Needs Assessment of the HOYA Clinic Patient Population Georgetown University
Margaret Burke, Nikola Lekic, Anna McEvoy, Christine Oh, Stephen Sarmiento, Jenny Van Kirk, Emily Wang, Erwin Wang Georgetown University School of Medicine, Washington, D.C. Abstract
One of the great areas of health inequality in Washington, D.C. is lack of physician access for uninsured and underinsured patients. The Georgetown University School of Medicine-organized HOYA Clinic was developed in response to this gap in services, in order to provide free healthcare to those in need. In order to improve quality care and ensure patients are receiving the services they are most in need of, patient data was examined from HOYA Clinic visits for 2013. This needs assessment focused on examining the reasons patients visit the HOYA Clinic, their insurance status, and where else they would access healthcare services if the HOYA Clinic did not exist. The goal is that by better understanding patient utilization of the healthcare system, the HOYA Clinic can adapt to fulfill their needs and continue to provide meaningful service to the community. The data shows that insured patients would be more likely to visit the ER for the same reason they came to HOYA Clinic, while uninsured patients are most likely to not seek care anywhere if HOYA Clinic was not available. Given the mostly ambulatory diagnoses these patients present with, it points to the further need for the HOYA Clinic to improve primary care services. Ideally, this project can be used to advocate for the continued and evolving need for the HOYA Clinic to provide the healthcare services that will be most beneficial to improving overall health outcomes in its population.
Results A
B
Introduction Over the past decade, there has been a significant focus on improving access to quality healthcare nationally as well as within the District of Columbia. The nation’s capital has a lower rate of uninsured than the United States as a whole-- only an estimated 42,000 people, or 8% of the District’s population, compared to the national average of 15%.1 There is also a high number of physicians-per-capita. Even so, D.C. continues to have a higher rate of death attributable to heart disease (222.4/100,000) and diabetes (24.9/100,000) compared to the rest of the country (179.1/100,000 and 20.8/100,000 respe2ctively).1 There is a shift in healthcare towards an emphasis on preventive medicine, with heart disease and diabetes as its forefront, so one may wonder why such paradoxical statistics exist in Washington D.C. With a majority of the citizens insured and a plethora of physicians, the concern has less to do with how many doctors there are than where they are. According to the D.C. Board of Medicine Physician and Physician Assistant Workforce Capacity Report published September 2013, of the more than 8000 physicians licensed to work in the nation’s capital, only 453 of them are primary-care physicians who spend more than 20 hours a week seeing patients.2 Most of the actively practicing primary-care doctors are clustered in wards 1, 2, 3 and 5 near the city’s hospitals while many of the District’s uninsured population live in wards 4 and 7.2 Given such a need for ambulatory care within the underserved wards, the response by the Georgetown University School of Medicine is the HOYA Clinic, a student-driven free clinic partnered with the MedStar Georgetown University Hospital. The clinic first opened its doors in 2007 at D.C. General Emergency Family Shelter in ward 6. It has since grown to serving a total of 767 patients in 2013. The clinic aims to serve the homeless and uninsured population. The HOYA Clinic has provided services to bridge the gap that exists between those without any insurance as well as those with insurance but inadequate physician access. This research project aims to assess the insurance status of the HOYA Clinic’s patients as well as its role in providing ambulatory services within a community the lacks access to actively practicing primary care physicians.
Fig. 1 (A-B). A breakdown of where patients would have gone if the HOYA clinic were not available. A) Divided by insurance status. B) Divided by diagnosis type.
Of the 767 patient encounters at the HOYA Clinic in 2013, 486 encounters (63.4%) listed both full details about insurance status and preferred alternative care venues to HOYA. A similar proportion of uninsured (39.7%) and insured (31.0%) would have next sought care at another free clinic. Many more patients with insurance (28.5%) would go to the ER or urgent care while only 12.5% of uninsured would do so. A much higher proportion of uninsured patients (44.4%) would choose to do nothing than insured patients (18.4%) when no other choices are available. A noticeably higher number of insured patients (20.9%) would have seen their primary care doctor when compared to uninsured patients (3.4%). (p=0.66). Depending on individual diagnosis type, although more insured patients were more likely to see a primary care physician, this difference was not significant (p=0.17 to p=0.86). Among top diagnoses seen at the HOYA Clinic in 2013, there was no noticeable difference between what alternative care venues were considered by insured and uninsured patients.
Discussion and Conclusion
Methods Data is gathered from intake information received at HOYA Clinic that reports basic patient and visit information. This is collected by the current coordinator staff for the publically available annual report. The information aims to determine health markers in this patient population. Each patient that is seen at the clinic has one of these information forms filled out for them. Data collection through this method will continue indefinitely, the goal is to constantly evaluate the health of and identify any risks in this population over time. These findings will assist in improving the future quality and effectiveness of care offered to patients. The data stems from information including insurance status, reason for visit, if they are a resident of the shelter, how they heard about HOYA, what they would have done if they did not come to HOYA, vital signs, as well as the types of prescriptions or vaccines administered during the visit. The focus of this analysis is looking at healthcare habits of patients who are insured versus those who are uninsured. Co-investigators were provided with a de-identified database containing no HIPAA identifiers, unique codes, or keys. IRB exemption was granted for the project. Statistical analysis was conducted using pivot table analysis and t-tests for all patients seen in the 2013 calendar year.
Acknowledgments We would like to thank the HOYA Clinic’s medical directors Dr. Eileen Moore and Dr. Matthew Levy, Georgetown University School of Medicine, MedStar Georgetown University Hospital, the 2013 HOYA Clinic coordinator staff, especially Leslie Andriani, the HOYA Clinic volunteers, and our patients for their continued support of the HOYA Clinic.
References 1 “District of Columbia State Health Facts.” Kaiser State Health Facts. 2014. Web. 2 Mar 2014. http://kff.org/statedata/?state=dc 2 Physician and Physician Assistant Workforce Capacity Report 2.0. Government of the District of Columbia Department of Health Board of Medicine. September 2013. www.doh.dc/gov/bomed 3 Darnell, JS. Free Clinics in the United States: A Nationwide Survey. Arch Intern Med. 2010;170(11):946-953. 4 Zucker, J, et al. Measuring and Assessing Preventive Medicine Services in a Student-Run Free Clinic. Journal of Health Care for the Poor and Underserved. 2013;24(1):344-358. 5 Dubey V, Glazier R. Preventive care checklist form Evidence-based tool to improve preventive health care during complete health assessment of adults. Can Fam Physician. 2006 Jan;52:48–55. 6 http://www.commonwealthfund.org/Performance-Snapshots/Overuse-of-Health-Care-Services/Hospitalizations-for-Ambulatory-Care--8211-SensitiveConditions.aspx. Poster produced by Faculty & Curriculum Support, Georgetown University School of Medicine Poster produced by Faculty & Curriculum Support (FACS), Georgetown University Medical Center