The Outcomes Assessment Project: Giving Mobile Healthcare the Attention It Deserves
Jennifer Bennet, Executive Director, The Family Van/Harvard Medical School, Roxbury, MA
Anthony Vavasis, MD, Health Outreach To Teens, Callen-Lorde Community Health Center, NYC
Mobile Healthcare is in it ascendancy in the United States. Despite this, it remains an unknown quantity in terms of the breadth and efficacy of services delivered. A comprehensive analysis of Mobile Healthcare is crucial for the ongoing growth and support of mobile programs as a whole.
As a direct result of the MHCA 2006 Annual Forum, a collaboration has been developed with Mobile Health Clinics Association, Harvard Medical School's Department of Social Medicine and Ronald McDonald House Charities. These three entities have embarked on a nationwide project to demonstrate the value of mobile health. This project will work with Mobile Health providers to aggregate existing data on services provided and analyze it using sophisticated outcomes analysis methods. Ultimately our goal is to be able to demonstrate the value our services provided for programs both locally and nationally. Aggregating the data will create a national picture for Mobile Health services that will assist programs in generating reports that describe ways in which that program was cost effective and/or efficacious in its practice.
This innovative project has the potential to transform the nation's awareness and understanding of Mobile Healthcare. First, it will have amassed a robust data set that can fully describe the myriad practices of Mobile Health, from mobile pediatric dentistry to mobile mammography. Second, it can irrefutably demonstrate the efficacy and cost-effectiveness of Mobile Healthcare. Finally, it will empower the many grassroots mobile programs across the country by statistically validating the work each program does on a daily basis.
Mobile Mammography - Program Sustainability & Viability
Laura Fry, Radiology Coordinator, University of Louisville Hospital, Louisville, KY
Mary Solomon, Executive Director, Women's Outreach Network, Islip Terrace, NY
Mobile Mammography Vans have become an alternative to more traditional facilities for many women for many reasons. Many mobile mammography providers struggle to keep their programs viable. The cost of providing services continues to rise while reimbursement from Medicare, Medicaid and other insurance plans remain inadequate. The lack of certified mammography technicians available to staff vans and the shortage of Radiologists willing to interpret mammography screenings have also driven costs up. Complying with ACR and MQSA requirements is time consuming and expensive. The increase cost of equipment, maintenance, supplies, and even gasoline add to the financial stress we all experience. How do providers survive?
University of Louisville Hospital has worked collaboratively with the Kentucky Cancer Program and the Louisville Metro Health Department to facilitate mammography screenings for uninsured and underserved populations for 15 years. In addition, U of L has a strong corporate program. Together these programs screen approximately 6500 women annually. Despite this success, U of L still faces challenges; in particular the demand for services exceeds the amount of State funds that are available.
Women's Outreach Network, a Mobile Mammography Program, has been providing free mammography, clinical breast exams, and breast health education to uninsured and poorly insured women since December 1985. The program provides approximately 6500 examinations annually. How does a program that provides only screening mammography and clinical breast exams to low income, uninsured women survive 22 years? The answer, keep costs low.
- Employ an integrated and shared computer program on a local area network that provides
- Patient Information
- Staff and Van scheduling
- Sponsor and Outreach information
- Patient appointments
- Electronic billing
- Statistical Analysis and reporting
- Design a van for maximum efficiency
- Purchase appropriate equipment - mammography, generator,
- Make sure the van can travel almost anywhere - height and weight of van, pass plates
- Gas verses diesel fuel - truck verses RV
- Patient flow - privacy - clean and organized - no windows in exam areas
- Keep the van stored in a safe place at a low cost
- Keeping staff happy resulting in low turn over - especially the professional staff
- Cross train when possible - Female driver/receptionist, train technicians to do CBE's
- Logistics - Keep them simple
- Provide good directions for all van staff - be sure parking is set aside
- Start the work day early or late in the afternoon in an Urban center to beat the traffic
- Schedule patient appointments appropriately - know your community "no show rate"
- Have patient paper work done before patients arrive - confirm appointments
- Grants and Foundation Support
- Donated equipment
- Funding for uninsured
- Government grants and private foundation grants - Gap funding for poorly insured
- Corporate sponsorship
Partnerships for Emergency Relief Collaboration: A Post-Hurricane Imperative
Capi Landreneau, Director, Mobile Health Care, March of Dimes Foundation, White Plains, NY
Hurricane Katrina raised many issues related to disaster response. For the March of Dimes, it highlighted the need for a response directed at the specific needs of pregnant women and families with infants and fragile newborns. It also confirmed the need for community collaborations to create, deploy and sustain meaningful and effective programs designed to reach those who are most in need. Through the deployment of four mobile health centers in Louisiana and Mississippi, March of Dimes intends to provide over 15,000 medical visits to infants and women of childbearing age, in an effort to prevent a rise in poor birth outcomes, such as prematurity and infant mortality, in the wake of Hurricane Katrina.
In the U.S., prematurity is the leading cause of neonatal mortality (death during the first month of life), and second most frequent cause of infant mortality (less than one year of age). Annually, prematurity leads to an estimated 100,000 new cases of asthma, mental retardation, cerebral palsy, and vision and hearing disabilities. Prematurity is also associated with as much as half of all neuro-development problems in childhood.
