MARICOPA HEALTH CENTERS GOVERNING COUNCIL FQHC-LA NEEDS ASSESSMENT Maricopa Integrated Health System (MIHS) has completed this community health needs assessment study in an effort to identify the unmet health care needs of the population of Maricopa County. Patient & Community Health Needs Assessment – Primary Care Clinics.
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MARICOPA HEALTH CENTERS GOVERNING
COUNCIL FQHC-LA NEEDS
ASSESSMENT
Maricopa Integrated Health System (MIHS) has completed this community
health needs assessment study in an effort to identify the unmet health care
needs of the population of Maricopa County.
Patient & Community
Health Needs
Assessment –
Primary Care Clinics.
2
MIHS FQHC-LA Clinics
3
Table of Contents MIHS Overview ................................................................................................................................................................... 4
Maricopa County Demographics ........................................................................................................................................ 4
Population Profile & Estimates for Maricopa County Area to Be Served ........................................................................... 5
County Total Population and Population Living Below 200% of Poverty, by Age .............................................................. 6
Patient Health Needs Assessment ...................................................................................................................................... 7
Factors Impacting Access to Primary Health Care, Health Care Utilization, and Health Status ....................................... 12
Population to Primary Care Physician FTE Ratio ............................................................................................ 12
Population’s Proximity to Providers/Organizations That Provide Other Primary Health Care Services in the
Service Area ................................................................................................................................................... 12
Geographical/Transportation Barriers ........................................................................................................... 13
Unemployment, Income Level, or Educational Attainment .......................................................................... 13
Health Indicators .............................................................................................................................................................. 13
Prenatal, Perinatal ............................................................................................................................................................ 15
Young Children and Adolescents ...................................................................................................................................... 15
Behavioral Health Indicators ............................................................................................................................................ 16
County Health Rankings ................................................................................................................................................... 16
Needs Assessment Driven Initiatives to Improve Care ..................................................................................................... 17
Access to Care ................................................................................................................................................ 17
o Helping People to Obtain Coverage: COVERMEAZ.ORG .................................................................. 17
o Open Access Scheduling .................................................................................................................. 17
o Expanded Hours of Operation: Ten Hour Schedule Pilot ................................................................. 20
Integration of Services ................................................................................................................................... 20
o Cardiology in the Family Health Centers ......................................................................................... 20
o Pediatric Medical-Dental Home....................................................................................................... 21
o Dental-Ryan White Grant Initiative ................................................................................................. 21
o Digital Retinopathy Screening Program .......................................................................................... 22
Care Continuity – Refinement of the Patient Centered Medical Home Model ............................................. 22
o Population Management ................................................................................................................. 23
o Outreach and Preventive Services ................................................................................................... 23
o Utilization Management ................................................................................................................. 23
Expansion of Services in West Phoenix: Pendergast Family Health Center .................................................. 24
Pediatric Obesity ............................................................................................................................................ 24
Improving Clinical Outcomes: The Interdisciplinary Hypertension Task Force.............................................. 26
Conclusion: ....................................................................................................................................................................... 27
Appendix A: ...................................................................................................................................................................... 28
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MIHS Overview
Maricopa Integrated Health Systems’ (MIHS) federally qualified health clinics offer outpatient
primary care on the Maricopa Medical Center campus in the Comprehensive Healthcare Center
(CHC) as well as in 12 Family Health Centers (FHC) located throughout Maricopa County. The
federally qualified health clinics located within the Comprehensive Healthcare Center (CHC)
include: The Internal Medicine Clinic, Same Day Clinic, Antepartum Testing Center, Women’s
Care Clinic, Arizona Children’s Center Pediatric Clinic and the Diabetes Outreach Clinic. Our
FQHC- LA Family Health Centers serve both adult and pediatric patients, providing primary
care services including: adolescent care, teen pregnancy, programs designed to meet the special
needs of refugees, diabetes outreach education, adult and pediatric dental, cardiology,
radiology, laboratory and pharmacy services. In addition, primary medical care designed to
meet the needs of the seriously mentally ill (SMI) patient population occurs at eight additional
clinic sites located throughout the Phoenix metropolitan area where the medical team co-locates
with behavioral health providers. These clinics are referred to as the Whole Health Home
Clinics (WHH).
Outside of the FQHC-LA scope of service, MIHS also offers a wide range of specialty services
including: gastroenterology, infectious diseases, rheumatology, neurology, endocrinology,
dermatology, sports medicine, urology, oncology, breast care, dialysis, general and specialized
surgery, hand and plastics, orthopedics, ear-nose-throat, ophthalmology, specialty pediatrics,
cardio-pulmonary care and physical and occupational therapy.
The geographic locations of the MIHS FQHC-LA clinics include the cities of Phoenix,
Avondale, El Mirage, Glendale, Chandler, Mesa, and Guadalupe, all of which reside in
Maricopa County, Arizona. The service area for MIHS is Maricopa County, with a total
population of 4,036,745 in 2014 (Nielsen Claritas Site Reports, 2014).
The 12 MIHS Family Health Centers and the FQHC-LA designated primary care clinics in the
Comprehensive Healthcare Center receive leadership oversight by the HRSA-sanctioned
Maricopa Health Centers Governing Council with responsibilities that include ensuring the
organization is community based, and that it is responsive to the needs of the population it
serves.
Maricopa County Demographics
Maricopa County covers 9,225 square miles, making it the 14th largest county in land area in the
continental United States, and larger than seven states. Individuals and corporations make up
30% of total land ownership, with the remainder publicly owned. The County has a full-service
economy that provides large markets in retail, health care, research, customer service,
entertainment, financial and banking, wholesale trade, agricultural, arts and cultural, construction,
manufacturing, light industry, distribution, and recreation and leisure services. Maricopa
County’s economic base continues to evolve and become more diverse. The reliance on tourism
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and construction is decreasing as other industries grow. Maricopa County’s quality of life, cost of
living, skilled workforce, accredited universities and favorable business climate contribute to the
improvement of its economy. (http://www.maricopa.gov/OpenBooks/profile.aspx)
The population in this area is estimated to have changed from 3,817,117 to 4,036,745, resulting
in a growth of 5.8% between 2010 and 2014. Over the next five years, the population is projected
to grow by 6.9%. By comparison, the population of the United States is projected to grow by
3.5% (Nielsen Claritas Site Reports, 2014).
The median age for Maricopa County is 35.4, while the average age is 37.0. Five years from now,
the median age is projected to be 36.4. The median age for the United States is 37.7, while the
average age is 38.5. Five years from now, the median age is projected to be 38.6 (Nielsen Claritas
Site Reports, 2014).
Maricopa County’s current population: 56.8% are White, 4.7% are Black or African American,
30.9% are Hispanic, 3.7% are Asian and Other Pacific Islander and 3.9% are “all others.” The
current estimated Hispanic or Latino population is 30.9%, while the United States current
estimated Hispanic or Latino population is 17.6% (Nielsen Claritas Site Reports, 2014).
