article thumbnail

Comparing impact of a holistic patient centered navigation model to an online navigation service on health care utilization [Population health and epidemiology]

Annals of Family Medicine

Context Social prescribing has been linked to better access, improved health and wellbeing, and decreased health care utilization (HCU). Population Primary care providers in 12 Ottawa and Sudbury (Ontario, Canada) practices referred their patients with health or social needs to access needed SP services. in Year 0 and 1.7 (0.7,

article thumbnail

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

Annals of Family Medicine

Study Design and Analysis: We used information gathered from site visits and team meetings to understand how Compass Rose was being utilized across sites. We also assessed patterns of social risks and need for assistance among our patient populations. Of those patients with an episode (i.e.,

Referral 130
Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

Health Trends Across Communities: Engaging Healthcare Systems, Public Health and Community in a Statewide Public Health Tool [Social determinants and vulnerable populations]

Annals of Family Medicine

Context: Building patients’ and health professionals’ trust in health research includes responsibly sharing health information. Objective: To use an iterative, community-engaged process to inform the development of the publicly-available HTAC dashboard. Study Design and Analysis: Qualitative descriptive.

Community 130
article thumbnail

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. A community collaborative mural focused on vascular health. Conclusions The PORTRAIT dissemination project utilized a community-engaged mural to raise awareness about PAD.

Community 130
article thumbnail

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. The final question asked patients, who have at least one risk factor, if they would like assistance with their need(s). Study Design and Analysis: Descriptive analysis of secondary data.

article thumbnail

Implementation of a novel linkage of primary care electronic medical record data with hospital data in South Eastern Ontario [Big data]

Annals of Family Medicine

Context: Currently, primary care data, community data, and hospital data are not linked in Ontario, resulting in a disconnect in continuity of care. Datasets: Primary care EMR data from the Eastern Ontario Network and acute care, post-acute, and community mental health and addictions data from the Shared Health Integrated Information Portal.

article thumbnail

Primary Care Utilization in Native American Communities: Challenges and Opportunities [Health care disparities]

Annals of Family Medicine

Context: American Indian/Alaskan Native (AI/AN) patients are disproportionately affected by deleterious health outcomes for many preventable disease when compared to their non-indigenous counterparts. It is paramount to understand the barriers faced by the AI/AN community to better serve their medical needs.