Changing Clinic-Community Social Ties in Immigrant-Serving Primary Care Practices in New York City: Social and Organizational Implications of the Affordable Care Act's Population-Health-Related Provisions

• Published in: RSF : Russell Sage Foundation journal of the social sciences Vol. 6; no. 2; pp. 264 - 288
• Main Authors: Gore, Radhika, Dhar, Ritu, Mohaimin, Sadia, Lopez, Priscilla M., Divney, Anna A., Zanowiak, Jennifer M., Thorpe, Lorna E., Islam, Nadia
• Format: Journal Article
• Language: English
• Published: New York Russell Sage Foundation 01.07.2020
• Subjects: Ambulatory care; Cardiovascular disease; clinic-community social ties; Clinics; Coaching; Community; Community health workers; Computerized medical records; Disease management; Disease prevention; Electronic health records; Health; Health care policy; Health literacy; Health records; Hypertension; Immigrants; Initiatives; Innovations; Medicaid; Medical records; Medical workers; Minority & ethnic groups; Noncitizens; Part IV. Effects on Disadvantaged Populations; Patient Protection & Affordable Care Act 2010-US; Patients; Physicians; Population; Primary care; racial-ethnic minorities; small primary care practices; United States > US; New York City New York
• ISSN: 2377-8253; 2377-8261
• DOI: 10.7758/RSF.2020.6.2.12

Small primary care practices are critical to advancing Affordable Care Act (ACA) aims, yet their efforts and experiences remain little studied. We examine two strategies derived from ACA population-health provisions—enhanced use of electronic health records (EHRs) and community health worker (CHW)–led peer coaching—for hypertension control in sixteen small practices serving South Asian immigrant communities in New York City. Based on interviews with physicians, staff, and CHWs, we analyze “street-level” dilemmas encountered in implementing the strategies. Findings indicate that the strategies reinforce clinic-community social ties but present distinct challenges for small practices: internal management constraints that impede formal CHW-physician contact, and external incentives linked to EHR tools that, physicians and staff perceive, do not meet immigrant communities' needs and expectations in medical encounters.