There is still a significant population of uninsured healthcare patients in the United States. For millions of these individuals, coverage in the existing healthcare system is not a possibility. The emotional, psychological and physical consequences of this situation are tremendous. The only resource for ongoing care available to these people – sometimes entire families – is the free clinic. For this reason, it is critical that these clinics have the support they need to operate in the absence of the revenue streams that are available to Community Health Centers. To provide equivalent care to that offered in a private clinic or CHC, the free clinic should also have an onsite point-of-care laboratory.
What is PoCECE?
Point of Care, Enhancing Clinical Effectiveness (PoCECE) is an initiative that provides clinics caring for underserved and vulnerable populations throughout the United States the essential diagnostic point of care (POC) testing they need to evaluate their patients on-site in a timely manner.
- PoCECE, funded by BD and implemented by Heart to Heart International (HHI) in conjunction with the National Association of Free and Charitable Clinics (NAFC), provides awards to safety net clinics with a desire to use POC testing to diagnose and set treatment protocols to improve patient outcomes.
- Heart to Heart International (HHI) has a fully developed POCT Safety Net Clinic Laboratory Package which encompasses all required components from validation and setup of equipment through training of personnel and compliant procedures and licensure. HHI’s laboratory experts will support the safety net clinic through the setup process and the first year of operation of the POCT laboratory.
- Due to the lack of the additional revenue streams, this service is typically not available in free clinics. A large percentage of patients seen at free clinics have chronic diseases that can and should be tracked with laboratory testing. Test results delivered several days after the patient is seen can lead to ineffective care and treatment. Or in the worst case, the patient cannot be reached and results are never delivered. Receiving test results during the office visit while the patient is available for provider counseling is best practice, leading to immediate, effective diagnosis and/or treatment.
- To encourage these practices and replicate them throughout the U.S. healthcare safety net system, BD, HHI and NAFC through PoCECE solicited innovative community-based approaches to address diagnosis and treatment of chronic disease care at free clinics. PoCECE identifies and communicates the best of what free and charitable clinics are currently doing to address the burden of chronic disease complications through practices that extend from the providers to the community.
Meet Our Winners
Downtown Clinic, Laramie Wyoming
The Downtown Clinic is just that – a downtown clinic in the college town of Laramie WY that has close ties with both the community they serve and the local university. The clinic has five paid staff and many volunteers. Their medical director is on faculty at the university, the local community provides dinner for the staff every Wednesday evening and the clinic draws on the student population for many of its volunteers. The clinic also includes a community vegetable garden, providing produce for their clients in season. They make an important distinction in referring to “clients” rather than patients, as they consider themselves partners, collaborating on health issues together. The clinic is currently not performing testing on-site and clients must travel 2.4 miles to get labs drawn. In a town with an inhospitable climate and no public transportation, that makes lab compliance a constant challenge. The Downtown Clinic should clearly benefit from on-site POC testing.
Community Health Services of Union County, Monroe NC
This is a diabetes clinic serving about 3500 uninsured patients in the Charlotte, NC suburbs. They will soon be expanding into general health care. They expect to add 15-20% patient volume and will also greatly benefit from expanded on-site laboratory testing at that time. This clinic states that they would be an educational laboratory, providing training for Wingate University healthcare students. The clinic already experiences frequent delays in care due to inability to contact patients, with 25% of contacts unsuccessful on the first attempt. They serve a significant number of undocumented immigrants in their practice, who are frequently unwilling to give accurate phone numbers out of fear. The immediate intervention made possible by POC laboratory testing would decrease the number of emergency room visits by their patients, driving down overall healthcare costs. This clinic is already providing very good medical care which can be improved significantly with the addition of on-site laboratory testing.
Free Clinic of Franklin County, Rocky Mount VA
The staff at this clinic (two paid staff, the rest volunteers) was very passionate about the benefit their clinic would derive from real-time results in a POC laboratory. They currently send all patients to the local hospital with an average turnaround time of about 72 hours. Tracking patients down once results are received is frequently problematic and clinicians are sometimes treating based on their “best guess”. One of the nurse practitioners gave the example of a time she saw a patient in the clinic and learned three days later that she had a 5.9 gm hemoglobin! At times, local law enforcement has been called in to help track down a patient. This clinic also provides a program of Diabetes Education classes to their patients. Due to cost, they are unable to send all participants out for A1c testing and are using metrics such as BMI and blood pressure to measure effectiveness in some cases. The ability to perform a pre-and post-A1c and lipid profile would be a much more reliable measure of long-term improvement for their participants.
Heart to Heart has been active in the laboratory field since 2007, when they obtained their own CLIA license days before the Greensburg, KS tornado disaster. We assisted with the setup of our first safety net clinic POC laboratory in 2008 at the JayDoc Clinic here in Kansas City. Since then we have set up five additional POC laboratories, four more here in the Midwest and one in Pennsylvania. We are currently working with the winners of the BD Point of Care Enhancing Clinical Effectiveness grant. Over the summer of 2017, laboratory experts with HHI will work with the three winning clinics to install point-of-care laboratory testing in their clinics. Our collaboration will continue after implementation, as we provide ongoing technical support and track selected metrics to determine the benefits provided by the availability of on-site laboratory testing.
Meet a Volunteer!
Meet Cynthia Kelley, one of our uber-volunteers here at Heart to Heart International. The efforts and tireless enthusiasm of volunteers such as Cynthia make projects such as this possible. She has been involved every step of the way, from the screening of initial applications through onsite assessments to training and implementation of the point of care laboratories. Cynthia came to us with many years of experience and expertise in clinical laboratory and laboratory management.
Safety-Net Clinic Package
We’ve developed a Point of Care test menu for safety-net clinics in the US and can provide a full Clinic Package to provide laboratory testing with timely results – allowing a physician to diagnose and treat patients on-site. We are honored to partner with Abbott Point of Care (POC) for the state of the art diagnostic equipment and supplies for this program. Through our partnerships, with companies like Abbott and BD, we also provide connections to reagent and supply replenishment, access to competency training and can coordinate volunteer lab technicians.
Learn how to install a lab in your clinic or health center.