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Purpose: While COVID-19 has upended lives, it has also catalyzed innovation with potential to advance health delivery. Yet, we know little about how the delivery system, and primary care in particular, has responded and how this has impacted vulnerable patients. We aimed to understand the impact of COVID-19 on primary care practice sites and their vulnerable patients and to identify explanations for variation. Approach: We developed and administered a survey to practice managers and physician leaders from 173 primary care practice sites, October-November 2020. We report and graphically depict results from univariate analysis and examine potential explanations for variation in practices' process innovations in response to COVID-19 by assessing bivariate relationships between seven dependent variables and four independent variables. Findings: Among 96 (55.5%) respondents, primary care practice sites on average took more safety (8.5 of 12) than financial (2.5 of 17) precautions in response to COVID-19. Practice sites varied in their efforts to protect patients with vulnerabilities, providing care initially postponed, and experience with virtual visits. Financial risk, practice size, practitioner age, and emergency preparedness explained variation in primary care practices' process innovations. Many practice sites plan to sustain virtual visits, dependent mostly on patient and provider preference and continued reimbursement. Value: While findings indicate rapid and substantial innovation, conditions must enable primary care practice sites to build on and sustain innovations, to support care for vulnerable populations, including those with multiple chronic conditions and socio-economic barriers to health, and to prepare primary care for future emergencies.

This chapter seeks to quantify the effects of geographic access to community health centers on the likelihood of an individual having a regular source of health care.

Utilizing survey and center location data, the analysis employs bivariate cross-tabulation with chi-square and multinominal logistic regression to quantify the relationship between variables.

While individuals living in close spatial proximity to community health centers were more likely to identify a community health center as a regular source of care as compared with those without proximal access, the effect of community health center access on the identification of any source of regular health care was generally insignificant or negative, except for populations with a chronic medical condition.

While these findings support current literature suggesting that spatial proximity to care is insufficient to transform at-risk populations into regular primary care users, it is important to note that it is possible that individuals prefer to access primary care services outside of their immediate neighborhoods, potentially mediating the observed effect of proximity to care on the likelihood of having a regular source of care. Also, because this analysis is based on cross-sectional survey data, it is impossible to make a causal argument about the relationship between variables. Only the observed association can be asserted and used to inform future studies.

Existing research supports a positive association between community health center utilization and measures of health for social groups traditionally facing barriers to care, but few studies isolate the effect of center availability and health, particularly when considering those living in the catchment area but are not regular users. Due to the complexity and prevalence of barriers to health care for vulnerable and at-risk populations, these findings suggest that improving geographic access to primary health care does not guarantee positive outcomes for target groups. The magnitude of social disadvantage on vulnerable and at-risk populations can have a devastating effect on health care outcomes that is not easily overcome by social programs.

Today, the presence of unwanted activities threatening the safety of the field, which has negative effects on daily life and social psychology, is increasing day by day. There is no doubt that it is inevitable to avoid these threats, but it is possible to take some measures to reduce the destructive power of these threats. Nowadays, increasing terrorist attacks increase the importance of field safety design in urban areas. There is a loss of life in attacks around the world. The subject of this study is to investigate the design criteria related to the built environment and the measures to be taken in the case of bomb attacks in the built environment. In this study, a checklist will designed to measure the security design process around the building. The checklist titles are taken mainly from the “Safety design and Landscape Architecture” series of the Landscape Architecture Technical Information Series/LATIS publications by the American Society of Landscape Architects (ASLA) and the Risk Management Series of the Federal Emergency Management Agency/FEMA (FEMA, 2003, 2007; LATIS, 2016) and others. The checklist created as a result of literature review will be tested in Istanbul Sultanahmet Square. As a result of the study, it was determined that improvements should be made in the areas of vehicular and pedestrian access, parking lots, lighting and trash receptacle designs around Sultanahmet Square.

Workplace voice is well-established and encompasses behaviors such as prosocial voice, informal complaints, grievance filing, and whistleblowing, and it focuses on interactions between the employee and supervisor or the employee and the organizational collective. In contrast, our chapter focuses on employee prosocial advocacy voice (PAV), which the authors define as prosocial voice behaviors aimed at preventing harm or promoting constructive changes by advocating on behalf of others. In the context of a healthcare organization, low quality and unsafe patient care are salient and objectionable states in which voice can motivate actions on behalf of the patient to improve information exchanges, governance, and outreach activities for safer outcomes. The authors draw from the theory and research on responsibility to intersect with theories on information processing, accountability, and stakeholders that operate through voice between the employee-patient, employee-coworker, and employee-profession, respectively, to propose a model of PAV in patient-centered healthcare. The authors complete the model by suggesting intervening influences and barriers to PAV that may affect patient-centered outcomes.