AAPI Nexus: Asian American, Native Hawaiian, Pacific Islander Communities and Federally Qualified Health Centers

Abstracts for “Special Issue on Asian American, Native Hawaiian, Pacific Islander Communities and Federally Qualified Health Centers”
Volume 12, Number 1-2, Fall 2014

Creating Community Criteria for Research Participation at Community Health Centers 

By Mary Frances Oneha, Ho`oipo DeCambra, Liss Ieong, Hui Song, Thu Quach, Rosy Chang-Weir, Ninez A. Ponce, Rachelle Enos, Shao-Chee Sim, and Marjorie Kagawa-Singer

Abstract:  Research conducted to benefit communities is often done without community involvement, threatening its relevance for the groups the studies purport to serve. A great need exists for education of both researchers and community members on how research can be more appropriately conducted in partnership with community members. This paper presents Community Criteria for Research Participation developed by community health centers (CHCs) with input from academic partners to support CHCs’ capacity to conduct research of community significance.

Building a Community Health Center Data Warehouse to Promote Patient-Centered Research in the Asian American, Native Hawaiian, and Pacific Islanders Population 

By Vivian Li, Rosy Chang Weir, Thu Quach, Suzanne Gillespie, Mary Ann McBurnie, Ady Oster, Reesa Laws, Kari Alperovitz-Bichell, Erin O’Brien Kaleba, Christine Nelson

Abstract:  In 2010, the Health Resources and Services Administration (HRSA) established the Community Health Applied Research Net- work (CHARN) to build research infrastructure and capacity at community health centers (CHCs) and to promote comparative effectiveness research in these safety-net settings. A data warehouse with standardized data was created to capture, manage, and share patient-level data with all eighteen participating CHCs, including four CHCs primarily serving Asian American, Native Hawaiian, and Other Pacific Islanders (AANHOPI). AANHOPI patients face unique health risks, yet these large and diverse populations are historically understudied. The CHARN data warehouse provides important opportunities for understanding the health needs of this heterogeneous population.

Clinical Quality Indicators of Asian American,Native Hawaiian, and Other Pacific Islander Patients Seen at Health Resources and Services Administration-Supported Community Health Centers 

By Alek Sripipatana and Quyen Ngo-Metzger

Abstract:  The Health Resources and Services Administration supports federally qualified health centers that provide health care services to more than 21.7 million low-income and medically underserved patients, the majority being racial/ethnic minorities. Nationally, Native Hawaiians and Pacific Islanders (NHPIs) represent 1.3 percent of all health center patients; however, NHPIs constitute more than half of the patients for some health centers. National data of health center clinical quality indicators were analyzed to explore potential differences between Native Hawaiian, Pacific Islander, and Asian American patients. Even among a group of medically underserved patients, health disparities were found in NHPIs, illustrating the relevance of disaggregating data in identifying idiosyncratic differences deserving culturally appropriate interventions.

Early Implementation Lessons on the Patient Protection and Affordable Care Act Outreach and Enrollment Efforts in the Asian American and Pacific Islander Communities 

By Regina Lee, Jen Lee, David Aguilar, Betty Cheng, Kevin Lee, and Thu Quach

Abstract:  Enacted in 2010, the Patient Protection and Affordable Care Act (ACA) intended to make health insurance coverage more affordable and accessible for millions of Americans. However, achieving this goal requires significant targeted, culturally and linguistically appropriate outreach and education efforts for vulnerable communities, such as low-income, underserved Asian Americans and Pacific Islanders. This article describes multiple innovative strategies and approaches used by two well-established community health centers, Charles B. Wang Community Health Center in New York and Asian Health Services in California, as well as the early-stage impacts of outreach and enrollment assistance for the state exchange marketplaces promoting the ACA.

Risk Adjustment with Social Determinants of Health and Implications for Federally Qualified Health Centers under the Affordable Care Act 

By Thu Quach, Todd P. Gilmer, Sherry Hirota, and Ninez A. Ponce

Abstract:  Adjustments for the underlying differences in risks among patients in payment approaches has been widely used and accepted; yet current risk adjustment approaches are limited because they do not account for the various social determinants of health (SDH) that can also influence health outcomes. This can have implications for providers serving disadvantaged populations. This article discusses why the inclusion of SDH in the formulas for risk adjustment is important for federally qualified health centers (FQHCs) under the Patient Protection and Affordable Care Act (ACA) and recommends ways in which FQHCs can be leaders in informing payment reform policies.