Population Profile & Estimates for Maricopa County Area to Be Served Maricopa*
Proportion of Population Less than 200% of Poverty 35.9%
Total Population 3,839,007
Population <200% of Poverty 1,379,171
County Seat
Phoenix**
County Seat Population 1,501,462
Racial Minorities as a percent of total population
35.5%
Hispanics as a percent of total population 2014
42.6%
Percent Increase in Hispanics and Latinos from 2010 to 2014
8.4%
Sources: *U.S. Census Bureau, 2009-2013 5-Year American Community Survey, ACS_13_5YR_S1701.xls.
**Nielsen Claritas Site Reports, 2014
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County Total Population and Population Living Below 200% of Poverty, by
Age County Profile
Total
Population
Population
Below 200%
Percent by
Age Group
Below 200%
Under 6 years 330,649
169,574 51.3%
6 to 11 years 333,701
159,325 47.7%
12 to 17 years 329,250
143,027 43.4%
18 to 24 years 368,560
179,649 48.7%
25 to 34 years 546,124
198,077 36.3%
35 to 44 years 525,988
169,653 32.3%
45 to 54 years 507,354
131,054 25.8%
55 to 64 years 412,961
97,506 23.6%
65 to 74 years 273,143
65,820 24.1%
75 plus years 211,277
65,486 31.0%
Total 3,839,007
1,379,171 35.9%
Source: U.S. Census Bureau, 2009-2013 5-Year American Community Survey, ACS_13_5YR_B17024.xls.
According to the US Census, American Community Survey Data for 2013, 46.3% of the total
population below 200% of poverty was actually living with incomes below 100% of poverty, or
About 16.7% of the overall population lives in poverty (ACS_13_5YR_B17024.xls).
Among unrelated individuals for whom poverty status has been determined, women are more
likely to be living below 100% of poverty in Maricopa County than men. Females of all ages
represent 51.8% of the population below 100% of poverty, with 25.9% of all women living below
100% of poverty vs. 23.1% of all men (ACS_13_5YR_S1701.xls).
Total Population
2010 Census
Population
2014 Population
Estimate
2019
Projection
%
Growth
Maricopa County 3,817,117 4,036,745 4,316,020 6.92%
Arizona 6,392,017 6,667,596 7,038,507 5.56%
United States 308,745,538 317,199,353 328,309,464 3.50%
Ethnicity
White,
Non-Hispanic
Black,
Non-Hispanic
Hispanic Asian & Pac. Islands,
Non-Hispanic
All Others
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Maricopa County 56.8% 4.7% 30.9% 3.7% 3.9%
Arizona 56.0% 3.9% 31.0% 3.0% 6.1%
United States 62.0% 12.3% 17.6% 5.1% 3.0%
Age Distribution
0-14 15-17 18-24 25-34 35-54 55-64 65+
Maricopa County 21.4% 4.3% 9.8% 14.0% 26.4% 11.0% 13.2%
Arizona 20.6% 4.2% 9.9% 13.4% 25.2% 11.7% 15.0%
United States 19.3% 4.1% 10.0% 13.2% 26.6% 12.6% 14.2%
Gender Distribution
Male Female Females of Child
Bearing Age (15-44)
Maricopa County 49.50% 50.50% 20.38%
Arizona 49.77% 50.23% 19.46%
United States 49.22% 50.78% 20.20%
Adult Education Level
Less than
9th Grade
Some High
School
High School
Degree
Some College or
Associates Degree
College Degree
or Greater
Maricopa
County
6.44% 7.42% 23.30% 33.66% 29.18%
Arizona 6.31% 8.13% 24.63% 34.53% 26.41%
United States 6.05% 8.22% 28.37% 28.97% 28.38% Household Income
$0
- $24,999
$25,000
- $49,999
$50,000
- $74,999
$75,000 - $99,999 $100,000 +
Maricopa
County
24.0% 26.4% 18.4% 11.9% 19.2%
Arizona 26.7% 27.1% 18.3% 11.2% 16.7%
United States 24.4% 24.4% 18.0% 11.9% 21.3%
Patient Health Needs Assessment
In an effort to solicit feedback from patients utilizing MIHS FQHC-LA services, a patient health
needs assessment questionnaire was developed by the leadership team and produced in both
English and Spanish. (See Appendix A) The purpose of the survey was multifold. It was utilized
to identify the health concerns of our patient population as well as identify the demographic
indicators which may be health indicators. Furthermore, it would be used by the governing council
and the administrative team to identify gaps in care and to determine ways in which service
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delivery could be elevated. The questionnaire was distributed to patients at each of the family
health centers in a random manner. Data collection ceased once thirty completed surveys were
returned at each site resulting in a total sample size of 390 surveys.
Upon review of the aggregate data, MIHS patient survey respondents reflect a pronounced
difference in certain demographic regards. Females represented 69.4% of participants. Our patient
population, reflected accurately in the survey responses, is drawing more heavily from the
Hispanic population than would be suggested by the demographic properties of Maricopa County.
Respondents were twice as likely to be either Hispanic or Black, and half as likely to be White.
MIHS Survey Maricopa County
Hispanic 60.2% 30.9%
Caucasian/White 25.7% 56.8%
African American Black 9.3% 4.7%
Asian & Pacific Islander 2.8% 3.7%
Other 2.0% 3.9%
We are also serving a lower-income, less-educated population than the County at large.
MIHS Survey Maricopa County
$0-$24,999 78.5% 24.0%
$25,000-$49,999 16.8% 26.4%
$50,000-$74,999 3.3% 18.4%
$75,000-$99,999 0.2% 11.9%
$100,000 or more 1.1% 19.2%
MIHS Survey Maricopa County
Some high school 34.1% 13.9%
High school graduate 32.4% 23.3%
Some college 25.2% 33.7%
College graduate 8.3% 29.2%
The employment status reported by patients offers a narrow snapshot with 32.0% of respondents
maintaining full or part-time employment. Homemakers comprised the largest portion of
responses at 26.3%. 29.1% identified themselves as unemployed or disabled, with 8.5% marked as
students.
“What is your current employment status?”
Employed full-time 20.3%
Employed part-time 11.7%
Student 8.5%
Homemaker 26.3%
Unemployed 16.5%
Disabled 12.6%
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Retired 4.0%
While 72.2% of our patients indicated that they use a physician’s office for their routine health
care needs, 16.6% access care in a routine episodic fashion. Of those, 7.7% respondents are using
sub-optimal avenues of seeking routine healthcare through emergent/urgent care as the primary
source. Unfortunately 11.2% of respondents do not seek health care on any routine basis.
(Note: patients were allowed to select more than one response).
“Where do you go for routine healthcare?”
Physician's office 72.2%
Health Department 10.6%
Emergency Room 3.6%
Urgent Care Clinic 4.1%
Clinic in a Grocery/Drug store 0.7%
I do not receive routine healthcare 11.2%
Other 0.3%
Encouragingly, the vast majority of our survey respondents are able to get an appointment when
they need it. We do have an opportunity to improve appointment availability, affecting close to
12.2% of the represented population. Affordability does impact a segment of the population still
facing financial difficulties accessing healthcare despite the recent regulatory changes.
