187652 Referral Management Initiative: An approach to improve and coordinate access to specialty care in a community health center serving public housing recipients

Tuesday, October 28, 2008: 3:15 PM

Ariel L. Sarmiento, MPH , New York Children's Health Project, Children's Hospital at Montefiore, New York, NY
Alan Shapiro, MD , South Bronx Health Center for Children and Families, Bronx, NY
Jo Applebaum, MPH , Community Pediatrics, Children's Hospital at Montefiore, Bronx, NY
Community health centers provide much needed primary care services to public housing residents. In this setting, specialty care needs, both psychosocial and medical, are often identified. However, this population faces numerous barriers to accessing specialty care, including transportation, language and culture, insurance status, and long waiting periods between referral and scheduled specialty care appointments.

The South Bronx Health Center for Children and Families (SBHCCF) provides comprehensive primary care in an underserved community. Approximately 65% of SBHCCF patients live in public housing. The Referral Management Initiative (RMI) was launched in 1997 to improve access to specialty care. RMI's Family Health Workers coordinate specialty referrals by scheduling appointments on behalf of patients. This coordination is particularly helpful in cases of multi-specialty referrals as is often needed in this high-risk population. Transportation, mostly by mass transit, ambulette or car service, is also arranged by RMI staff to facilitate appointment adherence. Additionally, RMI completes the referral loop by ensuring that SBHCCF providers receive feedback on specialty consults. A proprietary web-based tracking database plays a pivotal role in coordinating these support services.

In 2007, RMI facilitated 3,439 referrals and arranged 5,199 two-way transportation services, which resulted in 4,553 medical specialty appointments for SBHCCF patients. Over a three-year period, patients' likelihood of keeping appointments continuously increased from 59% in 2005, to 61% in 2006, and 63% in 2007. Prior to the implementation of RMI, adherence with specialty appointments was approximately 7%.

Learning Objectives:
Describe how the referral management model as an ancillary service can enhance primary care as well as improve patientsí access to specialty care. Evaluate their own health centerís capacity to adapt such a model. Apply and institutionalize such model in their own health center as a patient resource. Recognize issues that influence access to specialty care in an underserved, urban population. Discuss the role transportation plays in facilitating underserved communities' access to specialty care.

Keywords: Community Health Centers, Community-Based Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Program Director of our organization's Referral Management Initiative.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.