Patient flow considerations for homeless women accessing mainstream medical services

Traditional health care delivery systems operate on the assumption that patients can travel to the health centers and hospital clinics to obtain primary and preventive care. Implicit in this assumption is that all patients have a minimum of cognitive wherewithal and mental stability or at least a support system to turn to for help. Women of Means is a grassroots non-profit healthcare delivery model of volunteer physicians and nurses who go into homeless shelters to provide free and unfettered medical care to homeless women in the Boston area. Common medical problems are hypertension, diabetes, asthma, COPD, trauma and violence including head injury, mental illness and substance abuse. Data collected in 2007 from a study funded by Blue Cross Blue Shield Foundation of MA showed that as many as 70% of the 1800 women we served in two large shelters were enrolled in Medicaid and had assigned primary care providers, including specially trained homeless providers. Nevertheless, reports from the women indicated that it was still “too hard” to get consistently continuous care from their official medical “home”. Risks of interrupted patient flow are additional costs of correcting unmonitored chronic disease, worsening of acute illness, missed diagnoses, increased hospitalization and ER use, even death. Women of Means has identified twelve patient flow categories within which are areas where homeless women are routinely more likely to encounter barriers to consistent continuity of care. These barriers can cause frustration, confusion, PTSD flares, humiliation, fear, disrupted care, and hopelessness. Patient flow categories are: Starting Location, Contacting Health Care Services, Transportation, Getting Around the Clinic/Hospital, Patient Registration, The Visit, Discharge Planning, Outpatient Testing, Pharmacy, Over-the-Counter Supplies, Taking Prescription Meds, and Follow-Up. For each area, there are several steps where knowledge of the specific patient and her circumstances with targeted outreach interventions improved access and continuity. Over the past 9 years of practice, Women of Means has identified and learned to overcome these barriers and assist thousands of homeless women in accessing more consistent care from their primary providers and the area clinics by having established relationships with the women, knowing their circumstances and emotional/mental capacities, making phone calls, sending e-mails, letters, faxes, even accompanying women to important appointments. Women of Means free care combined with its targeted outreach services at critical areas of patient flow for homeless women improves continuity of care and reduces the costs of caring for this vulnerable population.