DRAFT BOARD OF DIRECTORS PROGRAM AND … Materials (002)_1.pdfchanging schedule templates to...

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DRAFT BOARD OF DIRECTORS

PROGRAM AND PERFORMANCE IMPROVEMENT COMMITTEE November 13, 2018

PARTICIPANTS: P. Sheitel, C. Taylor, C. King, S. Levine, S. Sherman STAFF: N. Kalyanaraman, T. Gedin, J. Caughlan, A. Trustman ABSENT: N. Khanna, C. Welsh, I. Hanna

I. APPROVAL OF SEPTEMBER MINUTES: Stuart Levine made a motion and Crista Taylor seconded

that motion to approve the minutes of September 11, 2018 minutes. Minutes approved by unanimous consent.

II. HOURS OF SERVICE - EXTENDED HOURS AT WEST BALTIMORE AND BALTIMORE COUNTY: The

agency will be providing expanded access by adding evening hours at both sites. West Baltimore’s will extend hours on Wednesdays by staggering staff so that they can provide care until 7pm. For the Baltimore County clinic, we are still working with the county to determine security coverage before we can settle on the day of the week to have extended hours. Per HRSA requirements, changes to hours of operations must be approved by the board. Stuart Levine made a motion and Chelsea King seconded that motion to approve extended hours of service at West Baltimore and Baltimore County. Motion approved by unanimous consent.

III. HRSA SCOPE ADDITION: COMPLEMENTARY AND ALTERNATIVE MEDICINE (YOGA): We are

adding yoga as one of the services we offer. The yoga class is a drop-in class offered to both staff and clients and is run by certified instructors. For a service to be covered under FTCA, we have to add it to our HRSA scope of services. All scope changes require board approval. Chelsea King made a motion and Stuart Levine seconded that motion to approve adding complementary and alternative medicine - Yoga to our HRSA scope. Motion approved by unanimous consent.

IV. PERFORMANCE IMPROVEMENT PLAN:

We updated the PI Plan from our last meeting with goals for each of the measures including dental varnishes and depression remission which we added since the last meeting.

The 2019 prioritized goal measure definitions give the baseline for 2017/2018, goals for 2019, and national and state averages for comparisons. We used these data points to determine our goals and ultimately want to be better than the state and national average. For those measures that don’t have good benchmarks, we can only determine our targets based on our data.

There is a difference in our goals for the adult and child weight screening and intervention measures because of the different baselines for these measures.

V. PERFORMANCE IMPROVEMENT:

Missed Appointments: The overall average has declined from 31% to 28% after the implementation of automated reminder calls in October 2017. Several departments have conducted individualized root cause analyses and have plans to test changes. Examples of these changes include creation of a transportation assistance guide, modified workflows and changing schedule templates to increase same-day access. Will continued to monitor in 2019.

Client Experience: Our client survey takes place twice a year and we are working on

surveying specific questions more frequently. Currently we are focused on the client experience with after hour phone access. We saw an increase in survey scores due to increased communication of our after-hours number with clients both verbally and as part

of our automated call reminder system. We will continue to work on this measure but it will no longer be a part of the 2019 plan.

Diabetes HbA1c: Made some changes during the time working on the measures:

standing orders for nurses to titrate medications and tools for providers to use when they are prescribing to customize medication choices for each client

health education materials for patients to use with providers

general educational material for clients throughout the clinic

getting data from outside providers on A1c values so that we have up to date information

increased collaboration between providers and nurses to improve medication adherence We’ve spent 2 years on diabetes as part of the PI Plan and at this point will be taking it off of our PI Plan as we look to maintain the gains we’ve made.

Colorectal Cancer: We are pushing for increased FIT testing which is a kit that people can take with them and return to the lab with a stool sample. One of our efforts is to mail out the FIT kits and have clients mail the completed kits directly to LabCorp. Clients have been given incentives for the completion of any colon cancer screen test. We are also incorporating colon cancer screening into our medical assistant workflows so that offering the screening is not provider dependent. Also, we are using our community health workers to get clients to their colonoscopy screening appointment and having nurses educate patients on how to do the pre-test prep. This will not be a PI Plan measure for 2019.

Cervical Cancer Screening: This is done by our providers and we are working with each provider to identify

barriers to providing this screening test. We are also working on pre-visit planning for women that we know are scheduled for an appointment to proactively identify those who we will offer testing to. We have surpassed our goals and so this will no longer be on our PI Plan.