“Can you get an appointment at the Doctor's office when you need it?”
Yes 87.8%
No 12.2%
If respondent answered "No" to Question above (select all that apply)
No Appointment available 57.8%
Cannot afford it 28.4%
Clinic hours 13.7%
Cannot take time off from work 11.8%
No transportation 7.8%
No specialist in my community for my condition 6.9%
Other 8.8%
Thirty-four percent of respondents indicated either no health insurance or utilization of MIHS’
sliding fee discount program. Almost half (45%) indicated coverage through the state Medicaid
program “AHCCCS.”
“What type of healthcare coverage do you have?”
Medicare 9.9%
Medicaid - AHCCCS 45.0%
Commercial Health Insurance 6.4%
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Copa Care/Sliding fee discount program 31.4%
No healthcare coverage 6.3%
Other 1.1%
We also asked questions related to preventative health efforts. Encouragingly, 72.4% of the
respondents rated their overall health as good or above.
“How would describe your overall health?”
Excellent 15.1%
Very Good 23.1%
Good 34.2%
Fair 23.8%
Poor 3.8%
The predominant health challenges identified by our respondents include: dental care,
hypertension, diabetes management, being overweight and pain.
“Please select the top 3 health challenges you face”
Dental Care 26.7%
High Blood Pressure/Stroke 24.4%
Diabetes 21.5%
Overweight 21.4%
Pain 21.5%
Depression/Mental health issues 14.1%
Breathing Problems 10.8%
Heart Disease 4.4%
Alcohol use 3.2%
Cancer 1.7%
Drug use 1.0%
None 23.4%
Other 3.1%
To help focus our resources towards assisting patients to adopt healthier choices, we asked about
current health habits. Of special note, less than 40% of respondents reported engaging in exercise
on a regular basis. Additionally, only 30% of the respondents eat the recommended servings of
fruit and vegetables. Only 33.1% receive a flu shot despite its promotion and availability.
Interestingly, all respondents denied the use of illegal drugs, only 0.7% reported the chewing of
tobacco and 0.9% reported the abuse or over use of prescription drugs. Additionally, the
consumption of high levels of alcoholic beverages was limited to 2.2%. If the aforementioned
anonymous, self-reported information is accurate, the data suggests a low incidence in the
consumption of mind altering substances amongst this population.
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“Please choose all statements below that apply to you.”
Exercise 3 times per week 37.2%
Eat at least 5 servings of fruits & vegetables 30.7%
Eat fast food more than one per week 27.2%
Smoke cigarettes 13.2%
Chew tobacco 0.7%
Use Illegal drugs 0.0%
Abuse or over use prescription drugs 0.9%
Consume more than 4/5 alcoholic drinks 2.2%
Use sunscreen or protective clothing 23.0%
Receive a flu shot each year 33.1%
Have access to a wellness program through my employer 4.1%
None of the above apply to me 16.4%
As part of the assessment of healthy behaviors or habits, we asked respondents to report which
preventive health diagnostic tests they have completed in the last year. Blood pressure check, pap
smear, physical exam and flu shot were reported with the greatest frequency for each test. Areas of
opportunity identified include: skin cancer screening, hearing screening, bone density testing and
colorectal exams. These results were not surprising given the difficulty with patient compliance
for colorectal screening and the limited availability of dermatology specialty appointments for
skin cancer screening.
“Which of the following preventive procedures have you had in the past 12 months?”
Mammogram 30.3%
Pap Smear 37.2%
Prostate cancer screening 16.1%
Flu shot 32.7%
Colon/rectal exam 5.8%
Blood Pressure 37.4%
Blood sugar check 28.2%
Skin cancer screening 2.0%
Cholesterol screening 28.9%
Vision Screening 21.9%
Hearing Screening 4.8%
Cardiovascular Screening 6.8%
Bone Density test 5.4%
Dental cleaning/x-rays 24.7%
Physical exam 35.8%
None of the above 19.0%
Note: Percentages for certain procedures have, as their denominators, only the gender for which that procedure is
suggested (specifically: mammogram, pap smear, prostate screening, and bone density tests). In future surveys, it
is intended that patient age and other risk factors will also be assessed to more accurately define what percentage
of our patient population is adhering to recommended screening schedules.
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Factors Impacting Access to Primary Health Care, Health Care Utilization,
and Health Status
Population to Primary Care Physician FTE Ratio According to a recent report from the University of Arizona, there were 3,137 primary care
physicians practicing in Maricopa County in 2010. With a 2010 population of 3,817,117, the
primary care FTE ratio was 82.2 per 100,000 populations. With an additional 6,098 non-primary
care physicians, the total active physician ratio was 241.9 per 100,000. This compares favorably to
the rest of Arizona, with only 218.3 physicians per 100,000 overall, but well behind the national
average. Arizona ranked 35th in physician FTE ratio, as the national average was 255.8/100,000
(Source: Arizona Primary Care Residency Training Assessment and Development Project).
Population’s Proximity to Providers/Organizations That Provide Other Primary
Health Care Services in the Service Area
The urban center of Phoenix has multiple FQHC and FQHC look-alike clinics with wide-spanning
coverage. The above map demonstrates service points with a five-mile radius depicted. MIHS alone
operates 13 such clinics in the area, as well as 8 specific to the needs of the SMI population.
Additionally, the larger population centers in Maricopa County which fall outside the metropolitan
Phoenix area (Wickenburg, Buckeye, and Gila Bend) each have an FQHC providing services.
However, as Maricopa is such a large area geographically, there is considerable population outside
of these urban centers for whom access to care is much less manageable. We estimate there to be a
population of at least 130,000 outside of these coverage zones, residing in the suburban or rural
cities and towns not within a five-mile radius of one of Maricopa County’s FQHCs. These locales
include Queen Creek, Fountain Hills, Anthem, New River, Sun Lakes, and more.
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Geographical/Transportation Barriers
While the geographic majority of the service area is predominantly rural, most of the population
resides within the Phoenix metropolitan area, which continues to sprawl. Whether urban or rural,
a good deal of travel requires an automobile to be convenient. Public transportation is available,
but can be time-consuming and complicated over large distances. Demographic comparison data
for radii around each clinic is covered in the clinics’ individual needs assessments, but data for
all of Maricopa County is summarized above.
Unemployment, Income Level, or Educational Attainment Demographic comparison data for radii around each clinic is covered in the clinics’ individual
needs assessments, but data for all of Maricopa County is summarized above, with state and
national data for comparison.
Health Indicators
In a joint community health assessment, the Maricopa County Department of Public Health and
the Arizona Department of Health Services reviewed data from death certificates, disease reports,
hospital discharges, birth certificates, and other sources, and identified five key community health
priorities. These health indicators were selected through data-driven processes and also reflected
the voices of community members and public health professionals. The public health strategic
health priorities considered most important are: diabetes, obesity, lung cancer, cardiovascular
disease, and access to health care (Source: Maricopa County Department of Public Health (2014).
Maricopa County Community Health Assessment. Phoenix, AZ: Author).
