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Quality Healthcare for the Underserved Populations of Los Angeles County

September 8, 2008

Imagine calling your primary healthcare provider and actually getting an appointment to see him / her that same day. Next, imagine having your physician show you a graph of your progress in combating a health issue with a click of a mouse. If you needed a surgical procedure, wouldn’t it be comforting to know that an entire team of medical professionals (providers, specialists, consultants and pharmacists) were working together to ensure a seamless system of care? These are some of the great benefits that QueensCare Family Clinics offers to its medically indigent population.

QueensCare and QueensCare Family Clinics are dedicated to providing high quality, accessible healthcare to the underserved populations of Los Angeles County. Most of us are aware of the healthcare crisis affecting our country; but few are aware that Los Angeles County has more uninsured persons than any other county in the nation. Last year, over 137,000 visits were performed for individuals and families at our seven clinics sites alone. Community clinics often struggle to keep up with the state of the art in clinic management and technology. At QueensCare, we pride ourselves on being at the forefront of creating innovative and much needed solutions to healthcare problems. This year, our innovation has led us to launch four new extraordinary programs, including the installation of Electronic Health Records, Advanced Access, Medical Specialty Services, and Clinical Pharmacy Services.

By launching an Electronic Health Record (EHR) system, we have changed the face of medicine in our clinics. Doctors now have a complete medical record with laboratory results, prescribed medications and general health history available at their fingertips. Medical providers see drug interaction warnings and patient allergies every time a drug is prescribed. Patients can see how their health is progressing by looking at color graphs tracking disease trends and treatment outcomes. Coordination of clinical care has vastly improved with the ability to send lab and prescription orders electronically. Electronic data can be merged to give a quick summary of a patient’s health history and raise instant alerts for chronically ill patients. Disease management efforts become easily coordinated, eliminating gaps in knowledge anywhere along the continuum. In the near future, patient records will be portable, allowing transmission from one caregiver to another, and leading to improved care and efficiency. In short, EHR provides the underserved population served by QueensCare Family Clinics with the benefits of cutting edge medical technology that all of us deserve.

The availability of data to track general health and treatment trends across patient populations is vastly improved with EHR. Creating this wealth of data would take innumerable man hours to gather under manual charting systems. Through EHR, treatment decisions and outcomes become measurable, facilitating more responsive treatment plans for individual patients and identified patient populations.

“Do today’s work today”, that’s the motto of QueensCare’s Advanced Access program. It aims to give patients timely access to their healthcare provider, as well as to reduce the amount of time patients spend at the clinics. As part of its efforts to enhance operational efficiency and improve patient care, QueensCare Family Clinics’ East Los Angeles clinic joined the Advanced Access program in October of 2006. This one year training, resource and evaluation program sponsored by L.A. Care Health Plan included fourteen local, “safety-net” community clinics, all of which face similar access barriers. “The core principle of Advanced Access is that patients calling to schedule a doctor visit are offered an appointment the same day,” says Dr. Mark Murray, who has pioneered the Advanced Access program in numerous practices domestically and internationally.

By December of 2007, 14 months after QueensCare Family Clinics launched Advanced Access, the Advanced Access implementation team at the East Los Angeles clinic proudly reported that delays for appointments were reduced from a 38 day waiting period to the same or next day appointment availability. Clinic patients enjoy the benefits of reduced waiting times during the actual appointment, as well. The average time a patient spends at the clinic is down 23% from the time charted a year ago. After a successful pilot initiative at its East Los Angeles clinic site, QueensCare Family Clinics has begun to roll out the Advanced Access program to the remainder of its seven clinic sites. The goal is to be able to offer 100% of patients an appointment on the day that they request.

Although primary care providers address most of the issues at hand, occasionally specialized care is required. QueensCare has an extensive network of medical specialists and surgeons, who perform a wide array of diagnostic and therapeutic procedures. Specialty referrals are not a new concept, but to the underserved they are often an insurmountable hurdle to healthcare. QueensCare’s specialty panel makes this kind of care available to low income patients at no or low cost to the patient. The following real life example demonstrates the importance of this relationship. Dr. Alfred Glover, our troubadour podiatrist frequently has diabetic patients with toe ulcers. He refers to the primary care provider for diabetic care, who passes the patient to the cardiologist to ensure a good working heart. In turn the vascular surgeon organizes the procedure to return blood flow to the ulcer; only then, can Dr. Glover operate to remove the necrotic ulcer.

QueensCare and QueensCare Family Clinics have a unique partnership with the University of Southern California (USC) School of Pharmacy. Clinical pharmacists from the USC School of Pharmacy work along side other QueensCare Family Clinic providers to help treat patients with chronic diseases such as hypertension, diabetes, heart failure, and asthma. In addition to their doctoral in pharmacy, the USC pharmacists have specialized training in chronic disease management. QueensCare providers can refer patients with complicated conditions, such as multiple diseases requiring a multitude of medications; or uncontrolled patients who are not responding to treatment, to the clinical pharmacists. The clinical pharmacists can help initiate and adjust medications; monitor patient progress and safety; identify and prevent dangerous drug to drug interactions; and help resolve difficult conflicts between drugs and disease states. This collaboration has also proven to be cost effective in that patients whose disease is under control experience less costly complications from their disease. Additionally, efficient and effective use of medications prevents unnecessary drug costs.

The collaboration with the USC School of Pharmacy started four years ago with one full-time clinical pharmacist working at three different clinics. Due to the program’s success, it has expanded to two full-time pharmacists covering five QueensCare Family Clinics. As a testament to the value of these clinical pharmacists, for the second consecutive year the program will train a Pharmacy Resident, a licensed pharmacist developing his / her clinical expertise, to continue this valuable program.

We are very proud of our innovations and we’ll be expanding them further as our experience grows. While we are thankful for all the efforts that have enabled us to provide our patients with the benefits of advanced medical technology, we acknowledge that there is much left to accomplish. In order to relieve the healthcare crisis, we must all get involved! This affects us all - insured and uninsured. Remember, we are all one paycheck away from being without health insurance.

At QueensCare, we believe that access to good healthcare is fundamental for everyone.

 

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