California Health Care Improvement Projects (CHIPs)

Evaluating the impact of social services integrated care for people experiencing homelessness

Whole Person Integrated Care (WPIC) is a section within SF DPH’s Ambulatory Care that brought together programs serving people experiencing homelessness (PEH)/transitioning out of homelessness to provide coordinated and integrated care. As part of WPIC’s development, our Urgent Care (UC) clinic integrated with Street Medicine’s Open Access clinic. Two-thirds of the patients are PEH, and the program addresses both urgent needs and transitional primary care for individuals who are unconnected to care and not getting their needs met elsewhere in the system. Due to programmatic shifts over the past five years UC’s social work staff positions shrunk from 1.5 staff to zero.

This CHIP used data to identify UC patient social service needs and included a provider time study in determining the impact on care and productivity as a result of not having social services staff.

Increasing Employee & Dependent Engagement with Recommended Cancer Screenings

Due to the COVID-19 pandemic, participation in recommended routine screening declined across the country – in the first six months of the pandemic alone there were 10 million missed cancer screenings. As a result of this decline, individuals are not receiving appropriate early screening and diagnosis, resulting in an increase in cancer diagnoses at advanced stages of the disease. Delayed diagnosis is expected to lead to a higher cost of care, loss of productivity, and increased morbidity and mortality that would have been avoided with appropriate screening.

As Google’s Global Employee Health team, my team is responsible for helping Benefits program partners drive high-quality health outcomes for Googlers based on evidence-based clinical guidelines.

This project consists of two phases:

1. Research Phase: Apply qualitative and quantitative study methods to understand key barriers to employees following preventative cancer screening guidelines, despite these services being free through the health plan [completed]
2. Intervention Phase: Based on research learnings, develop, test, and launch preventativecare nudges, personalized to an individual’s specific needs [in progress]

Five Health Maintenance Screenings as Initial Street Medicine Core Metrics

Street Medicine is the delivery of individually tailored health and social services to people experiencing unsheltered homelessness (PEUH) in their own environment. Because Street Medicine has historically existed on the margins of the medical field – run as part time teams with volunteer staff - and because of that individually tailored approach, the field lacks universally recognized measures of success.

This CHIP developed five Health Maintenance Screenings as initial Street Medicine core metrics to partially answer the question “how do you know when you’re doing a good job?” Interviews of stakeholders at USC, other Street Medicine providers and patients identified Healthcare maintenance screening as a key gap in Street Medicine. Key tasks addressed by the CHIP included: selection of the screening tests, choosing laboratory testing over Point-of-Care testing, exploring the feasibility of non-blood specimens, improving integration of the lab system and electronic medical record, and implementing new Street-based treatment options for the conditions diagnosed by the new screenings. Four of the five screenings (HIV, Hepatitis C, Syphilis and Colorectal Cancer) have been successfully implemented. The fifth screen (Cervical Cancer) is still in the planning stage.