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Evaluating Structural Barriers to Quality Care in the SHOW Free Clinic

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Homelessness is a pervasive in American society. The causes of homelessness are complex, but health and homelessness are inextricably linked. Student-run free clinics care for underserved populations, including people experiencing homelessness, but they have multiple agendas—to provide care but also

Homelessness is a pervasive in American society. The causes of homelessness are complex, but health and homelessness are inextricably linked. Student-run free clinics care for underserved populations, including people experiencing homelessness, but they have multiple agendas—to provide care but also to give students hands-on experience. It is plausible that these two agendas may compete and give patients sub-par quality of care.
This study examines patient care in the SHOW free clinic in Phoenix, Arizona, which serves adults experiencing homelessness. This study asks two questions: First, do clinicians in Phoenix’s SHOW free clinic discuss with patients how to pay for and where to access follow-up services and medications? Second, how do the backgrounds of patients, measured by scales based on the Gelberg-Anderson behavioral model for vulnerable populations, correlate with patient outcomes, including number of unmet needs in clinic, patient satisfaction with care, and patient perceived health status? To answer these questions, structured surveys were administered to SHOW clinic patients at the end of their visits. Results were analyzed using Pearson’s correlations and odds ratios. 21 patients completed the survey over four weeks in February-March 2017. We did not identify any statistically significant correlations between predisposing factors such as severity/duration of homelessness, mental health history, ethnicity, or LGBTQ status and quality of care outcomes. Twenty nine percent of surveyed patients reported having one or more unmet needs following their SHOW clinic visit suggesting an important area for future research. The results from this study indicate that measuring unmet needs is a feasible alternative to patient satisfaction surveys for assessing quality of care in student-run free clinics for homeless populations.

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2017-05

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Comparative Analysis of Interprofessional Clinic Models: Recommendations for Best Practice Implementation

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As the complexity of healthcare continues to rise, the need for change in healthcare delivery is more prominent than ever. One strategy identified by the World Health Organization (WHO) for responding to these increasing complexities is the use of interprofessional

As the complexity of healthcare continues to rise, the need for change in healthcare delivery is more prominent than ever. One strategy identified by the World Health Organization (WHO) for responding to these increasing complexities is the use of interprofessional practice and education to improve patient outcomes, reduce costs, and enhance the patient experience of care (Triple Aim). Interprofessional collaboration among diverse disciplines is evident on the Phoenix Biomedical Campus, integrating a wide variety of institutions and multiple health profession programs; and at the Student Health Outreach for Wellness (SHOW) free clinic, -- a successful tri-university, student-led, faculty mentored, and community-based model of interprofessional learning and care -- based in downtown Phoenix. This project conducted a comparative analysis of interprofessional components of 6 different clinical models in order to provide recommendations for best practice implementation. These models were chosen based on availability of research on interprofessionalism with their clinics. As a result, three recommendations were offered to the SHOW clinic for consideration in their efforts to improve both patient and educational outcomes. Each recommendation was intentionally formulated for its capacity to increase: interprofessionalism and collaboration between multiple disciplines pertaining to healthcare, among healthcare professionals to promote positive patient and educational outcomes. These recommendations include implementing an interprofessional education (IPE) course as a core component in an academic program's curriculum, offering faculty and professional development opportunities for faculty and mentors immersed in the interprofessional clinics, and utilization of simulation centers. Further studies will be needed to evaluate the impact these specific interventions, if adopted, on patient and educational outcomes.

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2017-05

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Care Not Cash: A New Kind of Reform

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This thesis examines Care Not Cash, a welfare reform measure that replaced traditional cash General Assistance program payments for homeless persons in San Francisco with in-kind social services. Unlike most welfare reform measures, proponents framed Care Not Cash as a

This thesis examines Care Not Cash, a welfare reform measure that replaced traditional cash General Assistance program payments for homeless persons in San Francisco with in-kind social services. Unlike most welfare reform measures, proponents framed Care Not Cash as a progressive policy, aimed at expanding social services and government care for this vulnerable population. Drawing on primary and secondary documents, as well as interviews with homelessness policy experts, this thesis examines the historical and political success of Care Not Cash, and explores the potential need for implementation of a similar program in Phoenix, Arizona.

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2017-05

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Social Impact Bonds to Address Phoenix Homelessness

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Social impact bonds (SIBs) are a multi-year contract between social service providers, the government, and private investors. The three parties agree on a specific outcome for a societal issue. Investors provide capital required for the service provider to operate the

Social impact bonds (SIBs) are a multi-year contract between social service providers, the government, and private investors. The three parties agree on a specific outcome for a societal issue. Investors provide capital required for the service provider to operate the project. The service provider then delivers the service to the target population. The success of the project is evaluated by outside party. If the target outcome is met, the government repays the investors at a premium. Nonprofit service providers can only serve a small community as they lack the funding to scale their programs and their reliance on government funding and philanthropy leads to a lot of time focused on raising money in the short-term and inhibits them from evolving their programs and projects for long-term strategic success. Government budgets decline but social problems persist. These contracts share risk between the government and the investors and allow governments to test out programs and alleviate taxpayer burdens from unsuccessful social service programs. Arizona has a severe homelessness problem. Nightly, 6000 people are homeless in Maricopa County. In a given year, over 32,000 individuals were homeless, composed of single adults, families, children, and veterans. Homelessness is not only a debilitating and difficult experience for those who experience it, but also has considerable economic costs on society. Homeless individuals use a number of government programs beyond emergency shelters, and these can cost taxpayers billions of dollars per year. Rapid rehousing was a successful intervention model that the state has been heavily investing in the last few years. This thesis aimed to survey the Arizona climate and determine what barriers were present for enacting an SIB for homelessness. The findings showed that although there are many competent stakeholder groups, lack of interest and overall knowledge of SIBs prevented groups from taking responsibility as the anchor for such a project. Additionally, the government and nonprofits had good partnerships, but lacked relationships with the business community and investors that could propel an SIB. Finally, although rapid rehousing can be used as a successful intervention model, there are not enough years of proven success to justify the spending on an SIB. Additionally, data collection for homelessness programming needs to be standardized between all relevant partners. The framework for an SIB exists in Arizona, but needs a few more years of development before it can be considered.

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2016-05