Rich Zimmerman Illinois Department of Public Health, Springfield IL Utilizing a “Time Study” with Viral Hepatitis Integration Projects to Streamline Clinic Flow Rich Zimmerman Illinois Department of Public Health, Springfield IL

Time Study Goal: examine length of pre and post hepatitis integration visits and identify impact of expanded hepatitis prevention services had on waiting and interaction time periods Staff/client interaction periods combined into three types of services Registration Medical Education/counseling

Background: Illinois VHIP Project 2000 Accomplishments Funded Five Pilot Sites to: Provide hepatitis B vaccination services to STD clinic clients and others identified through community-based outreach initiatives Establish an improved system to collect behavioral risk data, history of hepatitis and hepatitis vaccination Establish seroprevalence rates among clients aged 18 and older Establish opportunities and identify barriers to hepatitis B vaccination 2001 Initiatives Funded Seven Pilot Sites to: Provide hepatitis A and B vaccination services to clients with a history of IDU-related and/or MSM risk behavior(s) Establish an improved system for collecting data on vaccination return rates Perform hepatitis B and C testing on clients with IDU-related risk only. Establish a database that links information from the risk assessment survey with data from the lab and vaccination return data

So Much To Do . . . So Little Time! We need to: Educate clients about hepatitis Coordinate services with other Health Department programs (CD, IMM) Motivate clients to return for 2nd and 3rd doses Perform reminder/recall We have to: Send in risk assessment surveys (RAS) on every client Submit an extra specimen on IDUs Complete a spreadsheet entry on clients vaccinated Provide other clinic services

Where can we save time and add services? Service Flow Chart for Four VHIP Pilot Clinics Participating in “Time Study”

VHIP Time Study Data Collection Data Elements Collected PRE - VHIP projects collected time-specific service data for 1 week in early 2001 prior to new VHIP Service Roll-out to IDUs and MSMs VHIP projects and IDPH reviewed clinic protocols, procedures and process to identify areas where services could be improved. VHIP Project staff wanted to improve services POST - VHIP projects collected data for 1 week in mid-April or early May 2001 VHIP Timestudy Date: _______ Client # ___________ Enter times below: Clinic arrival: ____________ RAS returned: ____________ LAB __________ to _________ EXAM: ________ to _________ Counseling ______ to _______ RX ________ Other _________ Vaccination: ______ to _____ Client Dismissed __________

Adjusted Average Time Spent Providing Generalized STD Services by Four IL VHIP Pilots Included Registration & RAS Completion Included Lab, Exam, Vaccination, Treatment Included Education, Pre & Post Test Counseling

Clinics were able to reduce overall client visit time by: Integrating hepatitis prevention with other STD messages Streamlining clinic flow to reduce waiting times Focusing on service first during clinic Increasing staff at two clinics to provide clinic and recall services Utilizing both interactive and waiting periods to deliver STD and hepatitis services by using written materials, posters, and videos to enhance prevention messages

Average Total Time Spent Accessing Services: Pre and Post Integration of Services to Targeted Populations Winnebago Macon Lake DuPage

QUESTIONS Richard Zimmerman Illinois Department of Public Health STD Section 525 West Jefferson Street, Ground Floor Springfield, IL 62761 Phone:  217-782-2747 Fax: 217-524-5443 email: rzimmerm@idph.state.il.us