Clínica Esperanza/Hope Clinic (CEHC) provides primary healthcare to uninsured Rhode Island residents. CEHC aims to offer high-quality and culturally competent care with an emphasis on prevention. It is run by volunteer healthcare providers and staff, with support from community donations. The document discusses CEHC's services, patient demographics, outcomes in managing chronic conditions, and initiatives like the CHEER walk-in clinic and Navegantes program to improve healthcare access and navigation. It also notes ongoing challenges around increasing demand and reducing emergency room use.
Closing rural hospitals are reducing access to care in multiple states
Between January 2010 and January 2020, 114 rural hospitals closed. More than 30 of these were critical access facilities. Data from the University of North Carolina Cecil G. Sheps Center for Research provides further insights showing that from 2005 to 2020 a total of 170 rural hospitals shut down. There seems to be no indication this trend is subsiding and a sizable portion of it has occurred during a time of record economic expansion. There is no telling how many more would have closed their doors had a weakened economy continued.
Read the complete story here and contact John Baresky for further details...
Understand why hospitals must take the lead in eliminating disparities in care
Learn about the various dimensions of health care disparities. This presentation provides a background on the factors contributing to health care disparities, the ways in which race, ethnicity and language (REaL) data may be applied to improve health equity, as well as strategies through which to enhance the collection of REaL data.
Authors: Bohr D, Bostick N
Addressing health equity & the risk in providing careEvan Osborne
What Is Health Equity & Why Should It Be Addressed?
How Does Health Equity Impact Providers & Payors?
How Can Providers & Payors Be Rewarded For Addressing Health Equity?
How Can Health Equity Be Addressed Through Technology?
Closing rural hospitals are reducing access to care in multiple states
Between January 2010 and January 2020, 114 rural hospitals closed. More than 30 of these were critical access facilities. Data from the University of North Carolina Cecil G. Sheps Center for Research provides further insights showing that from 2005 to 2020 a total of 170 rural hospitals shut down. There seems to be no indication this trend is subsiding and a sizable portion of it has occurred during a time of record economic expansion. There is no telling how many more would have closed their doors had a weakened economy continued.
Read the complete story here and contact John Baresky for further details...
Understand why hospitals must take the lead in eliminating disparities in care
Learn about the various dimensions of health care disparities. This presentation provides a background on the factors contributing to health care disparities, the ways in which race, ethnicity and language (REaL) data may be applied to improve health equity, as well as strategies through which to enhance the collection of REaL data.
Authors: Bohr D, Bostick N
Addressing health equity & the risk in providing careEvan Osborne
What Is Health Equity & Why Should It Be Addressed?
How Does Health Equity Impact Providers & Payors?
How Can Providers & Payors Be Rewarded For Addressing Health Equity?
How Can Health Equity Be Addressed Through Technology?
Promoting health and preventing illness among African American men, who die disproportionately from preventable diseases, is a challenging health disparity that has seen limited progress. However, focusing our efforts in places outside of traditional clinical and community settings such as the barbershop has shown promise for ameliorating these disparities.
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay.
Disparities in Health Care: The Significance of Socioeconomic StatusAmanda Romano-Kwan
This research paper discusses the disparities in the health care system, with a specific focus on socioeconomic status and how it affects the access and availability of quality care.
Dr. Kavuludi was well received by Boise area Rotary clubs who have helped support Genesis World Mission's efforts. The Burangi project already has an established connection to the Malindi Kenya Rotary.
Dr. Kavuludi presented to Idaho State University Medical Students in more depth than the dinner address.
Warning: this presentation is a medical presentation and includes graphic pictures of the body that is not suitable for children or sensitive audiences.
Promoting health and preventing illness among African American men, who die disproportionately from preventable diseases, is a challenging health disparity that has seen limited progress. However, focusing our efforts in places outside of traditional clinical and community settings such as the barbershop has shown promise for ameliorating these disparities.
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay.
Disparities in Health Care: The Significance of Socioeconomic StatusAmanda Romano-Kwan
This research paper discusses the disparities in the health care system, with a specific focus on socioeconomic status and how it affects the access and availability of quality care.
Dr. Kavuludi was well received by Boise area Rotary clubs who have helped support Genesis World Mission's efforts. The Burangi project already has an established connection to the Malindi Kenya Rotary.
