Jason Zucker JasonZucker@gmail.com NJMSClinic.com 1/30/2010 Quality Assessment and Improvement at the Student Family Health Care Center Jason Zucker JasonZucker@gmail.com NJMSClinic.com 1/30/2010

Student Family Health Care Center The Student Family Health Care Center at New Jersey Medical School Founded in 1967 2 nights per week 8-9 visits per night Over 200 student volunteers Rotating Attending’s Chronic Care model

Quality Assessment

Initiation No previous reviews Limited research into student run free clinics Recruitment of Students IRB Paperwork

Planning Discussion of topics Background Research Hypertension Diabetes Preventive Medicine Patient Attendance and Follow-ups Background Research Design of chart review data extraction form Design of phone interview form

Planning -Team Roles Project Lead: Advisors: Chart Reviews: Jason Zucker Advisors: Dr. Robin Schroeder, Dr. Steven Keller Chart Reviews: James Zasadzinski MS II, Sarah Park MS II, Christine White MS II, Kai Zhao MS II, Arun Gurunathan MS II, Jasneet Kaur MS II, Brandis Belt MS III Research and Analysis: Jennifer Gillen MSIV, Jennifer Salston MS III, Jason Ackrivo MS III, Patricia Lewandoski MS III, Janet Lee MS III, Mamoona Khokar MS III Phone Surveys: Summer Elshanawy MS IV, Janet Cruz MS IV

Execution

Quality Improvement

Hypertension Analysis of: Controlled vs Not Controlled Thiazides ACE-I Multi-drug therapy Ethnicity BMI Smoking Status Age Receiving Free Medications Distance from clinic

Hypertension Total Number of Patients Patients with systolic BP at target Hypertension 41 25 Hypertension and Diabetes 19 5 60 30

Hypertension Figure 6 Controlled Not Controlled HTN – Avg BMI 34.05 33.85 HTN+DM – Avg BMI 28.24 38.13

Hypertension Controlled Not Controlled Total African American 18 21 39 Hispanic 10 5 15 28 26 54

Hypertension Conclusion: Quality Improvement: “The quality of care in this student run free clinic does not appear to differ from studies performed in more traditional settings” Quality Improvement: Consider Calcium channel blockers as 2nd line treatment for African Americans with hypertension Additional education on medication adherence Increased weight loss education in DM patients with Hypertension

Diabetes Analysis of: % of Patients Controlled vs Not Controlled 1,2, or 3 HbA1Cs in last year Lipid panel in past year Microalbumin in past year Documented foot exam in past year Optho exam in past year Controlled vs Not Controlled Co-morbidities: BMI, Age, Smoking, Dyslipidemia, Hypertension Attendance at clinic Receiving Free Medications

Diabetes Total Patients % HbA1C< 7% 5 23.81% At least 1 HbA1C measurement within last year or since diagnosis 21 100.00% At least 2 HbA1C measurements within last year or since diagnosis 13 61.90% At least 3 HbA1C measurements within last year or since diagnosis Lipid Panel within 1 year of last visit 20 95.24% Microalbumin within 1 year of last visit Documented foot exam within 1 year of last visit 16 76.19% Optho exam within 1 year of last visit 11 52.38% Total Diabetics

Diabetes Controlled - HbA1C<7 Uncontrolled HbA1C>7 Patients with Dyslipidemia 5 12 Patients with Hypertension 6 13 Patients who are Smokers 1

Diabetes Conclusion: Quality Improvement: “In comparison to the goals set forth by Healthy People: 2010, as well as to values published by other clinics, we are still providing a comparable if not superior quality of care” Quality Improvement: Use of flow sheets for all diabetic patients Focus on interventions for patients with co-morbidities Improved relationship with Ophthalmology clinic

Preventive Medicine Analysis of: % of Patients Receiving colonoscopy Influenza vaccine Pneumococcal vaccine Smoking counseling Alcohol screening Yearly mammograms Pap smears

Preventive Medicine % of Patients Compliant Colonoscopy (% of 50+ y.o. patients who received colonoscopy) 40.74% Influenza vaccination (% of patients who received influenza vaccination in 2008-2009 season) 17.5% Pnemococcal vaccine (% of 65+ y.o. patients who received a pneumococcal vaccine) 0% Anti-smoking (% of smokers counseled on smoking cessation) 94.44% Alcohol Screening (% patients who were screened for alcohol abuse) 74.2% Mammogram (% of 40+ y.o. women who received a mammogram in the last year) 31.91% Pap Smear (% of eligible women who received a pap smear in the past 3 years) 51.61%

Preventive Medicine Conclusion: Quality Improvement: In most areas our preventive medicine services are below both national averages and national goals Quality Improvement: Develop increased relationships on our campus to increase patient access to mammograms and colonoscopy's Increased use of flow sheets to ensure compliance Grant applications to increase supply of vaccines Increased patient education focused on Preventive Medicine

Phone Interviews Preliminary Results # 1 Reason for coming Lack of Insurance # 1 Complaint Time it takes to get through # 1 Like Thoroughness of the visit Avg Student Doctor Rating – 9.0 Avg Attending Rating – 9.17 Avg Staff Rating – 9.08 Overall Satisfaction – 9.21

Closure Implementing Quality Improvement Ideas Writing to share with other clinics Develop plan to future evaluate the benefits of implemented improvement ideas

Questions