Examining Provider Bias In Health Care Through Implicit Bias Rounds

The following comes from the July 17, 2017, article by Vidya Viswanathan, Matthew Seigerman, Edward Manning, and Jaya Aysola on the Health Affairs Blog.


In 2015, a 27-year-old patient presented to our primary care resident practice in intractable pain, having been recently discharged from the hospital following surgery for a complex shoulder fracture. The orthopedic surgeons evaluated him the day before and scheduled a second surgery but did not adequately treat his pain. The inpatient nurse had told him he would be discharged with the oral pain regimen he had been taking for the past day or so within the hospital. But upon discharge, he found himself without those prescriptions and came to our primary care practice in severe pain. When we reviewed his inpatient record to determine the reason for this discrepancy, the attending physician discovered the phrase “drug-seeking” in the record. The rationale for this statement was not provided, nor the context. When questioned by his new primary care provider about this, the patient was shocked. He tried to recollect what he may have said to result in that assumption. He had no prior history of documented substance or prescription drug abuse.

The patient in question was a young black male and the victim of a drive-by shooting by a stranger. He had been sitting in the passenger seat of a stationary car when it happened. Standard practice in this type of case involves long-acting oral opioid medication, with gradual adjustments of a medication regimen tailored to meet the needs of the patient. But the patient didn’t receive the standard of care, and we naturally wondered why. The answer may be implicit bias.

The literature suggests that he would be more likely to be perceived as drug-seeking when requesting pain relief, compared to his white counterpart. Bias is particularly well-documented in pain management, with black children and adults receiving less adequate pain treatment than their white counterparts in the emergency department for the same presenting condition, even when accounting for insurance status and severity of pain. Longitudinal, national data on 156,729 pain-related emergency department visits found that even among those presenting with the same condition, non-Hispanic white patients were significantly more likely to receive an opioid than all other ethnic minorities examined. Researchers using an instrument to assess implicit bias in more than 2,500 physicians found a significant implicit preference for white Americans relative to black Americans among physicians of all racial/ethnic groups except for black physicians. Another study found that physicians were twice as likely to underestimate pain in black patients compared with all other ethnicities combined and also more likely to overestimate pain in nonblack patients than in black patients.

To address the case of our patient who was inadequately treated for pain based on apparently false assumptions—and other patients who have experienced a different standard of care due to implicit bias—we believe there needs to be formal discussion of this source of clinical errors at institutions. We propose the initiation of a new kind of case conference—“Implicit Bias Rounds”—to specifically identify and discuss these cases.

How Does Bias Occur?

We conceptualized Implicit Bias Rounds based on theories on why disparities in care occur despite well-intentioned providers and despite the recognition of the importance of cognitive error as a source of diagnostic error. Providers, when faced with the need to make complicated judgments quickly and with insufficient and imperfect information, may rely on assumptions associated with a patient’s social categories to fill in the gaps with information that may be relevant to diagnosis and treatment. Physicians are at risk for relying on stereotypes or assumptions for efficient decision making, even when attempting to be objective. In addition to the assumptions providers may make about patients that are dissimilar to them, they may also unconsciously favor patients whose identity they relate to. Such affinity bias may cause a provider not to consider the possibility of a drug problem in an adolescent that appears similar to him, despite a positive urine screen for marijuana. Current efforts in medicine to combat bias may also serve to perpetuate them: Physician-anthropologist Arthur Kleinman states that one problem with traditional cultural competency training is that it may erroneously characterize culture as static and cultural understanding as a technical skill.

It is not enough to merely consider potential sources of provider bias without considering proposed strategies to mitigate that bias. Evidence tells us that simply adjusting the explicit medical curricula is not enough to change implicit bias; increasing positive role modeling for medical trainees is more effective. Strategies proposed to combat implicit bias include consciously thinking of the patient’s perspective and approaching each provider-patient interaction as a shared negotiation between worldviews. Focusing on specific and unique details about an individual, instead of his or her social category, serves to combat biases by diminishing stereotyping and promoting empathy building. Clinicians who are trained to consider the unique perspectives and experiences of their patients are more likely to show empathy toward them, the study suggests. Priming physicians with information about the relevance or irrelevance of sociocultural factors in medical care can combat cognitive errors that stem from stereotyping. A regular intervention such as Implicit Bias Rounds would serve to implement these strategies on a consistent basis.

