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Community Integration: Pushing the Boundaries for a Better World

Integrated Care News by CFHA

The plane was piloted by a native of the island, deeply committed to helping his community. What followed was a powerful expression of community and compassion. We offered trauma-informed support and helped newly displaced individuals connect with health and community resources.

Community 130
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Compass Rose for Generating Community-based Referrals via Epic: Best Practices and Lessons Learned [Social determinants and vulnerable populations]

Annals of Family Medicine

We also assessed patterns of social risks and need for assistance among our patient populations. Setting or Dataset: We used data from Epic on social needs screening and Compass Rose utilization. Of those patients with an episode (i.e.,

Referral 130
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Creative Dissemination: Community-Engaged Mural to Disseminate the PORTRAIT Registry on Peripheral Arterial Disease [Cardiovascular disease]

Annals of Family Medicine

Public health initiatives, including community engagement projects, are vital for promoting early diagnosis and encouraging behaviors to combat PAD. Materials detailed resources for PAD screening, physical activity, and smoking cessation and were distributed through dissemination activities and partners.

Community 130
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Risks and Needs: Lessons Learned from Assessing Patients Willingness to Receive Help for Social Risks in Primary Care [Social determinants and vulnerable populations]

Annals of Family Medicine

Context: In May 2023, Mayo Clinic implemented a revised screening tool to assess social determinants of health (SDOH) for its patients. Objective: To assess the impact of a question on need for assistance with social risk factors identified through routine screening.

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Pap-HPV co-testing adoption trends for cervical cancer screening in a multi-state Practice Research Network (PBRN) 2012-2017 [Health care disparities]

Annals of Family Medicine

Context: In 2012, the United States cervical cancer screening (CCS) guidelines changed to add co-testing (Papanicolaou [Pap] and human papillomavirus [HPV] test) to Pap-only. Little is known about variation in adoption of CCS modalities in federally qualified health centers (FQHCs) in communities where cervical cancer disparities persist.

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Three Practices, Three Stories: best practices and unique approaches to substance use screening in rural primary care [Behavioral, psychosocial, and mental illness]

Annals of Family Medicine

Context: Primary care (PC) practices that implement Screening, Brief Intervention, and Referral to Treatment (SBIRT) can identify, reduce, and prevent problematic alcohol use that otherwise could go undetected. While screening and brief counseling in PC is considered best practice, it is not standard practice.

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Patient Advocacy Group Leaders Perceptions on Primary Cares Role in Caring for Patients with a History of Breast Cancer [Health care services, delivery, and financing]

Annals of Family Medicine

Context Patient advocacy groups engage patients, families, and caregivers in navigating the cancer landscape, focusing on early detection/screening, as well as psychosocial and financial support during treatment. As these groups have grown, they have major influences over their communities, funding, and policy.