Successful implementation of the Affordable Care Act (ACA) depends on the capacity of local communities to mobilize for action. Yet the literature offers few systematic investigations of what communities are doing to ensure support for enrollment. In this empirical case study, we report implementation and outcomes of Enroll Wyandotte, a community mobilization effort to facilitate enrollment through the ACA in Wyandotte County, Kansas. We describe mobilization activities during the first round of open enrollment in coverage under the ACA (October 1, 2013-March 31, 2014), including the unfolding of community and organizational changes (e.g., new enrollment sites) and services provided to assist enrollment over time. The findings show an association between implementation measures and newly created accounts under the ACA (the primary outcome).
Implementation of the Ebola response was credited with reducing incidence of Ebola virus disease (EVD) in West Africa; however little is known about the amount and kind of Ebola response activities that were ultimately successful in addressing the 2014 outbreak. We collaboratively monitored Ebola response activities and associated effects in Margibi County, Liberia, a rural county in Liberia deeply affected by the outbreak. We used a participatory monitoring and evaluation system, including key informant interviews and document review, to systematically document activities, code them, characterize their contextual features, and discover and communicate patterns in Ebola response activities to essential stakeholders. We also measured incidence of EVD over time. Results showed a distinct pattern in Ebola response activities and key events, which corresponded with subsequent decreased EVD incidence. These data are suggestive of the role of Ebola response activities played in reducing the incidence of EVD within Margibi County, which included implementing safe burials, social mobilization and community engagement and case management. Systematic monitoring and evaluation of response activities to control disease outbreaks holds lessons for implementing and evaluating similar comprehensive and multi-sectoral community health efforts.
Minority individuals experience a disproportionately greater incidence and prevalence of type 2 diabetes. Innovative approaches are needed to reduce health disparities and associated harms among vulnerable populations with diabetes. This thesis examines the effects of the implementation of a coordinated care model with underserved populations in Patient Centered Medical Homes (PCMH) at four sites (Florida, Ohio, Oklahoma, and Tennessee). The model featured diabetes self-management education (DSME) and a patient support intervention delivered within the PCMH context. The components of the comprehensive intervention included DSME, support for managing diabetes and distress, enhanced access and linkage to care, and improvement to quality of care. The primary dependent measures in this study included four clinical health measures-glycosylated hemoglobin (A1C), blood pressure, body mass index, and lipids-and the AADE7 Self-Care Behaviors TM . Coordinated care teams that delivered the intervention included primary care physicians, nurse care coordinators, certified diabetes educators, health behavior coaches, and diabetes patient supporters. Community health workers and medical assistants provided additional individualized support to patients. Care teams provided DSME as well as customized and coordinated patient support within a PCMH setting.This study was part of a larger participatory evaluation of the Bristol-Myers Squibb Foundation's Together on Diabetes initiative. A statistically significant decrease was seen in A1C, the primary clinical health outcome. This decrease was seen across all four implementation sites; ranging from a decrease of 0.4% to 0.9% after 6 months. This improved A1C level was associated with implementation of the DSME and support intervention. Substantial policy and practice changes were also brought about at two of the four PCMH sites. Use of DSME within the PCMH model is a promising strategy for reducing clinical markers for diabetes among vulnerable populations.iv Systems changes, including policy and practice changes, have the potential to have lasting effects within PCMH practice for reducing the burden of diabetes.
Although credited with ultimately reducing incidence of Ebola Virus Disease (EVD) in West Africa, little is known about the amount and kind of Ebola response activities associated with reducing the incidence of EVD. Our team monitored Ebola response activities and associated effects in two rural counties in Liberia highly affected by Ebola. We used a participatory monitoring and evaluation system, and drew upon key informant interviews and document review, to systematically capture, code, characterize, and communicate patterns in Ebola response activities. We reviewed situation reports to obtain data on incidence of EVD over time. Results showed enhanced implementation of Ebola response activities corresponded with decreased incidence of EVD. The pattern of staggered implementation of activities and associated effects-replicated in both counties-is suggestive of the role of Ebola response activities in reducing EVD. Systematic monitoring of response activities to control disease outbreaks holds lessons for implementing and evaluating multi-sector, comprehensive community health efforts.
To address the Ebola outbreak in West Africa, the World Health Organization and the United Nations Children’s Fund led a multilevel and multisectoral intervention known as the Ebola response effort. Although surveillance systems were able to detect reduction in Ebola incidence, there was little understanding of the implemented activities within affected areas. To address this gap, this empirical case study examined (a) implementation of Ebola response activities and associated bending the curve of incidence of Ebola virus disease and (b) candidate factors associated with fuller implementation of the Ebola response effort. A mix of qualitative and quantitative methods were used to address these questions. A participatory monitoring and evaluation system was used to capture, code, characterize, and communicate nearly a hundred Ebola response activities implemented in Lofa County, a highly affected area in Liberia. The Ebola response effort was enabled by community engagement and collaboration across different sectors. Results showed fuller implementation corresponded with a marked reduction in Ebola virus disease. This report concludes with a discussion of how monitoring and evaluation can strengthen implementation of activities needed to address disease outbreaks.
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