Read the full article.

Racial Differences in Outcomes Demand Greater Vigilance

The following excerpt comes from the July 17, 2017, article by Ada Stewart on the Leader Voices Blog: A Forum for AAFP Leaders and Members.


My father didn’t have a documented history of heart disease. He was never diagnosed as having hypertension, diabetes or other conditions that would have alerted us to the fact that he was at risk. So it was a shock — and one of the events that led me to the field of medicine — when he died of a massive heart attack at age 59.  

Unfortunately, his story isn’t unique.

It’s well documented that blacks are more likely than whites to suffer from an array of health conditions, including asthma, diabetes, hypertension and lung cancer. However, a study published this month in Circulation makes it clear just how different the outcomes are for black men compared with those for their white peers. Black men ages 45-64 (like my father) are twice as likely to die from a first heart attack.

My father lacked health insurance, so he rarely sought care and missed opportunities for discussions about risk factors and prevention, blood pressure and cholesterol screenings, as well as potentially life-saving treatment that may have resulted from such visits.

It’s a familiar story. One of the study’s authors said in an interview that “racial and institutional discrimination” and a lack of access to care are major factors in the wide difference in outcomes. In fact, researchers found that black patients actually have a lower risk for nonfatal cardiac events, but that lack of access to care means that too many black patients aren’t properly diagnosed with a heart condition until it’s too late.

Researchers said blacks have a higher burden of unfavorable social determinants of health,  and access to care is only one such factor. Others include limited access to nutritious food, social stressors, poor neighborhood safety and lack of recreational facilities.

Education and health literacy also are social determinants of health, and researchers said lack of patient awareness is a potential issue that should be considered regarding this issue. Although most patients likely would recognize that severe chest pain is a symptom of a heart attack, they might be less likely to recognize milder symptoms that could be cause to seek care.

So what can family physicians do? We can make sure our at-risk patients who do seek our care understand the symptoms of a heart attack and know when they need to seek treatment. We also can talk to them about exercise, nutrition, tobacco cessation and other prevention efforts, as well as the importance of follow-up when they are being treated for conditions such as hypertension and diabetes.

Read the full article.

The Messenger Also Matters: Value-Based Payment Can Support Outreach To Vulnerable Populations

 

The following excerpt comes from the July 10, 2017 article by Ruth C. Browne, Marilyn Fraser, Judith Killen, and Laura Tollen on the Health Affairs Blog.


With the proliferation of value-based payment initiatives and implementation of the Affordable Care Act’s (ACA’s) coverage expansions, states have had many opportunities in recent years to improve the health of vulnerable populations through health promotion, prevention, and care coordination. We believe value-based payment models can and must support accountable health care delivery systems in partnering with community-based “messengers” to engage vulnerable individuals in health education and promotion. We explore one such messenger program, ACCESS, a Brooklyn-based project of the Arthur Ashe Institute for Urban Health, which trains barbers and hairstylists to help formerly incarcerated men learn to recognize and act upon their own health risk factors. Value-based payment offers an opportunity to support programs such as this.

“Messengers,” as we define them here, are community health workers—those who serve “as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.” Unfortunately, there are few dedicated funding streams available to support the messenger role. Fee-for-service payment arrangements do not reimburse these activities. Value-based payment, on the other hand, not only highlights the need to support messengers but also potentially provides funding to do so.

Value-based payment programs hold the health care delivery system accountable for meeting health goals for entire enrolled or attributed populations, which requires more than just providing better medical care. Shortfalls in medical care are responsible for only an estimated 10 percent of early mortality in the United States, while individual health-related behavior is responsible for 40 percent. Even the finest delivery system can only expect to see a modest improvement in the health of its community if it focuses only on the very thing it has been designed to do—providing medical care to sick people. Value-based payment requires delivery systems to redefine nothing less than their product, place, and providers. The product must be health; the place must be where people live and work; and the providers must include credible, community-based messengers.

