Jennifer Tabler

Organizational Culture Associated With Provider Satisfaction

Background: Organizational culture is key to the successful implementation of major improvement strategies. Transformation to a patient-centered medical home (PCHM) is such an improvement strategy, requiring a shift from provider-centric care to team-based care. Because this shift may impact provider satisfaction, it is important to understand the relationship between provider satisfaction and organizational culture, specifically in the context of practices that have transformed to a PCMH model. Methods: This was a cross-sectional study of surveys conducted in 2011 among providers and staff in 10 primary care clinics implementing their version of a PCMH: Care by Design. Measures included the Organizational Culture Assessment Instrument and the American Medical Group Association provider satisfaction survey. Results: Providers were most satisfied with quality of care (mean, 4.14; scale of 1–5) and interactions with patients (mean, 4.12) and were least satisfied with time spent working (mean, 3.47), paperwork (mean, 3.45), and compensation (mean, 3.35). Culture profiles differed across clinics, with family/clan and hierarchical cultures the most common. Significant correlations (P ≤ .05) between provider satisfaction and clinic culture archetypes included family/clan culture negatively correlated with administrative work; entrepreneurial culture positively correlated with the Time Spent Working dimension; market/rational culture positively correlated with how practices were facing economic and strategic challenges; and hierarchical culture negatively correlated with the Relationships with Staff and Resource dimensions. Conclusions: Provider satisfaction is an important metric for assessing experiences with features of a PCMH model. Identification of clinic-specific culture archetypes and archetype associations with provider satisfaction can help inform practice redesign. Attention to effective methods for changing organizational culture is recommended.

The influence of adolescent eating disorders or disordered eating behaviors on socioeconomic achievement in early adulthood

OBJECTIVE Much research documents the etiology and health consequences of adolescent eating disorders (ED), but very little is known about the long-term effects of EDs on the transition to adulthood. This study explores gender differences in the influence of EDs or disordered eating behaviors (DEB) on measures of socioeconomic independence in early adulthood. METHOD Using the National Longitudinal Study of Adolescent Health (Add Health), this study compares individuals who self-identified as have been diagnosed with an ED or engaged in DEBs in late adolescence to those without ED or DEB on three measures of socioeconomic independence during early adulthood, including educational attainment, income, and likelihood of owning a home. This study uses multiple regression techniques and attempts to account for early-life conditions and health outcomes associated with EDs and DEBs. RESULTS For females, ED or DEB in late adolescence had a statistically significant, negative association with educational attainment (coefficient = -0.20, p = .05), personal income (coefficient = -0.12, p < .05) and odds of owning a home (odds ratio = 0.73, p < .02) in early adulthood. For males, ED or DEB was not associated with socioeconomic attainment. DISCUSSION Our findings suggest that EDs and DEBs are negatively associated with socioeconomic achievement during early adulthood for females, but not for males. EDs or DEBs during adolescence may set individuals on a different trajectory whereby they do not have the same life chances or opportunities for success in adulthood. These results confirm the public health message that EDs or DEBs have lasting negative consequences for women.

Prevalence of Intimate Partner Violence and Its Impact on Health: Female and Male Patients Using a Free Clinic

Purpose. Examine the prevalence of intimate partner violence (IPV) with physical and mental health indicators among free clinic patients. Methods. A cross-sectional study conducted via self-administered surveys. English and Spanish-speaking women and men aged 18 to 64 years responded to standardized questionnaires regarding IPV, physical and mental health, depression, and emotional support. Results. The overall prevalence of IPV was 41%. U.S.-born participants reported a higher prevalence of IPV (women 61%, men 69%) compared with the national average (women 36%, men 29%) and the non-U.S.-born or immigrant participants (women 39%, men 7%). Women with IPV reported poorer mental health but the same level of physical health functioning compared with women without IPV. The impact of IPV on health was somewhat different for men. Conclusions. Intimate partner violence is associated with poor health outcomes, especially for U.S.-born participants. Further research is warranted to understand causal mechanisms and to aid patients.