Diabetes is the seventh leading cause of death in Maricopa County. In 2010, the prevalence of
diabetes in Maricopa County is believed to have resulted in over 5,400 emergency room visits and
6,300 other hospitalizations. Diabetes prevalence is higher in Blacks, Hispanics, and American
Indians.
Maricopa County has a high prevalence of obesity among both children (15.5%, among children
under five years old) and adults (one in four). These individuals are at increased risk for
comorbidities such as breast cancer, heart disease, and diabetes. The potential life years lost from
heart disease and diabetes totaled 30,914 in 2010. Hispanics are more likely to be obese (32.8%)
than Whites (22.8%).
Cancer is the primary cause of mortality in Maricopa County. In 2010, cancer contributed to
1,164 emergency room visits, 16,318 hospital stays, and 5,508 deaths. Cancer was the third most
important health problem chosen by community members in the Maricopa County Community
Health Survey. Lung cancer, specifically, is the leading cause of cancer death in the county, but is
also the most preventable. Smoking is the leading risk factor for lung cancer, and one in seven
Maricopa County adults smoke. Lung cancer mortality in the county is highest among Whites
(57.1%).
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Cardiovascular disease is the second highest cause of mortality in Maricopa County, resulting in
an estimated 21,413 emergency room visits, 58,176 hospital stays, and 5,143 deaths in 2010. One-
quarter of Maricopa County residents are aware that they have high blood pressure, which is a
major risk for cardiovascular disease. High blood pressure was the fourth most important health
problem chosen by community members in the Maricopa County Community Health Survey.
The ability to simply access and utilize healthcare might yield the greatest potential to influence
the health of individuals, and the public in general. It was identified as the single most important
health indicator by MCDPH health professionals. One in four Maricopa County residents had not
seen a provider in the previous year, while one in six indicated that they had delayed or foregone
medical care because of cost. Lower income residents are less likely to visit a doctor. As of 2010,
one in seven residents did not have health insurance.
Maricopa County National
Asthma 13.9% 13.2%
Heart Attack 4.7% 4.4%
Angina 3.7% 4.5%
Stroke 2.6% 2.9%
Obesity 25.4% 27.7%
Diabetes 9.4% 10.2%
Source: BRFSS 2012 Arizona Behavioral Risk Factor Surveillance System Survey: Arizona Department of Health
Services
Mortality per 100,000 Maricopa County Arizona National
Major Cardiovascular Disease 187.0 112.9 126.0
Source: Arizona State Health Assessment, February 2014: Arizona Department of Health Services
The CDC uses the age-adjusted death rate as a measure of the overall health of the population.
The total number of health events, i.e., the number of deaths occurring in a population, is useful
for determining the magnitude of a public health problem. Without using age-adjusted death rates
that are weighted for the age distribution of the population, the magnitude of the age-adjusted
death rate would be greater in those populations with older individuals, and for chronic diseases,
where mortality is greater in older individuals. The following table shows age-adjusted death
rates for Maricopa County, the state of Arizona, and the United States’ national benchmarks.
Age-Adjusted Rates for Selected Underlying Causes of Death, 2012
*Maricopa
County
*Arizona **National
Benchmark
All Causes 640.5 687.2 732.8
Heart Disease 129.4 145.8 170.5
All Cancer 108.0 149.8 166.5
Cerebrovascular (Stroke) 27.2 29.9 36.9
Unintentional Injuries
36.1 42.4 39.1
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Pneumonia & Influenza 5.5 9.1 14.4
Diabetes (single cause) 22.8 23.5 21.2
Suicide 13.9 16.2 12.6
Homicide 5.2 5.9 5.4
AIDS and HIV 1.7 1.5 2.2
Asthma 1.0 - 1.1
Drug Induced 14.5 16.3 12.8*
Firearm Related 12.3 13.8 10.1*
Alcohol Induced 11.5 14.2 7.6*
*Maricopa County Health Status Report 2012: Maricopa County Department of Public Health
**wonder.cdc.gov data query, 2012 data
Prenatal, Perinatal
# of
individuals
Rate or
%
Arizona,
2012
US,
2011
Unlinked infant mortality
– rate per 1,000 live births
Neo-natal 218 4.0 3.9 4.0
Post-natal 105 1.9 1.9 2.0
Total 323 5.9 5.8 6.1
LBW (<2500g) - % 3,731 6.9% 6.9% 8.0%
Births to teen mothers - % 10-14
Years Old
38 0.07% 0.08% 0.1%
15-17
Years Old
1,445 2.7% 2.8% 2.1%
15-19
Years Old
4,660 8.6% 9.4% 7.7%
Total 10-19
Years Old
4,698 8.6% 9.5% 7.8%
(Source: Maricopa County Health Status Report 2012: Maricopa County Department of Public Health)
Young Children and Adolescents
Mitigating early risk factors including acute infections preventable through immunizations are
critical for a healthy start. Although local data are not available at the county level in Arizona,
overall the state’s pediatric immunization rate trails behind the nation. For the pediatric
immunization 4-3-1-3-3-1-4 series, Arizona’s rate was 69% as of September 2013, compared
to 72% nationally (Source: http://www.azdhs.gov/phs/immunization/).
As noted, extraordinary weight gain is a risk factor for children, leading to youth who are
overweight or even obese by the time they are adolescents. In 2009, 31.0% of Maricopa
County 2-5 year olds were classified as overweight or obese, or in the 85% percentile or above
for weight, a figure that also raises concerns about growing rates of chronic disease as these
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youth age into adulthood (Source: FY2011 – 2015 Strategic Plan, Maricopa County).
Behavioral Health Indicators
Interviews with key stakeholders also identified behavioral health issues as another major
concern within the communities served by MIHS; particularly among low-income
populations.
Locally, the behavioral health-related data available supports these assertions. The most recent
US CDC Behavioral Risk Factor Surveillance System (BRFSS) data for Arizona overall found
the prevalence of depression is increasing in the state as shown in the table below.
BRFSS Arizona survey results: “Ever told you that you have a form of depression?” Year Percent Responding “Yes” Confidence Interval N (“yes”)
2011 17.5% (15.7-19.2) 1,231
2012 18.8% (17.3-20.3) 1,327
2013 18.1% (16.1-20.0) 845
Source: http://apps.nccd.cdc.gov/brfss/
The table below shows increasing depression rates for all age categories reflecting the concerns
expressed above.
Had at Least One Major Depressive Episode in the Past Year, by Age Group, 2009-10
Arizona Total US
12-17 Years 7.65%, 95%CI = (6.84 - 10.20) 8.07%, 95%CI = (7.74 - 8.41)
18-25 Years 8.58%, 95%CI = (6.98 - 10.51) 8.15%, 95%CI = (7.81 - 8.51)
26+ Years 6.58%, 95%CI = (5.22 - 8.25) 6.45%, 95%CI = (6.16 - 6.76)
Source: Substance Abuse and Mental Health Services Administration. (2012). State Estimates of Substance Use and
Mental Disorders from the 2009-2010 National Surveys on Drug Use and Health, NSDUH Series H-43, HHS
Publication No. (SMA) 12-4703. Table B.26.