Dr. Kavuludi presented to Idaho State University Medical Students in more depth than the dinner address.
Warning: this presentation is a medical presentation and includes graphic pictures of the body that is not suitable for children or sensitive audiences.
Health Care: Understanding the Future, a Canadian Perspective by Carolyn Benn...neelumaggarwal
In April of 2010, the Canada US Business Council (formerly the Canadian Club of Chicago), hosted Dr. Carolyn Bennett, Liberal Critic for Health, Parliament of Canada. This talk gave the Canadian perspective on health care in addition to showing the similarities and differences between the two health care systems.
Bridging Clinical Gaps and Disparities in Care in TNBCbkling
This webinar will focuses on racial, ethnic, and socioeconomic disparities with the clinical gaps in treatment for women with triple-negative breast cancer (TNBC). Our guest speaker Shonta Chambers, MSW, is the EVP of Health Equity and Community Engagement at the Patient Advocate Foundation and Principal Investigator for SelfMade Health Network. Come and learn about this complex subtype, barriers to care, address the myths and fears around clinical trials in specific racial and ethnic communities, and help bridge the clinical gaps to improve survival outcomes for patients with TNBC.
This webinar discussed how to educate Nurse Practitioners who have completed Community Health Center. Inc’s NP Residency or NPs who have significant experience as a Primary Care Provider on the integration of specialty care for key populations, including:
• HIV care
• Hepatitis C management
• Medication-assisted treatment for opioid use and other substance use disorders
• Sexually transmitted disease (STI) screening and management
• Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, Asexual (LGBTQIA+) health, including hormone replacement therapy and gender affirming care.
Panelists:
• Charise Corsino, MA, Program Director, Nurse Practitioner Residency Programs, Community Health Center, Inc.
• Marwan Haddad, MD, MPH, AAHIVS, Medical Director, Center for Key Populations, Community Health Center, Inc.
• Jeannie McIntosh, APRN, FNP-C, AAHIVS, Family Nurse Practitioner, Center for Key Populations, Community Health Center, Inc.
NTTAP Webinar Series - June 7, 2023: Integrating HIV Care into Training and E...CHC Connecticut
In order for health centers to provide compassionate and respectful HIV prevention, care, and treatment in comprehensive primary care settings, the clinical workforce must be knowledgeable, confident, and competent in their ability to do so.
We’ll explore the need to integrate HIV care into training and education for the clinical care team, as well as educational models to train the next generation. Using Community Health Center Inc.’s Center for Key Populations Fellowship for Nurse Practitioners (NPs) as a framework for best practices, experts will discuss how to implement specialty care for key populations in your training programs. Additionally, participants will gain awareness of the importance of training the clinical workforce on key population competencies in HIV programs (e.g. HCV, MOUD, LGBTQI+ health, homelessness, and harm reduction).
This presentation on findings from a trial of providing HIV medication to people not eligible for Medicare was given by Tony Maynard from the National Association of People With HIV Australia (NAPWHA) at AFAO'S HIV and Mobility Forum on 30 May 2016.
Describe rationale for free care in Providence Rhode Island, the mission and aims of the Clinica Esperanza / Hope Clinic, the current patient demographics, and plans for the future.
A tremendous need exists to engage hard-to-reach populations in HIV/AIDS care. That’s because numerous factors prevent people living with HIV/AIDS (PLWHA)—especially disadvantaged and disproportionately affected populations—from engaging in care or remaining in care.
This Webcast introduces providers to several successful strategies for reaching the most vulnerable populations:
Howell Strauss, DMD, AIDS Care Group, discusses traditional street outreach, as well as his involvement with both the SPNS Oral Health Initiative and the SPNS Jail Initiative.
Lisa Hightow-Weidman, MD, MPH, Department of Infectious Diseases University of North Carolina at Chapel Hill, shares best practices in social marketing outreach in the context of her work as a SPNS Young Men who Have Sex with Men of Color Initiative grantee.
COVID 19 Team-Based Approaches to Patient PopulationsCHC Connecticut
As presented as part of The Path Forward on Jan 28, 2021:
Stable housing and health outcomes are inextricably linked. When a patient loses housing – or is in jeopardy of losing housing– health outcomes suffer. COVID has led us to a moment of crisis. Thirty million to 40 million people in the United States face eviction. People of color are disproportionately impacted. Addressing housing as a social determinant of health is critical to achieving health equity. This webinar brings together experts from housing, healthcare and the intersection of both to share innovative short- and long-term solutions you can implement in your community.