Credible messengers can bring to delivery systems important knowledge about social determinants of health that impact individuals’ ability to access and act upon health-related information. We focus here on one social determinant—incarceration. Individuals formerly incarcerated have become eligible for Medicaid in large numbers and, as such, participate in a variety of value-based payment initiatives. New York State, where the ACCESS program has been implemented, is moving aggressively toward value-based payment in Medicaid. In 2015, the state announced its intention to shift 80–90 percent of its Medicaid managed care provider payments from fee-for-service to value-based arrangements by 2020.

In the United States, nearly 700,000 state and federal prisoners are released annually, and more than 11 million cycle through local jails. Incarcerated individuals have poorer physical health status than the rest of the population, a high burden of mental health and substance abuse disorders, and, once they are released, are more likely than the general population to be uninsured. However, under the ACA, more than one-third of inmates released annually from state and federal prisons are estimated to be Medicaid-eligible. If this pattern holds true for those released from local jails as well, there are potentially millions of formerly incarcerated individuals newly eligible for Medicaid—and for the value-based payment initiatives that may come with it.

The burdens of incarceration are distributed unevenly. Sixty percent of New York State prisoners come from New York City, and two-thirds of the 28,000 people released each year return to the city. Some Brooklyn neighborhoods have especially high incidences of incarceration and concomitant prison spending, earning them the dubious honorific of “million-dollar blocks,” even though they are among the poorest neighborhoods in Brooklyn.

At the Arthur Ashe Institute for Urban Health (AAIUH), we found a striking overlap between Brooklyn’s million-dollar blocks and areas where we were already engaged in health-promotion activities. Founded in 1992, the AAIUH is an independent, nonprofit organization that collaborates with community members to incubate, test, and replicate neighborhood-based interventions to improve health conditions disproportionately affecting minorities. Arthur Ashe, a world-renowned African American tennis champion and social justice advocate, founded the AAIUH in partnership with the State University of New York Downstate Medical Center. Using community-based participatory research, the AAIUH navigates disparate worlds—the institutional universe of academic medicine and day-to-day life in multi-ethnic, multi-linguistic neighborhoods.

Among other projects, the AAIUH has a long history of training barbers and hairstylists to deliver health education related to breast cancer, cardiovascular disease, asthma, and diabetes in women, and HIV/AIDS and prostate cancer in men. When we began the ACCESS program in 2009, exploratory work revealed that more than 80 percent of barbers working in our ongoing projects had themselves spent at least one night in jail. This made them particularly credible messengers for our priority population of formerly incarcerated men and the supportive women in their lives. Guided by input from a community-based advisory board, we conducted focus groups of barbers, stylists, and customers to determine the best way to discuss incarceration and health, and which health issues would be most important to the community. Based on that input, the program emphasized cardiovascular disease, stress, and HIV/AIDS. We developed a health curriculum to increase awareness of these conditions, emphasizing prevention and the importance of “knowing your numbers”—that is, understanding health indicators such as blood pressure and cholesterol levels. The curriculum included a resource guide for community health and social services related to the priority conditions and services for the re-entry population.

We trained barbers and stylists to deliver the curriculum in six establishments in the Bedford-Stuyvesant and Crown Heights areas of Brooklyn, emphasizing that health messages must be delivered in a way that could be useful to any member of the community who might know someone who had been incarcerated, instead of focusing solely on the formerly incarcerated themselves. In addition to the health messages and the resource guide, ACCESS included an HIV-focused health education video played several times a day in participating salons and barbershops and 12 AAIUH-sponsored Health Resource Days held at these establishments.

