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value="z-author">Z-A By Author</option><option value="asc">Date Ascending</option><option value="desc">Date Descending</option></select></div></div><input type="hidden" name="start" form="facetForm" value="0"/></div><section class="c-scholworks"><div class="c-scholworks__main-column"><ul class="c-scholworks__tag-list"><li class="c-scholworks__tag-article">Article</li><li class="c-scholworks__tag-peer">Peer Reviewed</li></ul><div><h3 class="c-scholworks__heading"><a href="/uc/item/6fg3t0z2"><div class="c-clientmarkup">Trends in access to care among rural patients served at HRSA鈥恌unded health centers</div></a></h3></div><div class="c-authorlist"><ul class="c-authorlist__list"><li class="c-authorlist__begin"><a href="/search/?q=author%3APourat%2C%20Nadereh">Pourat, Nadereh</a>; </li><li><a href="/search/?q=author%3ALu%2C%20Connie">Lu, Connie</a>; </li><li><a href="/search/?q=author%3AChen%2C%20Xiao">Chen, Xiao</a>; </li><li><a href="/search/?q=author%3AZhou%2C%20Weihao">Zhou, Weihao</a>; </li><li><a href="/search/?q=author%3AHair%2C%20Brionna">Hair, Brionna</a>; </li><li><a href="/search/?q=author%3ABolton%2C%20Joshua">Bolton, Joshua</a>; </li><li class="c-authorlist__end"><a href="/search/?q=author%3ASripipatana%2C%20Alek">Sripipatana, Alek</a> </li></ul></div><div class="c-scholworks__publication"><a href="/uc/ucla_postprints">UCLA Previously Published Works</a> (2022)</div><div class="c-scholworks__abstract"><div class="c-clientmarkup"><h3>Purpose</h3>Nearly one-fifth of Americans live in rural areas and experience multiple socioeconomic and health disparities. Health Resources and Services Administration (HRSA)-funded health centers (HCs) provide comprehensive primary care in rural communities. However, no prior research has examined trends in access to care in rural HC patients. We examined the change in access to care among patients served at rural HRSA-funded HCs in the United States between 2009 and 2014.<h3>Methods</h3>We compared patients by year to examine measures of access using multilevel generalized structural equation logistic regression models with random effects. We used the 2009 and 2014 cross-sectional Health Center Patient Surveys and identified 2,625 adult rural HC patients. Dependent variables were subjective (unmet need/delay in medical care, mental health, dental care, and prescription medications) and objective measures (preventive care and other health care utilization) in access to care. Our independent variable of interest was time, comparing access in 2009 and 2014.<h3>Results</h3>Rural HC patients reported higher predicted probability of influenza vaccine receipt (37% vs 51%), and lower unmet (25% vs 14%) and delayed medical care (36% vs 18%) between 2009 and 2014. Any emergency department visits in the last year increased (32% vs 46%) and mammogram (70% vs 55%) and Pap test (83% vs 72%) screening rates decreased.<h3>Conclusions</h3>Observed increases in access to care among rural HC patients are positive developments but the challenges to access care still persist. Remote services, such as telehealth, could be cost-effective means of improving access to care among rural patients with limited provider supply.</div></div><div class="c-scholworks__media"><ul class="c-medialist"></ul></div></div></section><section class="c-scholworks"><div class="c-scholworks__main-column"><ul class="c-scholworks__tag-list"><li class="c-scholworks__tag-article">Article</li><li class="c-scholworks__tag-peer">Peer Reviewed</li></ul><div><h3 class="c-scholworks__heading"><a href="/uc/item/4hd74686"><div class="c-clientmarkup">The role of dentist supply, need for care and long鈥恡erm continuity in Health Resources and Services Administration鈥恌unded health centres in the United States</div></a></h3></div><div class="c-authorlist"><ul class="c-authorlist__list"><li class="c-authorlist__begin"><a href="/search/?q=author%3APourat%2C%20Nadereh">Pourat, Nadereh</a>; </li><li><a href="/search/?q=author%3AChen%2C%20Xiao">Chen, Xiao</a>; </li><li><a href="/search/?q=author%3ALu%2C%20Connie">Lu, Connie</a>; </li><li><a href="/search/?q=author%3AZhou%2C%20Weihao">Zhou, Weihao</a>; </li><li><a href="/search/?q=author%3AHoang%2C%20Hank">Hoang, Hank</a>; </li><li><a href="/search/?q=author%3AHair%2C%20Brionna">Hair, Brionna</a>; </li><li><a href="/search/?q=author%3ABolton%2C%20Joshua">Bolton, Joshua</a>; </li><li class="c-authorlist__end"><a href="/search/?q=author%3ASripipatana%2C%20Alek">Sripipatana, Alek</a> </li></ul></div><div class="c-scholworks__publication"><a href="/uc/ucla_postprints">UCLA Previously Published Works</a> (2021)</div><div class="c-scholworks__abstract"><div class="c-clientmarkup"><h3>Objectives</h3>Health Resources and Services Administration-funded health centres (HCs) are an important source of dental services for low-income and vulnerable patients in the United States. About 82% of HCs in 2018 had dental workforce, but it is unclear whether this workforce meets the oral health needs of HC patients. Thus, we first examined (a) whether dental workforce was associated with any dental visits vs none and (b) whether HC patients with any visits were more likely to have a visit at the HC vs elsewhere. We then examined (c) if need for oral health care and long-term continuity at the HC were associated with dental visits and visits at the HC.