing research expertise and community partners playing a supporting role.To demonstrate how national umbrella organizations deeply rooted in communities, cognizant of community needs, and drawing on the insights and assets of community partners, can lead efforts to address health disparities affecting their constituents through research.Case studies of two Asian American, Native Hawaiian, and Pacific Islander national organizations.Strategically engaging a diverse range of partners and securing flexible funding mechanisms that support research were important facilitators. Main challenges included limited interest of local community organizations whose primary missions as service or health care providers may deprioritize research.Efforts to make research relevant to the work of community partners and to instill the value of research in community partners, as well as flexible funding mechanisms, may help to promote community-driven research.

Objectives. We sought to examine the utilization and impact of enabling services, such as interpretation and eligibility assistance, among underserved Asian American, Native Hawaiian, and other Pacific Islander (AANHOPI) patients served at 4 community health centers. Methods. For this project, we developed a uniform model for collecting data on enabling services and implemented it across 4 health centers that served primarily AANHOPI patients. We also examined differences in patient characteristics between users and nonusers of enabling services. Results. Health center patients used many enabling services, with eligibility assistance being the most used service. In addition, compared with nonusers, users of enabling services were more likely to be older, female, AANHOPI, and uninsured (P < .05). Conclusions. For underserved AANHOPI patients at community health centers, enabling services are critical for access to appropriate care. We were the first to examine uniform data on enabling services across multiple health centers serving underserved AANHOPI patients. More data on enabling services and evaluation are needed to develop interventions to improve the quality of care for underserved AANHOPI patients.

Objectives. Asian American and Pacific Islanders (AAPIs) historically have faced multiple social and racial/ethnic health disparities in the United States. We gathered national-level health-care data on AAPIs and examined medically underserved health service areas for them. Methods. We used 2000 U.S. Census data and the Bureau of Primary Health Care (BPHC) 2004 dataset for primary care physician full-time equivalents per 1,000 population, as well as AAPI population, AAPI poverty, and AAPI limited English proficiency, to develop an index of medically underserved AAPI counties (MUACs). The index identifies U.S. counties that do not adequately serve AAPIs. Results. We identified 266 counties of medically underserved health service areas for AAPIs across the nation, representing 12% of all U.S. counties. One hundred thirty-eight (52%) MUACs were not designated as BPHC medically underserved counties. Of these counties, 20 (14%) had an AAPI population of at least 10,000, and 29 (21%) had an AAPI population of at least 5,000. Conclusion. This project complements federal efforts to identify medically underserved health service areas and identifies U.S. counties that need new or expanded health services for medically underserved AAPIs.

Background : The mission of the Community Health Applied Research Network (CHARN) is to build capacity to carry out Patient-Centered Outcomes Research at community health centers (CHCs), with the ultimate goal to improve health care for vulnerable populations. Objectives : The CHARN Needs Assessment Staff Survey investigates CHCs’ involvement in research, as well as their need for research training and resources. Results will be used to guide future training. Methods : The survey was developed and implemented in partnership with CHARN CHCs. Data were collected across CHARN CHCs. Data analysis and reports were conducted by the CHARN data coordinating center (DCC). Results : Survey results highlighted gaps in staff research training, and these gaps varied by staff role. Conclusions : There is considerable variation in research involvement, partnerships, and focus both within and across CHCs. Development of training programs to increase research capacity should be tailored to address the specific needs and roles of staff involved in research.

The Affordable Care Act provides opportunities to reimburse non-medical “enabling services” that promote the delivery of medical care for patients with social barriers. However, limited evidence exists to guide delivery of these services. We addressed this gap by convening community health center patients, providers and other stakeholders in two panels that developed a framework for defining and evaluating these services. We adapted a group consensus method where the panelists rated services for effectiveness in increasing access to, use, and understanding of medical care. Panelists defined 6 broad categories, 112 services, and 21 variables including the type of provider delivering the service. We identified sixteen highest-rated services and found that the service provider’s level of training affected effectiveness for some but not all services. In a field with little evidence, these findings provide guidance to decision-makers for the targeted spread of services that enable patients to overcome social barriers to care.

This study classified for resemblance 102 preschool children, who were described by their nursery school teachers using the California Child Q-sort. Inverse (Q) factor analysis identified three personality prototypes initially defined in terms of ego resiliency and ego undercontrol: overcontrolled resilient, resilient under-controlled, and brittle. These personality prototypes showed strong to moderate similarity with typologies obtained in comparable studies and theoretical meaningful relations with experimental measures of ego functioning and IQ. Ten years later, as adolescents, overcontrolled resilients were shy and restrained yet conscientious and intelligent; resilient undercontrollers were extraverted, assertive, and impulsive; and brittles were relatively unintelligent. The discussion focused on the several meanings of person-centered methods, the sample-dependence of personality typologies, and the complementary contributions made by person versus variable-centered analytical strategies in the study of human development.

Background: The Community Health Applied Research Network, funded by the Health Resources and Services Administration, is a research network comprising 18 Community Health Centers organized into four Research Nodes (each including an academic partner) and a data coordinating center. The network represents more than 500,000 diverse safety net patients across 11 states.Objective: The primary objective of this paper is to describe the development and implementation process of the CHARN data warehouse.Methods: The methods involved regulatory and governance development and approval, development of content and structure of the warehouse and processes for extracting the data locally, performing validation, and finally submitting data to the data coordinating center.Progress to Date: Version 1 of the warehouse has been developed. Tables have been added, the population and the years of electronic health records (EHR) have been expanded for Version 2.Conclusions: It is feasible to create a national, centralized data warehouse with multiple Community Health Center partners using different EHR systems. It is essential to allow sufficient time: (1) to develop collaborative, trusting relationships among new partners with varied technology, backgrounds, expertise, and interests; (2) to complete institutional, business, and regulatory review processes; (3) to identify and address technical challenges associated with diverse data environments, practices, and resources; and (4) to provide continuing data quality assessments to ensure data accuracy.