Documentation may be better accomplished when a population of patients is targeted for review at times when they are not actually in clinic. Americorps volunteers who serve as case managers, a part-time lay health worker, and four medical students who coordinate service-learning activities. We developed an Access database to monitor clinical services, pharmaceutical utilization, and case management with a focus on preventive care, referral data, Medicaid enrollment, and pharmaceutical costs and utilization. Students in pharmacy, medicine, and nursing conducted quality assurance projects, including a patient satisfaction survey and chart reviews to assess hypertension management and antibiotic usage. FINDINGS TO DATE: On-site dispensing was promoted over vouchers at a cost saving of $21.34 per prescription with a total saving of about $20,000 a year. Blood pressure control was achieved in 46% of hypertensive patients, but almost half failed to return for follow-up. Narrowspectrum antibiotics were selected as first-line therapy 66% of the time, but over-prescribing for URI was also noted. In a predominantly uninsured (73%) clinic population, 27% of all patient encounters resulted in referrals with 30% of all referrals for dental care, 17% to primary care providers and medical specialists, and only 1% to behavioral health. Sub-optimal documentation was noted in chart reviews. KEY LESSONS LEARNED: Based on our findings, we implemented an appointment reminder system, progress note templates, and a mechanism for tracking referrals. Providing routine feedback to volunteer providers on findings such as mental health referrals may promote more aggressive screening and counseling. In conclusion, quality assurance projects incorporated into volunteer clinic activities can identify unmet health needs and areas requiring improvement. Services Administration is the second and current stage of program development. Focus groups and advisory work groups with pharmacists, physicians and nurse practitioners, and counselors are being held to identify potential barriers to participation. Actuarial consultants are developing cost estimates and financial models for the proposed program. Project leaders work with state and federal regulatory and legislative officials to facilitate program planning and implementation. Phase III: Implementation of a pilot project is targeted for the summer of 2001. FINDINGS TO DATE: The phase I community planning created program framework with the San Francisco Department of Public Health as holder of a central Narcotics Treatment Program (NTP) licensure for the OBOAT Program, in which interested and eligible public and private-sector physicians, counselors, and pharmacists would be trained to offer methadone and other approved medicines to treat opiate addiction in the setting of their regular clinical practices. Pharmacists view the opportunity for professional development as an incentive for potential program participation. They view lack of lack of methadone education in pharmacy school and inexperience with methadone dispensing to addicts as barriers to potential program participation. The planning process has challenged physicians in the narcotic treatment arena and those in the primary care arena to learn about each other's`c ulture'' and communicate effectively to develop an innovative program that will serve patients in new way. KEY LESSONS LEARNED: The planning process has involved reframing opiate addiction treatment as a medical model, rather than a regulatory model. Close collaboration with existing methadone clinics has been critical in moving program planning forward. Close work with state legislature has resulted in recent passage of enabling legislation as well as allocation of additional resources. (CTI) is a computer-based application that automatically calls patients to remind them of their appointments. This program is interfaced with the scheduling system to automatically download patient and appointment information. It uses an interactive voice response technology to call patients 24 ± 72 hours before their appointment. If there is no answer, the patient will be called back up to 5 times. All patients with appointments scheduled at least 72 hours ahead of time at several Community Health Clinics over a period of 6 weeks were eligible for our study. 5,696 patients had appointments during this time and thus could have been called by the CTI system. During randomized alternating one week periods, patients at each of the participating clinics were assigned to receive automated appointment reminders. Patients not receiving calls were used as the control group. Kept and missed appointment rates were recorded for each of these groups. FINDINGS TO DATE: 5,696 patients (3, 038 in the appointment reminder group, 2,617 of whom consented to being called by the system; 2,658 in the control group) were prospectively followed over a 6 week period. The kept appointment rate in the appointment reminder group was 69.2%. The kept appointment rate in the control group was 64.1%. This result translated into an 8% increase in kept appointments when the automated system was used (p < 0.01). The increase occurred despite the fact that only 1,192 of 2,617 eligible patients were actually contacted. KEY LESSONS LEARNED: A computerized telephone reminder system increased the kept appointment rate in our Community Health Clinics. This increase may have a considerable economic impact. Assuming an increase in the kept appointment rate of 8% translates into 8% more patient visits, this could represent 9,000 more visits a year to our clinics. If the average charge for an outpatient visit is $177.35, 9,000 more visits represents $1.5 million in increased charges. Implementation of such a system could have a large positive economic and health impact in a public health system such as ours.