Dataset Information

Incentivizing primary care providers to innovate: building medical homes in the post-Katrina New Orleans safety net.

ABSTRACT:

Objective

To evaluate safety-net clinics' responses to a novel community-wide Patient-Centered Medical Home (PCMH) financial incentive program in post-Katrina New Orleans.

Data sources/study setting

Between June 2008 and June 2010, we studied 50 primary care clinics in New Orleans receiving federal funds to expand services and improve care delivery.

Study design

Multiwave, longitudinal, observational study of a local safety-net primary care system.

Data collection

Clinic-level data from a semiannual survey of clinic leaders (89.3 percent response rate), augmented by administrative records.

Principal findings

Overall, 62 percent of the clinics responded to financial incentives by achieving PCMH recognition from the National Committee on Quality Assurance (NCQA). Higher patient volume, higher baseline PCMH scores, and type of ownership were significant predictors of achieving NCQA recognition. The steepest increase in adoption of PCMH processes occurred among clinics achieving the highest, Level 3, NCQA recognition. Following NCQA recognition, 88.9 percent stabilized or increased their use of PCMH processes, although several specific PCMH processes had very low rates of adoption overall.

Conclusions

Findings demonstrate that widespread PCMH implementation is possible in a safety-net environment when external financial incentives are aligned with the goal of practice innovation.

SUBMITTER: Rittenhouse DR

PROVIDER: S-EPMC3922467 | biostudies-literature | 2014 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Incentivizing primary care providers to innovate: building medical homes in the post-Katrina New Orleans safety net.

Rittenhouse Diane R DR Schmidt Laura A LA Wu Kevin J KJ Wiley James J

Health services research 20130626 1

<h4>Objective</h4>To evaluate safety-net clinics' responses to a novel community-wide Patient-Centered Medical Home (PCMH) financial incentive program in post-Katrina New Orleans.<h4>Data sources/study setting</h4>Between June 2008 and June 2010, we studied 50 primary care clinics in New Orleans receiving federal funds to expand services and improve care delivery.<h4>Study design</h4>Multiwave, longitudinal, observational study of a local safety-net primary care system.<h4>Data collection</h4>Cl ...[more]

PMID: 23800148

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Project description:BACKGROUND: Empirical observations on how businesses respond after a major catastrophe are rare, especially for a catastrophe as great as Hurricane Katrina, which hit New Orleans, Louisiana on August 29, 2005. We analyzed repeated telephone surveys of New Orleans businesses conducted in December 2005, June 2006, and October 2007 to understand factors that influenced decisions to re-open amid post-disaster uncertainty. METHODOLOGY/PRINCIPAL FINDINGS: Businesses in the group of professional, scientific, and technical services reopened the fastest in the near term, but differences in the rate of reopening for businesses stratified by type became indistinguishable in the longer term (around two years later). A reopening rate of 65% was found for all businesses by October 2007. Discriminant analysis showed significant differences in responses reflecting their attitudes about important factors between businesses that reopened and those that did not. Businesses that remained closed at the time of our third survey (two years after Katrina) ranked levee protection as the top concern immediately after Katrina, but damage to their premises and financing became major concerns in subsequent months reflected in the later surveys. For businesses that had opened (at the time of our third survey), infrastructure protection including levee, utility, and communications were the main concerns mentioned in surveys up to the third survey, when the issue of crime became their top concern. CONCLUSIONS/SIGNIFICANCE: These findings underscore the need to have public policy and emergency plans in place prior to the actual disaster, such as infrastructure protection, so that the policy can be applied in a timely manner before business decisions to return or close are made. Our survey results, which include responses from both open and closed businesses, overcome the "survivorship bias" problem and provide empirical observations that should be useful to improve micro-level spatial economic modeling of factors that influence business return decisions.

Project description:BackgroundHurricane Katrina made landfall in New Orleans, Louisiana as a Category 3 storm in August 2005. Storm surges, levee failures, and the low-lying nature of New Orleans led to widespread flooding, damage to over 70% of occupied housing, and evacuation of 80-90% of city residents. Only 57% of the city's black population has returned. Many residents complain of gentrification following rebuilding efforts. Climate gentrification is a recently described phenomenon whereby the effects of climate change, most notably rising sea levels and more frequent flooding and storm surges, alter housing values in a way that leads to gentrification.ObjectiveTo examine the climate gentrification following hurricane Katrina by (1) estimating the associations between flooding severity, ground elevation, and gentrification and (2) whether these relationships are modified by neighborhood level pre- and post-storm sociodemographic factors.MethodsLidar data collected in 2002 were used to determine elevation. Water gauge height of Lake Ponchartrain was used to estimate flood depth. Using census tracts as a proxy for neighborhoods, demographic, housing, and economic data from the 2000 decennial census and the 2010 and 2015 American Community Survey 5-year estimates US Census records were used to determine census tracts considered eligible for gentrification (median income < 2000 Orleans Parish median income). A gentrification index was created using tract changes in education level, population above the poverty limit, and median household income. Proportional odds ordinal logistic regression was used with product terms to test for effect measure modification by sociodemographic factors.ResultsCensus tracts eligible for gentrification in 2000 were 80.2% black. Median census tract flood depth was significantly lower in areas eligible to undergo gentrification (0.70 m vs. 1.03 m). Residents of gentrification-eligible tracts in 2000 were significantly more likely to be black, less educated, lower income, unemployed, and rent their home rather than own. In 2015 in these same eligible tracts, areas that underwent gentrification became significantly whiter, more educated, higher income, less unemployed, and more likely to live in a multi-unit dwelling. Gentrification was inversely associated with flood depth and directly associated with ground elevation in eligible tracts. Marginal effect modification was detected by the effect of pre-storm black race on the relationships of flood depth and elevation with gentrification.ConclusionsGentrification was strongly associated with higher ground elevation in New Orleans. These results provide evidence to support the idea of climate gentrification described in other low-elevation major metropolitan areas like Miami, FL. High elevation, low-income, demographically transitional areas in particular - that is areas that more closely resemble high-income area demographics, may be vulnerable to future climate gentrification.

Dataset Information

Incentivizing primary care providers to innovate: building medical homes in the post-Katrina New Orleans safety net.

Objective

Data sources/study setting

Study design

Data collection

Principal findings

Conclusions

Publications

Incentivizing primary care providers to innovate: building medical homes in the post-Katrina New Orleans safety net.

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