December 2012 VOL 3, NO 6

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Best Practices in Addressing Health Inequities

Lauren Kelley, MSW, MPA
Adrienne Lofton, RN, MSN

Ms Kelley described Project Access–New Haven, a volunteer, community-based program that uses a best-practice model to increase access to care for underserved patients and reduce health disparities in New Haven, Connecticut. The program model, referred to as a volunteer provider network, was developed in 1996 in Asheville, North Carolina, and has been replicated by over 50 communities across the United States. Project Access–New Haven, founded in 2009 and implemented in September 2010, increases access to healthcare for low-income, uninsured, and underinsured residents of the greater New Haven area by using patient navigation to coordinate the provision of donated medical care and services to this population. Stakeholders had experienced long wait times for appointments, disease advancement, and overutilization of hospital emergency departments and inpatient services.

Ms Lofton is the nurse navigator for the program. She described the core program components, which include over 300 volunteer physicians who donate their time; Yale-New Haven Hospital and the Hospital of Saint Raphael, which donate all inpatient and outpatient medical services; and contributions from the business community, eg, Metro Taxi, which provides transportation. Patients have to give back by volunteering or by writing a thank you or article; they are also responsible for meeting with and communicating regularly with their navigator and keeping their appointments. Patient navigators facilitate referrals; conduct intake interviews; work with providers to determine health needs and develop individual care plans; identify and address barriers to care, eg, by coordinating translation or transportation services; and coordinate delivery of care and services, eg, schedule and remind patients of appointments and follow up with patients and providers after appointments to determine plans and services.

Project Access–New Haven has overcome barriers to care by providing free coordinated timely care, bilingual navigators, hospital translator services, transportation (taxi service), and assistance with prescription medications and surgical supplies. The program has resulted in a low no-show rate and greatly reduced usage of the emergency department. Ms Lofton presented a case study program of care for a patient referred by a navigator and diagnosed with Hodgkin lymphoma. The program saved over $400,000 because of the value of donated services.

Ms Kelley described collection of key program metrics to evaluate Project Access–New Haven. So far, the program has greatly reduced median wait from referral to enrollment and no-show rates. Follow-up data show that compared with baseline, self-reported health is improved, patients are more likely to be engaged in usual activities, and access to healthcare is improved.

Conference participants were very interested in how Project Access–New Haven obtained free taxi service for their patients. It was explained that one of the program doctors made an appointment with the taxi company and explained the program, pointing out that some physicians had suburban offices where appointments might be more timely than at the city hospital. Patients were given a code and the costs of services provided were tracked. Ms Lofton said that the success of the program lies with the doctors who won’t take no for an answer. A lot of companies want to help, but no one had asked them. Ms Kelley said that once some companies become partners, others may also want to participate. Someone asked about tax benefits for the taxi company. Ms Kelley said they track costs so the company can have the information. Someone commented that there is a taxi program available through the American Cancer Society.

There was a question about plans to expand screening. Ms Lofton said they will next look at high utilizers of the emergency department, many of whom are on Medicaid. These patients don’t necessarily have urgent medical needs, but they don’t use primary care. There is a pilot program to try to get chronic emergency department utilizers, who most probably have chronic conditions, to use primary care. There are many other needs, eg, dental care. The navigation model is new in Connecticut, but so far nearly $3 million worth of services has been donated.

Lillie Shockney said that AONN is going to identify what is missing in various regions and communities and will be a partner to help provide services.

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