The overarching goal of this work is to streamline the departments screening for social determinants of health, improve the referral process and refer more individuals to assistance. Steps that were taken to implement this project were to assess the current scope of referral practices among all staff who make referrals, mainly frontline staff. The quality improvement project team also assessed options for how to streamline the referral process by eliminating the paper referrals and exploring options to digitalize the process. The beginning stages of the project relied heavily on the participation of staff from across the department. Programs included the Neighborhood Social Work team, Access to Care, Immunizations clinic, Tuberculosis Clinic, Women's Health Clinic, Alcohol and Drug Services, Sexual Health Clinic, Clinical Health Administration, Health Equity, and the Medicaid Administrative Claiming program.
After the process mapping was completed, the project team had a solid understanding of each individual process for making referrals across the department. The process mapping showed that every person who makes referrals for health insurance or social needs is completing the referral differently. Steps were ultimately taken to streamline this process, integrating the screening questions into the Electronic Health Record, which would ping”, or send a notification, to either the Access to Care program or Neighborhood Social Work team depending on the need. For health insurance, this provided an opportunity for the Access to Care program to work on educating clients on their options for health coverage and care. These conversations proved to be very successful for clients, as most were perceived to have a better understanding of their next steps after speaking with an Access to Care team member.
Several programs play a lead role in the development and ongoing maintenance of this program. Most notably, the Access to Care program, Neighborhood Social Work team, Immunizations Clinic team, Clinical Health Administration and Office of Planning and Quality Improvement. The Office of Planning and Quality Improvement facilitated the process mapping meeting, as well as the follow up meetings to help keep conversations on track. The Access to Care and Neighborhood Social Work team led the process from the beginning, coordinating meetings and providing feedback to the process along the way. The Immunizations clinic has played a role in the ongoing maintenance and tweaking of the project, as their staff have the direct contact with clients who are answering screening questions. Clinical Health Administration has been the primary contributor to the digitalization of the tool, integrating the screening questions into NextGen (the Electronic Health Record), working with the Immunizations team to identify the best timing for the questions to be asked, and training the Access to Care and Neighborhood Social Work teams on how to receive and follow up on a referral.
With the rapid increase of referrals that were recorded in the pilot phase of this project, Columbus Public Health has recognized the need to expand capacity within the Access to Care program to assist with the need. As of December 2018, about two months after the introduction of the screening tool, the number of referrals for health insurance through this screening tool have climbed to more than 220. Currently, Columbus Public Health is reassessing it's capacity to serve, with the goal of expanding the Access to Care program to include a Health Education Program Planner (HEPP). The HEPP would work to expand and maintain the referral program, working with individual clinics to roll out this tool across the department over the next 1-2 years. This position would also be responsible for managing data and developing reporting measures for each clinic, as well as coordinate follow up efforts with Access to Care interns. With the Department's limited budget to expand capacity beyond the addition of a HEPP, the Access to Care program will be partnering with the Office of Planning and Quality Improvement to obtain field placements for students interested in Access to Care. Columbus Public Health is one of five contracted Community Based Training Partners within a 5 state region for the University of Michigan Public Health Training Center (UMPHTC) through a large grant funded by HRSA. Students who are recruited through this opportunity will be managed by the Office of Planning and Quality Improvement, but will complete project-based work under the Access to Care program to assist with the rapidly growing referral process.