In this webinar, Dr. Brian C. Castrucci President and Chief Executive Officer of the de Beaumont Foundation, presented new polling about vaccine confidence and Dr. Ayne Amjad, Commissioner and State Health Officer for West Virginia, and Dr. Costello, Assistant Professor of Pediatrics at West Virginia University School of Medicine, presented insights from their research and successful vaccine outreach campaign to rural communities in West Virginia. Dr. Lauren Smith, Chief Health Equity and Strategy Officer for CDC Foundation, moderated the conversation and an audience Q&A with Drs. Amjad and Costello.
1Running Head Chronically Ill and Disabled Persons 5Chronic.docxeugeniadean34240
1
Running Head: Chronically Ill and Disabled Persons
5
Chronically Ill and Disabled Persons
Chronically Ill and Displaced Persons
HCA430: Special Populations (HCJ1543A)
Regina Brown
November 10, 2015
Recap of the Model Program
The model program proposed in Week 2 was known as Visibility and Accessibility Center (VAC). The main purpose of VAC is to enhance status awareness among the people living diagnosed with chronic conditions as well as those who have not detected their status of chronic ailments. The VAC works closely with state and federal agencies, health care providers, health plans and consumers in order to design and develop programs that offer better services to vulnerable populations. The main vision of the VAC is to reduce premature deaths caused by chronic conditions by at least 20 percent every year in the specific communities being served by the program. This can be achieved through encouragement and rigorous sensitization of the communities to go for early and regular tests in order to determine the absence or presence of a chronic condition hence developing earlier solutions to the problem. Shortly after the flagship, VAC has conducted assessment of the situation of the pilot community being served. During the assessment, VAC discovered that there are certain barriers that impede individuals’ accessibility to healthcare facilities as well as better treatment. The following are the three types of barriers obtained during the research.
Barriers to Affordability and Accessibility of Healthcare Services among the Chronically Ill and Disabled Persons
Micro-level Barriers
One of the micro-level or individual barriers is limited finances. Most of the people assessed by the VAC come from poor neighborhoods where the income-level per person is quite low. Some of the chronically ill and disabled persons studied during the assessment could not afford proper medication due to limited funds (The UN Chronicles, 2015). The chronically ill and disabled persons are also required to obtain primary health care or essential health coverage which assists them in improving health conditions through constant medication. VAC has also discovered that most chronically ill and disabled persons are not covered in various insurance plans. This complicates the situation even further given their financial conditions.
Macro-level Barriers
The macro-level barriers come from state or community regulations to healthcare provisions. One of the barriers that affect provision of health care services among the chronically ill and disabled persons is being undocumented and uninsured especially among the immigrants (Irs.gov, 2015). The undocumented immigrants are basically excluded from state Medicaid expansions as well as purchasing of health insurance the new market places. Apart from being unable to get enrolled in the insurance plans, most immigrants are also low-income earners hence there is limited capacit.
The goal of this webinar was to educate healthcare professionals about the differences between palliative and curative care while exploring the history and philosophy of the hospice movement.
Introduction to Computational Vaccinology and iVAX by EpiVaxAnnie De Groot
This presentation was developed for Dr. Anna Durbin's vaccine class at Johns Hopkins. It was delivered simultaneously to my vaccine class at URI. Both classes had their first introductory lecture at the same time, so we joined them by webinar. The slides cover the EpiVax approach to computational vaccinology, which is relatively novel as compared to other groups working in the field. A number of case studies, including H7N9, are provided.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...
Clinica Esperanza/Hope Clinic "International Healthcare on the local bus line" in Providence, Rhode Island
1. INTERNATIONAL HEALTHCARE
ON THE RIPTA BUSLINE
“A Place to be Healthy”
Slides by Ali Bicki, Jenn Pigoga, Jacob Buckley, Valerie Joseph, Annie De Groot,
Carmen Shulman, Jillian Peters, and Farzana Kibria
2. Clínica Esperanza/Hope Clinic (CEHC) Mission:
n Offer high quality primary medical care to RI residents
without health insurance
n Emphasis on linguistically-competent, culturally-attuned care
n Focus on prevention and health maintenance
n Run by highly qualified health providers and community
representatives
n Supported by an volunteer staff and paid staff
n Welcomes bright ideas from volunteers and patients
“A Place to be Healthy”
Mission Statement
8. Need for Health Screening: A local example. A paper on tuberculosis (TB) transmission in Rhode Island
illustrates the importance of health prevention activities for all uninsured residents regardless of legal status.