County Health Rankings
According to a recent study, Maricopa ranks second best in the state for health outcomes, behind
only Santa Cruz. Researchers considered length of life (from NCHS mortality files) and quality
of life (three measures from the BRFSS and low birth weight from NCHS natality files) in
making this assessment. Maricopa also ranked second best in health factor score, behind only
Pima County. This measure included weighted scores for health behaviors, clinical care, social
and economic factors, and the physical environment from a variety of surveillance and health
statistics sites (Source: University of Wisconsin Population Health Institute. County Health
Rankings 2015).
(http://www.countyhealthrankings.org/sites/default/files/state/downloads/CHR2015_AZ_0.pdf)
17
Needs Assessment Driven Initiatives to Improve Care
The results of the MIHS FQHC-LA Needs Assessment (n=390) in concert with the five
community health priorities as defined by the Maricopa County Department of Public Health and
the Arizona Department of Health Services, serve as the foundation in the development of
multiple strategies within the MIHS FQHC-LA division to elevate service offering thus
improving care from the perspective of the patient. Additional data were utilized to ensure the
relevance of direction including: patient experience results, clinical outcome measures and
operational performance scores. A brief synopsis of initiatives that emerged as a result of this
approach includes the following:
Access to Care Identified as the key health priority for Maricopa County by the Maricopa County Department of
Public Health and the Arizona Department of Health Services, access to care (obtaining
appointments) within the MIHS FQHC-LA clinics was identified by our patients as an
opportunity for improvement. A synopsis of three strategies designed to improve access to care
follows:
Helping People to Obtain Coverage: COVERMEAZ.ORG
MIHS embraced and adopted the philosophy epitomizing a “Culture of Coverage.” We
transformed how we communicated with and delivered financial assistance to our customers. The
Culture of Coverage story begins with the belief that every employee has countless opportunities
to make a difference in people’s lives. The story ideally ends with customers able to access high-
quality care without having to choose between medicine and food. The Affordable Care Act
(ACA) roll-out required additional resources to reach as many people as possible. MIHS teamed,
for the first time, with VISTA and the Americorps program and many other organizations for this
enrollment campaign. Activities included health literacy classes, refugee outreach events, and
calling and awareness campaigns.
Open Access Scheduling
Historically, access to health care at an FHC was accomplished by advanced scheduling of
appointments. A patient with a chronic medical condition, who required routinely scheduled
follow up, would be scheduled for their next appointment at the time of discharge from the
appointment. The Medical Assistant (MA) would schedule the appointment and print a document
for the patient. The patient would depart the FHC with a printed appointment time. This might be
a date approximately one or two months in the future. As our FHCs see a large volume of
chronically ill patients, the schedules were frequently full two-to-four weeks out. Using this
approach to scheduling, the FHCs experienced an average 20-30% no show rate. It also led to
patient dissatisfaction when patients were not able to access care for acute issues.
This manner of appointment utilization led to those who needed access for an acute condition
being unable to obtain access. Knowing there would be a significant no show rate, staff would tell
18
the upset patients to “come in and we’ll work you in.” The managers would spend significant time
coordinating with busy providers to “squeeze” one more patient into their schedule. This lack of
predictability led to frustration for all: patient, provider, and staff. A sizeable no-show rate
represents lost opportunities for efficient patient care and revenue capture.
In 2013, the El Mirage FHC began an Open Access Pilot. The approach called for 50% of
appointments to be left open for open access scheduling. This meant that on the day the FHC
opened, half of their appointments would be available for same day scheduling. During the two
month transition period when previously-scheduled appointments were seen, the patients were
educated on the new scheduling approach. At the time of their discharge from the appointment,
written instructions were provided to the patient to call on the day they wanted to be seen. The
exceptions to the open access scheduling were those patients who relied on taxi transportation and
who were medically fragile requiring support from others for transportation to their appointment.
Following a three month trial, a bilingual patient satisfaction survey was carried out. Almost
unanimously, patients responded they were extremely satisfied with access to health care services
at El Mirage. The ongoing patient satisfaction feedback also consistently receives positive
comments regarding the easy access to care at El Mirage.
The no show rated dropped from 35% to 15%. The providers and staff now have a stable, more
predictable day with less crisis management of walk-ins. The front office staff and manager are
relieved of the daily duties of trying to “work in” sick patients who now could call in for their
same day appointment. The pilot was deemed an unequivocal success.
The lessons learned from this experience were shared with the other FHCs:
There is a period of transition from pre-scheduling to open access when the existing
appointments must be completed.
The transition period is the opportunity to educate the staff and patients about the new
scheduling approach.
Once the open access system is in place, there is a tendency for providers and staff to make
exceptions for pre-scheduling into an open access appointment. This is referred to in articles
as “the creep”. If this is not managed it could delay the success of the open access model.
Leaders must reinforce, manage and present the data to demonstrate to the team their
success.
Using the lessons learned from El Mirage FHCs experience, all of the FHCs are now participating
in open access scheduling. The percentage of open access as well as the number of providers
varies by site as follows.
One FHC is currently in a tightly structured pilot of open access. The guidelines include:
All providers are participating in open access with the same template.
The first three appointments of each session are pre-scheduled.
19
The only exceptions to open access are as follows:
o The patient depends upon taxi transportation.
o OB patients.
o Medically fragile patients who rely upon caregivers for transportation.
In its first month since implementation, this approach is demonstrating success. Historically, the
FHC experienced 50-60% no show rates within certain patient subgroups. This subset of patients
included the Maricopa Medical Center Emergency Room follow up patients.
At five of the FHCs, both physicians and mid-levels participate in open access scheduling. The
physician group includes providers from Family Practice, Internal Medicine, and Women’s Health
and Pediatric specialties. The percentage range of open access ranges from 25-60%. At four of the
FHCs, mid-level providers only participate in open access scheduling. Their open access
availability ranges from 30-60%. More common is the 50% open access model. At one FHC with
six providers, the provider preference has been to remain on a pre-scheduled template model. One
exception is a seasoned Nurse Practitioner (NP) who requested to be placed on a 100% open
access template. Her only exception to open access scheduling is for patients who rely upon taxi
transportation. These patients are allowed to schedule five days in advance of the appointment.
The success of this approach has been impressive. The NP consistently sees 9.5-10+ patients per
session while her counterparts average 8.5 per session. The no show rate of the NP is 10% while
the others experience 25%. As a result of the NP’s success, a second NP (who’s resisted open
access scheduling), is now requesting to be 100% open. A physician who experiences a no show
rate of 26-30% is also requesting the same 100% open approach.
Across the Ambulatory Division, the FHCs are embracing open access scheduling with the goal of
improving access to care. The consistent outcomes demonstrated include:
Increased volumes.
Sick patients who need to be seen are now able to access their provider. This results in
increased patient satisfaction.
Reduced no show rates leading to increased provider and staff efficiency. Consistently the
no show rates dropped from the mid-twenties to the high teens.
Increased provider satisfaction.