The states along the gulf coast affected by the hurricanes have prematurity and infant mortality rates that are among the highest in the nation. In the wake of the 2005 hurricanes on the Gulf Cost, these grave statistics are expected to worsen due to reduced access to prenatal care and education and increased stress levels for pregnant mothers and families. Functioning hospitals and health centers in the area are seeing two and three-fold increases in the number of pregnant women and newborns due to closed facilities in harder hit areas, such as New Orleans and towns directly in the path of the hurricanes. The result is that women of childbearing age, including those already pregnant, are not able to access the care they need; areas where displaced women and families are now living need great help to coordinate and provide services. Because most shelters have closed and families have been dispersed to other housing in these states, the challenge of outreach, identification and delivery of services is now very great and will remain so for several years. It is essential that these women be reached now to prevent a catastrophic rise in poor birth outcomes in this region in the near future.
1. Have a better understanding of the history of Mobile Health within March of Dimes
2. Be able to discuss and differentiate models used for implementation of mobile health programs
3. Discuss key components March of Dime finds necessary for a successful mobile health program
4. Discuss how four mobile health care vehicles are to be deployed and operated as part of March of Dimes Hurricane Assistance.
About the March of Dimes
The March of Dimes is a not-for-profit voluntary health agency whose mission is to improve the health of babies by preventing birth defects, premature birth and infant mortality. It was founded in 1938 by President Franklin Delano Roosevelt to defeat polio. Within 17 years, the Salk vaccine was developed and polio was defeated. The March of Dimes then turned its attention to an even greater challenge: fighting birth defects and other infant health problems.
The March of Dimes is a national organization with Chapter in every state. We carry out our mission through an infrastructure of national, regional and local staff and volunteers who identify needs of pregnant women and families with infants, and work with medical, public health and community partners to address those needs.
Extending Health Care to Homeless People
John Lozier, Executive Director and Patricia Post, Policy Analyst
National Health Care for the Homeless Council, Nashville, TN
Robert Donovan, MD, Medical Director, Cincinnati Health Network, Inc., Cincinnati, OH
This panel discussed the value of mobile health care for people without stable housing and the challenges this outreach modality presents to Health Care for the Homeless programs that are using it.
John Lozier addressed the significance of mobile health outreach to homeless populations as one of a number of innovative outreach strategies used by HCH programs over the last 25 years to help overcome intrinsic and extrinsic barriers to health care for homeless people.
Patricia Post summarized findings from a new report by the National Health Care for the Homeless Council — Reaching Out to Help In: Mobile Health Care for Homeless People — based on telephone interviews with program administrators and direct service providers working in 33 Health Care for the Homeless (HCH) projects across the U.S. Topics include the utility of extending care to homeless populations via mobile health outreach; the diversity of services, staffing models, and mobile units used by surveyed programs; financing mechanisms and community partners; program obstacles, lessons learned, and factors to which these programs attribute their success.
Robert Donovan, one of the contributors to the National' Council's report, described the Cincinnati Health Network Mobile Health Program which he directs. His presentation will address the challenge of blending mobile health outreach with services provided in fixed-site clinics, and the importance of collaboration with community partners — including public health departments, community health centers, hospitals, and academic medical centers — to enhance service capacity and assure continuity of care.
- Discuss the value of mobile health outreach to homeless people and the challenges it presents to Health Care for the Homeless providers;
- Describe the staffing and other challenges posed by limited resources for mobile health outreach and the importance of collaboration with community partners to enhance service capacity;
- Explain how the use of mobile clinics and other vehicles to extend health care to homeless populations complements other outreach modalities used by HCH providers.
Mobile Health Programs: Eye Care Screening for Underserved Populations
Brian Quinn, Director, Grants & Communications, Friends of the Congressional Glaucoma Caucus Foundation, Lake Success, NY
Kathleen Curtin, Executive Director, Maryland Society for Sight, Baltimore, MD
James Wheeler, Chief Operating Officer, Lions Sight Research Foundation, San Antonio, TX
Founded in late 2000, the Friends of the Congressional Glaucoma Caucus Foundation (FCGCF) conducts no-cost glaucoma screenings all across the United States. During the first two years, the Foundation worked mostly in New York City and Washington, DC; in 2003, it began using a mobile unit to reach other parts of the country.
Now the FCGCF owns and operates eight mobile units and supports or is in partnership with ten other programs. These mobile units have enabled the Foundation to reach 37 of the lower 48 states. Mobile units were introduced in January, 2003, and by year's end, some 25% of all screenings involved a mobile unit. FCGCF added two units in 2003, three in 2004, three in 2005, and two in 2006; and over that same period we contracted with other organizations, such as the Lions Sight Research Foundation in San Antonio, Texas, the Maryland Society for Sight, and The Family Van at Harvard Medical School to support their own mobile units and to bring the total of units employed for screenings to 18. By 2006, mobile units accounted for 45% of all FCGCF-sponsored screenings.
During the year 2006 alone, the Friends of the Congressional Glaucoma Caucus Foundation screened 53,937 men and women in 1,401 locations across the United States. Altogether, the Foundation set up and conducted 2,724 screenings, for an average of more than SEVEN screenings a DAY, 365 days a year. Of those screened, 6,186 showed signs of early or established glaucoma. Another 7,837 evidenced eye diseases other than glaucoma. (See Column 7, Table 1). The numbers of screenings and results are also shown, under the heading "Mobile Units."
TABLE 1: FCGCF Findings, 2001 to 2006
|Number of Screenings
|Other Eye Diseases Found
The eight mobile units owned and operated by the Friends of the Congressional Glaucoma Caucus Foundation have traveled a combined 242,500 miles (or about 3,000 miles PAST the moon, which is 239,000 miles away) in their screening activities.