The project evaluation consisted of pre- and post-intervention surveys of patrons. The pre-intervention survey assessed patrons’ familiarity with risk factors, prevention, and resources related to the priority conditions. For example, patrons were asked multiple-choice questions such as: “What are some of the warning signs of a heart attack? What is a normal blood pressure reading?” The post-intervention survey of the same individuals sought to determine whether they had been exposed to the intervention and whether their knowledge regarding any of the previously asked questions had changed. Survey respondents’ ability to identify ways to assess their cardiovascular disease risk increased from 44 percent to 62 percent, and understanding that condom use can decrease the spread of HIV increased from 77 percent to 88 percent.

Read the full article.

Useful Resources: Health Literacy

Health Literacy is key to individuals being able to access, understand, and fully use health information and services. For this reason, the Agency for Healthcare Research and Quality (AHRQ) has developed a listing of tools and other resources to help healthcare professionals in “making information easier to understand and systems easier to navigate.” The resource list is divided into the following topics:

Visit the AHRQ website to learn more about the available Health Literacy Resources.

Workers Who Give Care To The Homebound Often Can’t Afford To Get Their Own

From the article by Shefali Luthra on Kaiser Health News:

For more than two decades, Celeste Thompson, 57, a home care worker in Missoula, Mont., had not had regular contact with a doctor — no annual physicals and limited sick visits. She also needed new glasses.

Like many others who work in the lower rungs of the health care system, she has worked hard to keep her clients healthy by feeding them, dressing them and helping them navigate chronic conditions.

But because of the low wages and the hourly structure of this industry — which analysts estimate is worth nearly $100 billion annually and projected to grow rapidly — workers like Thompson often don’t have health insurance. Many home health agencies, 80 percent of which are for-profit, don’t offer coverage, or their employees don’t consistently clock enough hours to be eligible. They generally earn too much to qualify for public aid but too little to afford the cost of premiums.

“It’s a social justice issue. We have a workforce that is the backbone of long-term [care] services, and they themselves don’t have coverage,” said Caitlin Connolly, who runs a campaign to increase home care wages at the National Employment Law Project, an advocacy organization.

In 2015, Montana opted in to the 2010 health law’s expansion of Medicaid, the state-federal low-income health insurance program. Thompson, who was making about $10 an hour, immediately signed up.

Her vision care was among the first things she focused on. She had not visited an eye doctor in nine years — a problem because her job includes keeping track of patients’ pill bottles and making sure they take the right medications. “I had to use a magnifying glass to see small print,” said Thompson, who now wears bifocals. Her doctor has since warned her she may need a stronger correction soon.

…Thompson is part of a large population of home-based caregivers who might be affected by such changes. From 2010 to 2014, about half a million of these workers gained new health insurance through Obamacare, estimates PHI, a New York-based nonprofit that researches this slice of the labor force and advocates for improved working conditions, in a March issue brief.

Most home care workers’ gains came from living in states that, like Montana, expanded Medicaid. But even with Obamacare in place, many home health workers — perhaps 1 in 5 — remain uninsured. By contrast, about 8.6 percent of all Americans lack coverage.

Read the full article.

The Future of Health Care Is Outside the Doctor’s Office

From the article by Mattie Quinn on Governing:

Eastern Kentucky, with its small communities nestled in the Appalachian Mountains, is well known as one of the poorest pockets of the country. What’s sometimes forgotten, though, is how the region’s economic decline has gone hand-in-hand with a long history of poor health.

In the early 1990s, state policymakers began to grapple with what to do about the region’s high rates of cancer, diabetes and heart disease, as well as the apparent lack of such basic good health practices as preventive screenings. In many ways, the people in the region seemed to be living outside the health-care system. That’s why, in 1994, lawmakers and health officials raised a simple question: How do we get people into the system in the first place?

“We knew we needed to create a position that would work as a patient advocate,” says Fran Feltner, director of the Center of Excellence in Rural Health at the University of Kentucky. At the time, “lawmakers sort of joked that if there was money left after the legislative session, they would create a program that would include an advocacy position,” she says. “Surprisingly, there was money left, so the Kentucky Homeplace was born.”