Clusters of tuberculosis transmission among uninsured and undocumented immigrants are not uncommon in
Rhode Island []. Of the 265 TB patients included in the epidemiological analysis, 176 (66.4%) were foreign born
from 42 different countries; 68.2% did not speak English. The predominant country of birth of the foreign-born
persons in the TB clusters was Cambodia (12.5%), followed by Guatemala (10.8%), Dominican Republic (10.2%),
Laos (6.3%), the Philippines (5.1%), and Portugal (5.1%). The analysis of characteristics of the foreign-born TB
patients revealed several possible barriers to TB prevention, including language difficulties, lack of medical
insurance, young age and lack of familiarity with the health care system. The authors concluded that “expanded
TB screening services that actively move into at-risk communities outside of traditional health clinic sites
will be important in reaching these persons during the window period [for prevention].” TB testing was one
of the first preventive health programs implemented at CEHC. TB testing is one of several services, with HIV and
HCV testing and free vaccines (e.g. flu), that are offered to all walk-ins; registration as a patient is not required.
n Why provide Free Care?
A Cautionary Tale
TB Clusters in RI:
Foreign-born
9. The Uninsurance Trap
The Uninsurance Trap.
Perhaps more important for the
neighborhoods that are the subject
of our work, poor health
contributes to the cycle of poverty
at the individual level. In 2006, the
total health care spending by
uninsured persons was estimated
at 6.4 billion dollars, the majority of
which (5.3 billion dollars) was paid
out of pocket.
Health Care Reform will diminish but not resolve the problem. Even after heatlh care reform,
free clinics will continue to provide an important alternative source of care to patients who might
defer care until it becomes an emergency, or seek primary care in the ER.
In Massachusetts, more than 300,000 individuals remained uninsured despite state-wide
health reform. The working poor who do not have access to, or cannot afford, either employer
sponsored insurance or state subsidized insurance, predominate among the uninsured.
..
10. Summary of Changes in Medicaid and Health Care
Exchanges with the Affordable Care Act
Medicaid
Exchange
Coverage
U.S.
Born
and
Naturalized
Ci3zens!
All
individuals
up
to
138%
of
FPL
in
states
that
implement
the
expansion.!
Individuals
without
affordable
employer
coverage
can
buy
coverage
through
exchange
marketplaces.
!
Lawfully
Present
Immigrants!
Many
remain
subject
to
a
five-‐year
wait
or
excluded.
States
may
choose
to
eliminate
the
five-‐year
wait
for
otherwise
eligible
children
and
pregnant
women,
but
not
for
other
adults.
!
May
purchase
exchange
coverage
and
receive
tax
credits
on
the
same
basis
as
ci3zens.
Individuals
with
incomes
below
100%
of
poverty
who
are
ineligible
for
Medicaid
based
on
immigra3on
status
may
purchase
exchange
coverage
and
receive
tax
credits!
Undocumented
Immigrants!
Remain
ineligible
for
Medicaid.!
Prohibited
from
purchasing
exchange
coverage
and
receiving
tax
credits.!
Source:
Kaiser
Family
Founda3on.
hTp://kaiserfamilyfounda3on.files.wordpress.com/2013/03/8279-‐02.pdf.
Table
1.
12. Time Since Incoming
Patients were Last Seen by
a Healthcare Provider.
Nearly 40% of patients not seen
by MD in 3 years despite chronic
health problems
20% of currently uninsured
patients were last seen outside of
the U.S. prior to seeking care at
CEHC.
