MPH Practicum
Quality and Access to Care Evaluation
Health Centers: JOWyatt and WCHC
Amarillo Public Health Department
Compiled by Costa Ndayisabye
March 21, 2016
Introduction
In order to ensure patients are receiving the appropriate health services that reflect the national or universal standards, health care quality assessment is an important element that health care providers should consider in their routine.
As per the assignment, this quality indicator assessment was conducted through a systematic comparison of data provided by the Amarillo Public Health Department to the national health care quality standards. The major issue of this quality assessment focuses on “Patient wait times to receive health care”.
Data Comparison
Timely care varies depending on states or cities. Research conducted did not specifically find the national law that standardizes time patients should wait to get the wanted health care service. However, there are many reports that provide the best health quality as far as wait time is concerned. These reports, therefore, were critically reviewed to extract data that would be compared to the Quality Indicator sheet from the City of Amarillo Public Health Department (Denoted APHD in this evaluation). To ensure accuracy of relevant data extraction reports from trusted sources such as GIGAOM, the Agency for Healthcare and Quality from the Department of Health and Human Services, Huffington Post, New York Times, Vital.com, etc. were examined.
- Wait time for a new patient appointment with a PCP for patient with an acute condition.
According to Rosenthal (2014) from the New York Times a survey has indicated that the twin cities of Dallas-Forth Worth have the lowest wait time for new patient appointments with family practice physicians, which is 5 days compared to Boston, where new patients could wait up to 60 days. The maximum wait time of 2 days indicated in the Quality Indicator sheet from the city of Amarillo Public Health Department is reasonable. Median: 32.5
- Average wait time for a new patient appointment after FNAC approval:
Average (year 2006-2013): 30 Hours
I would refer this point to the aforementioned standard in description 1, where the average wait time for new patient appointment with a PCP for patient with an acute condition is 5 days as portrayed on in the chat 2.
- Average or range of wait time from initial contact with clinic to first prenatal appointment
According to Merritt Hawkins (2014) Boston has the highest cumulative average for OB physician appointment in the country and Dallas has the lowest.
Chat 2: Survey of Patient Appointment Wait Times (Merritt Hawkins, 2014).
Average (year 2006-2013): 9 days (APHD)
National Report: 28 days
With the above information time range depicted on the Quality Indicator sheet from the city of Amarillo Public Health Department indicated 4-day difference with cumulative average for OB appointment in Dallas.
- Current wait time reported by ADPH for:
- a) WCHC
Average (2006-2014)= 16 minutes (APHD)
- b) JOWyatt
Average (2006-2014)= 22 minutes (APHD)
National Report patient average wait time to see the provider: 19 minutes. Alabama has the highest (23 min) and Wisconsin has the shortest (15 min) reported by Daily News (2015)
- Percent of 2-year olds seen in JOWyatt with up-to-date immunizations
Average: 88% (2006-2012) (APHD) Note: There are no data for years 2013 and 2014
National average: is standing at 78 percent in 2014 (Children Trends Data Bank, 2015)
4A: Percentage of diabetics receiving year referral to ophthalmologist for eye exam
Average: 82% (2006-2014)
No current statistics, however, a 2013 report indicated an average of 52% national for retinal eye exam (NCQA, 2015).
4B: Percentage of diabetics receiving controlled blood sugar services
Average: 95% (2006-2014) (APHD)
Sufficient data are not available to estimate the national average of diabetics who receive controlled blood sugar service.
4C: Percent of diabetics receiving microalbumin or creatinine clearance screening
There is no specific data (percentage) found, however a report produced by the Nation Institute for Diabetes and Digestive and Kidney Diseases stated that “Nearly 24 million people in the United States have diabetes, 2 and nearly 180,000 people are living with kidney failure as a result of diabetes” (NIH, 2014) which means 100% of individual diagnosed with diabetes should go through microalbuminuria screening (2014)
4D: Percent of diabetics receiving annual foot exams
Average: 84% (2006-2014) (APHD)
National Average: 74% (CDC, 2012).
5A: Percent of women 50+ of age referred for yearly mammograms:
Average: 92% (2006-2014) (JOWyatt)
Average: 86% (2006-2014) (WCHC)
National average: 66.8% (2013) (CDC, 2015).
5B: Percent of women referred for mammograms that received mammograms.
Average: 76% (2006-2012) (JOWyatt)
Average: 80% (2006-2012) (WCHC)
National average: no data available
- Customer Satisfaction:
Average: 90% (2006-2014) (JOWyatt)
Average: 95% (2006-2014) (WCHC)
National Average: N/A
- Body Mass Index
7A: Patients with height and weight
Average: 99% (2006-2014) (APHD)
7B: Patients with Body Mass Index over 30.
