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      The scope and impact of mobile health clinics in the United States: a literature review

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          Abstract

          As the U.S. healthcare system transforms its care delivery model to increase healthcare accessibility and improve health outcomes, it is undergoing changes in the context of ever-increasing chronic disease burdens and healthcare costs. Many illnesses disproportionately affect certain populations, due to disparities in healthcare access and social determinants of health. These disparities represent a key area to target in order to better our nation’s overall health and decrease healthcare expenditures. It is thus imperative for policymakers and health professionals to develop innovative interventions that sustainably manage chronic diseases, promote preventative health, and improve outcomes among communities disenfranchised from traditional healthcare as well as among the general population.

          This article examines the available literature on Mobile Health Clinics (MHCs) and the role that they currently play in the U.S. healthcare system. Based on a search in the PubMed database and data from the online collaborative research network of mobile clinics MobileHealthMap.org, the authors evaluated 51 articles with evidence on the strengths and weaknesses of the mobile health sector in the United States. Current literature supports that MHCs are successful in reaching vulnerable populations, by delivering services directly at the curbside in communities of need and flexibly adapting their services based on the changing needs of the target community. As a link between clinical and community settings, MHCs address both medical and social determinants of health, tackling health issues on a community-wide level. Furthermore, evidence suggest that MHCs produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups. Even though MHCs can fulfill many goals and mandates in alignment with our national priorities and have the potential to help combat some of the largest healthcare challenges of this era, there are limitations and challenges to this healthcare delivery model that must be addressed and overcome before they can be more broadly integrated into our healthcare system.

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          Most cited references67

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          National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary.

          This report presents data on U.S. emergency department (ED) visits in 2007, with statistics on hospital, patient, and visit characteristics. Data are from the 2007 National Hospital Ambulatory Medical Care Survey, which uses a national probability sample of visits to emergency departments of nonfederal general and short-stay hospitals in the United States. Sample data were weighted to produce annual national estimates. In 2007, there were about 117 million ED visits in the United States. About 25 percent of visits were covered by Medicaid or the State Children's Health Insurance Program (SCHIP). About one-fifth of ED visits by children younger than 15 years of age were to pediatric EDs. There were 121 ED visits for asthma per 10,000 children under 5 years of age. The leading injury-related cause of ED visits was unintentional falls. Two percent of visits resulted in admission to an observation unit. Electronic medical records were used in 62 percent of EDs.
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            Culturally competent healthcare systems. A systematic review.

            Culturally competent healthcare systems-those that provide culturally and linguistically appropriate services-have the potential to reduce racial and ethnic health disparities. When clients do not understand what their healthcare providers are telling them, and providers either do not speak the client's language or are insensitive to cultural differences, the quality of health care can be compromised. We reviewed five interventions to improve cultural competence in healthcare systems-programs to recruit and retain staff members who reflect the cultural diversity of the community served, use of interpreter services or bilingual providers for clients with limited English proficiency, cultural competency training for healthcare providers, use of linguistically and culturally appropriate health education materials, and culturally specific healthcare settings. We could not determine the effectiveness of any of these interventions, because there were either too few comparative studies, or studies did not examine the outcome measures evaluated in this review: client satisfaction with care, improvements in health status, and inappropriate racial or ethnic differences in use of health services or in received and recommended treatment.
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              Outcomes and costs of community health worker interventions: a systematic review.

              We conducted a systematic review on outcomes and costs of community health worker (CHW) interventions. CHWs are increasingly expected to improve health outcomes cost-effectively for the underserved. We searched Medline, Cochrane Collaboration resources, and the Cumulative Index to Nursing and Allied Health Literature for studies conducted in the United States and published in English from 1980 through November 2008. We dually reviewed abstracts, full-text articles, data abstractions, quality ratings, and strength of evidence grades and resolved disagreements by consensus. We included 53 studies on outcomes of CHW interventions and 6 on cost or cost-effectiveness. For outcomes, limited evidence (5 studies) suggests that CHW interventions can improve participant knowledge compared with alternative approaches or no intervention. We found mixed evidence for participant behavior change (22 studies) and health outcomes (27 studies). Some studies suggested that CHW interventions can result in greater improvements in participant behavior and health outcomes compared with various alternatives, but other studies suggested that CHW interventions provide no statistically different benefits than alternatives. We found low or moderate strength of evidence suggesting that CHWs can increase appropriate health care utilization for some interventions (30 studies). Six studies with economic information yielded insufficient data to evaluate the cost-effectiveness of CHW interventions relative to other interventions. CHWs can improve outcomes for underserved populations for some health conditions. The effectiveness of CHWs in many health care areas requires further research that addresses the methodologic limitations of prior studies and that contributes to translating research into practice.
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                Author and article information

                Contributors
                YuSteph@hku.hk
                Caterina.Hill@gmail.com
                MRicks@mba2016.hbs.edu
                Jennifer_Bennet@hms.harvard.edu
                Nancy_Oriol@hms.harvard.edu
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                5 October 2017
                5 October 2017
                2017
                : 16
                : 178
                Affiliations
                [1 ]Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Rd, Pokfulam, Hong Kong, Special Administrative Region of China
                [2 ]ISNI 000000041936754X, GRID grid.38142.3c, Department of Global Health and Social Medicine, , Harvard Medical School, c/o The Family Van, ; 1542 Tremont St, Roxbury, MA 02120 USA
                [3 ]ISNI 000000041936754X, GRID grid.38142.3c, Harvard Business School, Soldiers Field, ; Boston, MA 02163 USA
                [4 ]ISNI 000000041936754X, GRID grid.38142.3c, Harvard University T.H. Chan School of Public Health, ; 677 Huntington Ave, Boston, MA 02115 USA
                [5 ]ISNI 000000041936754X, GRID grid.38142.3c, The Family Van: Harvard Medical School, ; 1542 Tremont St, Roxbury, MA 02120 USA
                [6 ]ISNI 000000041936754X, GRID grid.38142.3c, Harvard Medical School, ; 260 Longwood Ave, Suite 244, Boston, MA 02115 USA
                [7 ]ISNI 0000 0000 9011 8547, GRID grid.239395.7, Department of Anesthesia and Critical Care, , Beth Israel Deaconess Medical Center, ; 330 Brookline Ave, Boston, MA 02215 USA
                Article
                671
                10.1186/s12939-017-0671-2
                5629787
                28982362
                5fa24617-e909-4005-8e5d-3a917eea1707
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 19 April 2017
                : 24 September 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000045, Aetna Foundation;
                Award ID: 15-0041
                Award Recipient :
                Categories
                Review
                Custom metadata
                © The Author(s) 2017

                Health & Social care
                mobile health clinics,health disparities,social determinants of health,community-clinical linkage,preventative care,chronic disease management,population health,cost-effectiveness

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