Effects of the COVID-19 Pandemic on Patient Navigation for Health-Related Social Needs: Reflections From the Accountable Health Communities Model.

BACKGROUND AND OBJECTIVES: This paper uses data from the Center for Medicare & Medicaid Innovation's Accountable Health Communities (AHC) Model to assess the effects of the COVID-19 pandemic on patient navigation (PN) for health-related social needs. METHODS: We analyzed evaluation data from 28 organizations implementing the Center for Medicare & Medicaid Innovation's AHC Model. We first distilled themes from 81 stakeholder interviews conducted in 2021. We then analyzed quantitative beneficiary-level data on acceptance of navigation among 133,173 unique Medicare and Medicaid beneficiaries who were eligible for navigation between January 2019 and March 2021. RESULTS: During the pandemic, interview participants described greater complexity of patients' cases and uncertainty regarding community service availability. Changes to navigation staffing and mode led to improvements in navigation quality and efficiency, but also challenges such as reduced rapport with patients. The pandemic increased navigator stress and burnout but also deepened appreciation for navigation among navigators and their patients. Beneficiaries were more likely to accept navigation during the pandemic than before the pandemic ( P < .05). CONCLUSIONS: Changes in PN during the pandemic were perceived as both good and bad. Future work is needed to assess the long-term implications of pandemic-related changes to navigation for patients and navigators.

Elements of a Workplace Culture of Health, Perceived Organizational Support for Health, and Lifestyle Risk.

PURPOSE: We investigated the impact of elements of a workplace culture of health (COH) on employees' perceptions of employer support for health and lifestyle risk. DESIGN: We used 2013 and 2015 survey data from the National Healthy Worksite Program, a Centers for Disease Control and Prevention (CDC)-led initiative to help workplaces implement health-promoting interventions. SETTING: Forty-one employers completed the CDC Worksite Health Scorecard to document organizational changes. PARTICIPANTS: Eight hundred twenty-five employees provided data to evaluate changes in their health and attitudes. MEASURES: We defined elements of a COH as environmental, policy, and programmatic supports; leadership and coworker support; employee engagement (motivational interventions); and strategic communication. Outcomes included scores of employees' perceptions of employer support for health and lifestyle risk derived from self-reported physical activity, nutrition, and tobacco use. ANALYSIS: We estimated effects using multilevel regression models. RESULTS: At the employee level and across time, regression coefficients show positive associations between leadership support, coworker support, employee engagement, and perceived support for health ( P < .05). Coefficients suggest a marginally significant negative association between lifestyle risk and the presence of environmental and policy supports ( P < .10) and significant associations with leadership support in 2015 only ( P < .05). CONCLUSION: Relational elements of COH (leadership and coworker support) tend to be associated with perceived support for health, while workplace elements (environmental and policy supports) are more associated with lifestyle risk. Employers need to confront relational and workplace elements together to build a COH.

Mental health indicators associated with oil spill response and clean-up: cross-sectional analysis of the GuLF STUDY cohort.

BACKGROUND: Adverse mental health effects have been reported following oil spills but few studies have identified specific responsible attributes of the clean-up experience. We aimed to analyse the effects of the 2010 Deepwater Horizon (Gulf of Mexico) disaster on the mental health of individuals involved in oil spill response and clean-up. METHODS: We used data from the Gulf Long-term Follow-up Study, a cohort of workers and volunteers involved in oil spill clean-up after the Deepwater Horizon disaster. We included 8968 workers (hired after completing training for oil spill response and clean-up) and 2225 non-workers (completed training but were not hired) who completed a Patient Health Questionnaire-8 and four-item Primary Care PTSD Screen to assess for probable depression and post-traumatic stress disorder (PTSD) indicators. Participants were recruited between March 28, 2011, and March 29, 2013. The mental health indicators were assessed at home visits done between May 12, 2011, and May 15, 2013. We used regression models to analyse the effect of potentially stressful job experiences, job type, and total hydrocarbon exposure on mental health indicators. FINDINGS: Oil spill response and clean-up work was associated with increased prevalence of depression (prevalence ratio [PR] 1·22, 95% CI 1·08-1·37) and PTSD (PR 1·35, 95% CI 1·07-1·71). Among workers, individuals who reported smelling oil, dispersants, or cleaning chemicals had an elevated prevalence of depression (1·56, 1·37-1·78) and PTSD (2·25, 1·71-2·96). Stopping work because of the heat was also associated with depression (1·37, 1·23-1·53) and PTSD (1·41, 1·15-1·74), as was working as a commercial fisherman before the spill (1·38, 1·21-1·57; and 2·01, 1·58-2·55, respectively). An increase in exposure to total hydrocarbons appeared to be associated with depression and PTSD, but after taking into account oil spill job experiences, only the association between the highest amount of total hydrocarbons and PTSD remained (1·75, 1·11-2·76). INTERPRETATION: Oil spill clean-up workers with high amounts of total hydrocarbon exposure or potentially stressful job experiences had an increased prevalence of depression and PTSD. These findings provide evidence that response and clean-up work is associated with adverse psychological effects and suggest the need for mental health services both before and after the event. FUNDING: National Institutes of Health (NIH) Common Fund and the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences.

The Centers for Disease Control and Prevention: Findings From The National Healthy Worksite Program.