VI. CREDENTIALING AND PRIVILEGING

As part of HRSA requirements, we have to credential and privilege every licensed independent provider which includes LCSW-Cs, LCPCs, and OTs in addition to the MD, NP, DMD and DDS who we currently credential and privilege. All providers listed had no adverse finding, no malpractice history, and no disciplinary findings:

LCSW-Cs: Megan Henry, Therapist Case Manager Jan Caughlan, Sr. VP of Behavioral Health Lawanda Williams, Director of Housing Services Katherine O’Bannon, Behavioral Health Consultant Faith Meisenberg, Therapist Case Manager Kimberly Riopelle, Supportive Housing Coordinator Elizabeth Camlin, Case Manager Gretchen Tome, Lead Behavioral Health Therapist Allison Innocent, Behavioral Health Consultant Kathryn League, Director of Community Services Darrin Coley, Lead Therapist Case Manager Deborah Wilcox, Pediatrics Social Worker Jannatul Ferdous, Director of Behavioral Health Justin Shea, Behavioral Health Therapist Gwendolyn Brock, Therapist Case Manager Lydia Santiago, Behavioral Health Therapist CRNPs: Elizabeth Goldberg, Psychiatric Nurse Practitioner LCPC: Arianne Jennings, Addictions Coordinator

Jacquelyn Wisner is an internist who has not been granted temporary privileges yet and will not be granted privileges at this meeting. The committee asked for more information on her time away from practicing medicine, her knowledge base and whether she is up to date on standards of care. We will be looking further into her references and identify a plan that would address these concerns. Nilesh will email results to the committee.

Chelsea King made a motion and Crista Taylor seconded that motion to approve the credentialing/privileging of the above providers, with the exception of Jacquelyn Wisner whose application is deferred until the next meeting. Motion approved by unanimous consent.

VII. Audio/Video Recording of Client Encounters Policy: We created a policy and procedure for learners who willneed to record either audio or video of a clinical encounter as part of their coursework. In brief, afterobtaining consent, the recording will be stored on an HCH issued encrypted flash drive. The file should beaccessed from the flash drive but not downloaded. Once it has been used, the flash drive is to be returnedto the agency. Chelsea King made a motion and Stuart Levine seconded that motion to approve theaudio/video recording of client encounters policy. Motion approved by unanimous consent.

VIII. Social Determinants of Health: The agency has collected social determinants of health data throughout itsexistence. This information is recorded differently by different disciplines and even providers. This is why weundertook the process of collecting the SDH through standardized tools in our electronic health record. Thisallows staff to see this data easily and for the agency to use to data to guide our care. The standardized toolwe are using is one that was developed for FQHCs and is called PRAPARE. It was piloted at 8 sites across thecountry about 3 years ago and since then has been slowly adopted by FQHCs. The tool is a series of 21questions with a pre-built EHR form that we were able to customize for our use. At every visit we ask abouthousing status, housing stability, transportation, insurance status and their safety. Quarterly we ask aboutask social support structure and stressors. Annually ask we ask about measures that are generally notvariable: race, work history, preferred language, education, material security, ethnicity, veteran status,neighborhood, employment and income. Our goal is to capture this information on 100% of the patientsseen. We are particularly targeting housing status, income and family size. This is useful to get a sense ofpeople who might need further assistance with housing needs and accessing income supportive benefitswhich are two areas we are investing in this coming year.

Next Meeting: Tuesday, January 8, 2019

CLINICIANS UNDER CONSIDERATION FOR PERMANENT PRIVILEGES

NAME: Chauna Brocht, LCSW-C

PRACTICE AREA: Behavioral Health

APPLICATION DATE: 12/6/2018

STAFF OR VOLUNTEER: Staff

NPDB & BPQA: 12/20/2018

HOSPITAL AFFILIATION: None

LICENSURE AND TRAINING VERIFIED: 12/10/2018

CONF. AND TRAINING VERIFIED: 12/10/2018

REPLIES:

TEMP PRIVILEGES:

TO BOARD: Program Committee 01/08/2019

NAME: Jacqueline Wisner, MD

PRACTICE AREA: Medical

APPLICATION DATE: 9/6/2018

STAFF OR VOLUNTEER: Staff

NPDB & BPQA: 9/6/2018

HOSPITAL AFFILIATION: None

LICENSURE AND TRAINING VERIFIED: 8/15/2018

CONF. AND TRAINING VERIFIED:

REPLIES: Recommend without reservation 9/7/2018 Recommend without reservation 9/14/2018

TEMP PRIVILEGES:

TO BOARD: Program Committee 01/08/2019

Health Care for the Homeless Prioritized Quality Measures: December 2018

Measure Baseline Goal Trailing

Year Previous Month

Current Month

Significant Trend?