Stress, Coping Strategies, and Depression--Uninsured Primary Care Patients.

OBJECTIVES People of low socio-economic status (SES) are particularly at risk for developing stress-related conditions. The purpose of this study is to examine depression, stress, and coping strategies among uninsured primary care patients who live below the 150th percentile of the federal poverty level. Specifically, this study compares the experiences of impoverished US-born English speakers, non-US-born English speakers, and Spanish speakers. METHODS Uninsured primary care patients utilizing a free clinic (N = 491) completed a self-administered survey using standardized measures of depression, perceived stress, and coping strategies in the spring of 2015. RESULTS US-born English speakers reported higher levels of depression and perceived stress compared to non-US-born English speakers and Spanish speakers. US-born English speakers are more likely to use negative coping strategies than non-US-born English speakers and Spanish speakers. Perceived stress and negative coping strategies are significant predictors of depression. CONCLUSION US-born English speakers, non-US-born English speakers, and Spanish speakers reported different coping strategies, and therefore, may have different needs for addressing depression. In particular, US-born English speakers need interventions for reducing substance use and negative psychological coping strategies.

Depression, somatic symptoms, and perceived neighborhood environments among US-born and non-US-born free clinic patients.

Objectives The study’s purpose was to examine the impact of somatic symptoms and perceived neighborhood environment on depression using a comparison among US-born and non–US-born free clinic patients. Methods US-born English speakers (n = 99), non–US-born English speakers (n = 89), and non–US-born Spanish speakers (n = 158) 18 years old or older (N = 346) were surveyed at a free clinic that provides primary care to people without health insurance. Depression, somatic symptoms, and perceived neighborhood environment were measured using standardized instruments. Results US-born English speakers reported higher levels of depression and a greater number of somatic symptoms than non–US-born Spanish speakers and non–US-born English speakers. Non–US born English speakers reported lower levels of depression and fewer somatic symptoms than Spanish speakers. Somatic symptoms and perceived neighborhood satisfaction were related to depression. Conclusions Developing mental health services for patients in a free clinic setting is needed; however, because of limited financial and human resources, providing mental health services in a free clinic setting often is difficult. Community-based health promotion programs as supplements to efforts within clinical settings would be valuable in improving the mental health of free clinic patients. Future studies should implement collaborative pilot programs and evaluate health outcomes.

One Size Doesn't Fit All - Partners in Hospice Care, an Individualized Approach to Bereavement Intervention.

We concluded in a recent study that a one-size-fits-all approach typical of group interventions often does not adequately accommodate the range of situations, life experiences, and current needs of participants. We describe how this limitation informed the design and implementation of an individually delivered intervention format more specifically tailored to the unique needs of each bereaved person. The intervention comprises one of the three interrelated studies within Partners in Hospice Care (PHC), which examines the trajectory from end-of-life care through bereavement among cancer caregivers using hospice. The PHC intervention employs an initial needs assessment in order to tailor the session content, delivery, and sequencing to the most pressing, yet highly diverse needs of the bereaved spouses/partners. Although an individually delivered format has its own challenges, these can be effectively addressed through standardized interventionist training, regular communication among staff, and a flexible approach toward participants’ preferences and circumstances.

Somebody has to DUST! Gender, health, and housework in older couples

ABSTRACT This study examines the link between health and housework among older couples. For those out of the paid labor force, many of the standard arguments about relative resources and time availability no longer hold. Women spend more time on domestic tasks than men at any age; however, it is unclear how health shapes the household division of labor based on gender among older adults. This study examines the relative effect of three dimensions of health. Women’s poor health increases the chance of an equal division of labor, but the gender nature of household tasks may limit women’s ability to cut back.

