Medscape
January 29, 2014
From Medscape:
For 28 years, Heartland Alliance Health, Inc. (HAH), the healthcare arm of Heartland Alliance, the leading antipoverty organization in the Midwest, has delivered high-quality healthcare to Chicago’s most vulnerable people — those living in poverty, the homeless, people living with HIV/AIDS, the mentally ill, substance abusers, and immigrants and refugees. Nearly all participants are under the 100% poverty level; in 2012, 80% were uninsured. Without HAH’s services, these individuals would struggle to meet their basic healthcare needs.
HAH’s comprehensive services — including primary, oral, and behavioral healthcare, complemented by nutrition, housing, and case management programming — create a holistic, multidisciplinary response to participants’ complex needs. Each year, HAH assists more than 10,000 people to improve their health and manage their chronic diseases through participant-centered, data-driven care.
Yet, like most Federally Qualified Health Centers, HAH struggled to ensure that participants undergo colon cancer screening according to accepted guidelines.
In 2012, the local hospital to which HAH was referring participants for colonoscopy sent a letter to HAH suggesting that they would stop offering participants appointments because of a high no-show rate, even among insured participants. HAH started a quality improvement (QI) project to increase screening rates and decrease no-shows, with a goal of better understanding why screening rates were so low among both insured and uninsured participants.
As a first step, an advance practice nurse (APN) at HAH researched patient records and followed up with participants and the local hospital gastrointestinal (GI) service to understand what had happened with each referral. The evaluation revealed:
• 33% completion rate;
• 7% cancellation rate;
• 38% no-shows; and
• 22% unknown.
The APN and the HAH medical director met for a brainstorming session to identify the problems and to determine what data were needed to better understand why the screening rates were so low. They looked at 3 key components for their QI project: which processes needed to be reviewed, who needed to be involved, and what was missing within the existing structure that was creating barriers and preventing participants from undergoing effective colon cancer screening.
In looking at the GI referral service, the QI team noted that reports were not consistently added to the participant’s HAH chart. In fact, reports were in the charts of only 7% of participants who completed screening.
Next, they looked at HAH providers. They found that follow-up was inadequate and that the notes after the scheduled test date did not indicate whether the test was done.
Finally, they looked at what might be leading patients to miss their appointments. It was clear that patients were notified before the test, and although the HAH case managers were involved, the patients still did not show.
