I am curious what other Healthcare for the Homeless programs are doing for QI; particularly programs that operate in camps, vans and shelters.
Our ability to control outcomes is limited. Our resources to measure processes and outcomes are limited.
We've had some success with improving intake procedures (more comprehensive Hx), increasing administration of immunizations and improving staff use of motivational interviewing techniques, but we don't have good data and we're casting about for what to work on next. All experiences and suggestions welcomed.


PS, does anyone know if there's a function where I can be e-mailed when someone replies to my posting?
Thanks,
Kate

Kate,

Please excuse my very tardy reply to your original posting from January 2009.

You bring up a very critical issue for homeless and under-served care providers - Quality Improvement (QI). This is an "age old" issue that care providers and program administrators have been wrestling with for a very long time. Many programs have "defaulted" (I use this word intentionally, because a lot of QI measures that are being supported and used in HCH and homeless health care settings are not homeless specific) to conventional QI indicators.

One such example of a QI measure that is used in patient care management is the HgbA1C variable for DM patients. Although this is a very important outcome measure for diabetes management - it does not "drill down" to the unique (and complex) needs of homeless clients.

Dr. Dave Buck out of Baylor College and the Houston HCH project has developed a tool that he uses to track QI. His "tool" (or approach) is coined "Goal Negotiated Care (GNC)" (you can see a presentation that Dr. Buck delivered at the June 2009 National HCH Conference in Washington, DC at: http://www.nhchc.org/2009conference/workshops/W06.html). You can review an article that Dr. Buck and his colleagues published at: http://www.homeless-healthcare.org/Research%20materials/GNC_HIC2006.pdf

Although not entirely a QI measure or modality, GNC is designed to help the provider generate outcome measures that can be reviewed and referenced for future encounters with a client; and/or for program/project evaluation. Dr. Buck developed a computer platform to run the GNC program - and designed the tool to be specifically utilized in a "street outreach" environment. To learn more about the mobile electronic medical records (EMR) program developed by Dr. Buck and colleagues, see: http://www.homeless-healthcare.org/Research%20materials/GNC_HIC2006.pdf

A place to go for all things "street medicine" is the International Street Medicine Institute and the work of Dr. Jim Withers. You can view the ISMI website and gain more contact information at: http://www.streetmedicine.org/

Finally, the National Health Care for the Homeless Council has a web-based resource page that is specifically dedicated to Clinical Performance Improvement Measures. There is a listing for a practical guide that offers HCH specific QI and QA ideas for programs and projects to incorporate in their care delivery work. You can access the site at: http://www.nhchc.org/clinicalperformance.html

I hope this meager bit of information is helpful to your work. Once again, please excuse my tardy reply.

Good luck and let me know if I can be of any further assistance,

Wayne Centrone