OBJECTIVE: To evaluate employers' implementation of evidence-based interventions, and changes in employees' behaviors associated with participating in the national healthy worksite program (NHWP). METHODS: NHWP recruited 100 small and mid-sized employers and provided training and support for 18 months. Outcome measures were collected with an employer questionnaire, an employee survey, and biometric data at baseline and 18 months later. RESULTS: The 41 employers who completed the NHWP implemented significantly more evidence-based interventions and had more comprehensive worksite health promotion programs after participating. Employees made significant improvements in physical activity and nutritional behaviors, but did not significantly improve employee weight. CONCLUSIONS: Training and technical support can help small and mid-sized employers implement evidence-based health interventions to promote positive employee behavior changes. A longer follow up period may be needed to assess whether NHWP led to improvements in clinical outcomes.

Integrating Community Health Workers (CHWs) into Health Care Organizations.

Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.

Why Does Disaster Recovery Work Influence Mental Health?: Pathways through Physical Health and Household Income.

Disaster recovery work increases risk for mental health problems, yet the mechanisms underlying this association are unclear. We explored links from recovery work to post-traumatic stress (PTS), major depression (MD), and generalized anxiety disorder (GAD) symptoms through physical health symptoms and household income in the aftermath of the Deepwater Horizon oil spill. As part of the NIEHS GuLF STUDY, participants (N = 10,141) reported on cleanup work activities, spill-related physical health symptoms, and household income at baseline, and mental health symptoms an average of 14.69 weeks (SD = 16.79) thereafter. Cleanup work participation was associated with higher physical health symptoms, which in turn were associated with higher PTS, MD, and GAD symptoms. Similar pattern of results were found in models including workers only and investigating the influence of longer work duration and higher work-related oil exposure on mental health symptoms. In addition, longer worker duration and higher work-related oil exposure were associated with higher household income, which in turn was associated with lower MD and GAD symptoms. These findings suggest that physical health symptoms contribute to workers' risk for mental health symptoms, while higher household income, potentially from more extensive work, might mitigate risk.

Differences in Hospital Managers', Unit Managers', and Health Care Workers' Perceptions of the Safety Climate for Respiratory Protection.

This article compares hospital managers' (HM), unit managers' (UM), and health care workers' (HCW) perceptions of respiratory protection safety climate in acute care hospitals. The article is based on survey responses from 215 HMs, 245 UMs, and 1,105 HCWs employed by 98 acute care hospitals in six states. Ten survey questions assessed five of the key dimensions of safety climate commonly identified in the literature: managerial commitment to safety, management feedback on safety procedures, coworkers' safety norms, worker involvement, and worker safety training. Clinically and statistically significant differences were found across the three respondent types. HCWs had less positive perceptions of management commitment, worker involvement, and safety training aspects of safety climate than HMs and UMs. UMs had more positive perceptions of management's supervision of HCWs' respiratory protection practices. Implications for practice improvements indicate the need for frontline HCWs' inclusion in efforts to reduce safety climate barriers and better support effective respiratory protection programs and daily health protection practices.

Mental health service use by cleanup workers in the aftermath of the Deepwater Horizon oil spill.

High rates of mental health (MH) problems have been documented among disaster relief workers. However, few workers utilize MH services, and predictors of service use among this group remain unexplored. The purpose of this study was to explore associations between predisposing, illness-related, and enabling factors from Andersen's behavioral model of treatment-seeking and patterns of service use among participants who completed at least one full day of cleanup work after the Deepwater Horizon oil spill and participated in home visits for the NIEHS GuLF STUDY (N = 8931). Workers reported on MH symptoms and whether they had used counseling or medication for MH problems since the oil spill. Hierarchical logistic regression models explored associations between predictors and counseling and medication use in the full sample, and type of use (counseling only, medication only, both) among participants who used either service. Analyses were replicated for subsamples of participants with and without symptom inventory scores suggestive of probable post-disaster mental illness. Having a pre-spill MH diagnosis, pre-spill service use, more severe post-spill MH symptoms, and healthcare coverage were positively associated with counseling and medication use in the full sample. Among participants who used either service, non-Hispanic Black race, pre-spill counseling, lower depression, and not identifying a personal doctor or healthcare provider were predictive of counseling only, whereas older age, female gender and pre-spill medication were predictive of medication only. The results were generally consistent among participants with and without probable post-disaster mental illness. The results suggest variability in which factors within Andersen's behavioral model are predictive of different patterns of service use among disaster relief workers.

Structuring agency: examining healthcare management in the USA and Australia using organizational theory.

PURPOSE: Since the 1970s, the healthcare industry has undergone significant changes. Using neo-institutional and resource dependency theories, the purpose of this paper is to explore how managers perceive constraint and enact agency amidst these historic challenges--perhaps most significantly, declining funding and increasing regulation. DESIGN/METHODOLOGY/APPROACH: The data come from ten interviews with healthcare managers, spanning for-profit, non-profit, and government legal forms and hospital and nursing home sub-industries in both Queensland, Australia and North Carolina, USA. The authors look for patterns across the interviews. FINDINGS: The paper shows that governments and umbrella "parent" organizations force managers to adhere to institutional expectations in exchange for resource investment. Managers navigate these environmental obstacles using a shared business-minded approach and competitive differentiation. Yet various interest groups--including front-line workers, physicians, and patients--challenge this paradigm, as they demand a focus on quality of care. Managers' efforts are likewise curbed by the very resource and institutional pressures they resist. ORIGINALITY/VALUE: The authors understand changes in the healthcare industry as resulting from an increasingly powerful managerial logic, at odds with traditional professional and societal values. Interest groups are best positioned to challenge this logic.