TY - JOUR
T1 - Changing clinic-community social ties in immigrant-serving primary care practices in New York City
T2 - Social and organizational implications of the affordable care act's population-health-related provisions
AU - Gore, Radhika
AU - Dhar, Ritu
AU - Mohaimin, Sadia
AU - Lopez, Priscilla M.
AU - Divney, Anna A.
AU - Zanowiak, Jennifer M.
AU - Thorpe, Lorna E.
AU - Islam, Nadia
N1 - Funding Information:
This study focuses on small primary care practices that serve South Asian immigrant communities in New York City. We examine how the practices implement EHR and CHW strategies as part of a hypertension control project targeted to South Asians from Bangladesh, India, and Pakistan—minority groups that have an especially high burden of cardiovascular disease and unique cultural and linguistic barriers to health behavior change (Yi et al. 2016; Sohal et al. 2015). The project, known as IMPACT (Implementing Million Hearts for Provider and Community Transformation), was funded by the Centers for Disease Control and Prevention (CDC) (Lopez et al. 2017). IMPACT’s aims for cardiovascular health advanced the goals of the Million Hearts initiative, an innovation model of the Center for Medicare and Medicaid Innovation, which falls under the authority of Section 3021 of the ACA. Million Hearts aligns and coordinates public-and private-sector efforts to prevent cardiovascular disease nationally (CMS 2019). We show that IMPACT’s EHR and CHW strategies are not just instrumental for hypertension control, but also build upon and can reinforce social relations between small primary care practices and the immigrant communities they serve. Our findings offer lessons for other aspects of the ACA’s population health-related provisions based on the experience of small practices, which have been largely peripheral in studies of ACA-derived population health innovations.
Publisher Copyright:
© 2020 Russell Sage Foundation.
PY - 2020/7
Y1 - 2020/7
N2 - Small primary care practices are critical to advancing Affordable Care Act (ACA) aims, yet their efforts and experiences remain little studied. We examine two strategies derived from ACA population-health provisions-enhanced use of electronic health records (EHRs) and community health worker (CHW)-led peer coaching-for hypertension control in sixteen small practices serving South Asian immigrant communities in New York City. Based on interviews with physicians, staff, and CHWs, we analyze "street-level"dilemmas encountered in implementing the strategies. Findings indicate that the strategies reinforce clinic-community social ties but present distinct challenges for small practices: internal management constraints that impede formal CHW-physician contact, and external incentives linked to EHR tools that, physicians and staff perceive, do not meet immigrant communities' needs and expectations in medical encounters.
AB - Small primary care practices are critical to advancing Affordable Care Act (ACA) aims, yet their efforts and experiences remain little studied. We examine two strategies derived from ACA population-health provisions-enhanced use of electronic health records (EHRs) and community health worker (CHW)-led peer coaching-for hypertension control in sixteen small practices serving South Asian immigrant communities in New York City. Based on interviews with physicians, staff, and CHWs, we analyze "street-level"dilemmas encountered in implementing the strategies. Findings indicate that the strategies reinforce clinic-community social ties but present distinct challenges for small practices: internal management constraints that impede formal CHW-physician contact, and external incentives linked to EHR tools that, physicians and staff perceive, do not meet immigrant communities' needs and expectations in medical encounters.
KW - Clinic-community social ties
KW - Community health workers
KW - Electronic health records
KW - Racial-ethnic minorities
KW - Small primary care practices
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U2 - 10.7758/rsf.2020.6.2.12
DO - 10.7758/rsf.2020.6.2.12
M3 - Article
AN - SCOPUS:85093903442
SN - 2377-8253
VL - 6
SP - 264
EP - 288
JO - RSF
JF - RSF
IS - 2
ER -