Chronic Disease

Diabetic Clients with HgbA1c ≤ 9.0% 63% 73% 68% 69% 71%

Preventive Care

Colorectal Cancer Screening 31% 50% 46% 54% 59%

Cervical Cancer Screening 50% 60% 57% 66% 68%

Influenza Vaccination 35% 45% 32% 34% 38%

Social Determinants

Missed Appointment Rate* 31% 25% - 28% 28%

Client Experience: After Hours Access* 3.2 4.0 - 3.6 3.3

*Data for this measure is from November, as December data is not yet available.

Social Determinants Measures Missed Appointments: The overall HCH Missed Appointment rate average has declined from 31% to 28% after the implementation of automated reminder calls in October 2017. Plans for moving forward include creating a multi-pronged approach to appointment reminders and examining how to create more person-centered scheduling for clients who see multiple disciplines.

Client Experience: The score from the November Client Experience Survey for after hours phone access was 3.3, which is almost as low as our baseline. Lessons learned from this work has been the importance of advertising and provider reminders to clients that they can call and get medical and behavioral health help even when the clinic is closed.

Added RN data

Added OT data

28%Average = 28%

Began automatedappointment

reminders

Reminder phone callsFlexible templates

Goal = 25%

20%

30%

40%

Jun

'16

Jul '

16

Au

g '1

6

Sep

'16

Oct

'16

No

v '1

6

De

c '1

6

Jan

'17

Feb

'17

Mar

'17

Ap

r '1

7

May

'17

Jun

'17

Jul '

17

Au

g '1

7

Sep

'17

Oct

'17

No

v '1

7

De

c '1

7

Jan

'18

Feb

'18

Mar

'18

Ap

r '1

8

May

'18

Jun

'18

Jul '

18

Au

g '1

8

Sep

t '1

8

Oct

'18

No

v '1

8

De

c '1

8

Jan

'19

Feb

'19

Mar

'19

HCH Missed Appointment Rate: June 2016 - November 2018

3.3

Average = 3.5

Goal = 4

1

2

3

4

5

Nov-16 Jun-17 Nov-17 Jun-18 Aug-18 18-Sep 18-Oct 18-Nov 18-Dec

Ave

rage

Clie

nt

Sco

re

Survey Month

Client experience score for after hours phone access (1-5 scale)

West Baltimorefixed phone routing

Advertized number at fallsway through bulletin board & fliers;Unit clerks began telling clients

After-hours number added to appointment cards

RN follow-up calls

Chronic Disease Measures Diabetes HbA1c: The rate of Diabetic clients with an A1c less than or equal to 9.0% was 71% in December. Improvement efforts are currently focused on optimizing care team coordination of diabetic clients and ensuring diabetic clients overdue for A1c are re-engaged in care.

Preventive Care Measures Colorectal Cancer Screening: The monthly screening rate for colorectal cancer reached its highest to date in December, at 59%. Two changes occurred in November and December to contribute to this increase: a retraining on the FIT standing order for all CMAs and RNs as well as a strengthening of internal coordination among RNs and CHWs for clients needing colonoscopies.

P.O.C. A1c machinesRN visit referral

RN Standing OrdersPrescribing Algorithm

Diabetes Ed Books

A1c lookup in CRISP

Re-think your drink

71%

Average = 70%

Goal = 73%

60%

70%

80%

May

16

Jun

16

Jul 1

6

Au

g 1

6

Sep

16

Oct

16

No

v 1

6

De

c 1

6

Jan

17

Feb

17

Mar

17

Ap

r 1

7

May

17

Jun

17

Jul 1

7

Au

g 1

7

Sep

17

Oct

17

No

v 1

7

De

c 1

7

Jan

18

Feb

18

Mar

18

Ap

r 1

8

May

18

Jun

18

Jul 1

8

Au

g 1

8

Sep

18

Oct

18

No

v 1

8

De

c 1

8

Jan

19

Feb

19

Mar

19

19

-Ap

r

19

-May

HCH Diabetic Clients with A1c ≤9.0%: November 2016 - December 2018

Standing order added

Staff CompetitionClient IncentivesOutreach Calls

Preventive Health Tracker

Mailing FITs

Patient Navigation process developed

59%

Average = 44%

Average = 53%

Goal = 50%

20%

30%

40%

50%

60%

70%

Jul 1

6

Au

g 1

6

Sep

16

Oct

16

No

v 1

6

De

c 1

6

Jan

17

Feb

17

Mar

17

Ap

r 1

7

May

17

Jun

17

Jul 1

7

Au

g 1

7

Sep

17

Oct

17

No

v 1

7

De

c 1

7

Jan

18

Feb

18

Mar

18

Ap

r 1

8

May

18

Jun

18

Jul 1

8

Au

g 1

8

Sep

18

Oct

18

No

v 1

8

De

c 1

8

Jan

19

Feb

19

Mar

19

19

-Ap

r

19

-May

HCH Colorectal Cancer Screening Rate: July 2016 - December 2018

Preventive Care Measures (CONT.) Cervical Cancer Screening: The Cervical Cancer Screening rate for December was 68%, the best month yet. In November and December two clinics who had not yet reached the improvement goal met and planned changes to try. Their success was responsible for the overall increase for November and December.

