Act Local, Think Global:

Applying systematic screening to health services in central California

Irit Sinai, Ph.D.

THIS PROJECT WAS FUNDED BY THE OFFICE OF POPULATION AFFAIRS UNDER GRANT #FPRPA006055

Systematic Screening

Detects unmet health needs

Improves clinic efficiency

Engages patient as a partner

Developed by the Population Council; further tested by FHI Tested in several developing countries

family planning

diabetes care

Research Questions
1. Does systematic screening increase: number of health services received in visit? number of referrals? 2. Does systematic screening increase the proportion of: women coming in for diabetes referred to FP/STI? men coming in for adult services referred to FP/STI? women coming in for FP/STI referred to diabetes testing/services?

Study Design
YEAR 1 YEAR 2 YEAR 3

Formative Research
Patient in-depth interviews Provider in-depth interviews In-use testing

Paper Tool Evaluation

Patient exit interviews Patient chart reviews Service statistics Provider shadowing Provider in-depth interviews Cycle time

EMR Evaluation
Patient exit interviews Patient chart reviews EMR reports Provider shadowing Provider in-depth interviews On-site technical assistance

Fidelity of the Intervention: Shadowing Results

All providers demonstrated good compliance with the systematic screening protocol, but some challenges were identified, especially in clinics with high patient volume Scheduling same day additional services was sometimes a problem

Time constraints in balancing this new patient care activity with other duties

Exit interview results

Client profile Mean age % female % High school or college education % Spanish speaking Services clients want Nutrition/weight management Diabetes Birth control Utilization of additional services In year 3 % clients who received services in addition to those they came for increased from 28.1% to 28.8% % of people who received nutrition and weight services (who did not come for these services) increased from 4.3% to 13% Year-3 endline n=273 34 88% 60% 52% Year 2 endline n= 332 30% 19% 15%

Patient chart review results

Mean number of services received in a single visit

Year 2 # increased slightly from baseline to endline in intervention clinics # significantly decreased from baseline to endline in control areas

Year 3 # significantly increased, form 1.43 to 1.65

Mixed results with respect to specific services Significant increase in nutrition and weight services No significant change in family planning and STI services

Opinions of Clinic Staff: Results of In-depth Interviews

Recommended it be continued and expanded Simple to implement and well-received

Raised patient awareness of available services

Increased provider understanding of patient needs Improved patient provider communication
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I was surprised that it was so well received by patients, and how frequently they were interested in further services.

Systematic Screening Implementation Tips for Success

Determine which services are utilized, and which are underutilized Study patient flow, Involve staff in design and include incentives to sustain compliance Pre test process and tool Provide training, support, supervision and monitoring during startup

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Include activities to ensure staff feel comfortable providing the additional services

Conclusion
As a model to address multiple needs during a single visit, integration of systematic screening into a linked EMR template is a promising patientcentered approach to increase use of underutilized services

www.gvhc.org

Thank you! www.irh.org

Irit Sinai, sinaii@georgetown.edu