Date of Award

January 2018

Document Type

Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Judith Kunisch

Abstract

CONTEXT: My Health LA (MHLA) is a Los Angeles County program that allows residents who are poor, without medical insurance (due to unaffordability and/or illegal immigration status), and without a primary care provider (un-empaneled) to enroll with an affiliated primary care clinic and receive free healthcare – related services.1 Despite the launch of this initiative in October 2014, 35 percent of MHLA enrollees did not follow-up with a primary care clinic and 15 percent of their emergency department (ED) visits were considered avoidable in fiscal year 2015-2016. OJECTIVE: In light of these findings, the MHLA enrollment pathway was evaluated at select agencies for the delineation of pilot improvement models. Design, Settings & Participants: Five sites were selected for the program evaluation, including a large urban medical center’s emergency and urgent care departments, and three primary care clinic sites adjacent to the medical center. Data inquiry, interagency observations, and patient and workforce interviews were conducted. MAIN OUTCOME MEASURES: The structure, process, and outcomes of the program were evaluated. Findings were compared with other evidence-based interventions for similar populations for the delineation of process improvement models. RESULTS: Identified successes within the enrollment pathway included free primary care services, use of a navigator in the ED, and improved chronic illness management. Identified challenges included flawed program perceptions, patient communication gaps, and current program limitations. CONCLUSION: A five-fold pilot process improvement model was proposed: short-term enhancement of communication surrounding the patient, short-term enhancement of communication to the patient at enrollment, medium-term enhancement of patient care coordination, medium to long-term initiation of financial incentives for clinics with satisfactory MHLA enrollee primary care engagement and long-term expansion of service coverage.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 09/03/2020

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