Influenza Vaccinations: The following charts show the percentage of clients who have presented to HCH since September 1st who have received a flu shot this season (beginning August 1st) or have documentation of receiving a flu shot this season. We started well below our prior year performance, as we began administering the flu shot the last week of September. In October our rate improved, but significant strides need to be made to approach our goal of vaccinating 45% of our clients.

Preventive Health Tracker introduced

EHR training

Balt Co & Mobile intervention

68%

Average = 50%

Average = 61%

Goal = 60%

40%

50%

60%

70%

16

-No

v

16

-De

c

17

-Jan

17

-Fe

b

17

-Mar

17

-Ap

r

17

-May

17

-Ju

n

17

-Ju

l

17

-Au

g

17

-Se

p

17

-Oct

17

-No

v

17

-De

c

18

-Jan

18

-Fe

b

18

-Mar

18

-Ap

r

18

-May

18

-Ju

n

18

-Ju

l

18

-Au

g

18

-Se

p

18

-Oct

18

-No

v

18

-De

c

19

-Jan

19

-Fe

b

19

-Mar

HCH Cervical Cancer Screening Rate : November 2016 - December 2018

12%

28%31% 32%

Goal = 45%

0%

20%

40%

60%

Sep Sep - Oct Sep - Nov Sep - Dec Sep - Jan Sep - Feb Sep - Mar

Client Flu Immunization Rate: Trailing Season ComparisonDecember 2018

2017-2018 2018-2019

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Audio or Video Recording of Clinical Client Encounters Policy

PURPOSE The purpose of this policy is to outline the expectations and guidelines of Health Care for the Homeless (the Agency) and student learners with respect to recording client encounters for educational purposes. BACKGROUND The Agency serves as a clinical site for multiple university education programs. As a clinical site, the Agency agrees to provide student learners with opportunities to have an educational experience that meets certain learning objectives. These objectives will be outlined in both the affiliated education program and the Agency’s learner Curriculum. Some of these programs may require the video or audio recording of encounters with Agency clients. Any recordings will be used solely as an educational tool for review and supervision purposes. SCOPE This policy applies to clinical staff members, as well as all students, residents, interns and other learners (collectively referred to as “learners”), who have a documented requirement from their affiliated University Program for recording of Client encounters for educational and supervision purposes. DEFINITION

1. Client Encounter: An interaction between a client and an Agency provider, in a clinical setting, for the purpose of providing care service(s) or assessing the health status of the client. 1

POLICY General I. All learners requesting to record a clinical client encounter must provide their Agency supervisor

with written documentation from their Education Program. Documentation should contain: program requirements, use and handling of recording, and destruction practices.

II. Documentation must then be provided to the Agency Education Coordinator for inclusion in the student’s file.

III. The learner and Agency supervisor will identify a client, and request permission to record their clinical encounter. The learner and Supervisor will discuss the purpose of the request with the client, explain the Confidentiality Policy, and review the consent form. The Agency supervisor is responsible for ensuring that the client fully understands and accepts the terms of the consent.

IV. The client must agree to and sign the Agency Permission to Record consent form in the presence of both the learner and the Agency Supervisor. The consent must be immediately scanned into the patient’s chart and it must be documented in the encounter note in their chart.

V. All clients have the right, at any time before, during, or after the encounter, to rescind their consent. If consent is rescinded, all recording must immediately cease and/or be deleted.

Use of Equipment and Content of Recording

1. Recordings can only be made with approved Agency equipment – no personal equipment may be used at any time, for any reason.

1 Centers for Medicare and Medicaid Services

2

2. No demographic or identifying information will ever be recorded (full name, date of birth, social Security number, phone number, etc.) If such information is recorded, the encounter must either be rerecorded or edited to exclude the information.

Recording Storage and Handling

1. Learners will receive an agency supplied, encrypted flash drive for the recording. 2. The learner must sign an acceptable use form, which will be stored in their learner file, prior to

recording any client encounter. The acceptable use form will cover the requirements for the appropriate handling of the recording, including prohibitions and best practices to keep client information confidential. The learner will receive a copy of their signed form for reference.

3. All flash drives must be returned to the Agency upon completion of the education period. At this time all recordings will be destroyed.

4. In the event that a recording is distributed in an unintended manner, the Agency will immediately alert the privacy officer and the client. The agency will attempt to recover and destroy all existing copies.

Subpoena Response In the event the Agency receives a court ordered subpoena regarding the content of the recording, the privacy officer and CEO must be alerted immediately. The Agency will do the following:

1. Ensure the subpoena is valid. Valid Subpoenas will specify: a. Documents sought; b. Name of the issuing court; c. The title of the law suit and civil action number; and d. The time and place for production of documents.

2. Determine whether the court or entity issuing the subpoena has jurisdiction over the Agency. 3. If it is determined that the court/entity does not have jurisdiction, there is no requirement to

comply. 4. If there is jurisdiction, the required response will depend on the nature of the issuing entity:

a. Court Order, Warrant, or Subpoena signed by a judge or magistrate: The Agency will strictly comply and disclose only the information expressly authorized by the order.

b. Grand Jury Subpoena: The Agency will strictly comply with the terms. c. Subpoena signed by court clerk, lawyer, or prosecutor: No information may be disclosed

unless one of the following conditions are met: i. The Agency will contact the client orally or by letter, explain that the Agency has

received a subpoena requiring disclosure of the client’s information, and notify the client that the Agency is required to respond unless the client quashes the subpoena and notifies the Agency before the deadline for responding to the subpoena. If the Agency does not know the current address of the client, the Agency will send the letter and a copy of the subpoena to the client’s last known address and document the same. Once the Agency sends such notice, the burden is on the client to quash the subpoena if he or she wants to protect the information.

ii. Alternatively, the Agency may obtain satisfactory written assurances from the entity issuing the subpoena that either: (a) the entity made a good faith attempt to give the client written notice of the subpoena, the notice included sufficient information to permit the client to object to the subpoena, and the time for raising objections has passed or the court ruled against the client’s objections; or (b) the parties have agreed on a protective order or the entity seeking the information has filed for a protective order.

3

iii. Alternatively, the Agency may obtain a valid HIPAA authorization executed by the client. To be valid, the authorization must contain the elements and statements required by 45 CFR § 164.508.

iv. If none of the elements listed above can be satisfied, the information cannot be disclosed. However, a representative from the Agency will have to make an appearance in response to the subpoena and assert an objection based on HIPAA.

REVIEW CYCLE This policy will be reviewed every two-three years, or as deemed necessary based on the Agency need and to remain in compliant with federal, state and local laws and regulations.

Signed by: Nilesh Kalyanaraman

Position: Chief Health Officer

Date:

Reviewed every two years

Research America Inc. 785 Elmgrove Rd Rochester, NY 14624 - 585.231.1542 - www.researchamericainc.com

Health Care for the Homeless Executive Summary Report

Fall 2018 (With CAHPS Benchmark And Quartile Benchmark)

HEALTH CARE FOR THE HOMELESS 2018 STUDY Page 3

1. Methodology The following are the results of a patient experience program commissioned by the Health Care for the Homeless. This is the summary result of 378 completed surveys, with 243 (64%) completed by telephone and 135 (36%) completed via a web survey on a tablet at the providers’ offices. All surveys were completed between November 5, 2018 and December 7, 2018. A copy of the survey script is included in Appendix A of this report. A few questions are identical to those of the 2016/2017 survey, those questions are trended at the end of the report. CAHPS benchmark data and quartiles are sourced from 2016 CAHPS Clinician Group Chartbook Adult Survey 3.0 Combined. All information can be found on the Agency for Healthcare Research and Quality’s website: https://cahpsdatabase.ahrq.gov/CAHPSIDB/Public/CG/CG_Topscores.aspx Assuming a representative distribution among sites the maximum margins of error, calculated at a 95% confidence would be:

Clinic Site Surveys Margin of Error

Baltimore County 81 10.8%

West Baltimore 111 9.3%

Fallsway 186 7.2%

Significance testing throughout the tables in this report is denoted as follows:

- Column Proportions: Columns Tested (5%): A/B/C – Representing the three locations

Questions throughout the survey were based on a fully anchored agreement scale. “Don’t Know / Refused / Could not ascertain” are removed from table and chart base calculations.


2. Executive Summary1

Provider’s Office Relationship

Questions: A2 – A10, A21, A22 Most patients (94%) indicated the provider at the office was the provider they usually see for a checkup, advice, or sickness. There’s no definitive time period that respondents have been going to their current provider. The two most common responses are: At least 1 year but less than 3 years (29%) and Less than 6 months (20%). However, continuing the trend from prior reports, patients who visited the Baltimore County office were significantly more likely than both other offices to say they’ve been going to this provider for less than 6 months (41% vs 14% and 16%). Almost half of patients visited their current provider between 1 and 3 times in the past 6 months (47%). However, more than two-fifths visited the provider 5 or more times (41%). Patients that visited the Baltimore County office were significantly less likely to visit the office 10 or more times (9% vs 19% and 28%) and significantly more likely to visit the office once (20% vs 11% and 14%). Over half of patients visited their current provider’s office in the last 6 months to get an appointment for an illness, injury, or condition that needed care right away (52%). Patients that visited the West Baltimore office were significantly more likely to have contacted the office for care they needed right away (65% vs 46% and 47%).

Of the patients who contacted their current provider’s office for an appointment for care needed right away, over half (62%) always got an appointment as soon as they needed. West Baltimore stands out in the third quartile of CAHPS practices, while Fallsway and Baltimore County are in the first quartile.

Over three-fourths (80%) of patients made an appointment for a checkup or routine care with their current provider in the last 6 months.

Nearly two-thirds (61%) of the patients who made an appointment for a checkup or routine care in the last 6 months always got an appointment as soon as needed. Continuing the trend from prior reports, patients at the Fallsway office always got an appointment as soon as needed significantly less often (51%) than both other office locations. All locations are in the first or second quartile of national results.

Over three-fourths (82%) of patients said their provider’s office gave them information about what to do if they needed care during evening, weekends, or holidays. All locations are in the third or fourth quartile of national CAHPS results.

1 CAHPS benchmark data and quartiles are sourced from 2016 CAHPS Clinician Group Chartbook Adult Survey 3.0 Combined. All information can be found on the Agency for Healthcare Research and Quality’s website: https://cahpsdatabase.ahrq.gov/CAHPSIDB/Public/CG/CG_Topscores.aspx


Over half of patients (56%) contacted their provider’s office with a medical question during regular office hours.

Over half of patients (61%) who contacted their provider’s office with a medical question during regular business hours always received an answer to their question that same day. All locations are in the second or third quartile of national results.

Two-thirds of patients (66%) indicated that the clerks and receptionists at their provider’s office were always as helpful as they should be. The West Baltimore location has a significantly lower percentage of patients that said Never and Sometimes (9% vs 20% and 21%). All locations are in the first or second quartile of national results. Over three-fourths of patients (78%) indicated that the clerks and receptionists at their provider’s office always treat them with courtesy and respect. All locations are in the first or second quartile of national results.

Provider Interaction

A11 – A18 Over three-fourths of patients indicated that their provider always explained things in a way that was easy for them to understand (78%). Although this percent is high, all locations are in the first quartile of national CAHPS results. Over three-fourths of patients indicated that their provider always listened carefully to them (79%). All locations are in the first quartile of national CAHPS results. Almost three-fourths of patients said their provider always seemed to know important information about their medical history (74%). Results vary by practice, with the Fallsway location in the first quartile of national CAHPS results, Baltimore County in the second quartile, and West Baltimore in the third quartile. Most patients (86%) thought their provider always showed respect for what they had to say. Although this percent is high, all practice locations are in the first or second quartile of national CAHPS results. Over three-fourths (76%) of patients thought their provider always spent enough time with them. All practice locations are in the first quartile of national CAHPS results. Over three-fourths of patients (78%) said that their provider ordered a blood test, x-ray, or other test for them.

Of the patients who said their provider ordered a blood test, x-ray, or other test for them, over two-thirds (71%) said that someone from the provider’s office always followed up to give them the results. Results vary by location, with the Fallsway location falling in the first quartile, the West Baltimore location in the second quartile, and Baltimore County in the third quartile of national CAHPS results.

When using a 0 to 10 scale to rate their provider, over two-thirds (70%) rated their provider a 9 or 10. The average rating was 8.9. Very few patients (8%) gave a neutral or low rating of their provider. All practice locations are in the first quartile of national CAHPS results.


Provider Communication

A18A – A20 In the last 6 months, over half of patients (54%) saw a specialist for a particular health problem. The Fallsway location is in the fourth quartile of CAHPS results; both other locations fall in the second quartile of national CAHPS results. Over two-thirds (69%) of patients said their provider always seemed informed and up-to-date about the care they received from specialists. All locations are in the third or fourth quartile of national CAHPS practices. Over three-fourths (78%) of patients indicated someone from their provider’s office talked with them about specific goals for their health. All practices are in the fourth quartile of national CAHPS results. Nearly two-thirds of patients (65%) said someone from their provider’s office asked them if there were things that made it hard for them to take care of their health. All practices are in the fourth quartile of national CAHPS results. Almost three-fourths of patients (74%) talked with someone from their provider’s office about things in their life that worry them or cause stress. Like both other personal attention measures, all practices are in the fourth quartile of national CAHPS results. Most patients (91%) said they took prescription medicine in the last 6 months.

Of the respondents who took prescription medicine in the last 6 months, over half (59%) indicated someone from their provider’s office talked to them about all the prescription medicines they were taking. Results vary by location, with the Fallsway location being in the first quartile of national CAHPS results, the West Baltimore location in the second quartile, and the Baltimore County in the third quartile of results.

Provider Ratings

A22A – A22D Almost ninety percent (89%) of patients agree (top 2 box) that: my provider makes sure health care decisions and treatment goals fit with the other challenges I have in my life, yielding an average rating of 4.6 out of 5. This average rating is continuing to climb higher from the Fall 2017 and Spring 2018 scores. Only half of patients (52%) agree with the statement: I can reach a provider when the clinic is closed. However, about a third (34%) of patients disagree, resulting in an average rating of (3.3). The average rating for this statement is consistently the lowest of all 4 statements. The rating for Fall 2018 fell back towards the historical average after a jump in Spring 2018. A strong majority of patients (84%) agree that: I can get care here without missing out on meals or a place to sleep. The average rating is well in positive territory at 4.4 out of 5. After a drop in Fall 2017, the average score in Fall 2018 is in line with 2016, Spring 2017, and Spring 2018. Most patients (88%) express agreement with the statement: Health Care for the Homeless helps me gain the skills I need to manage my health care. The average rating is a very strong 4.5 out of 5. After a drop in Fall 2017, the average score in Fall 2018 is in line with 2016, Spring 2017, and Spring 2018.


Personal Health

A23 – A24 Patients most often evaluated their overall health as Good (33%) and Fair (32%). A smaller percentage rated themselves Excellent (7%) and Very Good (18%). Likewise, patients most frequently rated their overall mental or emotional health as Good (31%) or Fair (27%) with smaller percentages of Excellent (14%) and Very good (17%).

Subgroup Analysis

A26, A26a, A26b, A28, A29 Gender Nearly all patients surveyed identified as male (59%) or female (40%). One respondent identified as gender queer, neither exclusively male nor female, and one respondent did not feel comfortable providing a definition. Sexual orientation When asked about sexual orientation, the majority of patients were straight or heterosexual (92%), while a small percentage said lesbian, gay, or homosexual (4%), bisexual (3%), or something else (1%). Solely for the purposes of creating large enough sample sizes for analysis, we compared patients who identified as straight/heterosexual to all else (92% vs 8%). Finding differences is nearly impossible due to the small sample size, however…

… patients who identified as lesbian, gay, homosexual, bisexual, or something else tended to be on the younger size of the age ranges compared to patients who identified as straight or heterosexual

…two-thirds of patients who identified as lesbian, gay, homosexual, bisexual, or something else said they were female, while almost two-thirds of straight-heterosexual patients were male

Language other than English About a fourth of patients indicated that a language other than English was their primary language (25%). Patients whose primary language was not English were significantly more likely than patients who said English was their primary language to…

…have visited their provider 1 or 2 times in the last 6 months (47% vs 26%), the opposite is also true about visiting their provider 5 or more times

…have contacted their provider’s office to get an appointment for an illness, injury, or condition that needed care right away (61% vs 49%)

…be younger, specifically, 25 to 34 (15% vs 5%) and 35 to 44 (22% vs 12%)

…be female (53% vs 37%)

…have completed 8th grade or less (20% vs 5%)

…be of Hispanic or Latino origin or descent (39% vs 4%)


Hispanic or Latino origin or descent A small percentage of patients said they were of Hispanic or Latino origin or descent (13%). These patients were significantly more likely than patients who were not of Hispanic or Latino origin or descent to…

…have visited their provider 1 time in the last 6 months (33% vs 11%)

…have contacted their provider’s office to get an appointment for an illness, injury, or condition that needed care right away (65% vs 50%)

…have not received a blood test, x-ray, or other test from their provider (42% vs 18%)

…have rated their provider a 10 out of 10 (67% vs 52%), the average rating is also higher (9.2 vs 8.8), but not significantly different

…have not seen a specialist in the last 6 months (66% vs 44%)

…have not taken any prescription medicine in the past 6 months (27% vs 7%)

…use the middle of the scale “Good”, when considering their mental or emotional health (46% vs 29%)

…be younger, specifically, 25 to 34 (22% vs 5%) and 35 to 44 (28% vs 12%)

…be female (63% vs 38%)

…have completed 8th grade or less (39% vs 4%)

Race The majority of patients identified as Black or African American (62%), with considerably smaller percentages identifying as White (24%), American Indian or Alaska Native (6%) or Other (12%). Patients who identified as Black or African American were significantly more likely than White to…

…have visited their provider 10 or more times in the last 6 months (26% vs 14%)

…say for care they needed right away, they usually got an appointment as soon as needed (23% vs 8%), this is also reflected in a lower always (57% vs 74%)

…use the middle of the scale “Good”, when considering their mental or emotional health (34% vs 21%)


4. Time Period Comparison

The following are the average scores for 2016, Spring 2017, Fall 2017, Spring 2018, and Fall 2018 for all locations combined.