0-6
Months
24%
7-12
Months
32%
2-3
Years
29%
>3
Years
14%
Unknown
1%
Previous
Access to Care
13. n Primary Care Clinic
n Criteria for becoming a patient
ü Uninsured
ü First come first served
X Lottery
X If already in care at another practice
CEHC Overview
n CHEER walk-in clinic
ü Non-urgent health issue
X In need of urgent care
14. n Primary Health Care Tuesday, Thursday, Saturday
n Women’s Clinic Monday Night 1x/month
n Vida Sana Program – Health Literacy/Metabolic Syndrome
n PIMHA – “whole patient” job skills etc.
n Financial Literacy, Job Skills – Dorcas Place/CWE/LISC
n Diabetes Club / Group visits with Nurse Practitioners
n Outreach at in South Providence/ North Providence
n Health Screens at CEHC/outreach once per month
n Regular chart reviews – research - quality assurance
CEHC Overview
15. n Volunteer base
n 10 in 2008- 20 in 2009
n 30 in 2010- 40 in 2011
n >175 in 2014
n Board actively involved as volunteers
n Volunteer Medical Director/ Executive Director
n Donated labs, radiology, specialty services, and
medications from WIHRI, Lifespan, local MD providers.
n New volunteers and providers always needed
n (next orientation session is … this Tuesday!)
Clinic Overview:
Organizational Structure
17. Demographics:
Level of School completed
8th Grade or lower
Some high school
Graduated from high school
Some University
University graduate
But these patients have high aspirations
for their children!
18. Annual Income
If undocumented, work in jobs that do not provide
Health insurance, benefits, etc, low hourly wage:
$15k per year = $284 per week (if they get that)
21. Introduction
● What did we do?
o A community outreach study to assess key factors
including insurance status, lead awareness, and
community health needs
● How did we do it?
o By going out into the community in pairs of at least 2
to administer verbal surveys in a convenience
sampling format
22. Why did we do the survey?
● Compare results from “pre-Obamacare”
survey (Spring 2009) to today’s “post-
Obamacare” environment
● Evaluate health care access in the
community
● Determine whether or not CEHC is
serving the community’s needs
● Assess the awareness of lead paint
hazards and testing
● Funded by the RI DOH
23. Insurance Status
2014 Study (200 participants)
● Significant changes since 2009
o Fewer uninsured (38% vs.
92% in 2009)
o 9% private insurance (vs. 5% in
2009)
o 17% have Obamacare only
● Today, 33% covered by “public”
insurance…including “free care”
o Medicaid/RIte Care, Medicare,
Free Care, or some
combination of “public”
sources (vs. ~1% in 2009)
24. Survey: Why did uninsured participants not
have Obamacare?
Among the uninsured,
having an undocumented
immigration status was the
most common reason for
not obtaining Obamacare
coverage.
26. n Established with support from BCBSRI “Blue Angels” Funding
n The Navegantes/Navigators plan, organize and implement church-
based community health fairs and advocate for members of their
community.
n Navegantes/Navigators meet with patients and help them navigate
the system to obtain preventative services, chronic disease
management, support for medication adherence, health care
access, and other essential health information.
n The clinic now has five Navegantes health access coordinators.
They received intensive training sessions to become competent
referral sources, organizers and community educators.
The Navegantes
27. Percent of Patients
Experiencing Improvement in
their Chronic Condition
EMR records were reviewed and health indicators
(HbA1C, fasting glucose, blood pressure, weight, and
cholesterol) were tracked. Greatest improvements in
overall health indicators were observed in patients
with hypertension: 83% of patients with hypertension
reduced their blood pressure.
Almost three-quarters of patients with diabetes and
high cholesterol improved during the time period of
this review.
Over half of overweight or obese patients lost weight
while under care at CEHC.
Overall, about 63% of CEHC patients improved at
least one of their chronic conditions during the study
time period.
*Number of patients identified as having the health condition
with at least two measurements of the associated biomarker.
54.24%
(32 of 59*)
82.22%
(37 of 45*)
72.73%
(16 of 22*)
70.83%
(17 of 24*)
62.92%
(56 of 89*)
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
%PatientsthatImprovedConditionatAll
Chronic Condition
28. Systolic Blood Pressure
Changes among
Hypertensive Patients.
According to EMR records, patients in
care over four months experience
improvements in their blood pressure.
Patients in care at CEHC for over four
months decreased their systolic blood
pressure by, on average, 12 more
points than patients under care for less
than or equal to four months (N = 47, P
< 0.001).
CEHC Navegantes provide one-on-one
positive reinforcement sessions to
patients. Patients matched with
Navegantes decreased their systolic
blood pressure by, on average, 24 more
points than patients not matched with
Navegantes (N = 38, P = 0.008).