<h3>Methods</h3>This study used the 2014 Health Center Patient Survey, a nationally representative study of US HC patients, and the 2013 Uniform Data System, an administrative dataset of HC characteristics. We also used the 2013 Area Health Resource File to measure the contribution of local supply of dentists. We included working-age adult patients (n = 5006) and used multilevel structural equation models with Poisson specification.<h3>Results</h3>Larger dental workforce at the HC was significantly associated with 1% higher likelihood (relative risk [RR]: 1.01, 1.00-1.02) of any visits and 10% higher likelihood of a visit at the HC among those with a visit (RR: 1.10, 1.06-1.14). Patient self-reported oral health need was positively associated with 157% higher likelihood of dental visits (RR: 2.57, 2.29-2.88), and 42% higher likelihood of dental visit at the HC vs elsewhere (RR: 1.42, 1.19-1.69). Long-term continuity with the HC was not significantly associated with likelihood of dental visits, but was associated with 26% higher likelihood of visits at the HC among those who had any visits (RR: 1.26, 1.02-1.56).<h3>Discussion</h3>The findings highlight the potential impact of increasing dental workforce at HCs to promote access; the high level of need for oral health care at HCs; and the increased effort required to promote access among newer patients who may be less familiar with the availability of oral health care at HCs. Together, these findings reinforce the importance of addressing barriers of use of oral health services among low-income and uninsured patients.</div></div><div class="c-scholworks__media"><ul class="c-medialist"></ul></div></div></section><section class="c-scholworks"><div class="c-scholworks__main-column"><ul class="c-scholworks__tag-list"><li class="c-scholworks__tag-article">Article</li><li class="c-scholworks__tag-peer">Peer Reviewed</li></ul><div><h3 class="c-scholworks__heading"><a href="/uc/item/8w35h9b5"><div class="c-clientmarkup">Ensuring Equitable Care in Diabetes Management Among Patients of Health Resources & Services Administration-Funded Health Centers in the United States.</div></a></h3></div><div class="c-authorlist"><ul class="c-authorlist__list"><li class="c-authorlist__begin"><a href="/search/?q=author%3APourat%2C%20Nadereh">Pourat, Nadereh</a>; </li><li><a href="/search/?q=author%3AChen%2C%20Xiao">Chen, Xiao</a>; </li><li><a href="/search/?q=author%3ALu%2C%20Connie">Lu, Connie</a>; </li><li><a href="/search/?q=author%3AZhou%2C%20Weihao">Zhou, Weihao</a>; </li><li><a href="/search/?q=author%3AHair%2C%20Brionna">Hair, Brionna</a>; </li><li><a href="/search/?q=author%3ABolton%2C%20Joshua">Bolton, Joshua</a>; </li><li class="c-authorlist__end"><a href="/search/?q=author%3ASripipatana%2C%20Alek">Sripipatana, Alek</a> </li></ul></div><div class="c-scholworks__publication"><a href="/uc/ucla_postprints">UCLA Previously Published Works</a> (2023)</div><div class="c-scholworks__abstract"><div class="c-clientmarkup">AIM: To explore whether there are racial/ethnic differences in diabetes management and outcomes among adult health center (HC) patients with type 2 diabetes. METHODS: We analyzed data from the 2014 Health Center Patient Survey, a national sample of HC patients. We examined indicators of diabetes monitoring (A1C testing, annual foot/eye doctor visits, and cholesterol checks) and care management (specialist referrals, individual treatment plan, and receipt of calls/appointments/home visits). We also examined diabetes-specific outcomes (blood glucose levels, diabetes-related emergency department [ED] visits/hospitalizations, and diabetes self-management confidence) and general outcomes (number of doctor visits, ED visits, and hospitalizations). We used multilevel logistic regression models to examine racial/ethnic disparities by the above indicators. RESULTS: We found racial/ethnic parity in A1C testing, eye doctor visits, and diabetes-specific outcomes. However, Hispanics/Latinos (odds ratio [OR] 0.26), non-Hispanic African Americans (OR 0.25), and Asians (OR 0.11) were less likely to receive a cholesterol check than Whites. Non-Hispanic African Americans (OR 0.43) were less likely to have frequent doctor visits, while Hispanic/Latino patients (OR 0.45) were less likely to receive an individual treatment plan. CONCLUSION: HCs largely provide equitable diabetes care but have room for improvement in some indicators. Tailored efforts such as culturally competent care and health education for some racial/ethnic groups may be needed to improve diabetes management and outcomes.