Universal Screening for Social Needs in a Primary Care Clinic: A Quality Improvement Approach Using the Your Current Life Situation Survey

233 Background: Advance directives (ADs) are legal tools that direct treatment or decision making and appoint a surrogate decision-maker (health care proxy). The presence of ADs is associated with decreased rates of hospitalization, use of life-sustaining treatment, and deaths in a hospital setting. Additionally, completed ADs lead to increased use of hospice or palliative care, more positive family outcomes, improved quality of life for patients, and reduced costs for healthcare. Despite the benefits of advance care planning, only 18-36% of adults have completed advance care plans. The aims of our pilot study were to 1) implement a synchronized system for advance care planning across the UT Health San Antonio health system and 2) improve advance care planning rates in a primary care clinic and palliative oncology clinic. Methods: During a 10-month prospective period, system processes for advance care planning were reviewed with identification of three primary drivers for advance care plan completion: a) electronic/EMR processes, b) clinical workflows and training, and c) patient resources and education. As a result of this quality improvement initiative, standardized forms, resources, and processes for obtaining advance care plans were implemented in the selected clinics. Results: At baseline, the primary care clinic had 84/644 (13%) patients and the palliative oncology clinic had 25/336(7%) with completed advance care plans. With the implementation of a standardized process, 108 patients (23% increase in rate of completion) in the primary clinic and 56 patients (71% increase in rate of completion) in the palliative oncology setting completed advance care planning (ACP). Additionally, there was a 5-fold increase in billing of ACP CPT codes within the clinics during the first 6 months compared to the prior full year. Conclusions: While this quality improvement pilot initiative was limited to two clinics, the synchronized modifications suggest that the system changes could be expanded to other clinics in our UT health system to promote ACP discussions, completion of plans, and ultimately improved patient care.

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Formerly Incarcerated Community Health Workers Engaging Individuals Returning From Incarceration Into Primary Care: Results From the Transition Clinic Network

Frontiers in Public Health ◽

10.3389/fpubh.2021.681128 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jenerius A. Aminawung ◽

Tyler D. Harvey ◽

Jerry Smart ◽

Joseph Calderon ◽

Anna Steiner ◽

...

Keyword(s):

Primary Care ◽

Health Outcomes ◽

Community Health ◽

Community Health Workers ◽

Health Workers ◽

Primary Care Clinic ◽

Social Needs ◽

Care Clinic ◽

Primary Care Teams ◽

Improve Health

Over half a million individuals return from United States prisons and millions more from jails every year, many of whom with complex health and social needs. Community health workers (CHWs) perform diverse roles to improve health outcomes in disadvantaged communities, but no studies have assessed their role as integrated members of a primary care team serving individuals returning from incarceration. Using data from participants who received primary care through the Transitions Clinic Network, a model of care that integrates CHWs with a lived experienced of incarceration into primary care teams, we characterized how CHWs address participant health and social needs during interactions outside of clinic visits for 6 months after participants established primary care. Among the 751 participants, 79% had one or more CHW interactions outside of the clinic documented. Participants with more comorbid conditions, longer stays during their most recent incarceration, and released with a prescription had more interactions with CHWs compared to those with fewer comorbidities, shorter stays, and no prescription at release. Median number of interactions was 4 (interquartile range, IQR 2–8) and 56% were in person. The most common issues addressed (34%) were social determinants of health, with the most common being housing (35%). CHWs working in interdisciplinary primary care teams caring for people with histories of incarceration perform a variety of functions for clients outside of scheduled primary care visits. To improve health outcomes among disadvantaged populations, CHWs should be able to work across multiple systems, with supervision and support for CHW activities both in the primary care clinic and within the community.

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A Quality Improvement Initiative to Increase Colorectal Cancer (CRC) Screening: Collaboration between a Primary Care Clinic and Research Team

Journal of Family Medicine ◽

10.26420/jfammed.2017.1115 ◽

2017 ◽

Vol 4 (3) ◽

Cited By ~ 6

Author(s):

Beverly B Green

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Quality Improvement ◽

Research Team ◽

Primary Care Clinic ◽

Quality Improvement Initiative ◽

Care Clinic ◽

Crc Screening

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Using Quality Improvement Methods to Increase Duration of Breastfeeding in an Urban Primary Care Clinic

10.1542/peds.141.1_meetingabstract.292-a ◽

2018 ◽

Author(s):

Julie Ware ◽

Sarah Riddle ◽

Lauren Fischer ◽

Ann Thulin ◽

Terri Rutz

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Primary Care Clinic ◽

Care Clinic ◽

Duration Of Breastfeeding

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Measuring Perceived Level of Integration During the Process of Primary Care Behavioral Health Implementation

American Journal of Medical Quality ◽

10.1177/1062860617736607 ◽

2017 ◽

Vol 33 (3) ◽

pp. 253-261 ◽

Cited By ~ 2

Author(s):

Erin M. Staab ◽

Mara Terras ◽

Pooja Dave ◽

Nancy Beckman ◽

Sachin Shah ◽

...

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Behavioral Health ◽

Primary Care Clinic ◽

Health Clinic ◽

Care Clinic ◽

Primary Care Behavioral Health ◽

Item Level ◽

Levels Of Integration

Provider- and staff-perceived levels of integration were measured during implementation of a primary care behavioral health clinic; these data were used to tailor and evaluate quality improvement strategies. Providers and staff at an urban, academic, adult primary care clinic completed the 32-item Level of Integration Measure (LIM) at baseline and 7 months. The LIM assesses 6 domains of integrated care. Overall and domain scores were calibrated from 0 to 100, with ≥80 representing a highly integrated clinic. Response rate was 79% (N = 46/58) at baseline and 83% (N = 52/63) at follow-up. Overall, LIM score increased from 64.5 to 70.1, P = .001. The lowest scoring domains at baseline were targeted for quality improvement and increased significantly: integrated clinical practice, 60.0 versus 68.4, P < .001; systems integration, 57.0 versus 63.8, P = .001; and training, 56.7 versus 65.3, P = .001. Ongoing quality improvement, including organizational and financial strategies, is needed to achieve higher levels of integration.

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