-21.7
-9.4
-19.5
4.3
-25
-20
-15
-10
-5
0
5
10
Under Care
>4 Months
Under Care
≤4 Months
With
Navegante
Without
Navegante
AverageSystolicBPPointChange
29. THE HYPERTENSION PROJECT
An Assessment of Our Adherence to AHA Guidelines &
an Evaluation of Our Performance
By Carmen Shulman, Jillian Peters, and Farzana Kibria
30. Blood Pressures at Goal
55%
46%
59%
33%
53%
62%
0% 20% 40% 60% 80% 100%
Clinica Esperanza/Hope Clinic
Charlestown Area Medical Center
Rush University Hypertension Clinic
6 Texas Urban Community Clinics
44 US Community Health Centers
Winthrop University Hospital
Outpatient Clinic
31. CEHC Positives
n Increasing Volunteer Supply
n More Collaborations and Networks
n Improved access to free resources
n $97,000 in donated free care 2010; $163,000 in
2011; more in 2012
n Demonstrated need for services as state funding
for core services (for example, TB clinic) is cut
32. Access to Care Constraints
n Increasing demand – waiting list at > 150
n Many of the requests for care are for minor
medical problems (back pain, rash, STD)
n These patients wait > 4-6 months to be seen
n “Walk In Clinic” may solve this issue
n “Walk In” will also reduce ER use
34. n CHEER program runs out of CEHC as a free walk-in clinic
for uninsured Rhode Island community members. Staffed
by volunteers and nursing providers, CHEER provides
non-urgent health care services every weekday!
n A goal of CHEER is to save patients thousands of
unnecessarily spent dollars by deterring them from going
to local emergency rooms for non-life-threatening
problems.
n Nurse-Run!
CHEER clinic
35. Evaluation
1. Measure use of walk-in non-acute
healthcare to the uninsured provided by
expanding clinic hours at CEHC
2. Determine whether providing prospective
ER visitors the option of walk-in non-
acute care will reduce ER use
3. Calculate impact in terms of costs
avoided and QALYs.
38. Willingness and Ability
to Pay for Care
n Concordance between what CHEER patients were
willing and able to pay for their healthcare
n 54 (59% of respondents) had no difference between
what they were willing and able to pay
n 35 (38%) were willing to pay more than they could
afford—with an average shortcoming of $22.94
n 3 were willing to pay less than they could afford
n Distribution of what patients would be able to pay:
n $0 43 patients (45%)
n $1-10 21 patients (22%)
n $15-25 26 patients (27%)
n $30-60 6 patients (6%)
39. Patients’ ER Utilization
32
10
8
13
2
1
0
5
10
15
20
25
30
35
Past Year Past Month Past Week
Number of patients who had been to ER in timeframe
65 CHEER patients
(49% of respondents)
reported they would
have gone to the ER
for their chief complaint
if the CHEER clinic had
not been available.
40. Estimated* Costs Avoided
Total visits (5 months)** 252
Total visits discounted by 20%* 202
Average cost per CHEER visit $32
Average cost per ER visit in Rhode Island $792
Cost avoided per CHEER clinic visit $760
Costs avoided (5 months) $153,216
Costs avoided (12-month projection) $367,718
*See reasoning in Oriol et al., 2009
**Excluding four patients who were, in fact, referred to the ER
42. 5-Month
Return on Investment (ROI)
Operating Cost of CHEER Clinic $37,870
Tests, Other Operating Expenses $11,070
Wages and Taxes $26,800
Costs Saved = ER Costs Avoided + QALYS
Value
$1,313,053
Costs avoided by preventing ER visits $123,530
Value of potential life years saved by CHEER $1,189,523
5-Month ROI
= (Costs Saved – Operating Cost)
$1,275,184
($0.60-2.03 million)^
5-Month ROI Ratio
= 5-Month ROI ÷ Operating Cost
34:1
(16:1 – 54:1)^^Using other QALY estimates available in the literature, we calculated these conservative and liberal estimates
43. Designing a place-based health intervention
that addresses community needs.