</div></div><div class="c-scholworks__media"><ul class="c-medialist"></ul></div></div><div class="c-scholworks__ancillary"><a class="c-scholworks__thumbnail" href="/uc/item/8w35h9b5"><img src="/cms-assets/b8dbe30e956b6ac2164f5dc941a7c6f49b12c10cc9709dd3a574e333b7a9b2e5" alt="Cover page: Ensuring Equitable Care in Diabetes Management Among Patients of Health Resources &amp; Services Administration-Funded Health Centers in the United States."/></a></div></section><section class="c-scholworks"><div class="c-scholworks__main-column"><ul class="c-scholworks__tag-list"><li class="c-scholworks__tag-article">Article</li><li class="c-scholworks__tag-peer">Peer Reviewed</li></ul><div><h3 class="c-scholworks__heading"><a href="/uc/item/9k52r0ct"><div class="c-clientmarkup">Intersection of complexity and high utilization among health center patients aged 18 to 64 years.</div></a></h3></div><div class="c-authorlist"><ul class="c-authorlist__list"><li class="c-authorlist__begin"><a href="/search/?q=author%3APourat%2C%20Nadereh">Pourat, Nadereh</a>; </li><li><a href="/search/?q=author%3AChen%2C%20Xiao">Chen, Xiao</a>; </li><li><a href="/search/?q=author%3ATsugawa%2C%20Yusuke">Tsugawa, Yusuke</a>; </li><li><a href="/search/?q=author%3ALu%2C%20Connie">Lu, Connie</a>; </li><li><a href="/search/?q=author%3AZhou%2C%20Weihao">Zhou, Weihao</a>; </li><li><a href="/search/?q=author%3AHoang%2C%20Hank">Hoang, Hank</a>; </li><li><a href="/search/?q=author%3AHair%2C%20Brionna">Hair, Brionna</a>; </li><li><a href="/search/?q=author%3ABolton%2C%20Joshua">Bolton, Joshua</a>; </li><li class="c-authorlist__end"><a href="/search/?q=author%3ASripipatana%2C%20Alex">Sripipatana, Alex</a> </li></ul></div><div class="c-scholworks__publication"><a href="/uc/ucla_postprints">UCLA Previously Published Works</a> (2022)</div><div class="c-scholworks__abstract"><div class="c-clientmarkup"><h3>Objectives</h3>Existing literature indicates that multimorbidity, mental health (MH) conditions, substance use disorders (SUDs), and social determinants of health are hallmarks of high-need, high-cost patients. Health Resources and Services Administration-funded health centers (HCs) provide care to nearly 30 million patients, but data on their patients' complexity and utilization patterns are limited. We identified subgroups of HC patients based on latent concepts of complexity and utilization.<h3>Study design</h3>We used cross-sectional national data from the 2014 Health Center Patient Survey and latent class analyses to identify distinct and homogenous groups of complex high-utilizing patients aged 18 to 64 years.<h3>Methods</h3>We included indicators of chronic conditions (CCs), MH, SUD risk, and health behavior to measure complexity. We used number of outpatient and emergency department visits in the past year to measure utilization.<h3>Results</h3>HC patients were separated in 9 distinct groups based on 3 complexity latent classes (MH, multiple CCs, and low risk) and 3 utilization classes (low, high, and superutilizers). Conditions associated with each subgroup differed. The highest prevalence of bipolar disorder (45%) and high SUD risk (6%) was observed among MH superutilizers, whereas the highest prevalence of cardiovascular disease (48%) and obesity (96%) was seen among CC superutilizers. Most MH superutilizer patients concurrently had MH conditions and obesity and were smokers, but most CC superutilizer patients concurrently had hypertension, obesity, and cardiovascular disease.<h3>Conclusions</h3>Our examination of complexity and utilization indicated distinct HC patient populations. Managing the care of each group may require different targeted intervention approaches such as multidisciplinary care teams that include MH providers or specialists.