RT Journal Article
SR Electronic
T1 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
JF RSF: The Russell Sage Foundation Journal of the Social Sciences
FD Russell Sage Foundation
SP 264
OP 288
DO 10.7758/RSF.2020.6.2.12
VO 6
IS 2
A1 Radhika Gore
A1 Ritu Dhar
A1 Sadia Mohaimin
A1 Priscilla M. Lopez
A1 Anna A. Divney
A1 Jennifer M. Zanowiak
A1 Lorna E. Thorpe
A1 Nadia Islam
YR 2020
UL http://www.rsfjournal.org/content/6/2/264.abstract
AB 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.