Act Local, Think Global:

Irit Sinai, Ph.D.

THIS PROJECT WAS FUNDED BY THE OFFICE OF POPULATION AFFAIRS UNDER GRANT #FPRPA006055

Applying systematic

screening to health services

in central California

Detects unmet health needs

Improves clinic efficiency

Engages patient as a partner

Developed by the Population Council; further tested by FHI

Tested in several developing countries

Systematic Screening

Research Questions1. Does systematic screening increase:

• number of health services received in visit?• number of referrals?

2. Does systematic screening increase the proportion of:

• women coming in for diabetes referred to FP/STI?• men coming in for adult services referred to

FP/STI?• women coming in for FP/STI referred to diabetes

testing/services?

family planning diabetes care

Study Design

Formative

Research

Paper Tool

Evaluation

EMR Evaluati

on• Patient in-depth

interviews• Provider in-depth

interviews• In-use testing

• Patient exit interviews

• Patient chart reviews

• Service statistics• Provider

shadowing• Provider in-depth

interviews• Cycle time

• Patient exit interviews

• Patient chart reviews

• EMR reports• Provider shadowing• Provider in-depth

interviews• On-site technical

assistance

YEAR 1 YEAR 2 YEAR 3

Fidelity of the Intervention: Shadowing

Results

All providers demonstrated good compliance with the systematic screening protocol, but some challenges were identified, especially in clinics with high patient volume

Scheduling same day additional services was sometimes a problem

Time constraints in balancing this new patient care activity with other duties

Exit interview resultsClient profile Year-3 endline

n=273Mean age% female% High school or college education% Spanish speaking

3488%60%52%

Utilization of additional servicesIn year 3% clients who received services in addition to those they came for increased from 28.1% to 28.8%% of people who received nutrition and weight services (who did not come for these services) increased from 4.3% to 13%

Services clients want Year 2 endlinen= 332

Nutrition/weight managementDiabetesBirth control

30%19%15%

Mean number of services received in a single visit

Year 2# increased slightly from baseline to endline in intervention clinics# significantly decreased from baseline to endline in control areas

Year 3# significantly increased, form 1.43 to 1.65

Mixed results with respect to specific services• Significant increase in nutrition and weight services• No significant change in family planning and STI

services

Patient chart review results

Opinions of Clinic Staff:Results of In-depth Interviews• Recommended it be

continued and expanded• Simple to implement and

well-received• Raised patient awareness

of available services• Increased provider

understanding of patient needs

• Improved patient - provider communication

“I was surprised that it was so well

received by patients, and how

frequently they were interested in further services.”

www.gvhc.org

Systematic Screening

Implementation Tips for Success

o Determine which services are utilized, and which are underutilized

o Study patient flow, Involve staff in design and include incentives to sustain compliance

o Pre test process and toolo Provide training,

support, supervision and monitoring during start-up

o Include activities to ensure staff feel comfortable providing the additional services

ConclusionAs a model to address multiple needs during a single visit, integration of systematic screening into a linked EMR template is a promising patient-centered approach to increase use of underutilized services

Thank you! www.irh.org

www.gvhc.org

Irit Sinai, sinaii@georgetown.edu