Health

The HIV ACCESS program, a member of the Alameda Health Consortium, has existed since 1991 as a medical home model of care that promotes team-oriented, patient-centered health services.

In January 2012, HIV ACCESS engaged BTW to design and implement a local evaluation of a Patient Centered Medical Home (PCMH) demonstration project. As one of five sites statewide that have been granted funds by the California HIV/AIDS Research Program, HIV ACCESS it working to expand, systematize and institutionalize its existing PCMH components. This project is taking steps to integrate panel management, health information technology systems and staff training at three clinics in Alameda County—LifeLong Medical Care, the Adult Immunology Clinic at Alameda County Medical Center at Highland Hospital and Tri-City Health Center. The intent of the demonstration project is to better provide patient-centered care around HIV care, support services and prevention.

BTW strategically utilizes a mixed methods approach that incorporates surveys, interviews and focus groups to collect data to understand the impact of the demonstration project on clinics, their staff and the patients they serve.

Clinic Leadership Institute (CLI), a signature program of Blue Shield of California Foundation (BSCF), focuses on strengthening leadership in California’s community health centers field. CLI offers intensive, experiential instruction and supports (e.g., seminars, customized leadership projects, peer networking) through its Emerging Leaders, Executive Excellence, New Executive Transitions and CLI alumni programs.

BSCF engages BTW to conduct a multi-tiered evaluation of CLI’s effectiveness and impact on participating individuals and teams, their organizations and the broader health centers field. BTW’s evaluation incorporates mixed methods, engages multiple perspectives and tracks impacts over time to promote learning about leadership development and organizational effectiveness.

CLI is one of few programs of its kind; because of this, BTW’s findings help improve not only CLI itself, but also contribute to a strong and vibrant community health centers field.

The ultimate goal of The California Community Foundation’s (CCF) Health Care Program is to improve access to a regular, sustainable source of quality health care among low-income and vulnerable children and adults in Los Angeles County.

Since launching a 10-year strategic plan in 2006, the Health Care Program has invested more than $16 million in grants to over 85 organizations to advance its priorities. CCF commissioned BTW to evaluate the effectiveness of the Program’s investments in community from 2006-2010 and the Program’s overall progress in advancing towards its strategic goals. CCF had a particular interested in learning about its progress toward improving clinics’ organizational capacity, service delivery capacity and Healthy Kids health insurance enrollment and retention efforts.

The findings generated from the evaluation are intended to promote learning and reflection among CCF staff and stakeholders and enhance the Program’s ability to achieve and measure impact.

California School Health Centers Association (CSHC) is a statewide nonprofit leading the movement to locate health services in schools, thereby promoting children and youth’s health and academic success. CSHC conducts advocacy for school health services, provides hands-on technical assistance to help start and operate health centers, and offers a range of other supports to raise the visibility of school health centers and ensure that they are providing high-quality services to K-12 students.

BTW is working with CSHC to explore current and potential partnerships between school health centers and local community health centers to strengthen the coordination of care. BTW is also consulting with CSHC on the development of a performance measurement framework for school health centers so that these organizations can collect, document, use and share key data to facilitate care coordination and improve results.

Since 2005, BTW has worked with CCI (formerly known as the Community Clinics Initiative) to evaluate a number of their programs, ranging from programs focused on the use of health information technology to enhancing clinical leadership to improving facilities to strengthening clinics’ networking efforts with other community partners. In 2012, CCI became the Center for Care Innovations. With a new name and an expanded focus, CCI works with multiple funders on projects to bring people and resources together to accelerate innovation in the health care safety net.

BTW recently worked with CCI on an evaluation of their pilot Community Health Center Innovation Challenge program. This evaluation assessed the effectiveness of the grants and other supports including technical assistance offered by the Institute for Healthcare Improvement, learning communities and convenings. The evaluation also captured learnings about innovation and process improvements among the grantees.

Currently, BTW is working with CCI to gather data about how people prefer to connect to each other and manage information about the health care safety net. The assessment is examining the extent to which and how people use the CCI’s online community, the CCI Voice, as well as other tools.

The Community Health Center Innovation Challenge program supports the development, testing and refinement of innovative ideas in health centers with the aim of enhancing the patient experience, improving the health of populations and reducing health care costs. The program is a joint effort of Blue Shield of California Foundation and the Center for Care Innovations.

BTW is conducting an evaluation of this pilot program to assess the effectiveness of the grants and other supports including technical assistance offered by the Institute for Healthcare Improvement, learning communities and convenings. The evaluation also captures learnings about project implementation, process improvements and outcomes across the grant portfolio and in featured grantee projects.

In addition to informing program refinements in real-time, the evaluation results will help the program share, spread and spark innovations in the community health centers field and broader health care safety net.

In 2008 the Shasta Community Health Center (SCHC) adopted the use of Electronic Health Records (EHRs) to spur greater efficiency and quality of care. SCHC found that the learning curve for EHRs can be steep, putting an extra burden on some clinicians. To address these challenges, SCHC piloted an EHR scribe model.

Scribes are individuals trained in medical documentation and are present during patient visits to enter the appropriate information into the EHRs, as dictated by the clinician.

SCHC engaged with BTW to assess the effectiveness of the scribe model including clinician and patient satisfaction with the process, patient visit efficiency and flow, clinician productivity, fiscal impact on the clinic, and particularly important scribe and clinician characteristics contributing to the success of the model.

This evaluation is being used to inform both SCHC’s development of its EHR scribe program, as well as the understanding and adoption of the model by other clinics and the field more broadly.

The San Francisco Department of Public Health’s HIV Health Services (HHS), a clinic housed within San Francisco General Hospital, provides comprehensive HIV care and is working towards becoming a Patient Centered Medical Home (PCMH).

In May 2012, BTW prepared for and initiated consulting services for an evaluation of the PCMH demonstration project at two sites—the UCSF Positive Heath Program Ward 86 Clinic at San Francisco General Hospital and 360 the Positive Care Center at UCSF. This project focuses specifically on people 50 years of age and over living with HIV/AIDS. BTW assists in tool development and review, facilitates data collection, provides technical assistance throughout the project and conducts comprehensive analysis.

These data are to shed light on the particular medical and social needs of the HIV positive population over 50 years of age and their experiences within and beyond the clinic.