Federally Qualified Health Center Penetration Associated With Reduced Community COVID-19 Mortality in Four United States Cities.

BACKGROUND: The COVID-19 pandemic has had significant impacts on health care access and delivery, with disparate effects across social and racial lines. Federally Qualified Health Centers (FQHCs) provide critical primary care services to the nation's most underserved populations, including many communities hardest hit by COVID-19. METHODS: We conducted an ecological analysis that aimed to examine FQHC penetration, COVID-19 mortality, and socio-demographic factors in 4 major United States cities: New York, New York; Chicago, Illinois; Detroit, Michigan; and Seattle, Washington. RESULTS: We found the distribution of COVID-19 cases and mortality varied spatially and in magnitude by city. COVID-19 mortality was significantly higher in communities with higher percentages of low-income residents and higher percentages of racial/ethnic minority residents. FQHC penetration was protective against increased COVID-19 mortality, after model adjustment. CONCLUSIONS: Our study underpins the critical role of safety-net health care and policymakers must ensure investment in long-term sustainability of FQHCs, through strategic deployment of capital, workforce development, and reimbursement reform.

Beyond the bridge: evaluating a novel mental health program in the New York City jail system.

OBJECTIVES: We evaluated Beyond the Bridge, a novel mental health program in the New York City jail system designed to provide residentially based cognitive behavioral therapy in jail mental observation units. METHODS: We used propensity score matching and a dose-response analysis. Outcome measures included reduction in violent incidents and fights, reduction in uses of force by corrections officers, reduction in time spent on suicide watch and incidents of self-injurious behavior, and increased length of community survival. RESULTS: There were significant reductions in all outcomes when we compared program participants (n = 218) with an earlier cohort of patients residing on the mental observation unit before programming began (n = 413). However, when we compared program participants with a cohort of other patients residing on the units at the same time but who chose not to participate (n = 267), only time spent on suicide watch unit (rate ratio [RR] = 0.72; 95% confidence interval [CI] = 0.59, 0.89) and recidivism (RR = 0.70; 95% CI = 0.59,0.83) were significantly reduced. CONCLUSIONS: This evaluation and the model we piloted may provide useful information for other settings contemplating similar interventions.

The challenge of attribution: responsibility for population health in the context of accountable care.

One of the 3 goals for accountable care organizations is to improve population health. This will require that accountable care organizations bridge the schism between clinical care and public health. But do health care delivery organizations and public health agencies share a concept of "population"? We think not: whereas delivery systems define populations in terms of persons receiving care, public health agencies typically measure health on the basis of geography. This creates an attribution problem, particularly in large urban centers, where multiple health care providers often serve any given neighborhood. We suggest potential innovations that could allow urban accountable care organizations to accept accountability, and rewards, for measurably improving population health.