Kentucky may have backed into the program, but Homeplace has become an innovative model for serving people in poor, rural areas. At its heart is the advocacy position. Those who enroll in the program are matched with a community health worker — usually someone born and raised in the community. The health worker can assist with any number of things that might affect a person’s well-being, from getting them eyeglasses to helping them with food assistance to making sure they make medical appointments. “Those may seem like small problems for many people,” says Deana George, a community health worker with Kentucky Homeplace, “but I know I’ve made the process that much easier for our clients.”

After just a year with the program, George has several positive stories to share. She notes one proud moment of getting free cancer medication for a client — a medication that can run up to $10,000 a month. “When I bump into [clients] at the grocery store and they introduce me to their family, I know I’ve made a difference,” she says.

Not only has the program helped get people into care, it has also seen improvements in diabetes outcomes and in cancer screening rates. Nearly 80 percent of participants receive colon cancer screenings, well above the 40 percent national average. The program, which now serves 36 counties in Kentucky’s Appalachia region, has also introduced a new low-dose screening for lung cancer.

Health policymakers outside Kentucky have taken note. Homeplace, which is run through the Center of Excellence in Rural Health, was recognized as an “outstanding rural health program” by the National Rural Health Association, and the U.S. Department of Health and Human Services applauded its work in colon cancer screening rates. Feltner, who oversees the program, has won numerous health awards throughout the state and region. As she sees it, the community health worker is the key to the program’s success. “We’ve discovered the missing link, and that’s a person on a health-care team that makes sure a client has what they need outside of the clinic,” she says. “If a mom doesn’t have shoes for her kids, she’s likely not getting a regular Pap smear.”

Read the full article.

Travel Ban Spotlights U.S. Dependence On Foreign-Born Doctors

From the article by Lauren Silverman on Kaiser Health News:

Patients in Alexandria, La., were the friendliest people Dr. Muhammad Tauseef ever treated. They’d drive long distances to see him, and often brought gifts.

“It’s a small town, so they will sometimes bring you chickens, bring you eggs, bring you homemade cakes,” he said. One woman even gave him a puppy. “That was really nice.”

Tauseef was born and raised in Pakistan. After going to medical school there, he applied to come to the U.S. to train as a pediatrician.

It’s a path thousands of foreign-born medical students follow every year — a path that’s been around for more than half a century. And, like most foreign-born physicians, Tauseef came on a J1 visa. That meant after training he had two options: return to Pakistan or work for three years in an area the U.S. government has identified as having a provider shortage. He chose to work with mostly uninsured kids at a pediatric practice in Alexandria, La.

“That was a challenge,” he said, “but it was rewarding as well, because you are taking care of people who there aren’t many to take care for.”

The U.S. medical system depends on doctors like Tauseef, said Andrew Gurman, president of the American Medical Association. He worries that President Donald Trump’s executive order on immigration, which is now on hold after a federal appeals court ruling.

“International medical graduates have been a resource to provide medical care to areas that don’t otherwise have access to physicians,” he said. “With the current uncertainty about those physicians’ immigration status, we don’t know whether or not these areas are going to receive care.”

According to the AMA, about 280,000 international medical graduates practice in the U.S. today — that’s about one in four doctors. Some are U.S. citizens who’ve gone abroad for medical school, but most aren’t.

“They don’t all have permanent visas and so a lot of them are concerned about what their status is going to be, whether they can stay, whether they can go home to visit family and still come back, and the communities they serve have similar questions,” he said.

And the care is top-notch. A study just published in the journal BMJ shows Medicare patients treated by doctors from foreign medical schools get just as good care — and sometimes better — than those treated by U.S. medical graduates.

Read the full article.

 

CDC task force recommends engagement with community health workers for diabetes prevention

From the article from Healio: Endocrine today:

Interventions that utilize community health workers for diabetes prevention, typically implemented in underserved communities, can improve health and reduce health disparities for adults with diabetes, according to a recent report released by a CDC task force.

The Community Preventive Services Task Force is recommending interventions that engage community health workers for diabetes prevention to improve glycemic control and weight-related outcomes among people at increased risk for type 2 diabetes. Some evidence suggests interventions may reduce rates of progression from prediabetes to type 2 diabetes, although more research is needed, the report noted. The task force finding is based on evidence from a Community Guide systematic review of 22 studies conducted through May 2015.