Going forward, open access scheduling, a proven successful approach to increasing access to care,
will continue to be used. The Ambulatory Division is committed to seeking better ways to assist
our patient’s access health care services. We will continue to review new approaches, pilot those
we are considering, and learn from our successes as well as our mishaps.
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Expanded Hours of Operation: Ten Hour Schedule Pilot
With our mission to provide health care to the underserved population of Maricopa County, it is
important to consider the needs of those we are here to serve. Underserved patients frequently
have life challenges which present difficulties for them to access health care. They might be
reliant upon others for transportation. They might live in an area that provides no public
transportation. Perhaps the only means of accessing the Family Health Center (FHC) is by
walking with children in extreme, high temperatures. For some who labor for an hourly wage, it
might mean risking their jobs if they request time off from work to take a sick child to the family
health center.
The MIHS FQHC-LA Division is committed to assisting those who face these struggles. There
are many options for accessing the Family Health Center at non-traditional hours.
To provide health care access options for their communities, five FHCs are piloting ten-hour
provider schedules. The time of the first appointments range from 6:45 am to 7:00 am with the
latest appointment at 5:15 pm. Managers are reporting the first and the last appointments of the
day are the most popular. Patients report appreciation for these options as it relieves the stress of
arriving late or leaving early from their jobs. Another observation noted is the popularity of early
morning appointments during the Arizona summers. Families with children and seniors prefer to
come to their appointments early in the day to avoid the high temperatures of the afternoon.
The recently opened Pendergast FHC, located on a school campus, was designed with the plan to
be open ten hours daily. The first patient is seen at 7:00 am and the final patient is discharged at
6:00 pm. The early and late appointments are consistently sought by patients. Parents dropping
off their child to school often request early appointments. Those parents who need to bring a child
in after they finish their job for the day verbalize appreciation for the latter option. Many patients
who seek care at this site may not have a school child, but prefer the Center for its flexible
operating hours.
Presently, one additional FHC is planning to start 10 hour schedules in June of 2015. Other
managers state their providers are discussing this option to pilot in the future.
Integration of Services
Cardiology in the Family Health Centers
The Arizona State Health Assessment asserts that cardiovascular disease is the second leading
cause of death in the state of Arizona. Maricopa County Statistics report a rate of 48.33/100,000
hospital admissions in Maricopa County are related to congestive heart failure. Furthermore, a
detailed review of the need for cardiology care and the referral patterns of the MIHS FQHC-LA
primary care patient, demonstrated an increased number of patients identified with coronary artery
disease (CAD) and ischemic vascular disease (IVD) that would benefit from cardiology specialty
services. Following further review of the referral patterns from July 2012 to July 2013 it was
noted that, of 3,027 cardiology referrals generated by our primary care team, almost 50% did not
receive follow up within our system. Rationale frequently cited by patients included the lack of
21
convenience related to distance or geography and difficulty in obtaining a cardiology
appointment.
In the winter of 2014, the plan to have a Cardiology team provide care on a rotational basis at 6 of
the FHCs was complete and submitted to HRSA in the form of a Change in Scope (CIS) request.
Upon receipt of approval from HRSA, cardiology appointments were scheduled and immediately
filled to capacity. The success of this program will serve as a prototype for future projects
designed around integration.
Pediatric Medical-Dental Home
The prevalence of dental caries is widespread in the United States. Approximately 16% of school
age children have untreated dental caries. In the Hispanic adult population below the poverty
level, 52% have missing permanent teeth resulting from lack of dental care as well as untreated
underlying conditions.
Dental care was identified as a health care challenge with the greatest frequency on the MIHS
FQHC-LA Needs Assessment survey (n=390). Less than 8% of children receiving medical care
at MIHS utilize our dental services. Furthermore, AHCCCS reports that less than 50% of eligible
children in the state of Arizona have visited a dentist.
Due to the close proximity of the CHC clinics to our dental clinic, as well as the five FHCs that
offer both medical and dental services, MIHS has initiated the process to establish a medical-
dental home to better serve the children in our community. In order to ensure the MIHS pediatric
population has access to dental care the following initiatives have been implemented:
Collaboration has begun between the chair of pediatrics as well as the chair of dental services to
have a pedodontic resident see patients in the pediatric clinic during well child visits. After a
pedodontic resident examines a patient in the pediatric clinic, fluoride varnish is applied. Sealants
placed on permanent teeth help prevent caries from developing. MIHS health fairs are staffed by
dentists and employees to perform visual screenings, educate, and promote oral health care at our
clinics.
Additionally, we have opened a new a pediatric focused Dental Clinic. The new Pendergast
Family Health Center is located in a community center next to an elementary school. The clinic
provides 3 chairs for pediatric dental practice that began scheduling patients in February.
Dental-Ryan White Grant Initiative
Another focus of our dental practices is to provide care to Ryan White Grant recipients. One out
of every person living with HIV in Arizona seeks dental care at the MIHS McDowell dental
clinic. This fiscal year, the director of the Ryan White Grant and the Planning Council awarded
$630,000 to the MIHS dental department. Early studies report that approximately 90% of HIV
patients will present with at least one oral lesion in the course of their illness. Oral lesions in
patients with HIV may be particularly large, painful, or aggressive. Many oral lesions/conditions
have been used as indicators of immune suppression/disorder. Persons living with AIDS will
22
have more unmet oral healthcare needs than the general population. HIV medications have side
effects such as dry mouth which predisposes them to dental decay, periodontal disease, and fungal
infections. To address these issues, recent collaborative meetings with medical and dental staff as
well as the Grant team have concentrated on strategies to reach out to Ryan White clients to
encourage them to seek care, conduct warm hand offs between the medical, dental, and pharmacy
staff, and offer as many meaningful services as possible to encourage compliance with patients
needing several aspects of care (a patient centered approach). Prevention efforts consist of exams,
x-rays, and bi-annual dental cleanings to catch problems before they become more extensive.
Dental cleaning services were expanded this year with the move of a dental hygienist into the
McDowell Dental Clinic. The Grant director has also given MIHS permission to increase the
maximum allowable benefit per Ryan White patient needing dentures so this can be accomplished
during one grant year versus spreading out treatment over two to three years which prevents
infections.
Digital Retinopathy Screening Program
The Maricopa County Department of Public Health and the Arizona Department of Health
Services identified diabetes as one of the five health priorities for the county. Additionally,
diabetes was selected as one of the top three health challenges selected by MIHS patients on the
FQHC-LA Needs Assessment (n=390). Diabetic retinopathy is one of the most common causes
of loss of vision, as all patients with diabetes are at elevated risk. It is recommended that patients
with diabetes have an annual eye screening to prevent the progression of eye disease in which
symptoms may not occur until the disease process is advanced. In order to meet the needs of our
diabetic patients at the FHC sites, a new program was developed to provide mobile digital
retinopathy screening services. This program entails a digital retinopathy screening camera to be
moved from clinic to clinic on a weekly rotation. During the week that the camera is available in
the FHC, diabetic patients are scheduled for testing with the intent that they will be screened once
per year.
