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Open Access Publications from the University of California

Scholarly Works (10 results)

  • Article
  • Peer Reviewed
UCLA Previously Published Works (2019)
While the Patient Protection and Affordable Care Act (ACA), signed into law in 2010, expanded health insurance coverage to millions of Californians, it did not extend eligibility for coverage to undocumented U.S. residents. Federal policy prohibits the use of federal funds to provide Medicaid to undocumented individuals. In 2015, the state of California extended Medi-Cal (California's Medicaid program) to undocumented children using state funds, and policies to extend eligibility to undocumented adults have been proposed. This policy brief includes the latest data from the California Health Interview Survey (CHIS) on the health insurance, demographics, health status, and access to care of undocumented low-income Californians ages 19-64. The data indicate that the great majority of these undocumented adults are working, live in families with children, and report being relatively healthy. However, significant disparities exist in access to health care between this group and their documented counterparts. This overview of undocumented low-income adult residents of California provides insights into the implications of extending full-scope Medi-Cal eligibility to this population, who currently have very limited options for affordable health insurance coverage and experience access disparities.
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2022)
    Behavioral health integration (BHI) within primary care settings is shown to improve outcomes. However, achieving BHI requires identifying best practices and a reliable tool that can be used to measure existing levels and progress toward BHI. The objective of this study was to develop and apply a conceptual framework to measure BHI, test the approach, and examine challenges to achieving BHI. Surveys and interviews were conducted with key informants within 17 designated public hospitals in California at the midpoint of participating in a 5-year project to establish BHI. A framework and coding methodology were developed to assess BHI best practices at each hospital. BHI status was assessed in the domains of infrastructure and process. Each domain included 5 themes such as electronic health record integration and functionality (infrastructure) and interprovider communication (process). Themes were assessed using a 6-point scale for various activities under a theme and associated weights. Theme-specific values were standardized from 0% to 100% to compare BHI scores between hospitals. Overall progress toward BHI ranged from scores of 52% to 83% (mean 63%) and indicated greater contribution of infrastructure versus process implementation. Within the infrastructure domain, scores were higher for having institutional and provider support, but lagged in establishing provider proximity. Within the process domain, scores were highest for implementation of behavioral health screening, but were frequently lower for other themes such as use of care coordination and referral processes. Further research is needed to test the robustness of this approach in other settings.
      Cover page: Measuring Behavioral Health Integration in Primary Care
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2015)
      Community Health Centers (CHCs) are one of the principal safety-net providers of health care for low-income and uninsured populations. Co-locating dental services in primary care settings provides an opportunity to improve access to dental care. Yet this study of California CHCs that provide primary care services shows that only about one-third of them co-located primary and dental care services on-site. An additional one-third were members of multisite organizations in which at least one other site provided dental care. The remaining one-third of CHC sites had no dental care capacity. Policy options to promote co-location include requiring on-site availability of dental services, providing infrastructure funding to build and equip dental facilities, and offering financial incentives to provide dental care and recruit dental providers.
        • Article
        • Peer Reviewed
        Recent Work (2011)

        About 2.13 million nonelderly Californians who were uninsured for all or part of 2009 are newly-eligible for Medi-Cal under the Patient Protection and Affordable Care Act (ACA) of 2010.1 Analysis of the 2009 California Health Interview Survey indicates that this newly-eligible population is often single, working-age and employed. Their rates of most chronic conditions are similar to those currentlyenrolled in Medi-Cal, but they have less access to care. The characteristics of the population of the newly-eligible for Medi-Cal under ACA are likely to change by 2014 when the major provisions of the law are fully implemented. However, coverage of this newly-eligible lowincome population is likely to improve their access to health services.

          Cover page: Californians Newly Eligible for Medi-Cal
          • Article
          • Peer Reviewed
          Recent Work (2011)

          About 2.13 million nonelderly Californians who were uninsured for all or part of 2009 are newly-eligible for Medi-Cal under the Patient Protection and Affordable Care Act (ACA) of 2010.1 Analysis of the 2009 California Health Interview Survey indicates that this newly-eligible population is often single, working-age and employed. Their rates of most chronic conditions are similar to those currentlyenrolled in Medi-Cal, but they have less access to care. The characteristics of the population of the newly-eligible for Medi-Cal under ACA are likely to change by 2014 when the major provisions of the law are fully implemented. However, coverage of this newly-eligible lowincome population is likely to improve their access to health services.

            Cover page: Californians Newly Eligible for Medi-Cal under Health Care Reform
            • Article
            • Peer Reviewed
            Recent Work (2017)
              • Article
              • Peer Reviewed
              UCLA Previously Published Works (2018)

              Objective

              To conduct a parallel analysis of disparities in diabetes care quality among Latino and Asian community health center (CHC) patients by English language preference.

              Study setting/data collection

              Clinical outcomes (2011) and patient survey data (2012) for Type 2 diabetes adults from 14 CHCs (n = 1,053).

              Study design

              We estimated separate regression models for Latino and Asian patients by English language preference for Clinician & Group-Consumer Assessment of Healthcare Providers and System, Patient Assessment of Chronic Illness Care, hemoglobin A1c, and self-reported hypoglycemic events. We used the Blinder-Oaxaca decomposition method to parse out observed and unobserved differences in outcomes between English versus non-English language groups.

              Principal findings

              After adjusting for socioeconomic and health characteristics, disparities in patient experiences by English language preference were found only among Asian patients. Unobserved factors largely accounted for linguistic disparities for most patient experience measures. There were no significant differences in glycemic control by language for either Latino or Asian patients.

