Health department activities with community providers: A service integration model to strengthen screening for infectious diseases

Background: 

Federally Qualified Health Centers (FQHCs) are important partners for health departments, because they are located in communities with a high burden of preventable diseases.  The New York City Department of Health and Mental Hygiene (DOHMH) assessed compliance of FQHC providers with gonorrhea (GC) and hepatitis C screening guidelines and New York State HIV testing laws. 

Methods:  

We used disease surveillance data to identify neighborhoods with high rates of disease and mapped data and FQHC locations.  Working collaboratively through the Program Collaboration and Service Integration (PCSI) initiative, DOHMH partnered with 6 FQHCs (representing 15 sites) to strengthen screening.  We implemented a quality improvement project which included improving electronic health record (EHR) utilization, modifying workflows, changing policies, and training providers.  To measure progress, FQHCs extracted EHR data for these diseases at baseline (January – December 2012) and mid-point (May – September 2013). 

 

Results: 

All 6 FQHCs revised protocols or processes to strengthen sexual health screening, and two-thirds (67%) modified their EHRs.  Half (50%) added structured fields to their EHR to improve documentation and half (50%) modified EHR components to streamline testing.  HIV offer rates increased from 19% to 26%, and HIV testing rates from 14% to 18%, from baseline to mid-point.  We conducted 10 HIV training courses, 5 hepatitis C courses, and 4 GC courses, reaching over 300 providers and clinical staff. 

Conclusions: 

Internal health department collaboration led to coordinated assessment and assurance of high priority infectious disease activities with FQHCs.  By bundling technical service, DOHMH improved systems at FQHCs for more than one disease.