Community health workers are defined as front-line public health workers who serve as a bridge between underserved communities and health care systems. They typically are from or have a unique understanding of the community served, and they often receive on-the-job training and work without professional titles. Organizations may hire paid community health workers or recruit volunteers.

In the review, the task force evaluated the effectiveness of interventions in which community health workers connected with community groups or individuals who had one or more risk factors for type 2 diabetes. Included studies evaluated interventions that engaged community health workers as health education providers (n = 22); outreach, enrollment and information agents (n = 6); members of care delivery teams (n = 4); and patient navigators (n = 3).

Findings showed that interventions utilizing community health workers resulted in improved HbA1c, weight-related outcomes and rates of progression to type 2 diabetes, although the report noted that data on reduced progression came from three studies with small sample sizes.

Read the full article.

Study Offers Young Doctors Strategies To Deal With Discrimination

From the article by Carmen Heredia Rodriguez on Kaiser Health News:

n July 2013, a man arrived in the emergency room of a California hospital seeking treatment for his child. But when the intern on call walked in to see him, the father looked at her name tag and demanded another physician. As a Palestinian, he didn’t want his child treated by a Jewish doctor. The intern turned to her resident supervisor, Emily Whitgob, who told her colleagues about the incident.

The episode, Whitgob said, helped motivate her to study how doctors in training and their institutions should deal with patients’ prejudice and to publish a report that outlines strategies offered by the professionals she and the other authors consulted. The recommendations, published Wednesday in the Association of American Medical Colleges’ journal Academic Medicine, call for trainees to focus on their role as doctors by not taking hostile comments personally and meeting patients’ anxieties with empathy.

Researchers recruited 13 experienced faculty members from the pediatric department at Stanford University School of Medicine in California to review a series of scenarios illustrating patient discrimination against a medical trainee. Participants shared their reactions to the situation and outlined strategies for diffusing the tension in such encounters.

The issue has attracted national attention recently after Tamika Cross, a black physician from Houston, posted on social media that a flight attendant had dismissed her offer to help and disputed her credentials when looking for medical aid for a man who needed treatment mid-flight. Her Facebook post went viral, garnering over 48,500 shares as of Wednesday.

It’s not clear how often these episodes occur. But the journal article notes that a 2015 survey found 15 percent of pediatric residents at Stanford had experienced or witnessed mistreatment of medical residents by patients or families. Of those incidents, 67 percent involved discrimination by patients’ families. Half the people in the survey said they did not know how to respond to the discrimination and a quarter thought that the hospital was not likely to take any action against the patients’ families.

The situations can be complicated by the lack of racial and ethnic diversity in many hospitals. According to the most recent data available from the medical colleges association, black and Hispanics make up about 9 percent of U.S. doctors.

Whitgob, now a developmental behavioral pediatrics fellow at Stanford, said the results of her research can help create a set of guidelines to give hospitals and medical students a framework to handle patient discrimination in the field.

“I wanted to help create the tools so that they can cope with these events in the future,” she said.

The experienced doctors in the study noted that if the patient needs immediate medical attention, providers should ignore any hostile comments and quickly deliver that care.

When the need is not immediate, the study participants also recommend doctors speak honestly to patients about underlying emotional triggers, which may perhaps allow a more constructive dialogue that will get to the patient’s or family’s hostility and may allow both sides to work toward establishing enough trust for care to be given.

Formal training is needed to equip doctors with the skills to engage in these discussions, according to the report. By developing self-awareness and sensitivity, medical personnel can shift the focus away from the discriminatory remarks and emphasize patient care. The group also advised providers to set expectations early in medical training by communicating that discrimination can happen to anyone.

Many of these concepts should not be new to trainees. As part of their accreditation, medical schools already are required to teach students about culturally competent health care.

Read the full article.

