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

2. 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

3. Quality Assessment

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

5. 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

6. 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

7. Execution

8. Quality Improvement

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

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

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

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

13. 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

14. 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

15. 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

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

17. 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

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

19. 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 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%

20. 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

21. 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

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

23. Questions