225448 Welcoming refugees home: How a patient-centered medical home can improve care for refugees

Monday, November 8, 2010 : 10:30 AM - 10:45 AM

Hend Azzerayer, MPH , Center for Urban Health, Thomas Jefferson University, Philadelphia, PA
Rickie O. Brawer, PhD MPH , Center for Urban Health, Thomas Jefferson University Hospital, Philadelphia, PA
Marc Altshuler, MD , Department of Family and Community Medicine, Jefferson Medical College, Philadelphia, PA
Kevin Scott, MD , Department of Family & Community Medicine, Thomas Jefferson University, Philadelphia, PA
James Plumb, MD, MPH , Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
Julianne Ramic , Nationalities Service Center, Philadelphia, PA
Refugee health care is a growing challenge. Access is limited by cultural and language barriers. Refugees are often lost to follow up. Established refugee health programs often refer patients to a variety of providers once initial federally-mandated screening is completed. The Nationalities Service Center (NSC), a resettlement agency, and Jefferson Family Medicine Associates (JFMA) partnered to implement a novel refugee health care protocol. , JFMA, an NCQA-designated patient-centered medical home (PCMH), emphasizes the centrality of the physician-patient relationship by replacing one-time/episodic care for acute illnesses with ongoing coordinated care through utilization of a nurse coordinator, social worker, and NSC liaison. Initial visits are coordinated in dedicated refugee care sessions until patients are integrated as continuity patients with individual providers.

A mixed-method process evaluation (EMR reviews and key informant interviews) was conducted to evaluate clinic effectiveness/efficiency and patient/provider satisfaction and suggestions for clinic improvements. 246 medical charts were reviewed and 21 interviews conducted with 11 key NSC/JFMA providers and a convenience sample of 10 Iraqi refugees. Following initial health screening and vaccinations, 43% refugees made 4 or more visits for ongoing care, and time-to- initial screen improved with 83% seen within the recommended 90 days upon arrival. Findings include the need for enhanced linkages to state/local resources, expansion of the provider base, improvements in provider education/orientation, enhanced refuge patient orientation and communication strategies, ethnic community building, and preferences for trained in-person medical interpreters. As a result of this model, the NSC has been able to resettle refugees with medically complex problems.

Learning Areas:
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Other professions or practice related to public health
Program planning

Learning Objectives:
Describe key elements of the Patient-Centered Medical Home Model Identify how partnering with a community based resettlement organization and using the PCMH model can facilitate improved quality and access to care for refugees, particularly those with complex medical problems Describe the barriers and enabling factors related to delivering culturally and linguistically appropriate care for refugees

Keywords: Refugees, Health Care Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The evaluation of the refugee clinic was my capstone project for my MPH degree and I volunteered in the refugee clinic at Jefferson.
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.