Edwin Fonner,
Jr., DrPH
This report summarizes the evaluation of the Community Access Program (CAP) undertaken in fiscal year 2001-2002 by the Wallace County Family Practice Clinic and Greeley County Health Services. Two supplementary documents accompany the report: a Data Book and a Copy of Surveys. The objectives of the evaluation were to determine progress made in (1) developing a system of care for the medically underserved, (2) improving the safety net infrastructure, (3) reducing unmet needs, and (4) developing a healthcare partnership in the region.
Data Acquisition – Data collection for the evaluation consisted of interviews, a review of documents, a leadership survey, and a community needs assessment survey administered to all households in Wallace and Greeley Counties. A patient satisfaction survey will be conducted before year-end 2002. A good cross-section of information was collected from the interviews and surveys. Two-thirds of the leaders polled and one-third of the households returned surveys. Future data collection efforts should work to improve response rates from working families and medically underserved, including Hispanics.
Developing a System of Care – The area’s safety net has the basic resources available, effective linkages between providers, and good referral mechanisms. Pharmacy services for lower income patients, the new behavioral health program, and the sliding fee scale are functioning effectively. However, on top of a poor economy, the area is considered medically underserved and faces further jeopardy as direct care dollars from government sources are squeezed. There are significant waiting times for care by certain providers.
Enhancing Infrastructure – There were significant developments in the Virtual Private Network (VPN), the behavioral health program, and the indigent drug program. The possibility of continued funding from HRSA will help with capacity development, but add little to the declining direct care dollars for lower income patients. Information technology staff is limited and placed under greater pressure as more hardware, software, and end users are added to the VPN. Transportation is one of the main barriers to care in the region. A plan for future financial sustainability is partly based on a successful application for Community Health Center funding from HRSA.
Reducing Unmet Needs – A clear sense of the needs of the Medicare-age population was gained from surveys. However, there was less available data on working families and uninsured due to lower survey response rates. There are significant unmet needs in the region. High costs are causing people to delay needed care. Outreach by the CAP program must be selective in order to minimize the burden of uncompensated care on local providers.
Convening a Partnership – The partnership includes all of the key healthcare providers and has effective physician leadership. Partners have provided mostly positive feedback on the purpose, management, and function of the CAP program. Groups new to working with healthcare providers and those out of the immediate area may feel less involved in the CAP program.
Meeting CAP Objectives – The partnership has a comprehensive, well-crafted set of objective and qualified staffing. There may be a need for more consistent communications among program participants. The CAP program assimilates well into the existing system of care. Number of new patients served was limited in Year One due to the focus on systems development and start up.
Recommendations. Here are several considerations for helping CAP accomplish its program objectives.
Data Collection – Strive to improve data collection on the medically underserved, including working families, lower income uninsured, and Hispanics. More targeted surveys, interviews, and focus groups could help identify medical and social needs.
Outreach – Outreach should be focused on specific target populations to minimize the financial burden of more uncompensated care for providers. Helping the local Hispanic population with community gatherings may be a step in that direction.
Objective Setting – Healthy People 2010 should be used for setting community health improvement targets. Computing regional estimates of morbidity using census data and nation benchmarks may be a substitute for unavailable local health status data.
Delivery – The partnership could explore consolidating business functions and reducing expenses with the VPN. Ways to educate patients on the benefits of seeing available providers may reduce waiting times. Telehealth could be piloted to increase productivity of home health workers.
Information Technology – Securing additional system staff for backup, training, and additional development should be considered. Cross training staff could alleviate the workload on systems staff. Use of a case management system like one used in Manhattan KS could improve information sharing among staff.
Partnership Activities – Creating more consistent and formal communications, especially for partners located out of the two-county area or new to the CAP initiative, is recommended. Earlier meeting notifications and regular meeting times may increase participation. Incorporating state and local government officials in CAP will help advocacy.
Overall, the CAP initiative is well poised to address the needs of the medically underserved in the region as its Year Two participation unfolds. [Back to Main Page]