Referral tracking and completion in a Community Health Center

Referral tracking and completion in a

Community Health Center

Maricruz Cisneros

Mentor: Anje Van Berckelaer, MD

8/12/10

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What are Community health centers?

• Community Health Centers provide vital primary care to 20

million Americans with limited financial resources.

• Commitment

• Health

• Open-door policy

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How CHC make a difference

• Highly efficient and cost-effective care

• Savings to the health care system

• “assure that quality specialty medical, diagnostic and

therapeutic services are available to patients through a system

of organized referral arrangements”

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Challenge for providing specialty care

• CHC Physicians report difficulty accessing specialty care to

patients.

• Medicaid patients face difficulties accessing specialty care

• Make up more than 1/3 of CHC patients

• 5% patient visits result in a referral for specialty care.

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Research AIMS

• Implement a referral tracking system for Medicaid HMOinsured

CHC patients in West Philadelphia.

• Measure changes in referral completions after

implementation.

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Research study

• Research Study:

• Implement a referral tracking system for Medicaid HMOinsured

CHC patients enrollees seen at Sayre Health Center.

• Keystone Mercy

• Health Partners

• Access PA Medical Assistance

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Steps: My main role

• Referral tracking system:

Dec. 28 2009: Beginning of referral tracking

• Ways of obtaining referral completion data:

• Keystone Mercy: navinet.net, billing information from an

insurer

• Health Partners: medview

• Access PA Medical Assistance: medview

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Referral tracking system

Date

ordered

Patient

name

DOB

ActPol

Plan

Name

Act Pol

Policy

#

Order

description

Appt.

status

Appt.

date

Look up

date

1/2/10 Bob **/**/** Keystone

Mercy

3/4/10 Vanessa **/**/** Health

Partners

6/8/10 Lorena **/**/** Access PA

Medical

Assistance

****** Physical

therapy

Past-

Complete

****** Cardiologist Past- no

show

****** General

Surgery

3/2/10 8/10/10

5/6/10 8/10/10

8/10/10

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Next step

• Sep. 2010: Implementation office-assisted scheduling for

referrals

• Phase 1

• Phase 2

• March 2011 follow-up data collection from referrals issued

in Dec. 28 2009.

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Timeline

Phase 2: assistance

scheduling appt.

Dec. 28, 2009 Sep. 2010 March 2011

Phase 1: no assistance

scheduling appt.

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How to calculate

finding

Primary outcome variable:

• Referral Completion:

# of completed referrals X 100 = % of referral completion

# of referrals made

• Calculate:

% referral completion before and after implementation of assisted

scheduling.

• Specialty

• procedure

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Preliminary results

250

233

200

Total Specialty referrals

# of patients

150

100

81

50

35

6

12

16

0

• n=383

future no appt cancelled complete no show weren't

found

Appointment status

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Insurance Plans

Health Plans referral completion

% referral completion

30

25

20

15

10

5

0

28.42

16.1

12.2

Keystone Mercy Health Partners Acces PA Medical

Assistance

Insurance Plan

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Monthly

50

Monthly referral completions

45

% referral completion

40

35

30

25

20

15

10

5

0

0 1 2 3 4 5 6 7 8

Month

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Future Directions

• Interesting finding

• March-April 2011: follow-data collection from referrals issued in

March

• June 2011 Manuscript preparation and submission

• Increase referral completions among HMO Medicaid patients.

• Establish Sayres baseline for referral completion.

• Identify shortfalls in referral process.

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• Health Services Research/Qualitative research

• Problems found in our health care systems

• Importance of Research

• Importance of Teamwork

• Length of time

• IRB approval

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Acknowledgements

• Anje Van Berckelaer MD, Robert Wood Johnson Clinical

Scholars

• Joanne Levy and Staff

• Ruth Whistler, Executive Director of the AWC foundation.

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Questions/Comments