</div></div><div class="c-scholworks__media"><ul class="c-medialist"></ul></div></div></section><section class="c-scholworks"><div class="c-scholworks__main-column"><ul class="c-scholworks__tag-list"><li class="c-scholworks__tag-article">Article</li><li class="c-scholworks__tag-peer">Peer Reviewed</li></ul><div><h3 class="c-scholworks__heading"><a href="/uc/item/6f73j3xz"><div class="c-clientmarkup">Mental Health Staffing at HRSA-Funded Health Centers May Improve Access to Care</div></a></h3></div><div class="c-authorlist"><ul class="c-authorlist__list"><li class="c-authorlist__begin"><a href="/search/?q=author%3ABonilla%2C%20Amy%20G">Bonilla, Amy G</a>; </li><li><a href="/search/?q=author%3APourat%2C%20Nadereh">Pourat, Nadereh</a>; </li><li><a href="/search/?q=author%3AChuang%2C%20Emmeline">Chuang, Emmeline</a>; </li><li><a href="/search/?q=author%3AEttner%2C%20Susan">Ettner, Susan</a>; </li><li><a href="/search/?q=author%3AZima%2C%20Bonnie">Zima, Bonnie</a>; </li><li><a href="/search/?q=author%3AChen%2C%20Xiao">Chen, Xiao</a>; </li><li><a href="/search/?q=author%3ALu%2C%20Connie">Lu, Connie</a>; </li><li><a href="/search/?q=author%3AHoang%2C%20Hank">Hoang, Hank</a>; </li><li><a href="/search/?q=author%3AHair%2C%20Brionna%20Y">Hair, Brionna Y</a>; </li><li><a href="/search/?q=author%3ABolton%2C%20Joshua">Bolton, Joshua</a>; </li><li class="c-authorlist__end"><a href="/search/?q=author%3ASripipatana%2C%20Alek">Sripipatana, Alek</a> </li></ul></div><div class="c-scholworks__publication"><a href="/uc/ucla_postprints">UCLA Previously Published Works</a> (2021)</div><div class="c-scholworks__abstract"><div class="c-clientmarkup"><h3>Objective</h3>The study objective was to examine the association between mental health staffing at health centers funded by the Health Resources and Services Administration (HRSA) and patients' receipt of mental health treatment.<h3>Methods</h3>Data were from the 2014 HRSA-funded Health Center Patient Survey and the 2013 Uniform Data System. Colocation of any mental health staff, including psychiatrists, psychologists, and other licensed staff, was examined. The outcomes of interest were whether a patient received any mental treatment and received any such treatment on site (at the health center). Analyses were conducted with multilevel generalized structural equation logistic regression models for 4,575 patients ages 18-64.<h3>Results</h3>Patients attending health centers with at least one mental health full-time equivalent (FTE) per 2,000 patients had a higher predicted probability of receiving mental health treatment (32%) compared with those attending centers with fewer than one such FTE (24%) or no such staffing (22%). Among patients who received this treatment, those at health centers with no staffing had a significantly lower predicted probability of receiving such treatment on site (28%), compared with patients at health centers with fewer than one such FTE (49%) and with at least one such FTE (65%). The predicted probability of receiving such treatment on site was significantly higher if there was a colocated psychiatrist versus no psychiatrist (58% versus 40%).<h3>Conclusions</h3>Colocating mental health staff at health centers increases the probability of patients' access to such treatment on site as well as from off-site providers.</div></div><div class="c-scholworks__media"><ul class="c-medialist"></ul></div></div></section></section></main></form></div><div><div class="c-toplink"><a href="javascript:window.scrollTo(0, 0)">Top</a></div><footer class="c-footer"><nav class="c-footer__nav"><ul><li><a href="/">Home</a></li><li><a href="/aboutEschol">About eScholarship</a></li><li><a href="/campuses">Campus Sites</a></li><li><a href="/ucoapolicies">UC Open Access Policy</a></li><li><a href="/publishing">eScholarship Publishing</a></li><li><a href="https://www.cdlib.org/about/accessibility.html">Accessibility</a></li><li><a href="/privacypolicy">Privacy Statement</a></li><li><a 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Riverside"},{"id":"ucsd","name":"UC San Diego"},{"id":"ucsf","name":"UCSF"},{"id":"ucsb","name":"UC Santa Barbara"},{"id":"ucsc","name":"UC Santa Cruz"},{"id":"ucop","name":"UC Office of the President"},{"id":"lbnl","name":"Lawrence Berkeley National Laboratory"},{"id":"anrcs","name":"UC Agriculture & Natural Resources"}],"logo":null,"bgColor":null,"elColor":null,"directSubmit":null,"directSubmitURL":null,"directManageURLauthor":null,"directManageURLeditor":null,"nav_bar":[{"id":1,"name":"About eScholarship","type":"folder","sub_nav":[{"id":5,"name":"About eScholarship","slug":"aboutEschol","type":"page","url":"/aboutEschol"},{"id":11,"name":"eScholarship Repository","slug":"repository","type":"page","url":"/repository"},{"id":28,"url":"/publishing","name":"eScholarship Publishing","type":"link"},{"id":29,"name":"Site policies","slug":"policies","type":"page","url":"/policies"},{"id":13,"name":"Terms of Use and Copyright Information","slug":"terms","type":"page","url":"/terms"},{"id":26,"name":"Coming soon","slug":"comingSoon","type":"page","hidden":true,"url":"/comingSoon"},{"id":27,"name":"Privacy