2010 ANNUAL FORUM
September 25-28 ~ New Orleans, LA
Donald Weaver, MD
Acting Director, Office of Special Health Affairs
Health Resources and Services Administration
Assistant Surgeon General<
United States Public Health Service
Keynote Address ~On the Move to Improve the Health of Individuals and Communities
The Health Resources and Services Administration (HRSA) clearly appreciates and acknowledges the contribution of mobile health services in increasing access to health care for underserved populations nationwide.
This presentation highlighted many HRSA programs and what our HRSA grantees have done. For instance, our HRSA partners in maternal and child health provide health services to 6 out of 10 women who give birth in the U.S.; HRSA grantees help train the healthcare workforce; through HRSA's National Health Service Corps over 29,000 health professionals have received HRSA scholarships or loan repayments; through HRSA's Ryan White programs HIV/AIDS services are delivered to more than half the estimated people living with HIV/AIDS in the U.S. at over 900 clinics; and HRSA's Office of Rural Health Policy funded a new pilot program to provide technical assistance to 22 Rural Training Track programs across the nation.
HRSA does have more than 1,100 health center grantees that operate nearly 8,000 community based clinics in every state and territory. Many of these health centers serve patients through satellite or mobile clinics. HRSA funds help to support approximately 230 mobile health service clinics. Mobile health clinics provide care that is vital to the community it serves.
This presentation discussed how mobile clinics can focus their practice on prevention and primary care and the importance of oral and behavioral health integration. Finally, this presentation explained how community-responsive, culturally competent, interdisciplinary teams play an integral role in mobile health services.
- Discussion of HRSA funding
- How to focus your practice on prevention and primary care
- The importance of oral and behavioral health integration
- How to play an integral role in mobile health services as part of a community-responsive, culturally competent, interdisciplinary team
Charmaine Allesandro, RN, MSHA
Immunizations on the Move
When a child is up-to-date on the vaccinations recommended by the Center for Disease Control, he or she is protected against 16 serious childhood diseases that include such dangerous illnesses as Diphtheria, Hepatitis, and Meningitis. Vaccination is also the most cost effective way to keep a community healthy with both direct and indirect medical savings of $27 for every dollar spent on vaccination. Unfortunately, parents often do not know when immunizations are due; physician office visits are perceived as being too expensive by low-income parents; and parents often have to take time off from work to take a child to a doctor's office or clinic. These factors often lead to low immunization coverage rates in many communities, particularly in urban areas with high populations of low-income families. The main objective of the Greater New Orleans Immunization Network (GNOIN) is to increase vaccination rates of children, which can help keep these children healthy and protect a community from disease outbreaks. GNOIN provides free immunizations through a mobile health clinic that visits various neighborhoods in seven parishes (counties) in South Louisiana. The mobile health clinic is on the road four to five days each week and includes a schedule of weekdays, evenings and Saturdays.
All medical staff are registered nurses qualified to administer vaccinations, educate parents about immunizations, respond to any adverse reactions, and properly update a child's shot records on the state's computerized immunization registry (LINKS). The program places its greatest focus on increasing the immunization rates of toddlers, but vaccinations are provided to all children up to 18-years in age. All immunizations are entered into the state's computerized immunization registry each time a child receives a vaccination. Reminders are sent to all enrolled children at 2, 4, 6 and 15 months of age as well as 4 and 11 year-olds. Parent education is provided on all vaccine-preventable diseases, the vaccines that prevent them, and the importance of timely vaccinations. The GNOIN program model addresses several barriers to receiving vaccinations: it gives immunizations for free, it travels to neighborhoods for the convenience of parents, it sends out reminders when a child's shots are due, and it participates in a state immunization registry. GNOIN has been operating since 1999 and currently vaccinates 20,000 - 22,000 children each year. Since the program started operating, more than 90,000 children have been vaccinated and 195,000 shots have been administered. Children who visit our GNOIN immunization mobile clinic for vaccinations are 90% up to date. The 2008 National Immunization Survey ranked Louisiana 2nd in the country for immunization rates of toddlers.
- Getting the most out of a mobile program.
A). How to increase visits to the mobile unit
1.) Easy accessibility
2.) Clinic hours to accommodate working parents
3.) Partner with stakeholders
4.) Provide quality healthcare
5.) Provide efficient service
- . Sustainability
A). Turning Statistics into funding
1). Know what you're counting and why
2). Demonstrate your program's effectiveness
3). Learn from data and develop new programs
Screening Initiative with a Medicaid Carrier to Reach
Non-compliant Women Associated with Inner City Health Clinics
Mammography rates are below the Healthy People 2010 goals, especially for underserved populations. Community access to digital mobile mammography in the Philadelphia region is best facilitated through collaboration with healthcare carriers and primary care facilities.
In a partnership with Keystone Mercy Health Plan, a Medicaid carrier, Fox Chase Cancer Center held four screening events targeting non-compliant and underserved communities in three neighborhoods in Philadelphia, Pennsylvania. Eligibility criteria included non-compliant women 40 years of age and above, those receiving PA medical assistance coverage through the Keystone Mercy Health Plan and having a prescription from a physician. Women were recruited by telephone, offered transportation and a $25 gift card upon screening.