In the first phase of the program, three FHCs (Chandler, Glendale and Mesa) were selected as
pilot sites. In January 2015 the second roll out included three additional sites (Sunnyslope,
Avondale and South Central). Over 500 diabetic patients have been served year-to-date.
Program refinement includes the purchase of a second mobile eye camera to ensure coverage of
all FHC sites valley wide. The purchase of a second camera has yet to occur due to budgetary
constraints. In addition to the testing, we will continue to educate our patient population on the
preventative measures they can take to remain free of disease or to prevent further effects of
diabetes on their eye health. This will be carried out in partnership with our diabetic educators and
RN care coordinators as a function of the Patient Centered Medical Home (PCMH).
Care Continuity – Refinement of the Patient Centered Medical Home Model Maricopa Integrated Health System has 12 NCQA Recognized Physician Practice Connections-
Patient Centered Medical Home (PPC-PCMH), Level 3 primary care clinics that provide a variety
23
of clinic based care coordination and population management services. Through the use of
provider-led teams and 12 RN care coordination staff, the program offers the following:
Population Management
Each clinic has identified clinically important conditions that are the focus of our population
management efforts. The adult clinically important conditions are diabetes, hypertension,
depression and congestive heart failure. Pediatric clinically important conditions include obesity,
asthma, and developmental delays. Care is delivered in accordance with established standards of
care through the use of provider decision support tools such as standardized charting templates,
health maintenance reminders and best practice alerts. Clinic RN care coordinators collaborate
with providers and staff to track, monitor, and proactively outreach to patients to ensure timely
provision of care. Care coordinators utilize information technology solutions such as pre-visit
planning tools, disease registries, and patient recall lists to effectively identify and manage the
various populations.
Outreach and Preventive Services
Maricopa Integrated Health System utilizes the Epic Electronic Health Record (EHR) system to
provide health maintenance alerts during each visit to flag patient health services that are due.
These provider alerts include: immunizations, breast and colorectal screenings, diabetic care (foot
exam, retinal exams, HbA1c, LDL), and a variety of other services. We also utilize Epic
reporting to identify patients needing routine visits such as EPSDTs and well woman visits. Once
identified, designated staff perform outreach via phone calls, letters, and Mychart (patient portal)
messaging to encourage patients to schedule an appointment and complete the required services.
Utilization Management
RN care coordinators proactively manage and provide care coordination for internally and
externally identified high risk patient cohorts. Patients designated high risk include those patients
with frequent ED or inpatient utilization, at high risk for admission or readmission, and other
conditions as identified based on a variety of risk stratification and predictive modeling analytics.
Care coordinators track and monitor patients to ensure timely PCP and specialty visits are
completed and required care opportunities are addressed.
A designated discharge management team of RN care coordinators provide outreach and care
coordination for patients recently discharged from an inpatient stay or ED visit. Care coordinators
strive to reconnect patients with their PCP within 7 days of discharge and avoid unnecessary
readmissions. In addition, the discharge management team also provides intensive management
for patients identified during an inpatient stay as being at high risk for readmission. These
patients receive daily outreach calls and are scheduled for post hospital PCP visits within 48-72
hours to ensure close follow-up and monitoring.
24
Expansion of Services in West Phoenix: Pendergast Family Health Center
The U.S. Department of Health and Human Services - Health Resources Service Administration
(HRSA) has designated Arizona as an underserved area for pediatric dentistry and has funded the
development of pediatric dentistry residency programs in Arizona. In addition, the Centers for
Medicare and Medicaid Services have instructed AHCCCS to increase dental utilization by 12%
by 2015. Furthermore, dental care was identified by MIHS FQHC-LA patients as a priority health
concern.
AHCCCS has recently reported only half of the eligible children in Arizona have visited a dentist.
With the implementation of the ACA and its additional funds, AHCCCS is estimating as many as
300,000 additional children may be eligible for coverage in Arizona. Maricopa County may see as
much as one-third of that increase. There are draft plans being developed by AHCCCS to assign
children to dental panels or dental homes for their dental care, similar to that of the medical
model.
Although MIHS currently has only two dentists that specialize in pediatric visits, MIHS recently
approved a partnership with Lutheran Medical Center which establishes MIHS as a pediatric
dental residency training site. Lutheran’s residency training is a 24-month program including both
didactic and clinical experiences. Two new residents are accepted each year. The
Pendergast/MIHS project dovetails nicely with the new residency program as the pediatric dental
residents would receive clinical training at the Pendergast Clinic site.
Pediatric Obesity According to data from the National Initiative for Children’s Healthcare Quality Arizona ranks 25
with 30.6% of children considered overweight or obese. In the age range of 2-5 year olds who are
low income and participate in WIC, 30.6% are obese in Arizona. The percent of children 6-17
who get 4 or more days of vigorous activity per week is below the national average and the
percent of children age 1-5 who engage in 4 or more hours of screen time per day is above the
national average. The percent of overweight children by family income is 53. 3% for those
<100% FPL which is 10% above the national average while for those with >400% FPL it is
14.1% which is 6% below the national average for that income level making a significant
disparity level, ranking Arizona 49/50.
(http://www.childhealthdata.org/docs/nsch-docs/arizona-pdf.)
MIHS considers promotion of Healthy Weight, Nutrition, and Physical Activity for children to be
an extremely important health topic. As such we have incorporated strategies to promote
screening and counseling for obesity at all Well Child/EPSDT visits. MIHS has chosen to
incorporate the Arizona Chapter of the American Academy of Pediatrics’ version of the AAP’s
5210 program 5210 the Smart and Healthy Way to Go into the regular practice of our
EPSDT/Well child visits.
All children age two and over have height, weight, and BMI measured at all clinic encounters.
This data is plotted on the age appropriate growth charts within the EMR. The Well
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Child/EPSDT templates have been designed to include the calculated age specific BMI
percentage and this data is presented in the provider as a vital sign. MIHS did approximately
28,000 EPSDT/Well Child Visits last year.
At all Well Child/EPSDT visits for children age 2-18 providers are prompted as a regular part of
the Well Child/EPSDT template to provide nutrition and physical activity counseling based on the
AAP recommended 5210 strategy.
Example:
All children regardless of BMI percentage should have individual goal set around healthy
nutrition and physical activity as part of their routine well child visits. Use of this phrase is
tracked in the HER as one of our Pediatric Quality indicators for Meaningful Use.
Children who are found to have obesity or an elevated BMI for their age are then followed up on
an individual basis which can include laboratory studies as recommended by the AzAAP, 5210
the Smart and Healthy Way to Go Childhood Obesity Assessment and Treatment Algorithm, and
additional clinic visits for weight management and follow up.
(http://www.azpedialearning.org/pdf/ChildToolkit_Revised%202%20April%202008-
1%2020%20%283%29.pdf) (http://www.azwaytogo.org/?page_id=36)
To aid in these follow up visits, we have developed a form within the EMR that allows for
ongoing documentation and tracking of additional information for children who are overweight
and providers can follow that documentation on a flow-sheet.