statement","slug":"privacyPolicy","type":"page","url":"/privacyPolicy"}]},{"id":2,"name":"Campus Sites","type":"folder","sub_nav":[{"id":15,"url":"/uc/ucb","name":"UC Berkeley","type":"link"},{"id":16,"url":"/uc/ucd","name":"UC Davis","type":"link"},{"id":17,"url":"/uc/uci","name":"UC Irvine","type":"link"},{"id":6,"url":"/uc/ucla","name":"UCLA","type":"link"},{"id":18,"url":"/uc/ucm","name":"UC Merced","type":"link"},{"id":19,"url":"/uc/ucr","name":"UC Riverside","type":"link"},{"id":20,"url":"/uc/ucsd","name":"UC San Diego","type":"link"},{"id":9,"url":"/uc/ucsf","name":"UCSF","type":"link"},{"id":21,"url":"/uc/ucsb","name":"UC Santa Barbara","type":"link"},{"id":22,"url":"/uc/ucsc","name":"UC Santa Cruz","type":"link"},{"id":23,"url":"/uc/ucop","name":"UC Office of the President","type":"link"},{"id":24,"url":"/uc/lbnl","name":"Lawrence Berkeley National Laboratory","type":"link"},{"id":25,"url":"/uc/anrcs","name":"UC Agriculture & Natural Resources","type":"link"}]},{"id":10,"name":"UC Open Access Policies","slug":"ucoapolicies","type":"page","url":"/ucoapolicies"},{"id":12,"name":"eScholarship Publishing","slug":"publishing","type":"page","url":"/publishing"}],"social":{"facebook":null,"twitter":null,"rss":"/rss/unit/root"},"breadcrumb":[{"name":"eScholarship","id":"root","url":"/"}]},"campuses":[{"id":"","name":"eScholarship at..."},{"id":"ucb","name":"UC Berkeley"},{"id":"ucd","name":"UC Davis"},{"id":"uci","name":"UC Irvine"},{"id":"ucla","name":"UCLA"},{"id":"ucm","name":"UC Merced"},{"id":"ucr","name":"UC Riverside"},{"id":"ucsd","name":"UC San Diego"},{"id":"ucsf","name":"UCSF"},{"id":"ucsb","name":"UC Santa Barbara"},{"id":"ucsc","name":"UC Santa Cruz"},{"id":"ucop","name":"UC Office of the President"},{"id":"lbnl","name":"Lawrence Berkeley National Laboratory"},{"id":"anrcs","name":"UC Agriculture & Natural Resources"}],"query":{"q":"author:Bolton, Joshua","sort":"rel","rows":"10","info_start":"0","start":"0","filters":{}},"count":5,"info_count":0,"infoResults":[],"searchResults":[{"id":"qt6fg3t0z2","title":"Trends in access to care among rural patients served at HRSA\u2010funded health centers","abstract":"<h4>Purpose</h4>Nearly one-fifth of Americans live in rural areas and experience multiple socioeconomic and health disparities. Health Resources and Services Administration (HRSA)-funded health centers (HCs) provide comprehensive primary care in rural communities. However, no prior research has examined trends in access to care in rural HC patients. We examined the change in access to care among patients served at rural HRSA-funded HCs in the United States between 2009 and 2014.<h4>Methods</h4>We compared patients by year to examine measures of access using multilevel generalized structural equation logistic regression models with random effects. We used the 2009 and 2014 cross-sectional Health Center Patient Surveys and identified 2,625 adult rural HC patients. Dependent variables were subjective (unmet need/delay in medical care, mental health, dental care, and prescription medications) and objective measures (preventive care and other health care utilization) in access to care. Our independent variable of interest was time, comparing access in 2009 and 2014.<h4>Results</h4>Rural HC patients reported higher predicted probability of influenza vaccine receipt (37% vs 51%), and lower unmet (25% vs 14%) and delayed medical care (36% vs 18%) between 2009 and 2014. Any emergency department visits in the last year increased (32% vs 46%) and mammogram (70% vs 55%) and Pap test (83% vs 72%) screening rates decreased.<h4>Conclusions</h4>Observed increases in access to care among rural HC patients are positive developments but the challenges to access care still persist. Remote services, such as telehealth, could be cost-effective means of improving access to care among rural patients with limited provider supply.","content_type":null,"author_hide":null,"authors":[{"name":"Pourat, Nadereh","email":"pourat@ucla.edu","fname":"Nadereh","lname":"Pourat"},{"name":"Lu, Connie","fname":"Connie","lname":"Lu"},{"name":"Chen, Xiao","fname":"Xiao","lname":"Chen"},{"name":"Zhou, Weihao","fname":"Weihao","lname":"Zhou"},{"name":"Hair, Brionna","fname":"Brionna","lname":"Hair"},{"name":"Bolton, Joshua","fname":"Joshua","lname":"Bolton"},{"name":"Sripipatana, Alek","fname":"Alek","lname":"Sripipatana"}],"supp_files":[{"type":"pdf","count":0},{"type":"image","count":0},{"type":"video","count":0},{"type":"audio","count":0},{"type":"zip","count":0},{"type":"other","count":0}],"thumbnail":null,"pub_year":2022,"genre":"article","rights":null,"peerReviewed":true,"unitInfo":{"displayName":"UCLA Previously Published