Impact of a P4P and HIT Program to Reduce Emergency Department Hospital Utilization at Federally Qualified Health Centers in Hawai‘i 

By Rosy Chang Weir, Heather Law, Mary Frances Oneha, Sang Mee Lee, and Alyna T. Chien

Abstract:  Pay for performance (P4P) and health information technology (HIT) have been used to improve health care quality, but few studies examine interventions combining P4P with HIT support at federally qualified health centers (FQHCs). An intervention comparison, pre-post study was conducted to determine the effect of a P4P+HIT intervention on emergency department (ED) visits and hospitalizations. While ED utilization decreased in both intervention and comparison groups, there were no significant differences in ED or hospital utilization between intervention and comparison groups. Additional time or support above and beyond P4P+HIT may be necessary to improve the health care provided by FQHCs to underserved communities in Hawai‛i.

Addressing Barriers in Health Equity through Innovations in Health Information Technology: A Health Center’s Experiences in Implementing a Chinese Language Patient Portal 

By Christopher Mei, Esther B. Kim, Lynn Sherman, Shao-Chee Sim, Kai Yeung, Candy Poon, Maggie Wong, and Nick Egleson

Abstract:  Patient portals have the potential to empower patients to be more knowledgeable and proactive about their health. Implementation of patient portals has become increasingly critical at primary care sites that serve underserved communities, where there is a growing need for linguistically appropriate electronic access. The Charles B. Wang Community Health Center has recently developed a linguistically appropriate patient portal with the goal of providing increased access to its majority Chinese American patient population with low English proficiency and literacy levels. This article will discuss experiences learned from implementing a Chinese Language Patient Portal that addresses socioeconomic barriers and disparities in health care access.

Hawai‘i Patient-Centered Health Care Home Project: A Collaborative Partnership between Four Hawai‘i Federally Qualified Health Centers, AlohaCare, and the Hawai‘i Primary Care Association 

By Mary Frances Oneha, Robert Hirokawa, and Cristina Vocalan

Abstract:  Four Hawai‘i Federally Qualified Health Centers, a Managed Care Organization, and the Hawai‘i Primary Care Association established a partnership to pilot a unique Patient-Centered Health Care Home model. All sites were successful in implementing care coordination and a patient registry. A cohort of 432 patients with a diagnosis of diabetes and/or depression was activated into the program. Sixty percent of the cohort was Native Hawaiian, Other Pacific Islander, or Asian. Patients with uncontrolled diabetes lowered their HbA1c by one point (p < .05), and patients with severe depression lowered their PHQ-9 scores by 4.6 points (p < .05).

The Role of the Patient-Centered Medical Home in Addressing Hepatitis B Perinatal Transmission: Charles B. Wang Community Health Center’s Hep B Moms Program 

By Isha Weerasinghe, Nicole Bannister, Vivian Huang, Chari Cohen, Jeffrey Caballero, and Su Wang

Abstract:  Chronic hepatitis B (CHB) is a serious liver disease caused by the hepatitis B virus (HBV). Each year, approximately twenty-five thousand infants are born to HBV-infected mothers, and one thou- sand newborns become infected (Barbosa et al., 2014; Ward, 2008). To prevent HBV perinatal transmission and facilitate care management, health centers should utilize a patient-centered medical home model that provides coordinated, comprehensive, and culturally appropriate services. One model is the Hep B Moms Program at Charles B. Wang Community Health Center in New York City.

Setting Up a Medical Home for Chinese Immigrant Families with Children with Special Health Care Needs: A Step-Wise Approach

By Sherry Shao Fen Huang and Loretta Young Au

Abstract:  Children with special health care needs (CSHCN) require health services beyond what generally is required. CSHCN from immigrant families face additional challenges, including cultural, language, racial, and socioeconomic barriers. Federally qualified health centers provide an ideal setting to treat these children, pro- viding comprehensive, family-centered care that fits their linguistic and cultural needs. This article describes the development of a National Committee for Quality Assurance level 3 medical home, addressing cultural perspectives and barriers to quality care for the Chinese immigrant community by highlighting Edward Wagner’s Chronic Care Model, medical home criteria, electronic health records, parent engagement, staff development, and community collaboration.