Additionally, overweight children who are age 0-5 and their families can be referred to our First
Things First grant funded Pediatric Care Coordination Team who will assist with finding
community resources and self-management strategies on an individual basis and also assist with
follow up of any referrals that may be needed. Families can also be referred to one of our 4
regionally located clinic based Family Learning Centers for nutrition classes and support groups
as well as additional resources.
We have recently started a pilot project to develop an Obesity/Healthy Weight follow up clinic in
one of our CHC Pediatric Primary Care clinic with one of our primary care providers who has a
special interest in working with this population. We are currently working on strategies to get
families more involved such as having clinic sessions during our extended hours. This allows
families to come together while also exploring group visits that help develop support groups.
26
Improving Clinical Outcomes: The Interdisciplinary Hypertension Task Force Hypertension is one of the most common worldwide diseases afflicting mankind and it is
described as the most important modifiable risk factor for coronary heart disease (leading cause of
death in the United States), stroke (third leading cause), congestive heart failure, and end-stage
renal disease. Over 50 million Americans have high blood pressure warranting some form of
treatment. Blood pressure reduction has been shown to reduce the risk for developing
complications from hypertension, including myocardial infarction and stroke; hence, hypertension
control is defined as an intermediate or outcome measure, or one of the proxy measures for
assessing cardiovascular health in a community.
MIHS convened the Hypertension Task Force to address the issue of hypertension in 2014. This
interdisciplinary team chose to redesign the care system to improve blood pressure control in
patients with a diagnosis of hypertension so that 66 percent or more will have a blood pressure
less than 140/90 mm Hg. Historically, the FQHC-LA clinics had the following average percent
of controlled blood pressure:
FY 2013: 57.2%
A multipronged approach was used that included:
27
Development of an interdisciplinary quality improvement team with provider champions
A commitment from leadership which assisted with elimination of barriers
Development of critical pathways for hypertension control
Use of Survey Monkey to assess learning needs of the staff with subsequent development of
an online educational piece and hands on competency training
Care Team training including medical assistants, RNs, care coordinators, managers,
providers, residents
Insuring that the staff had appropriate equipment (manual blood pressure cuffs)
Education of staff on cultural factors that impact hypertension management
Standardization of patient education materials and blood pressure logs
o Lifestyle modifications including the DASH Eating Plan, weight reduction, dietary
sodium reduction, physical activity and limiting alcohol consumption
Blood pressure measurements checked and addressed at every visit with a return visit
scheduled with a nurse or provider if elevated
Building on the efforts of others by using changes that worked
The results were encouraging:
FY 2014: 66.8%
March 2015: 79.2%
Using this model, the Hypertension Task Force expanded and evolved into the Preventative Task
Force Committee that has systematically taken on additional issues such as colorectal screening,
depression screening, diabetes management and tobacco cessation.
Conclusion:
The Federally Qualified Health Centers’ assessment of need criteria in concert with the five health
priorities as identified by the Maricopa County Department of Public Health and the Arizona
Department of Health Services has established a foundation for the MIHS FQHC-LA team to view
and shape our services through the lens of the patient. The programs profiled in this report represent
a sampling of projects, performance improvement initiatives and programmatic changes designed to
address gaps in service and ultimately patient need.
Appendix A:
Maricopa Integrated Health System. “Count On Us To Care.”
FQHC-LA Division
Patient Health Needs Survey 2014
Maricopa Integrated Health System’s mission is to exceed the needs of our patients, their families, our physicians, and our staff through the
delivery of high-quality, comprehensive care to the people and communities we serve.
To ensure that we continue to exceed the needs of our patients and community, Maricopa Integrated Health System has launched a
comprehensive patient health needs assessment initiative at each of its primary care clinic sites. This assessment will help us to:
To ensure we meet your healthcare needs
Identify current and future healthcare needs in our communities
Increase community awareness of local and regional health problems
Determine trends in demographics related to health care
Improve and strengthen our programs and services
Your feedback in is invaluable in helping us shape the future of healthcare in our local community. By taking this brief survey, you have the
unique ability to provide insight into what you think are the most important and pressing healthcare needs of our local community and help
Maricopa Integrated Health System develop programs and strategies to meet them.
Question #1 How would you describe your overall health? Excellent Very good Good Fair Poor Question #2 Where do you go for routine healthcare?
Physician’s office Health Department Emergency room Urgent care clinic Clinic in a grocery or drug store
I do not receive routine healthcare Other – please list where you go for routine healthcare: ________________________________ _________________________________________________________________________________________________________________
Question #3 Can you get an appointment at this doctor’s office when you need it? Yes (Go to question 5 next) No Question #4 If you answered "No" to question 3, please choose all that apply.
No appointment available Cannot afford it Cannot take time off from work No transportation
The clinic hours don’t meet my needs. I would prefer appointments at the following times: earlier ___ evenings ____Saturdays____
No specialist in my community for my condition Other – please list why are not able to visit a doctor when needed: _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________
Question #5 What type of healthcare coverage do you have?
Medicare AHCCCS Commercial health insurance (Examples: Cigna, Humana, Anthem Blue Cross)
Copa Care / Sliding fee discount program No healthcare coverage
Other - please list what other type of health coverage you have: ________________________________________________ ___________________________________________________________________________________________________________________
Question #6 Please select the top 3 health challenges you face.
Cancer Diabetes Overweight Breathing problems High blood pressure / Stroke Dental care Heart disease
Pain Depression / Mental health issues Alcohol use Drug use None
Other – please list the other health challenges you face: _____________________________________________________________________ _______________________________________________________________________________________________________________________ Question #7 What else do you need to be healthier?
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Question #8 Please choose all statements below that apply to you.
I exercise at least 3 times per week. I eat at least 5 servings of fruits and vegetables each day.
I eat fast food more than once per week. I smoke cigarettes. I chew tobacco. I use illegal drugs.
I abuse or overuse prescription drugs . I consume more than 4 alcoholic drinks (if female) or 5 (if male) per day.
I use sunscreen or protective clothing for planned time in the sun. I receive a flu shot each year.
I have access to a wellness program through my employer. None of the above apply to me.
Question #9 Which of the following preventive procedures have you had in the past 12 months?
Mammogram (if woman) Pap smear (if woman) Prostate cancer screening (if man) Flu shot
Colon/rectal exam Blood pressure check Blood sugar check Skin cancer screening Cholesterol screening
Vision screening Hearing screening Cardiovascular screening Bone density test Dental cleaning/x-rays
Physical exam None of the above
Question #10 What is your gender? Female Male
Question #11 What is your race? African American/Black Caucasian/White Asian American Indian/ Alaska Native
Native Hawaiian/ Pacific Islander Other – please specify _____________________________
Question #12 What is your current employment status? Employed full-time Employed part-time Student Homemaker
Unemployed Disabled Retired
Question #13 What is your household income range? $0 - $24,999 $25,000 - $49,999 $50,000 - $74,999 $75,000 -
$99,999 $100,000 or more Don’t know
Question #14 What is the highest level of education you have completed? Some high school High school graduate
Some college College graduate
Question #15 How are we doing to meet your health needs? ________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Thank you for your time and partnership to make our community a healthier one.
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