Vida Sana / Healthy Life
44. A Place to Be Healthy
n Vida Sana was created to promote a healthier lifestyle in
Health Disparity Populations (HDPs) at risk for
metabolic syndrome
n HDPs in Providence, particularly the up to 50,000 undocumented
immigrants and other uninsured populations, face limited access
to care, poor health education, and other socioeconomic barriers
which worsen long-term outcomes of metabolic syndrome and
other chronic conditions
n Focus on
n Improving health literacy
n Creating a social learning environment (“A Place to Be Healthy”)
n Measuring metabolic outcomes in participants
n Funded by the RI Department of Health’s “Center for
Health Equity and Wellness Grant”
45. Vida Sana Mission
n Create a fun social learning environment
where participants learn about nutrition
and other healthy lifestyle choices
n Curriculum developed by Susan Oliverio, MD
n Designed to be accessible for either English-
or Spanish-speaking participants with low
literacy
48. Gloria Dei Church
Since March 2013
# of Participants: 20
# of Navegantes: 3
Site Based Action Team
Contact: Kayla Rodriquez,
Mercedes Batista
Open Table of Christ
Church
Since 12/12/2012
# of Participants: 33
# of Navegantes:
Site Based Action Team
Contact: Anna Vargas
Clinica Esperanza/Hope
Clinic
Ongoing since 08/22/2012
# of Participants : >50
# of Navegantes: 5
Site Based Action Team Contact:
Ingrid Castillo
Empowerment
Temple
Under Development
# of Participants
# of Navegantes:2
Site Based Action Team
Contact: Akosua Adu-
Boahene
Timeline of Vida Sana
v Group 1 at CEHC (Spanish) ~ Aug 2012
v Group 1 Completion of Program ~ October 2012
v Group 2 at OTC (Spanish) ~ Dec 2012
v Group 2 Completion of Program ~ Feb 2013
v Group 3 at CEHC (Spanish) ~ Jan 2013
v Group 3 Completion of Program ~ Mar 2013
v Group 4 at OTC (Spanish) ~ Mar 2013
v Group 4 Completion of Program ~ May 2013
v Group 5 at CEHC (English) ~ Mar 2013
v Group 6 at Gloria Dei Start March 2013
v Group 5 Completion of Program ~ May 2013
v Group 6 at Gloria Dei Completion -- June 2013
v Group 7 at CEHC started June 4, 2013
v Group 8 (English) at CEHC scheduled June 15
v Group 9 S(Spanish) at CEHC scheduled June 18
(2) Establish Outreach Sites
53. n Definition of completion: attended at least 6/8 sessions,
at least one social event, and at least one educational
event
10/24 11/20 12/14N: 8/10 12/15 20/20 5/13 13/18 10/11
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
GROUP 2 GROUP 3 GROUP 4 GROUP 5 GROUP 6 GROUP 7 GROUP 8 GROUP 9 GROUP 10 GROUP 11 GROUP 12
Percent Completion by Group
4/10 5/8
Completion (Groups 2-12)
54. Program Completion: Year 2
n Approximately two-
thirds (69%) of
participants completed
the program
n Slight improvement
over Year 1 (66%)
1 Session
4%
2 Sessions
17%
3 Sessions
6%
4 Sessions
2%
5 Sessions
2%
6 or More
Sessions
69%
55. Factors Affecting Completion
n Health Disparity Populations face several
socioeconomic barriers to program commitment
n Unable to afford to leave children at home unsupervised
n Need to maintain jobs which conflict with scheduling
n (YEAR 1 DATA) Only 41% of age 30-40 participants
completed the program, in comparison to between
70% and 78% for other age ranges. This population is
more likely to get a new job, have changes in family
dynamics, or have instability in living/transportation situations
n (YEAR 2 DATA…relationship did not hold) Those aged
51-60 years had the lowest program completion rate (62%),
followed by those <30 years (67%); those aged >60 years had
the highest program completion rate (75%)
56. Impact of Intervention
n Patients had metabolic syndrome, but not all
patients were overweight (they may have been
normal weight but had HTN, diabetes, and high
lipids).
n Thus – some results did not need to change.