October HDRG Recap: USA Faculty, Staff, and Students Serving the Community through Project Homeless Connect

The October 2016 meeting of the Health Disparities Research Group (HDRG), featured a team of faculty and students from the University of South Alabama (USA) who shared their experiences of as founders and participants in  Project Homeless Connect(PHC). This annual one day even provides various resources including medical services, legal services, dental and vision screenings, and access to housing assistance to homeless individuals and families in Mobile and Baldwin counties. The team from USA coordinates and provides all medical screenings and clinical services offered at the event.

Dr. Margaret Moore Nadler, USA College of Nursing, provided an overview of the experience of implementing PHC in Mobile and also the process through which the interprofessional team from the university became involved. The event began as a multi-agency and university partnership led by the Mobile-Baldwin Continuum of Care Board and Housing First (a local non-profit agency focused on advocacy and community collaboration to end homelessness). The original focus of the collaboration was to develop standards for counting the number of homeless individuals in the area in order to comply with Federal regulations that require “Point in Time” count every January. Through this collaborative process, the group learned that Birmingham and other cities across the nation put on annual service events often called Project Homeless Connect through which they provide a one day, one-stop opportunity for homeless individuals and families to access needed services and assistance under one roof. The Mobile collaborative group realized that such an event would be a great way to serve while also meeting the mandate of conducting the annual census.

During their presentation to HDRG, members of the interprofessional team focused on three key aspects of USA’s participation in PHC.

Benefits for the USA team

  • Working in an interprofessional team provides opportunities for developing understanding across disciplines and build relationships.
  • Through the service learning opportunities of PHC students are able to strengthen their cultural competency skills and are often challenged to expand their capacity for compassion and empathy. In demonstrating this point, Caleb Butler, a social work student, shared that while he was serving as an advocate at PHC he met someone who was his age, shared a similar family background, and came from the same hometown, yet he(Caleb), was a university student, while the other person was homeless. Caleb explained that through this experience his understanding of homelessness broadened, he developed more empathy, and he realized that anyone had the potential to become homeless.
  • Reciprocal learning between faculty and students occurs through the process of feedback and evaluation. Students from the College of Allied Health Professions, College of Medicine, and College of Nursing  run the medical clinic with backup support from faculty and community providers. After each PHC the teams debrief and discuss what worked and what didn’t in order to help all involved improve their skills and to make plans and adjustments for the future.

Improvement and Development

  • After reviewing three years of participation in Project Homeless Connect, the team is developing  a strategy for moving forward and improving care.
  • A 3-5 year strategic plan with the goal of expanding the health clinic portion of the PHC as a quarterly event. They plan to seek corporate sponsorships and grants to support this goal.
  • SMART objectives have been developed around providing better care, creating better health, and lowering costs.
  • Each area of clinical service will be evaluated to recognize what works and opportunities for improvement.
  • Marketing and advocacy strategies being developed to raise the profile of Project Homeless Connect both on campus and in the broader community. New partnerships are also being sought to enhance services offered.

Data Collection and Research

  • Through the forms that clients in Project Homeless Connect complete, an abundance of data is being collected and compiled in REDCap so that it can be that can be analyzed for trends and to inform performance improvement efforts. The goal is to have an accessible Homeless Health longitudinal data set that can be accessed by students, faculty and community partners who participate in Project Homeless Connect.
  • The team has identified research opportunities from this project:
    • Community Based Participatory Research
    • Readiness to change and patient referrals to community agencies
    • Use of motivational interviewing
    • Students participating in PHC: Attitudes towards the people who are homeless and now working
    • Needs assessment of USA student homelessness or risk factors for homelessness
    • Influence of  interprofessional education collaboration

The presentation team consisted of:

  • Dr. Margaret Moore Nadler, College of Nursing
  • Dr. Kathy Bydalek, College of Nursing
  • Ms. Clista Clanton, Biomedical library
  • Dr. Pam Johnson,College of Nursing
  • Ms. Mary Meyer, College of Nursing
  • Mr. Caleb Butler, Social Work Student in the Department of Sociology, Anthropology, and Social Work
  • Mr. William Crittenden, third year medical student in the College of Medicine

Download the presentation.

Watch the video: