Population-Centered Health Care
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Transcript of Population-Centered Health Care
Population-Centered Health Care
Mobilized Medical Unit
Patti MaisnerCapella University
Fall 206
Introduction
564, 000 homeless U.S. individuals in 2015 (National Alliance to End Homelessness, 2016)
U.S. homelessness is on the rise Disease rates are larger in this population Homelessness correlates with chronic illness At least 30% have health insurance
(Fresno-Madera Point in Time Count, 2014)
Continued …
Insured / uninsured homeless experience barriers to health care
Barriers include: Doctor bias Lack of trust Traveling with personal belongings Long appointment times Lack of support Mental illness causing apathy (Baggett, O'Connell, Singer, & Rigotti, 2010) Prevention of disease and primary health care
treatment are compromised (American Public Health Association, n.d.)
The connection between housing and health is coldly logical.
The sick and vulnerable become homeless, and the homeless
become sicker and more vulnerable. (Jacobson, 2016)
Continued …
Homeless use ER instead of primary care office visits
The financial health care system becomes burdened
Homeless patients do not follow-up with physician Small medical incidents result in illness needing
hospitalization Overall increase in health care costs due to lack of
prevention measures (Hayashi, 2016)
Recommendation:Population-Centered Health Care
Continued …
Population-centered health care will decrease gaps and barriers
Best solution: Mobilized Medical Unit Equitable access for homeless populations Preventive and primary health care
(Chen, 2016)
Continued …
(O'Toole, Johnson, Aiello, Kane, & Pape, 2016)
Ability to screen, test, and treat: *Diabetes *Heart Disease *Hypertension *HIV *Mental health issues *Alcohol, drug, and tobacco use (Valvassori, Sklar, Chipon-Schoepp, & Messer, 2014)
Continued …
• Clinic comes to where the homeless live• No judgement or bias from practitioners• Increases medical visits to remedy simple events• Tailored medical directives can be given• Free health screenings, immunizations, consults• Treats minor injuries• Helps manage and prevent chronic illness• Can see 10 – 25 patients per day• Reduces non-urgent ER visits (Srinivasan, 2015) (Mobile Clinic Project at UCLA, 2016)
Continued …
• Reduces traveling for the homeless• No lugging around personal belongings• Increases health and healthier living• Aligns with public health ‘preventative care’
model• Instills trust in the community• Empowers community members• Creates public health awareness• Reduces 911 calls• Every $1 invested saves $36 in healthcare costs
(Srinivasan, 2015)
(Lam, 2016)
Population-Centered Medicine and Ethical Considerations
Assess needs of a population rather than an individual
Ethical considerations: *Autonomy *Beneficence *Justice The medical team respects the homeless
individual Street side clinic has a net benefit for entire
community Offers detailed services to target population
(Anonymous, 2016)
Population-Centered Medicine and Systems Theory
Overall goals: *decrease inequities *delivery of health care to homeless population View systematically using four areas of
guidance *Input, Output, Processes, Feedback loop (Balcazar et al., 2009)
Understand how the homeless community: *Is organized *How they process and interpret change *How they are affected by change *Affected by their environment (Jones, 2002)
(Delone & McLean, 1988)
Continued …
Input: Mobile Medical Unit Output: Quality of care received by homeless
population Throughput: Processes inputs into outputs Feedback loop: Evaluation for practitioners
and homeless (National Center for Environmental Health, 2016)
FeedbackLoop
(Jones, 2002)
Population-Centered Medicine and Action Research
First person: inquiry into one’s own actions, intentions, so that they can change their strategy and actions to reach goal
Second person: Surveying group as to their satisfaction to align with first person reflection (Coghlan & Brydon-Miller, 2014)
Use these inquiries for evaluation Will fit into feedback loop section of
systems theory(Jones & Allen, 2016)
Process for Evaluation
Input: Money, documents, mobile unit, staff Processes: Case management details,
epidemiological data, community impact, and emergency room visits
Output: Quality of delivered care, and client satisfaction.
