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