The Patient Protection and Affordable Care Act (PPACA) affords opportunities to sustain the role of community health workers (CHWs). Among myriad strategies encouraged by PPACA are prevention and care coordination, particularly for chronic diseases, chief drivers of increased health care costs. Prevention and care coordination are functions that have been performed by CHWs for decades, particularly among underserved populations. The two key delivery models promoted in the PPACA are accountable care organizations and health homes. Both stress the importance of interdisciplinary, interprofessional health care teams, the ideal context for integrating CHWs. Equally important, the payment structures encouraged by PPACA to support these delivery models offer the vehicles to sustain the role of these valued workers.

No abstract

No abstract

No abstract

No abstract

No abstract

No abstract

Background: Minorities and impoverished persons experience disparities in access to healthcare. Large inequalities in out-of-hospital cardiac arrest (OHCA) care have been described. We sought to characterize racial and socioeconomic disparities in OHCA care and outcomes in Texas. Hypothesis: There are census tract level disparities in OHCA care and outcomes in Texas. Methods: We analyzed Texas-Cardiac Arrest Registry to Enhance Survival (CARES) data from 13 EMS agencies providing care in 15 counties to roughly 30% of the state population. We included all adult (>=18 year) OHCA from 1/1/14 through 12/31/18 with complete data. Using census tract data, we stratified census tracts into racial/ethnic categories: >50% non-Hispanic/Latino white, >50% black, and >50% Hispanic/Latino. We also stratified census tracts into neighborhoods above and below the median for socioeconomic characteristics: household income, employment rate, and high school graduation. We defined outcomes as bystander CPR rates, public bystander AED use, and survival to hospital discharge. Using mixed models, we analyzed the associations between outcomes and neighborhood (1) racial/ethnic categories and (2) socioeconomic categories. Results: We included data on 18,487 OHCAs from 1,727 census tracts. Relative to white neighborhoods, black neighborhoods had a significantly lower rate of bystander AED use (OR 0.3, CI 0.1-0.9), and Latino neighborhoods had a lower rate of bystander CPR (OR 0.7, CI 0.6-0.8), bystander AED use (OR 0.4, CI 0.3-0.6) and survival to hospital discharge (OR 0.9, CI 0.8-0.98). Lower income was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.8), bystander AED use (OR 0.5, 0.4-0.8), and survival to hospital discharge (OR 0.6, CI 0.5-0.9). Lower high school graduation was associated with a lower rate of bystander CPR (OR 0.8, CI 0.7-0.9) and bystander AED use (OR 0.6, CI 0.4-0.9). High unemployment was associated with lower rates of bystander CPR (OR 0.9, CI 0.8-0.94) and bystander AED use (OR 0.7, CI 0.5-0.99). Conclusion: Minority and poor neighborhoods in Texas experience large and unacceptable disparities in OHCA bystander response and outcomes. These data present an important opportunity for targeted resuscitation training and quality improvement.