              Conclusions

              Given the importance of patient retention in CHCs, our findings indicate opportunities to improve CHC patients' experiences of care and to reduce disparities in patient experience by English preference for Asian diabetes patients.
                Cover page: Disparities in Diabetes Care Quality by English Language Preference in Community Health Centers
                • Article
                • Peer Reviewed
                UCLA Previously Published Works (2020)

                Objective

                Improving oral health of low-income and uninsured young children remains challenging because of reluctance of general dentists to care for very young children or participate in Medicaid, limited involvement of primary care providers in children's oral health, and lack of parental awareness of the importance of early oral health care. These barriers can be addressed in health centers (HCs) that are the premier sources of primary care for low-income and uninsured populations and a significant Medicaid provider. Many HCs provide dental services on-site, but literature indicates that medical and dental services often remain siloed with limited interaction among providers in addressing the oral health needs of young patients including risk assessment, education, and caries prevention. Accordingly, we developed a conceptual framework and measuring tool for medical dental integration and sought to examine utility of this tool in a purposive sample of HCs.

                Method

                We developed a conceptual framework for integrated oral health delivery and designed a survey to measure this integration. We surveyed 12 HCs in Los Angeles County participating in a project to improve oral health-care capacity for young children after 2 years of implementation. We included measures of risk assessment, preventive interventions, communication and collaborative practice, and buy-in organized in structure and process domains. Two individuals independently scored the responses, and a third reviewed and finalized. We standardized final scores to range from 0 to 100.

                Results

                Overall integration scores ranged from 31% to 73% (mean = 64%). Process scores were higher than structure scores for nearly all HCs. Processes contributing to higher scores included referrals with warm hand-offs, leadership support for medical-dental integration, and involvement in dental quality improvement projects. Structure factors contributing to higher scores included the presence of medical oral health champions, linked electronic health records, and referral protocols.

                Conclusion

                We found that high levels of integration could be achieved despite structure and process limitations and sustainable integration depends on leadership and provider commitment and embedding of best practices in daily operations. Further research can illustrate the reliability of our tool and the impact of integration on access.
                  • Article
                  • Peer Reviewed
                  Berkeley Research Impact Initiative (BRII) (2018)

                  Objective

                  To compare the impact of implementing team-based diabetes care management involving community health workers (CHWs) vs. medical assistants (MA) in community health centers (CHCs) on diabetes care processes, intermediate outcomes, and patients’ experiences of chronic care.

                  Data sources

                  Clinical and administrative data (n = 6111) and patient surveys (n = 698) pre-intervention and post-intervention. Surveys (n = 285) and key informant interviews (n = 48) of CHC staff assessed barriers and facilitators of implementation.

                  Study design

                  A three-arm cluster-randomized trial of CHC sites integrating MAs (n = 3) or CHWs (n = 3) for diabetes care management compared control CHC sites (n = 10). Difference-in-difference multivariate regression with exact matching of patients estimated intervention effects.

                  Principal findings

                  Patients in the CHW intervention arm had improved annual glycated hemoglobin testing (18.5%, p < 0.001), while patients in the MA intervention arm had improved low-density lipoprotein cholesterol control (8.4%, p < 0.05) and reported better chronic care experiences over time (β=7.5, p < 0.001). Except for chronic care experiences (p < 0.05) for patients in the MA intervention group, difference-in-difference estimates were not statistically significant because control group patients also improved over time. Some diabetes care processes improved significantly more for control group patients than intervention group patients. Key informant interviews revealed that immediate patient care issues sometimes crowded out diabetes care management activities, especially for MAs.

                  Conclusions

                  Diabetes care improved in CHCs integrating CHWs and MAs onto primary care teams, but the improvements were no different than improvements observed among matched control group patients. Greater improvement using CHW and MA team-based approaches may be possible if practice leaders minimize use of these personnel to cover shortages that often arise in busy primary care practices.

                    • Article
                    • Peer Reviewed
                    UC Berkeley Previously Published Works (2021)
                    Protein isoforms play a key role in disease progression and arise from mechanisms involving multiple molecular subtypes, including DNA, mRNA and protein. Recently introduced multimodal assays successfully link genomes and transcriptomes to protein expression landscapes. However, the specificity of the protein measurement relies on antibodies alone, leading to major challenges when measuring different isoforms of the same protein. Here we utilize microfluidic design to perform same-cell profiling of DNA, mRNA and protein isoforms (triBlot) on low starting cell numbers (1-100 s of cells). After fractionation lysis, cytoplasmic proteins are resolved by molecular mass during polyacrylamide gel electrophoresis (PAGE), adding a degree of specificity to the protein measurement, while nuclei are excised from the device in sections termed "gel pallets" for subsequent off-chip nucleic acid analysis. By assaying TurboGFP-transduced glioblastoma cells, we observe a strong correlation between protein expression prior to lysis and immunoprobed protein. We measure both mRNA and DNA from retrieved nuclei, and find that mRNA levels correlate with protein abundance in TurboGFP-expressing cells. Furthermore, we detect the presence of TurboGFP isoforms differing by an estimated <1 kDa in molecular mass, demonstrating the ability to discern different proteoforms with the same antibody probe. By directly relating nucleic acid modifications to protein isoform expression in 1-100 s of cells, the triBlot assay holds potential as a screening tool for novel biomarkers in diseases driven by protein isoform expression.
                      Cover page: Multimodal detection of protein isoforms and nucleic acids from low starting cell numbers
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