Action research / Feedback loop: delivery of quality health care that is best fit for everyone
Continuous evaluation improving staff, services to target population
Trust, health care, client retention
(Crane & O'Regan, 2012)
Population-Centered Medicine, Leadership, and Collaboration
Writing prospectus Problem statement Project details Barriers and gaps to be resolved Form partnerships with community
agencies Align with key stakeholders Assess, plan, implement Medical Unit Monitor, manage, evaluate
(American Association of Colleges of Pharmacy, 2016)
Conclusion
Population-centered medicine can be customized to groups that share commonalities / disparities Mobilized medicine brings health care directly to marginalized populations as the homeless This is an ethically sound project as it increases the access to health care for the homeless
without harm Systems theory is provocative in that it evaluates inputs from practitioners and clients Action research utilizes this approach to generate data to further the delivery of quality health
care This type of project requires a team that has partnered to collaborate with shared goals They will assess the community, make a plan, then implement the medical unit ER visits, hospitalizations will be reduced Overall health of the community will be increased
References
American Association of Colleges of Pharmacy. (2016). Patient-centered care [Graphics]. Retrieved from http://www.aacp.org/news/academicpharmnow/2015issue3/Pages/@AACPpharmacy.aspx
American Public Health Association. (n.d.). Homelessness as a Public Health Problem. Retrieved from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2014/07/31/07/56/homelessness-as-a-public-health-problem
Anonymous. (2016). Public health ethics [Graphic]. Retrieved from http://slideplayer.com/slide/4968094/
Baggett, T. P., O'Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The Unmet Health Care Needs of Homeless Adults: A National Study. Am J Public Health, 100(7), 1326-1333. doi:10.2105/ajph.2009.180109
Chen, D. (2016). Salt Lake City Flu Shots [Photograph]. Retrieved from http://www.deseretnews.com/article/865648035/Salt-Lake-County-gives-out-flu-shots-to-homeless.html?pg=all
Coghlan, D., & Brydon-Miller, M. (2014, December 22). First person action research - SAGE research methods. Retrieved from http://methods.sagepub.com/reference/encyclopedia-of-action-research/n130.xml
Crane, P., & O'Regan, M. (2012). PAR model [Graphic]. Retrieved from https://www.dss.gov.au/our-responsibilities/housing-support/publications-articles/homelessness-youth/on-par-using-participatory-action-research-to-improve-early-intervention?HTML
Delone, & McLean. (1988). Systems theory: Success evaluation model [Graphic]. Retrieved from http://www.sajim.co.za/index.php/SAJIM/article/viewFile/531/612/2958
Fresno-Madera Point in Time Count. (2014). Unsheltered Homeless: Health Insurance [Graph]. Retrieved from http://pit2014.catishack.com/page3.php
Gilvar, J. (2103, September 1). Using patient-centered mobile health care to serve chronically homeless individuals. Retrieved from https://outreach-partners.org/2013/09/01/using-patient-centered-mobile-health-care-to-serve-chronically-homeless-individuals/
References
Hayashi, S. (2016, January 25). How Health and Homelessness Are Connected — Medically. The Atlantic.
Institute of Medicine (U.S.). (1988). Health care services for homeless people. In Homelessness, health, and human needs (pp. 103 - 135). Retrieved fromhttps://www.ncbi.nlm.nih.gov/books/NBK218235/
Jacobson, J. (2016). Still Paddling Alone [Photograph]. Retrieved from https://www.nationaljournal.com/s/581528?oref=t.com
Jones, B. L. (2002). Systems theory: Nevada health science [PowerPoint slides]. Retrieved from http://www.nevadahosa.org/PPT/Systems%20Theory.ppt
Jones, J., & Allen, J. (2016). Three fields of inquiry through action research [Graphic]. Retrieved from http://www.slideshare.net/BaspcanPage/p4-fp27-1-jones-and-allen
Kominski, Gerald F. Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management, 4th Edition. Jossey-Bass, 12/2013. VitalBook file.
Mobile Clinic Project at UCLA. (2016). Support the underserved [Photograph]. Retrieved from http://www.mobileclinicproject.org/
National Alliance to End Homelessness. (2016). National alliance to end homelessness: The state of homelessness in America 2016. Retrieved from http://www.endhomelessness.org/library/entry/SOH2016
O'Toole, T. P., Johnson, E. E., Aiello, R., Kane, V., & Pape, L. (2016). PACT (Homeless-patient aligned care team model for treatment engagement) [Graphic]. Retrieved from https://www.cdc.gov/pcd/issues/2016/15_0567.htm
Srinivasan, V. (2015, May 14). Mobile health clinics: Outcomes, community relationships, privacy concerns, success rates. Retrieved from http://www.slate.com/articles/health_and_science/medical_examiner/2015/05/mobile_health_clinics_outcomes_community_relationships_privacy_concerns.html
University of Kansas. (2015). 11. Influencing Policy Development | Community Tool Box. Retrieved from http://ctb.ku.edu/en/influencing-policy-development