Improving Access to Care for Asian American and Pacific Islander Communities by Integrating Primary Care into a Behavioral Health Setting: Lessons from the Field

By Michael B. McKee and Yoon Joo Han

Abstract:  International Community Health Services, a Federally Qualified Health Center, and Asian Counseling and Referral Service, a multi-social service agency, collaborated to develop a unique integrated model of care for Asian American and Pacific Islander patients with limited English proficiency and severe mental illness. In this practitioner’s essay, we explore lessons learned from a five- year demonstration project and discuss future implications related to health care reform and applicability to similar programs. Keys to the success of the project were committing to partnership, transforming staff roles, developing systems of documentation, adjusting productivity standards, and adapting for cultural competency.

Integrating Primary Care and Behavioral Health: A Nurse Practitioner’s Perspective

By Le Thai and Anne Saw

Abstract:  Health equity for individuals with serious mental illness (SMI) requires collaborative partnerships between primary care and behavioral health organizations. This paper presents the experiences and perspectives of a nurse practitioner in a large-scale pilot program to integrate primary care and behavioral health between an FQHC and a community mental health center, both serving predominantly Asian immigrant populations. This paper discusses lessons learned through program implementation and provides insights on developing a truly integrated system involving equal and full cooperation across disciplines to provide quality and holistic care for patients with SMI. Implications for clinical practice and policy are discussed.

Challenges to Improve Health Care Access for Cambodians

By Mariko Kahn and Elisa Nicholas

Abstract:  This resource paper examines the challenges faced by a mental health contract provider and a federally qualified health center in Long Beach to integrate these two systems of care to provide better health care to Cambodians. The issues of disparity, stigma, and cultural barriers prevalent in this underserved community were identified and strategies to address the barriers were implemented. The resulting product illuminates many of the challenges that integrated care presents to ethnic communities.

Opening Access for Burmese and Karen Immigrant and Refugee Populations in California: A Blueprint for Integrated Health Service Expansion to Emerging Asian Communities

By Kimberly S. G. Chang, Joan Jeung, Phyllis Pei, Kwee Say, Julia Liou, Huong Le, and George Lee

Abstract:  This article describes: 1) internal and external factors enabling the expansion of health care access to Burmese and Karen refugees, 2) operational processes required to expand integrated primary health care services to this emerging community, 3) the importance of culturally and linguistically competent services that incorporate prior experiences of forced immigration, and 4) les- sons learned and what to expect when expanding health care access to new populations within a federally qualified health center (FQHC). This case study may provide a blueprint for other FQHCs seeking to respond to emerging immigrant and refugee populations. Such expansion gains relevance as the nation grows more diverse and continues to rely on FQHCs to respond to the health needs of medically underserved populations.

Exploring Different Methods to Obtain Patient Experience Feedback in a Community Health Center for Quality Improvement and Quality Assurance Purposes

By Nina Huynh Song, Shao-Chee Sim, Gemma Borja, and Perry Pong

Abstract:  This paper will provide the policy context for the important role of capturing patient experience at federally qualified health centers (FQHCs), especially with the implementation of the patient-centered medical home model. We discuss various quantitative and qualitative methods that were utilized to capture patient experience at the Charles B. Wang Community Health Center in New York City. Specifically, we describe our experience in adapting, pilot testing, and refining the Consumer Assessment of Healthcare Providers and Systems survey to address the unique cultural and linguistic needs of our health center’s patient population. We also explore the benefits and limitations of these methods, and discuss factors that FQHCs should consider when capturing patient feedback.

Role of Community Institutional Review Boards in Community Health Center-Engaged Research with Asian Americans, Native Hawaiians, and Other Pacific Islanders

By Morgan Ye, Jacqueline H. Tran, Rachelle Enos, and Rosy Chang Weir

Abstract:  With the growing trend of community-based research, academic-based Institutional Review Boards (IRBs) often lack appropriate community-based ethical considerations in their reviews. Thus, the Association of Asian Pacific Community Health Organizations (AAPCHO) established an in-house community IRB to ensure that AAPCHO or member-initiated research is relevant to its community health centers (CHCs) and their Asian American, Native Hawaiian & Other Pacific Islander (AA&NHOPI) patients. Evaluations conducted at the IRB’s one-year mark demonstrated members and applicants’ satisfaction with the IRB’s performance. Evaluation results and best practices show that AAPCHO’s IRB promotes community leadership and research capacity and ensures community-applicable research plans.