Works","link_path":"ucla_postprints"}},{"id":"qt4hd74686","title":"The role of dentist supply, need for care and long\u2010term continuity in Health Resources and Services Administration\u2010funded health centres in the United States","abstract":"<h4>Objectives</h4>Health Resources and Services Administration-funded health centres (HCs) are an important source of dental services for low-income and vulnerable patients in the United States. About 82% of HCs in 2018 had dental workforce, but it is unclear whether this workforce meets the oral health needs of HC patients. Thus, we first examined (a) whether dental workforce was associated with any dental visits vs none and (b) whether HC patients with any visits were more likely to have a visit at the HC vs elsewhere. We then examined (c) if need for oral health care and long-term continuity at the HC were associated with dental visits and visits at the HC.<h4>Methods</h4>This study used the 2014 Health Center Patient Survey, a nationally representative study of US HC patients, and the 2013 Uniform Data System, an administrative dataset of HC characteristics. We also used the 2013 Area Health Resource File to measure the contribution of local supply of dentists. We included working-age adult patients (n = 5006) and used multilevel structural equation models with Poisson specification.<h4>Results</h4>Larger dental workforce at the HC was significantly associated with 1% higher likelihood (relative risk [RR]: 1.01, 1.00-1.02) of any visits and 10% higher likelihood of a visit at the HC among those with a visit (RR: 1.10, 1.06-1.14). Patient self-reported oral health need was positively associated with 157% higher likelihood of dental visits (RR: 2.57, 2.29-2.88), and 42% higher likelihood of dental visit at the HC vs elsewhere (RR: 1.42, 1.19-1.69). Long-term continuity with the HC was not significantly associated with likelihood of dental visits, but was associated with 26% higher likelihood of visits at the HC among those who had any visits (RR: 1.26, 1.02-1.56).<h4>Discussion</h4>The findings highlight the potential impact of increasing dental workforce at HCs to promote access; the high level of need for oral health care at HCs; and the increased effort required to promote access among newer patients who may be less familiar with the availability of oral health care at HCs. Together, these findings reinforce the importance of addressing barriers of use of oral health services among low-income and uninsured patients.","content_type":null,"author_hide":null,"authors":[{"name":"Pourat, Nadereh","email":"pourat@ucla.edu","fname":"Nadereh","lname":"Pourat"},{"name":"Chen, Xiao","fname":"Xiao","lname":"Chen"},{"name":"Lu, Connie","fname":"Connie","lname":"Lu"},{"name":"Zhou, Weihao","fname":"Weihao","lname":"Zhou"},{"name":"Hoang, Hank","fname":"Hank","lname":"Hoang"},{"name":"Hair, Brionna","fname":"Brionna","lname":"Hair"},{"name":"Bolton, Joshua","fname":"Joshua","lname":"Bolton"},{"name":"Sripipatana, Alek","fname":"Alek","lname":"Sripipatana"}],"supp_files":[{"type":"pdf","count":0},{"type":"image","count":0},{"type":"video","count":0},{"type":"audio","count":0},{"type":"zip","count":0},{"type":"other","count":0}],"thumbnail":null,"pub_year":2021,"genre":"article","rights":null,"peerReviewed":true,"unitInfo":{"displayName":"UCLA Previously Published Works","link_path":"ucla_postprints"}},{"id":"qt8w35h9b5","title":"Ensuring Equitable Care in Diabetes Management Among Patients of Health Resources & Services Administration-Funded Health Centers in the United States.","abstract":"AIM: To explore whether there are racial/ethnic differences in diabetes management and outcomes among adult health center (HC) patients with type 2 diabetes. METHODS: We analyzed data from the 2014 Health Center Patient Survey, a national sample of HC patients. We examined indicators of diabetes monitoring (A1C testing, annual foot/eye doctor visits, and cholesterol checks) and care management (specialist referrals, individual treatment plan, and receipt of calls/appointments/home visits). We also examined diabetes-specific outcomes (blood glucose levels, diabetes-related emergency department [ED] visits/hospitalizations, and diabetes self-management confidence) and general outcomes (number of doctor visits, ED visits, and hospitalizations). We used multilevel logistic regression models to examine racial/ethnic disparities by the above indicators. RESULTS: We found racial/ethnic parity in A1C testing, eye doctor visits, and diabetes-specific outcomes. However, Hispanics/Latinos (odds ratio [OR] 0.26), non-Hispanic African Americans (OR 0.25), and Asians (OR 0.11) were less likely to receive a cholesterol check than Whites. Non-Hispanic African Americans (OR 0.43) were less likely to have frequent doctor visits, while Hispanic/Latino patients (OR 0.45) were less likely to receive an individual treatment plan. CONCLUSION: HCs largely provide equitable diabetes care but have room for improvement in some indicators. Tailored efforts such as culturally competent care and health education for some racial/ethnic groups may be needed to improve diabetes management and outcomes.","content_type":"application/pdf","author_hide":null,"authors":[{"name":"Pourat, Nadereh","email":"pourat@ucla.edu","fname":"Nadereh","lname":"Pourat"},{"name":"Chen, Xiao","fname":"Xiao","lname":"Chen"},{"name":"Lu, Connie","fname":"Connie","lname":"Lu"},{"name":"Zhou, Weihao","fname":"Weihao","lname":"Zhou"},{"name":"Hair, Brionna","fname":"Brionna","lname":"Hair"},{"name":"Bolton, Joshua","fname":"Joshua","lname":"Bolton"},{"name":"Sripipatana, Alek","fname":"Alek","lname":"Sripipatana"}],"supp_files":[{"type":"pdf","count":0},{"type":"image","count":0},{"type":"video","count":0},{"type":"audio","count":0},{"type":"zip","count":0},{"type":"other","count":0}],"thumbnail":{"width":121,"height":179,"asset_id":"b8dbe30e956b6ac2164f5dc941a7c6f49b12c10cc9709dd3a574e333b7a9b2e5","timestamp":1733931783,"image_type":"png"},"pub_year":2023,"genre":"article","rights":null,"peerReviewed":true,"unitInfo":{"displayName":"UCLA Previously Published Works","link_path":"ucla_postprints"}},{"id":"qt9k52r0ct","title":"Intersection of complexity and high utilization among health center patients aged 18 to 64 years.","abstract":"<h4>Objectives</h4>Existing literature indicates that multimorbidity, mental health (MH) conditions, substance use disorders (SUDs), and social determinants of health are hallmarks of high-need, high-cost patients. Health Resources and Services Administration-funded health centers (HCs) provide care to nearly 30 million patients, but data on their patients' complexity and utilization patterns are limited. We identified subgroups of HC patients based on latent concepts of complexity and utilization.<h4>Study design</h4>We used cross-sectional national data from the 2014 Health Center Patient Survey and latent class analyses to identify distinct and homogenous groups of complex high-utilizing patients aged 18 to 64 years.<h4>Methods</h4>We included indicators of chronic conditions (CCs), MH, SUD risk, and health behavior to measure complexity. We used number of outpatient and emergency department visits in the past year to measure utilization.<h4>Results</h4>HC patients were separated in 9 distinct groups based on 3 complexity latent classes (MH, multiple CCs, and low risk) and 3 utilization classes (low, high, and superutilizers). Conditions associated with each subgroup differed. The highest prevalence of bipolar disorder (45%) and high SUD risk (6%) was observed among MH superutilizers, whereas the highest prevalence of cardiovascular disease (48%) and obesity (96%) was seen among CC superutilizers. Most MH superutilizer patients concurrently had MH conditions and obesity and were smokers, but most CC superutilizer patients concurrently had hypertension, obesity, and cardiovascular disease.<h4>Conclusions</h4>Our examination of complexity and utilization indicated distinct HC patient populations. Managing the care of each group may require different targeted intervention approaches such as multidisciplinary care teams that include MH providers or specialists.","content_type":null,"author_hide":null,"authors":[{"name":"Pourat, Nadereh","email":"pourat@ucla.edu","fname":"Nadereh","lname":"Pourat"},{"name":"Chen, Xiao","fname":"Xiao","lname":"Chen"},{"name":"Tsugawa, Yusuke","fname":"Yusuke","lname":"Tsugawa"},{"name":"Lu, Connie","fname":"Connie","lname":"Lu"},{"name":"Zhou, Weihao","fname":"Weihao","lname":"Zhou"},{"name":"Hoang, Hank","fname":"Hank","lname":"Hoang"},{"name":"Hair, Brionna","fname":"Brionna","lname":"Hair"},{"name":"Bolton, Joshua","fname":"Joshua","lname":"Bolton"},{"name":"Sripipatana, Alex","fname":"Alex","lname":"Sripipatana"}],"supp_files":[{"type":"pdf","count":0},{"type":"image","count":0},{"type":"video","count":0},{"type":"audio","count":0},{"type":"zip","count":0},{"type":"other","count":0}],"thumbnail":null,"pub_year":2022,"genre":"article","rights":null,"peerReviewed":true,"unitInfo":{"displayName":"UCLA Previously Published Works","link_path":"ucla_postprints"}},{"id":"qt6f73j3xz","title":"Mental Health Staffing at HRSA-Funded Health Centers May Improve Access to Care","abstract":"<h4>Objective</h4>The study objective was to examine the association between mental health staffing at health centers funded by the Health Resources and Services Administration (HRSA) and patients' receipt of mental health treatment.