Abstract
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.
- small primary care practices
- electronic health records
- community health workers
- racial-ethnic minorities
- clinic-community social ties
- © 2020 Russell Sage Foundation. Gore, Radhika, Ritu Dhar, Sadia Mohaimin, Priscilla M. Lopez, Anna A. Divney, Jennifer M. Zanowiak, Lorna E. Thorpe, and Nadia Islam. 2020. “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.” RSF: The Russell Sage Foundation Journal of the Social Sciences 6(2): 264–88. DOI: 10.7758/RSF.2020.6.2.12. We are grateful to all the physicians, clinic staff, and community health workers who shared their experiences with us. This study is supported by the National Institutes of Health National Institute on Minority Health and Health Disparities Grant U54MD000538 and Centers for Disease Control and Prevention Grant U48DP005008. NIs time is partially supported by National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases Grant R01DK11048, Grant R18DK110740, and Grant P30 DK111022; and National Institutes of Health National Center for Advancing Translational Science Grant UL1TR001445. The views expressed are those of the authors and do not necessarily represent the official position of the funding organizations. Direct correspondence to: Radhika Gore at radhika.gore{at}nyulangone.org, NYU Grossman School of Medicine, Department of Population Health, 180 Madison Ave., #9-44A, New York, NY 10016; Ritu Dhar at rdhar4{at}jh.edu, 42-12 50th Ave., Woodside, NY 11377; Sadia Mohaimin at sadia.mohaimin{at}nyulangone.org, NYU Grossman School of Medicine, Department of Population Health, 180 Madison Ave., #8–35A, New York, NY 10016; Priscilla M. Lopez at priscilla.lopez{at}nyulangone.org, NYU Grossman School of Medicine, Department of Population Health, 550 First Ave., New York, NY 10016; Anna A. Divney at anna.divney{at}sph.cuny.edu, CUNY School of Public Health, 55 W. 125th St., New York, NY, 10027; Jennifer M. Zanowiak at jennifer.zanowiak{at}nyulangone.org, NYU Grossman School of Medicine, Department of Population Health, 550 First Ave., New York, NY 10016; Lorna E. Thorpe at lorna.thorpe{at}nyulangone.org, NYU Grossman School of Medicine, Department of Population Health, 550 First Ave., New York, NY 10016; and Nadia Islam at nadia.islam{at}nyulangone.org, NYU Grossman School of Medicine, Department of Population Health, 550 First Ave., New York, NY 10016.
Open Access Policy: RSF: The Russell Sage Foundation Journal of the Social Sciences is an open access journal. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.