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      Don't Let Perfect Be the Enemy of Good: A Proof of Concept for a Custom National Data Repository of Quality Measures for Free and Charitable Clinics

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          Abstract

          Purpose:

          Free and charitable clinics (FCCs), nonprofits that utilize volunteer licensed health care professionals to provide health services at no cost or a small fee to low-income uninsured patients who are disproportionately from underrepresented communities, have been part of the safety net for over a century. Approximately 1400 known FCCs serve two million patients annually. Despite their longevity and sizable number, evidence regarding the quality of care in FCCs is lacking. We report new evidence generated by a national initiative, the Roadmap to Health Equity. Established in 2017, this consortium is co-led by two national organizations serving FCCs and an academic institution. It has involved more than 150 FCC stakeholders with the shared goal of improving the quality of care and reducing inequities. The centerpiece is a custom national data repository of 15 validated clinical quality measures and patient-level characteristics.

          Methods:

          Fifty FCCs pilot tested the data repository. Clinics submitted patient-level data on two blood pressure (BP) measures and at least one additional measure. Descriptive statistics were stratified by sex, race, ethnicity, and language.

          Results:

          In 2021, 33 pilot FCCs from 21 states reported data across 13 of the 15 clinical measures, representing 34,359 unique patients. For example, on average, 60% of patients had controlled BP, but Black patients had lower rates of BP control than Hispanic and White patients (55.9% vs. 62.1% and 63.0%, respectively).

          Conclusion:

          Our findings demonstrate a proof of concept. By standardizing quality measures alongside patient characteristics, clinics can become aware of racial/ethnic inequalities in health outcomes. This information can motivate clinics to investigate the causes and implement solutions. In an environment where outcome data from FCCs are scarce, the new national data repository lays the foundation for routine stratified reporting of a range of quality outcomes for an important safety net for the uninsured.

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          Most cited references19

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          Free clinics in the United States: a nationwide survey.

          Since an increasing proportion of the US population is without health insurance, a network of free clinics has gradually developed to provide care for the uninsured. Despite widespread concern about the uninsured and the viability of the safety net, free clinics have been overlooked and poorly studied, leaving old assumptions and beliefs largely unchallenged. As a result, policy discussions have been forestalled and potentially fruitful collaborations between free clinics and other safety net providers have been hindered. The objective of this study is to describe the attributes of free clinics and measure their contribution to the safety net.
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            Presence and characteristics of student-run free clinics in medical schools.

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              Medical Students as Health Educators at a Student-Run Free Clinic: Improving the Clinical Outcomes of Diabetic Patients

              Purpose Student-run free clinics (SRFCs) provide service–learning opportunities for medical students and care to underserved patients. Few published studies, however, support that they provide high-quality care. In this study, the authors examined the clinical impact of a medical student health educator program for diabetic patients at an SRFC. Method In 2012, the authors retrospectively reviewed the electronic medical records of diabetic patients who established care at Shade Tree Clinic in Nashville, Tennessee, between 2008 and 2011. They compared clinical outcomes at initial presentation to the clinic and 12 months later. They analyzed the relationship between the number of patient–student interactions (touchpoints) and change in hemoglobin A1c values between these two time points and compared the quality of care provided to best-practice benchmarks (process and outcomes measures). Results The authors studied data from 45 patients. Mean hemoglobin A1c values improved significantly from 9.6 to 7.9, after a mean of 12.5 ± 1.5 months (P < .0001). A trend emerged between increased number of touchpoints and improvement in A1c values (r 2 = 0.06, P = .10). A high percentage of patients were screened during clinic visits, whereas a low to moderate percentage met benchmarks for A1c, LDL, and blood pressure levels. Conclusions These findings demonstrate that a medical student health educator program at an SRFC can provide high-quality diabetes care and facilitate clinical improvement one year after enrollment, despite inherent difficulties in caring for underserved patients. Future studies should examine the educational and clinical value of care provided at SRFCs.
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                Author and article information

                Journal
                Health Equity
                Health Equity
                heq
                Health Equity
                Mary Ann Liebert, Inc., publishers (140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA )
                2473-1242
                15 September 2022
                2022
                15 September 2022
                : 6
                : 1
                : 708-716
                Affiliations
                [ 1 ]Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, Illinois, USA.
                [ 2 ]Department of Mathematics and Statistics, College of Arts and Sciences, Loyola University Chicago, Chicago, IL, USA.
                [ 3 ]National Association of Free and Charitable Clinics, Alexandria, Virginia, USA.
                [ 4 ]Americares, Stamford, Connecticut, USA.
                Author notes
                [*] [ * ]Address correspondence to: Julie S. Darnell, PhD, MHSA, Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL 60153-3328, USA. jdarnell1@ 123456luc.edu
                Author information
                https://orcid.org/0000-0002-2424-0805
                Article
                10.1089/heq.2022.0078
                10.1089/heq.2022.0078
                9536336
                36225664
                da26e8c5-b43c-45ec-91ba-7861161faae3
                © Julie S. Darnell et al., 2022; Published by Mary Ann Liebert, Inc.

                This Open Access article is distributed under the terms of the Creative Commons License [CC-BY] ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : Accepted August 10, 2022
                Page count
                Figures: 2, Tables: 2, References: 25, Pages: 9
                Categories
                Short Report

                free clinics,uninsured,quality improvement,quality indicators,healthcare disparities,health equity

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