<h4>Methods</h4>Data were from the 2014 HRSA-funded Health Center Patient Survey and the 2013 Uniform Data System. Colocation of any mental health staff, including psychiatrists, psychologists, and other licensed staff, was examined. The outcomes of interest were whether a patient received any mental treatment and received any such treatment on site (at the health center). Analyses were conducted with multilevel generalized structural equation logistic regression models for 4,575 patients ages 18-64.<h4>Results</h4>Patients attending health centers with at least one mental health full-time equivalent (FTE) per 2,000 patients had a higher predicted probability of receiving mental health treatment (32%) compared with those attending centers with fewer than one such FTE (24%) or no such staffing (22%). Among patients who received this treatment, those at health centers with no staffing had a significantly lower predicted probability of receiving such treatment on site (28%), compared with patients at health centers with fewer than one such FTE (49%) and with at least one such FTE (65%). The predicted probability of receiving such treatment on site was significantly higher if there was a colocated psychiatrist versus no psychiatrist (58% versus 40%).<h4>Conclusions</h4>Colocating mental health staff at health centers increases the probability of patients' access to such treatment on site as well as from off-site providers.","content_type":null,"author_hide":null,"authors":[{"name":"Bonilla, Amy G","fname":"Amy G","lname":"Bonilla"},{"name":"Pourat, Nadereh","email":"pourat@ucla.edu","fname":"Nadereh","lname":"Pourat","ORCID_id":"0000-0001-5118-1188"},{"name":"Chuang, Emmeline","fname":"Emmeline","lname":"Chuang"},{"name":"Ettner, Susan","fname":"Susan","lname":"Ettner"},{"name":"Zima, Bonnie","email":"bzima@mednet.ucla.edu","fname":"Bonnie","lname":"Zima","ORCID_id":"0000-0002-5542-1879"},{"name":"Chen, Xiao","fname":"Xiao","lname":"Chen"},{"name":"Lu, Connie","fname":"Connie","lname":"Lu"},{"name":"Hoang, Hank","fname":"Hank","lname":"Hoang"},{"name":"Hair, Brionna Y","fname":"Brionna Y","lname":"Hair"},{"name":"Bolton, Joshua","fname":"Joshua","lname":"Bolton"},{"name":"Sripipatana, Alek","fname":"Alek","lname":"Sripipatana"}],"supp_files":[{"type":"pdf","count":0},{"type":"image","count":0},{"type":"video","count":0},{"type":"audio","count":0},{"type":"zip","count":0},{"type":"other","count":0}],"thumbnail":null,"pub_year":2021,"genre":"article","rights":null,"peerReviewed":true,"unitInfo":{"displayName":"UCLA Previously Published Works","link_path":"ucla_postprints"}}],"facets":[{"display":"Type of Work","fieldName":"type_of_work","facets":[{"value":"article","count":5,"displayName":"Article"},{"value":"monograph","count":0,"displayName":"Book"},{"value":"dissertation","count":0,"displayName":"Theses"},{"value":"multimedia","count":0,"displayName":"Multimedia"}]},{"display":"Peer Review","fieldName":"peer_reviewed","facets":[{"value":"1","count":5,"displayName":"Peer-reviewed only"}]},{"display":"Supplemental Material","fieldName":"supp_file_types","facets":[{"value":"video","count":0,"displayName":"Video"},{"value":"audio","count":0,"displayName":"Audio"},{"value":"images","count":0,"displayName":"Images"},{"value":"zip","count":0,"displayName":"Zip"},{"value":"other files","count":0,"displayName":"Other files"}]},{"display":"Publication Year","fieldName":"pub_year","range":{"pub_year_start":null,"pub_year_end":null}},{"display":"Campus","fieldName":"campuses","facets":[{"value":"ucb","count":0,"displayName":"UC Berkeley"},{"value":"ucd","count":0,"displayName":"UC Davis"},{"value":"uci","count":0,"displayName":"UC Irvine"},{"value":"ucla","count":5,"displayName":"UCLA"},{"value":"ucm","count":0,"displayName":"UC Merced"},{"value":"ucr","count":0,"displayName":"UC Riverside"},{"value":"ucsd","count":0,"displayName":"UC San Diego"},{"value":"ucsf","count":0,"displayName":"UCSF"},{"value":"ucsb","count":0,"displayName":"UC Santa Barbara"},{"value":"ucsc","count":0,"displayName":"UC Santa Cruz"},{"value":"ucop","count":0,"displayName":"UC Office of the President"},{"value":"lbnl","count":0,"displayName":"Lawrence Berkeley National Laboratory"},{"value":"anrcs","count":0,"displayName":"UC Agriculture & Natural Resources"}]},{"display":"Department","fieldName":"departments","facets":[]},{"display":"Journal","fieldName":"journals","facets":[]},{"display":"Discipline","fieldName":"disciplines","facets":[]},{"display":"Reuse License","fieldName":"rights","facets":[]}]};</script> <script src="/js/vendors~app-bundle-7424603c338d723fd773.js"></script> <script src="/js/app-bundle-8362e6d7829414ab4baa.js"></script> </body> </html>