Results are therefore shown as “percent stable
or improved”
n Mainly improved waist circumference, systolic
BP, and health literacy
n Slight improvement in other results such as weight
57. Results Overview: Year 1
n Percent outcomes stayed stable or improved
over 8 week period
82.7% 79.8%
61.1% 59.6%
82.5%
92.2%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Weight Waist Circumference Glucose Cholesterol BP HL Test
Percent Stable/Improved
58. Waist Circumference Results
n Many kept waist circumference steady
n Those that improved had quite dramatic
improvements
N=109 Waist Circumference
Average Start 38.7 in
Average End 38.1 in
% Stable/Improved 79.8%
Average decrease for those that
improved
2 in
59. Weight/BMI Results
n Most improved weight, but only slightly
n Impressive for 8 week study period
N=110 Weight BMI
Average Start 180.5 lbs 28.2
Average End 177.2 lbs 27.7
% Stable/Improved 82.7% 82.7%
Average decrease for
those that improved
5.5 lbs 1.0
60. Blood Glucose Results
n Unable to enforce fasting glucose tests, so
results varied and not statistically rigorous
n Despite this, overall improvement seen
N=108 Blood Glucose
Average Start 124.6 mg/dl
Average End 118.0 mg/dl
% Stable/Improved 61.1%
Average decrease for those that
improved
26.8 mg/dl
61. Cholesterol Results
n Similarly not fasting tested, although
results less varied than for glucose
n Promising overall improvement observed
N=109 LDL Cholesterol
Average Start 190.7 mg/dl
Average End 185.6 mg/dl
% Stable/Improved 59.6%
Average decrease for those that
improved
18.6 mg/dl
62. Blood Pressure Results
n Hard to observe significant and consistent
changes for blood pressure in 8 weeks
n Most patients with >120 systolic at onset
remained stable or had slight improvement
N=63 (>120 at onset) Systolic Blood Pressure
Average Start 140
Average End 134
% Stable/Improved 82.5%
Average decrease for those that
improved
12
63. Health Literacy Test Results
n Consistent, large improvement in scores of
health literacy test
n Impact of participants attending a second Vida
Sana program noted (contributed to increase in
baseline pre-test and post-test).
N=103 Health Literacy Test
Average Start 71.1%
Average End 90.7%
% Stable/Improved 92.2%
Average increase (% pts) for those
that improved
22.9%
64. Other Findings
n Outcomes relatively consistent regardless of age
and starting BMI
n Glucose and cholesterol appear to improve
based on number of sessions patients attended
n Participants were engaged and enthusiastic
n Navegantes proud of accomplishments and
looking for ways to improve programs
n Some aspects of outcomes improved more
consistently in later Vida Sana programs
65. Goals for Future
n Setting up “self-sustaining” Vida Sana programs
n “See one, Do one, Teach one”
n Expand to new sites with more Navegantes
n Provide training, supplies, and support for sites to run
Vida Sana independently
n Having more consistent 3-month and later
follow-up data to observe if outcomes are
sustained
n Continue to reach health disparity populations,
with goal of having 1,000 Vida Sana “graduates”
67. Setting up “self-sustaining”
Vida Sana programs
n “See one, Do one, Teach one
n Expand to new sites with more Navegantes
n Provide training, supplies, and support for sites
to run Vida Sana independently
68. Who have we reached?
n January-May 2014
n 5 groups
n 85 total participants
n 57 completed (67%)
n From the publication
n 13 groups
n 192 participants
n 126 completed (66%)
n Total to date
n 18 groups
n 277 participants
n 183 completed (66%)
70. Acknowledgements
n Initial analysis provided by
n Jacob Buckley (Brown Undergraduate)
n Farzana Kibria (Smith College Praxis intern)
n Shahla Yekta, Ph.D. (CEHC Consultant)
n Valerie Joseph, R.N. (Nurse Manager)
n Ingrid Castillo (Head Navegante)
n Carlos Juarez (Clinic Coordinator)
n The Navegantes
71. Community Presence
n Of those who responded…
n 50% of CHEER patients had heard of the
clinic through word of mouth—e.g., from a
friend or family member
n 19% of CHEER patients had heard of the
clinic through other community-based non-
profit organizations, their church, another
community health center or hospital, or their
school or workplace
72. Conclusion
n CEHC has an important role serving a
basic need
n CHEER program– current data
demonstrates that investment is worth it!
n Vida Sana program appears to be an
effective intervention
73. Funding Needed
n Support for CHEER
n $100,000
n Support for Continuity of Care clinic
n $100,000
n Support for Operational Costs
n $50-60,000 per year
n Few donors contribute to this goal
n Need more support!
74. 40,000 to 60,000 Uninsured in Rhode Island
Improving Access to Health Care – People Stay Healthy
Healthy People build Strong Communities
Free Clinics Are an Essential Safety Net
Especially in these Difficult Economic Times
More to do