Average: 45% (2006-2014) (APHD)
7C: Patients with BMI over 30 referred for weight management consultation
Average: 100% (2014) (APHD)
- Smoking
8A: Patients 18 and over asked about smoking
Average: 95% (2006-2014) (APHD)
National average: 62.7% (2005-2009) (CDC, 2012)
8B: Patients with whom providers discussed cessation on smoking
Average: 95% (2006-2014) (APHD)
National average: N/A
CDC recommendation: No matter what your specialty is, you know the health risks of smoking. Health care professionals can help patients to quit smoking with simple talking points, educational materials, videos related to the hazard of smoking (2016)
- Indigent qualified for FNAC clinic services as a % of total eligible indigents in Amarillo:
Suggested answer: This will depend on individual FPG. Those who fall in 21 % FPG income (with proof) should be qualified (Texas DSHS, 2016)
2A: Average length time from submission of application to approval of eligibility for JOWyatt services
-Average: 14 days (2004-2012) (APHD)
2B: Average length of time from the eligibility completed application to approval (JOWyatt)
-Average: 4 days (2004-2012) (APHD)
Comparison for both 2A and 2B: It takes up to four weeks (30 days) to know if you are qualified for benefits (Texas Workforce Commission, 2015)
3A: Percent of persons approved for JOWyatt services out of total applicants
3B: Reasons for FNAC denial of applicant
4: Percent of JOWyatt patients who receive Medicare or Medicaid benefits
Indication: Benefits approval depends on the applicant fulfilling the criteria set by the service. Based on the 2016 Federal Poverty Guideline (FPG), poverty line of 21 % FPG income is the standard (Texas DSHS, 2016)
5A: Percent of lapsed appointments (no shows) out of total appointment set, at JOWyatt
Average (no shows at JOWyatt): 22% (2004-2014)
5B: Percent of lapsed appointments (no shows) out of total appointments set, at Women’s and Children’s for JOWyatt patients
Average (no shows at Women’s and Children’s): 24% (2004-2014)
6: Percent of lapsed appointments (no shows) out of total appointments set, at FNAC.
Average (no shows at FNAC): 37% (2004-2014)
Indication: In the country the national average of “no-show patients” was 5% in 2013 as reported by Medical Group Management (National Medical Fellowship, 2014).
- Claim denied for appropriateness (100%).
No available data to compare with.
Conclusion
Data used in this paper were obtained from different sources. There was not an experiment; rather, it was an assessment of various reports on health care quality. Data obtained, therefore, can provide a representation as to how the services provided by the JOWyatt and WCHC compare nationally and can be serve as a tool to track and identify where more effort is needed.
References
Centers of Diseases Control and Prevention (2012). Diabetes report card. Retrieved from http://www.cdc.gov/diabetes/pubs/pdf/diabetesreportcard.pdf
Children Trends Data Bank (2015). Immunization. Retrieved from http://www.childtrends.org/?indicators=immunization
Centers of Diseases Control and Prevention (2012). Tobacco Use Screening and Counseling During Physician Office Visits Among Adults — National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005–2009. Retrieved http://www.cdc.gov/mmwr/preview/mmwrhtml/su6102a7.htm
Centers for Diseases Control and Prevention (2016). Health care professionals:
Help your patients quit smoking Retrieved from
http://www.cdc.gov/tobacco/campaign/tips/partners/health/hcp/
Daily News (2015). Doctors’ office wait times get shorter: study. Retrieved from
http://www.nydailynews.com/life-style/health/doctors-office-wait-times-shorter-study-article-1.2161945
Merritt Hawkins (2014). Survey of patient appointment wait times. Retrieved from http://www.merritthawkins.com/2014-survey/patientwaittime.aspx
National Committee for Quality Assurance (2015). What is the Current State of Quality of Care in Diabetes? Retrieved from: http://www.ncqa.org/PublicationsProducts/OtherProducts/QualityProfiles/
FocusonDiabetes/WhatistheCurrentStateofQualityofCare.aspx#sthash.BSac0rdy.d uf
Nation Institute for Diabetes and Digestive and Kidney Diseases (2014). Kidney disease of diabetes. Retrieved from http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/kidney-disease-of-diabetes/Pages/facts.aspx
National Medical Fellowship (2014). No show rate. Retrieved from http://www.nmfonline.org/file/pclp-project-database/Nowacki-Daryl-Paper.pdf
Rosenthal, E. (2014). The health care waiting Game: Long waits for doctors’ appointments have become the norm. Retrieved from http://www.nytimes.com/2014/07/06/sunday-review/long-waits-for-doctors- appointments-have-become-the-norm.html?_r=0
Texas Department of State Health Services (2016). County indigent health Care program: Eligibility criteria. Retrieved from http://www.dshs.state.tx.us/cihcp/eligibility.shtm
Texas Workforce Commission (2015). Learning the Result of Your Application for Benefits. Retrieved from http://www.twc.state.tx.us/jobseekers/learning-result-your-application-benefits