4.5

4.4

3.3

4.6

4.5

4.4

3.6

4.5

4.3

4.2

3.3

4.4

4.6

4.5

3.4

4.6

4.5

4.5

3.2

4.5

0 1 2 3 4 5

Health Care for the Homeless helps me gain the skills Ineed to manage my health care.

I can get care here without missing out on meals or aplace to sleep.

I can reach a provider when the clinic is closed.

My provider makes sure health care decisions andtreatment goals fit with the other challenges I have in

my life.

Key Statement Trend Over Time

2016 Spring 2017 Fall 2017 Spring 2018 Fall 2018


5. CAHPS Benchmark Composite Scores3



6. CAHPS Quartile Benchmarking4

The following questions have information for CAHPS Quartiles available. Health Care for the Homeless overall results and locations are listed with the quartile they fall in to. The following notations denote quartiles:

Q1, results fall in the first quartile, the lowest 25% of practices

Q2, results fall in the second quartile, lower than 50% but greater than 25% of practices

Q3, results fall in the third quartile, lower than 75% but greater than 50% of practices Q4, results fall in the fourth quartile, the top 25% of practices


CAHPS Quartile Benchmarking All HCH (Quartile 4= Highest, Quartile 1 = Lowest)

Category Measure

June 2018

Quartile

November 2018

Quartile

Quartile Rank Trend

Com

posi

te 1

: Get

ting

Tim

ely

Appo

intm

ents

, Car

e an

d In

form

atio

n

In the last 6 months, when you contacted this provider's office to get an appointment for CARE YOU NEEDED RIGHT AWAY, how often did you get an appointment as soon as you needed? 1 1

In the last 6 months, when you contacted this provider's office to get an appointment for CHECKUP OR ROUTINE CARE, how often did you get an appointment as soon as you needed? 1 1

In In the last 6 months, when you contacted this provider's office to get an appointment for CHECKUP OR ROUTINE CARE, how often did you get an appointment as soon as you needed? 2 2

Com

posi

te 2

: How

Wel

l Pr

ovid

ers C

omm

unic

ate

With

Pa

tient

s

In the last 6 months, how often did this provider explain things in a way that was easy to understand? 1 1

In the last 6 months, how often did this provider listen carefully to you? 1 1

In the last 6 months, how often did this provider show respect for what you had to say? 1 1

In the last 6 months, how often did this provider spend enough time with you? 1 1

Com

posi

te 3

: Hel

pful

, Co

urte

ous,

and

Re

spec

tful

Offi

ce S

taff

In the last 6 months, how often were clerks and receptionists at this provider's offfice as helpful as you thought they should be? 1 1

In the last 6 months, how often did clerks and receptionists at this provider's office treat you with courtesy and respect? 1 1

Com

posi

te 4

: Pro

vide

rs U

se o

f In

form

atio

n to

Coo

rdin

ate

Patie

nt

Care

In the last 6 months, how often did this provider seem to know the important information about your medical history? 1 2

In the last 6 months, when this provider ordered a blood test, x-ray, or other test for you, how often did someone from this provider's office follow up to give you those results? 2 2

In the last 6 months, how often did you and someone from this provider's office talk about all the prescription medicines you were taking? 2 2

CAHPS Quartile Benchmarking All HCH (CONT.) (Quartile 4= Highest, Quartile 1 = Lowest)

PCHM

Com

posi

te: T

alki

ng w

ith y

our a

bout

taki

ng C

are

of Y

our O

wn

Heal

th

In the last 6 months, did someone from this provider's office talk with you about specific goals for your health? 4 4

In the last 6 months, did someone from this provider's office ask you if there were things that make it hard for you to take care of your health? 4 4

Did this provider's office give you information about what to do if you needed care during evenings, weekends, or holidays? 3 4

In the last 6 months, did you see a specialist for a particular health problem? 1 3

In the last 6 months, how often did the provider discussed in Question 1 seem informed and up-to-date about the care you got from specialist? 2 3

In the last 6 months, did you and someone from this provider's office talk about things in your life that worry you or cause you stress? 4 4

What number would you rate this provider? 9-10 1 1

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