Mobile health clinics can enhance health care accessibility and quality in underserved communities. Immigration Policy change and new health care regulations are vital to long-term health care costs reduction and population health improvement.

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Comparative Analysis
Mobile Clinics: Optimizing Access to Preventive Care
MICKELDER KERCY, MD
TEACHERS COLLEGE COLUMBIA UNIVERSITY
Key Issues in the U.S.
Haitian Population
Evaluation Plan
Access to Preventive and Coordinated Care
•Kings County Hospital Center: Plan to acquire a mobile van that will increase
access to health screenings and health education services as well as direct referrals for
additional care in the hospital setting.
•Literature: Mobile clinics are unequivocally successful at increasing access to preventive
health care services and routine management of certain health conditions. Even when care
is readily accessible, mobile clinics present an opportunity to seek services from unfamiliar
faces, which eliminates the fear of potential disease related discrimination.
Cost Containment
•Kings County Hospital Center: Potential health care savings due to the mobile clinic.
•Literature: Estimated return on investment is 2.1 (Hill et al., 2014).
Quality Care & Sustainability
•Kings County Hospital Center: No clear evidence of the long-term goal of the mobile clinic
to accommodate the needs of community members to receive assistance on how to be
empowered to prevent disease and manage their health in their own living environment.
•Literature: Mobile clinics has been resourceful to community members of underserved
communities, especially the male population who does not typically seek health care services
at hospital or in clinical settings. The Knowledgeable Neighbor Model is an ideal framework
to accomplish these goals.
In the capacity of a Community Health Educator and Researcher Consultant:
•Collaborate on a 3 year health equity project with the Kings County Hospital leadership
team members, the pastors of the churches located in the zip codes with the highest
agglomeration of Haitians and Haitian-Americans (18 years and older), and the
stakeholders at organizations such as the Haitian-American Community Coalition
(HCC) (n.d.) and the Haitian-American Caucus (n.d.).
•Assist in creating the logic model, planning the budget, and formalizing the hiring
process of the personnel and volunteers.
•Facilitate the training of community-based staff members in cultural competence and
motivational interviewing, based on the Knowledgeable Neighbor Model.
Workforce
•One program manager, one physician, two nurses, two health educators, one social
worker, and one medical assistant would be providing services to be reimbursed mainly
based on performance and quality measures.
•Volunteer students in public or community health reaching out to the population using
social marketing principles and delivering health education activities.
•Volunteer international medical graduates, medical students, and or nursing students
would primarily be screening community members for their medical and non-medical
concerns, and enabling them to use their blood pressure machines and glucometers.
Description of
Organization/Program
New Program Plan
Kings County Hospital Center
•University-affiliated hospital providing a wide range of simple to highly complex care
services to vulnerable populations in Brooklyn.
•A) Emergency department visits: 35% uninsured versus 40% Medicaid patients.
•B) Clinic visits: 39% uninsured versus 39% Medicaid patients.
•Member of the New York Health Hospital Health (HH) group – The Uninsured account
for $698 million in uncompensated care annually at HH.
•Report (2013) – Top priorities: Preventing and managing chronic diseases.
Program
•Hospital: Streamline patient appointment process, infrastructure expansion and remodeling,
increase patient visits frequency, employ more dieticians, and decrease readmission.
•Mobile health van: Health screenings, health education, and hospital referrals.
Literature Review
Study 1: Hill et al. (2012)
•Introduction: Low-income populations need preventive and cost-beneficiary services.
•Methods: Knowledgeable Neighbor Model - Staff members are integral members of the
community; and trained in cultural competency, and motivational interviewing.
•Results: Family Van Mobile Clinic - From 2006 to 2009, 5898 community members
(Massachusetts) received care, 65% self-identified as blacks, 82% were uninsured, 6%
spoke Haitian Creole, 23% screened for High blood pressure, 11% with pre-diabetes, and
3% with high blood sugar.
•Conclusion: Increased access to cost-effective and high-quality preventive care to
insured male who typically do not seek health care.
Study 2: Luke and Castañeda (2013)
•Introduction: Farmworkers are “a medically underserved population in the U.S”. What
are the best partnership practices to successfully reach out to them using mobile clinics?
•Methods: Literature review (January 1, 1990 – July 24, 2012) – PubMed and CINAHL
•Results: 18 articles. Based on the Community Coalition Action theory, successful mobile
clinic efforts are due to strategic partnerships between the nursing or medical school
leading the project with a variety of stakeholders; community-based engagement; and the
formal development, implementation, and evaluation of projects.
•Conclusion: Mobile clinics sustainability results from strong collaboration between the
lead agency and stakeholders such as academic institutions and local organizations.
Study 3: Gibson et al. (2014)
•Introduction: The literature is scarce about “the spatial distribution of MMC [mobile
medical clinics] clients, healthcare service utilization, and frequency of MMC usage”.
•Methods: The statistical software ArcGIS 10.1 was used to map the distribution of the
people served at the Community Health Care Van in New Haven (Connecticut). The
distribution data was compared to the services they were receiving. The relationship
between the distribution data and the frequency of visits to the van was estimated.
•Results: In total, 8404 people with documented addresses received some care at the
mobile clinic (January 2004 - December 2012). Most people (300-500 per census tract)
were living within 8 to 10 miles from the van, congruent with the theory of distant decay.
However, “most frequent visitations occurred between 11 and 20 miles”. Based on a
novel framework combining the Health Behavior Model, the theories of health
geography, and the Penchansky’s and Thomas’ five domains of health care access, need
factors were linked with the higher-frequency usage of services from distant clients.
•Conclusion: Proximity was a major determinant in accessing the van for some people.
Individuals who lived far away sought health care services at the van because of need
factor and to potentially avoid stigma and discrimination.
Implementation Plan
First 6 months
•Recruitment and training of the personnel and volunteers to deliver service exclusively to
local church members.
Following 6 months
•Beginning of the neighborhood community outreach on 3-5 days per week, based on
available human capital, workload, and budget capacity. The mobile clinic is stationed in
areas of high traffic such as the Nostrand avenue in the Flatbush neighborhood.
Policy Recommendations
Formative and Summative Evaluation Processes
(Access to care, Perception of quality of care, Cost-Effectiveness, and Sustainability)
•Quarterly analysis of the management information data to inform the logic model revision.
•HCAHPS-like surveys in different languages administered to each participant.
•Random sample of 40% of participants - Perception of the quality of care at the van
•Proportionate stratified random sampling of church members - Workshops assessments
•Amend the sponsor’s affidavit of support (USCI form I- 864) (Scherzer et al., 2010).
•Enact laws making immigrants eligible for Medicaid within the first 5 years of residency.
Thanks to Dr. Nicole Harris-Hollinsworth for her instructional support on this project.
Acknowledgment