Missed Opportunity: Hospice Care and the Family

A typical mission statement of hospice services is to provide quality, compassionate care to those with terminal illness and to support families through caregiving and bereavement. This study explored the ways that bereavement needs of caregivers, either predeath or postdeath of their spouse/partner, were addressed using qualitative retrospective phone interviews with 19 caregivers whose spouse/partner was enrolled in hospice care for cancer. Overall, participants expressed high satisfaction with hospice care, most often noting a high satisfaction with the quality of care provided to their spouse/partner. During the predeath phase, caregivers recalled being so focused on their spouse/partners needs that they rarely spoke with hospice staff about their own personal needs and emotions. Participants said that bereavement counseling occurred primarily after the death of the spouse/partner, in the form of generic pamphlets or phone calls from someone they had not met during prior interactions with hospice staff. These findings suggest that caregivers’ high satisfaction with hospice may be more associated with the quality of care provided to the spouse/partner than with bereavement support they received. Our findings illustrated a potential missed opportunity for hospices to address the family-oriented goals that are commonly put forward in hospice mission statements.

Disordered eating behaviors and cardiometabolic risk among young adults with overweight or obesity

OBJECTIVE To determine if unhealthy weight control behaviors or binge-eating behaviors among young adults with overweight/obesity are associated with body mass index (BMI) change and cardiometabolic risk at 7-year follow-up. METHODS We used longitudinal cohort data from 5,552 young adults with overweight/obesity at baseline (18-24 years) with 7-year follow-up (24-32 years) from the National Longitudinal Study of Adolescent to Adult Health. Baseline predictors were: (a) unhealthy weight control behaviors such as vomiting, fasting, skipping meals, or laxative/diuretic use to lose weight; or (b) binge-eating behaviors. Participants reporting either unhealthy weight control behaviors or binge-eating behaviors were considered to engage in any disordered eating behavior (DEB). Outcomes at 7-year follow-up were BMI change, incident diabetes, incident hypertension, and incident hyperlipidemia. RESULTS Young adults with overweight/obesity reporting unhealthy weight control behaviors at baseline had higher BMI and weight at 7-year follow-up than those without unhealthy weight control behaviors. In regression models adjusting for baseline BMI, race/ethnicity, age, and education, unhealthy weight control behaviors were associated with greater change in BMI in both sexes and binge-eating behavior at baseline was associated with greater odds of incident hyperlipidemia (odds ratio 1.90, 95% CI 1.29-2.79) at 7-year follow-up in males. CONCLUSIONS The higher risk for increased BMI (in both males and females) and incident hyperlipidemia (in males) over time in young adults with overweight/obesity who engage in DEBs underscores the need to screen for DEBs in this population and provide referrals and tailored interventions as appropriate.

Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters

OBJECTIVE This study seeks to examine the long-term reproductive consequences of eating disorders (ED), to assess variation in reproductive outcomes by ED type, and to examine reproductive differences between women with previous ED diagnosis and their discordant sisters. METHOD Using a sample of women with previous ED diagnosis generated by the Utah Population Database, this study compares the fecundity (parity) and age at first birth of women by ED subtype (bulimia nervosa [BN], anorexia nervosa [AN], and ED not otherwise specified [EDNOS]) (n = 1,579). We also employed general population match case-control, and discordant sibling pair analyses, to estimate the magnitude of association between EDs and reproductive outcomes. RESULTS Women previously diagnosed with AN or EDNOS experienced delayed first birth (HRR = 0.33, HRR = 0.34, respectively) and lower parity (IRR = 0.19, IRR = 0.22, respectively) relative to BN (p < .05), the general population (p < .05), and closest-aged sisters (p < .05). Women previously diagnosed with BN experienced more moderate reductions and delays to their reproduction, and had similar reproductive outcomes as their discordant sisters. DISCUSSION Clinicians should consider ED type and family fertility histories when addressing the long-term reproductive health needs of women with prior AN, BN, or EDNOS diagnosis. Women previously diagnosed with AN or EDNOS likely experience the greatest reductions and delays in reproduction across their lifespan. Reproductive health screenings may be especially critical for the wellbeing of women with a history of AN or EDNOS.