QI Supplemental Funding in Health Centers

For a variety of reasons related to economics, behaviors, and health care beliefs, residents of Eastern Kentucky fail to undergo recommended cancer screenings. In Kentucky, 18.3% of adult women have not had a Pap test in the past three years, and this statistic decreases with increasing levels of education. In the Kentucky River Area Development District, 22.3% of women report no Pap test in the past three years, which is the second highest rate in the state.i Appalachia has also been identified as a place based health disparity population due to its high rates of cervical cancer.ii Central Appalachian women are more likely to have lower incomes and less access to care than their more affluent, urban counter-parts, which also means that they are more likely to have a higher cancer incidence and receive delayed diagnoses, which affects their 5-year survival rates. According to Sarfaty, Wender, and Smith (2011), the Patient Centered Medical Home (PCMH) model must prioritize adherence to cancer screening as part of its management and delivery of quality medical care. The authors of this study suggest that capacities needed within the medical home to facilitate cancer screening include patient access and communication, health risk assessments, periodic preventive health exams, use of registries, the ability to track and follow up on tests and referrals, and feedback on performance.iii In order to meet the dual goals of increasing cervical cancer screening and achieving PCMH recognition, the University of Kentucky North Fork Valley Community Health Center (NFVCHC) proposes to develop a system of care lead by a PCMH team to facilitate improvement in cervical cancer screening rates at our NFVCHC facility through aggressive tracking and coordination of care with our community collaborators. Use of a Community Health Worker to provide community education to high-risk patients and a nurse primarily dedicated to improvement of clinical outcomes through vigorous monitoring of quality indicators will assist us in achieving these challenging objectives. In the short time frame remaining (four months) we propose to enlist a .25 Community Health Worker (10 hours weekly) to provide individualized education to our at risk female patients, and increase the allocated time for our Quality Improvement leader to spend focusing on referral tracking and care coordination (up to 55% of 1.0 FTE). As a result of these improvement processes we plan to increase our cervical screening from the current 43% (which is congruent with the Kentucky 2011 UDS average) to the 2011 community health center average of 58% for female patients from 24 through 64 years of age. We further anticipate that we will achieve recognition as a Level 1 Patient Centered Medical Home for the NFVCHC site within the next 12 months, as we work towards team based care that exceeds patient expectations.