Improving Healthcare Systems for Access to Care by Underserved Patients
Condition: Health Services Accessibility
Study type: Observational [Patient Registry]

Summary: 
      The investigators seek to improve health systems so underserved people, patients without
      insurance, Medicaid, Medicare, as well as self pay and their caregivers can better access
      health care for common problems and acute care needs (same day appointments).
    

Detailed description: 
      There are different types of participants in this study. Measurements will be assessed with a
      questionnaire. The first category includes patients, caregivers, clinical and operational
      leaders, and researchers who will be invited for the Delphi study to identify potential
      barriers to access and strategies to improve access. The second category includes clinic
      staff (physicians, nurses, medical assistants, registrars, etc.) and patients who will be
      interviewed during their clinic visits to identify key processes and patients' opinion about
      barriers to access. The third category includes all enrolled patients to identify the patient
      population characteristics. The fourth category includes the patients and providers of CHCs
      in the participating clinics who will be surveyed to assess experience with access to care
      and satisfaction with the changes in workflow and efficiency.Category 1: Delphi study. The
      investigators will invite 50-60 individuals (patients, caregivers, clinical and operational
      leaders, and researchers) for a panel size of 40-50. Category 2: Key Informant Interviews
      (Patients and clinic staff (physicians, nurses, medical assistants, registrars, etc). The
      investigators will interview at least one patient every time we go to the participating
      clinics. The investigators plan to visit each of the participating CHCs approximately every
      two months. The investigators expect to interview approximately 12 patients at each clinic
      each year, for a total of 84 each year at the seven clinics. Thus, the total number of
      patients interviewed will be 252 in three years (12 patients / clinic x 7 clinics = 84
      patients per year). The interview questions will be related to access barriers and efficiency
      of clinic processes. The investigators will receive the consent of the patient before
      starting the interview. The investigators will use IRB-approved consent forms for the study.
      The investigators will interview ten staff members during each visit to identify the key
      processes. The investigators anticipate interviewing approximately 8 providers and staff in
      each clinic during our bimonthly visits, as well as 3-4 during our bimonthly phone calls
      during the project period. This is expected to total 12 staff (including providers and
      managers) every two months at each clinic, or 6 x 12 = 72. This should total 72 x 7 = 504 at
      all the clinics each year. Some of these interviews will be quite brief, lasting only a few
      minutes, while others may last 45-60 minutes. Category 3: The investigators will collect
      de-identified patient data for the patient populations cared for by the participating CHCs,
      that will include age, gender, race, marital status, education, language, income, insurance,
      distance to healthcare facility, reason of the visit, diagnoses, co-morbidities, number of
      regular visits, visit types and durations, provider types, and time between visits. The
      investigators will work with IT and/or quality improvement staff at each of the CHCs to
      develop standard procedures to retrieve and de identify the data from electronic medical
      records and scheduling system. The investigators will analyze the data to determine patient
      population characteristics and care needs to inform the simulation models and analysis of
      impact of the interventions. In 2011, the total number of patients seen in seven partner
      clinic systems were approximately 130,000. However, the partner clinics provide care services
      at several sites. The investigators will choose a single site from each CHC system and
      analyze the data for the patients who had at least two prior visits to the selected site
      within two years prior to baseline. The investigators expect to analyze the visits for 60,000
      patients. The data for each clinic will be analyzed separately. Category 4; The investigators
      anticipate surveying a sample of patients at each of the clinics to assess familiarity with
      how to obtain access to care, knowledge of the intervention and satisfaction with access.
      This will be a blinded (deidentified survey) and not linked to any individual data, other
      than study site. The investigators anticipate sampling 100 patients at each site, including
      approximately 65 patients who participate at each site., per site. In this study, the
      investigators will not consider special vulnerable populations (fetuses, neonates, prisoners,
      and institutionalized individuals).
    

Observational model: Ecologic or Community
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Community Clinic patient Population
      
Keywords: patient access; patient centered care; scheduling; access barriers; improve efficiency; decision making tools; underserved