Interprofessional collaboration improving the health of urban poor

Saint Mary’s Health Clinic (SMHC) was established in 2005 as a free clinic offering low-income vulnerable adults a basic primary care medical home. Through strengthening an academic/health care delivery partnership, in 2012 SMHC began developing into an interprofessional collaborative (IPC) practice model; this required several expansions, including adding health educators and social workers as well as creating an interprofessional team culture, developing student patient advocacy teams focused on social determinants of health, and obtaining specialist physician consultants and monitoring patient outcomes.

 The setting is a community hospital sponsored free clinic working collaboratively with a state supported university and serving low-income, vulnerable clients. The practice moved from a traditional primary care practice to an IPC practice through expanding and then developing and participating in a series of team workshops. To gauge effectiveness of changes and to monitor progress, we collected extensive baseline data on patients’ clinical indicators and continued to collect these data annually for three years. We also assessed interprofessional team readiness and developed quality improvement subgroups. We revised original intervention plans as outcomes and processes indicated a need.

 Preliminary findings revealed clinically significant changes in diabetes and hypertension patient outcomes, increased staff satisfaction and enhanced interprofessional competencies. While only one clinical indicator reached statistical significance, i.e., LDL readings among patients with diabetes (p=.04) many processes improved, including the percent of patients failing to keep appointments (by 22%).

 After only 2 ½ years, an interprofessional primary care team has been developed that includes students as patient advocates and links to physician specialists. The interprofessional team has been able to assist complex, high need patients to improve their health and quality of life. We highlight lessons learned from: helping low-income, vulnerable populations manage chronic disease, developing a unique interprofessional collaborative model, incorporating students as  advocates and overcoming challenges with university-practice collaboration.