Program Narrative

Creating this collaborative, comprehensive and compassionate healthcare delivery system will improve the healthcare of the homeless in Houston and provide an invaluable opportunity in the education of medical, pharmacy, nursing and social work students, as well as family medicine and psychiatry residents.

THE NEED

In 1996, the University of Houston School of Public Policy, in conjunction with the Coalition for the Homeless of Houston/Harris County, conducted a survey of the homeless, and documented approximately 10,000 literally homeless persons in the Houston area. When asked, the majority of these respondents (34%) identified health-related illness as the primary factor leading to homelessness. This same survey recognized 150,000 additional persons as marginally homeless, or at high risk of homelessness. In February, 1999, a survey conducted at the Baylor/SEARCH clinic revealed that 51% of clients seeking healthcare services are turned away due to limited capacity. Additionally, comparing 1998 statistics to the first two quarters of 1999, client encounters at the SEARCH clinic are anticipated to increase by approximately 2,000 encounters this year. At the end of 1999, the total number of client encounters will be between 8,000 and 9,000. In May, 1999, under the guidance of David S. Buck, M.D., M.P.H., students from Baylor College of Medicine (BCM), the University of Texas – Houston Health Science Center (UT), and University of Houston (U of H) Graduate School of Social Work conducted a needs assessment of the healthcare services for Houston’s homeless. This assessment indicated that the unmet need for homeless healthcare continues to grow, and that the homeless continue to seek medical care primarily at hospital emergency rooms (the least effective and most costly option).

Furthermore, women and children constitute the fastest growing homeless subpopulation seeking healthcare at the clinic. In 1998, 24.2% of client encounters were women, as compared to 33.3% in the second quarter, 1999, which will increase female encounters by more than 1,000 in 1999.

A review of national and international studies (including public, private, and veterans’ hospitals) indicate that the overall admission rate for the homeless is 4 to 7 times that for housed indigent people. Estimates in Boston specify an average of one hospitalization per adult homeless patient per year. Further, homeless persons comprise 24 – 28% of Boston City Hospital admissions and 12% of private hospital hospitalizations. It becomes obvious, therefore, that the impact of homelessness on health is profound and the budgetary implications enormous.

As a consortium of healthcare providers, HHH presents a unique opportunity, in that Houston will be the first major city in the U.S. to bring together a majority of community-based agencies, healthcare clinicians, educational institutions, and public organizations to forge a common strategic plan to effectively address the health needs of the homeless. One of the primary goals of this consortium is to increase access to quality healthcare while concurrently reducing costly and ineffective service duplication. Accordingly, HHH has developed the Year 2000 Strategic Plan that will combine new programs with expansion of existing programs. The Year 2000 will include the following projects:

1. Electronic Medical Record: An electronic medical record (EMR) will connect all homeless healthcare providers, aiding in coordination and continuity of services. Access to homeless patient records, medications and lab reports, as well as access to appointment schedules at other clinical sites will allow increased cooperation among healthcare sites. BCM has made a commitment to assist in establishing and maintaining the EMR. In Phase I, the EMR will connect the two clinics at SEARCH and Bread of Life, The Methodist Hospital lab, and Ben Taub General Hospital Emergency Center. MedicaLogic, an EMR software vendor, has chosen HHH as its first community service project, and has agreed to donate all software licenses needed. Furthermore, the Compaq Contributions Program has pledged to assist the EMR project with a donation of hardware.

2. (Medical) Student Clinics: A student-run free clinic will be developed at the Bread of Life, DayBreak Community Health Center, providing quality, accessible healthcare for the homeless in a learning environment respectful of all participants. A first- or second-year medical student will be paired with a third- or fourth-year student to provide services, with a faculty preceptor present during all hours of patient care. Medical students from BCM and UT are presently working with volunteer faculty to design services for the initial site to begin January 2000 (this can be viewed at www.nohome.com). HHH will provide An on-site pharmacy through (will be provided by) the U of H School of Pharmacy with pharmacy students working directly with medical students. Additionally, students from the U of H Graduate School of Social Work will provide social service information and referral. It is anticipated that additional student-run clinics will be established during Phase II of the Strategic Plan.

3. Centralized Pharmaceutical Distribution System: The U of H School of Pharmacy will assist HHH in establishing three Class D pharmacies, the first two being at the Lord of the Streets and BCM/SEARCH clinics. A third pharmacy will be set up as part of the student-run free clinic. Each of these pharmacies will serve at teaching sites for the School of Pharmacy. Additionally, at the student clinic, the pharmacy students will work directly with medical, social work, and dental students to enhance each group’s base of knowledge.

4. Shelter Clinics: The HHH Strategic Plan, Phase I will increase access to healthcare by coordinating services at Bread of Life, DayBreak Community Health Clinic and SEARCH. HHH will organize homeless services and staff the two clinics, thereby reducing unnecessary duplication. As a result, the two clinics will be able to increase the capacity and scope of services offered to Houston’s homeless.

5. Outreach: Healthcare outreach services will continue at the Palmer Way Station five mornings per week. Currently, outreach services are also being provided one half-day a week at Open Door Mission and Star of Hope Men’s Shelter. Furthermore, medical outreach services to the street homeless will be expanded during year 2000. A mobile medical outreach program, utilizing a van driven to homeless encampments, will combine medical services with intensive case management. A chronically homeless person is most likely to come into a clinic for medical care if a relationship with a healthcare provider has first been established on the street. Relationships developed on the street, at shelters, and ERs can be continued in the clinic where health needs can be met and the causes of homelessness explored. Additionally, a new program is being developed with on-call healthcare providers who will be paged to the Ben Taub emergency room to meet homeless patients and schedule follow-up care. Based on programs in other cities, this plan has demonstrated increased effectiveness and success in improving follow-up care.

6. Dental Program: A Dental Director will be hired to expand and augment volunteer dental services at the SEARCH clinic. Clients at the Bread of Life, DayBreak Community Health Center and student-run clinics will also be referred to the SEARCH clinic for dental services.

ORGANIZATIONAL STRUCTURE

YEAR 2001 OBJECTIVES:

The Strategic Plan for HHH will include:

YEAR 2001 OUTCOME MEASUREMENTS

CURRENT COLLABORATIVE ALLIANCES

David S. Buck, M.D., M.P.H.
President and Chief Medical Officer
P.O. Box 66690
Houston, TX 77266
TEL: (713) 798-6067
FAX: (713) 759-1502

dbuck@bcm.tmc.edu

Frances Isbell, M.A.
Executive Director
P.O. Box 66690
Houston, TX 77266
TEL: (713) 798-6067
FAX: (713) 759-1502
fisbell@bcm.tmc.edu