Eighty two women were screened during the four-day event. Nearly 46% were above fifty years of age. Nearly 20% had an abnormal finding requiring additional screening. Seventy-seven of those screened (94%) completed the anonymous survey regarding race, ethnicity, and history of screening and patient satisfaction. Of those, 61% were African American/Black and 8% were Hispanic/Latina. Nearly 40% reported never being screened for breast cancer. About 90% rated their experience with the van as ‘very good' or ‘excellent.' Other evaluation data were collected regarding the participants background (date of last mammogram) and programmatic feasibility (use of incentives and no show rates). Within these four inner city health clinics, we identified a large population of women non-compliant with screening.
Mobile mammography programs provide an excellent strategy to reach underserved urban communities. Partnering with a healthcare carrier to identify and facilitate sites in areas most populated by non-compliant Medicaid subscribers, combined with a benefit package of transportation and gift card, stimulated participation.
Lessons Learned and Future Plans
Collaborating with healthcare carriers and primary care providers improves access and continuity of care for those needing additional follow-up care. Improved data collection methods are needed to better describe our service population and conduct health disparities research. Results from our program express a need for patient navigation services for those women with abnormal screening findings.
- How a multi-faceted collaboration between healthcare providers and a healthcare carriers increase screening participation.
- How persuasive is a cash incentive and transportation to getting a mammogram?
- Mobile mammography programs provide a convenient way to reach underserved urban communities.
- Improved data collection methods are needed to better describe our service population and conduct health disparities research.
Maryam Mohsenzadeh, DDS
Jill Moss, MSN, PHN
Manager, Community Outreach,
Queen of the Valley Medical Center; St. Joseph Health System
Mobile Dental Financial Stability and Continuity of Care
The Sisters of Saint Joseph of Orange set out 50 years ago with a mission to continually improve the health and quality of life of Napa County residents, especially the poor and vulnerable. This faith-based organization provides services to the community at large with the core values of Dignity, Service, Justice and Excellence as its foundation for care. Based on a community needs assessment, Queen of the Valley Medical Center established the Children's Mobile Dental Clinic in 2004 serving low income kids throughout Napa County. Currently, the mobile clinic serves over nine locations, providing preventative dental care and treatment through successful community partner relationships, contract negotiations and a discerning eye for the bottom line.
In this presentation, Dr. Mohsenzadeh explained how, by using her experiences in private practice and her knowledge of the Medical Center's mission, she has applied a series of performance improvement activities to increase revenue, decrease costs and increase access to care. QVMC now has a thriving mobile dental practice serving over 200 children per month during an average of 13 clinic days, while providing more than 500 specific services monthly. In particular she discussed how she made a very inefficient clinic more efficient, by maximizing the use of resources, negotiating with insurance agencies, accessing grant dollars, reorganizing staffing and implementing other significant improvements.
In addition, Dr. Mohsenzadeh discussed cover how this busy practice ensures continuity of care. She reviewed the process for scheduling patients for recall visits, how complex cases are managed and how cases that require care beyond the mobile clinic's scope of service are referred to other providers.
- Learn how to decrease costs without compromising care quality or access to care during these challenging economic times.
- Learn how to maximize staff time and clinic efficiency using simple time performance improvement activities.
- Learn how to maintain continuity of care for a complex socio economic patient population.
Larry Wolk, MD, MSPH
Founder & CEO
Mobile Care Coordinator
The Rocky Mountain Youth Clinics
Electronic Medical Records Systems in a Mobile Setting
The Rocky Mountain Youth Clinics (RMYC) is a Colorado non-profit organization with three large, traditional pediatric clinics, two mobile clinics and more than 20 smaller off-site satellite clinics. Our mission is to provide accessible, high-quality health and dental care to children and adolescents in the Denver Metro Area, regardless of insurance status or families' abilities to pay. We operate our mobile health and dental programs with two Ronald McDonald Care Mobiles®, each donated by the Ronald McDonald House Charities. These mobile clinics travel around Denver and Colorado to provide health and preventive dental care to medically and dentally underserved children and adolescents - from infants to 18-year-olds. Ronald McDonald House Charities has donated another Ronald McDonald Care Mobile® to our organization, which will expand our fleet of Care Mobiles® to three in late 2010.
The Rocky Mountain Youth Ronald McDonald Medical Care Mobile® is staffed by a mid-level healthcare provider and a driver/medical assistant. We provide well-child exams, sports physicals, diagnosis and treatment of minor acute illness, immunizations, routine lab tests, management of chronic illness and referrals to community agencies for other care. We have maintained ongoing partnerships with schools and community organizations in the area. In 2009, our mobile medical clinic served over 900 children, 85% of whom were uninsured, and provided more than 500 well child exams.
In 2008, the three traditional RMYC clinics transitioned from paper medical records to an Electronic Medical Records (EMR) system in order to streamline workflows and improve patient care. These changes were not implemented on our mobile clinics, however, due to the difficulties associated with operating EMR in a mobile setting. This all changed in 2009 when the RMYC Ronald McDonald Care Mobile Staff made an ambitious push to transition to EMR. We overcame many obstacles, including internet connectivity and staffing limitations, by using mobile broadband technology in creative ways and re-thinking the workflows of our staff members. After just a couple of months, our mobile clinic had fully transitioned to EMR. Doing so has streamlined patient care, allowed us to bill insurance and Medicaid for services, and enabled our mobile clinic staff to collaborate seamlessly with our traditional clinics. The benefits to our patients and our practice have far outweighed the work it took to implement EMR.
- Learn about Electronic Medical Records (EMR) as a practice management tool.
- Learn of the challenges associated with implementing an EMR in a mobile health setting.