Request for Funding
Medical Student Research Fellowship for Summer 2001
Mentor: Clare McCluggage, M.D. and Mark DeHaven, Ph.D.
Department: Family Practice and Community Medicine
Room number: DF0.334 (Clinical Services Building 1)
Mail Code: 9067
Phone number: 214-648-1350 or 214-648-1399
E-mail: Clare.McCluggage@UTSouthwestern.edu ; mark.dehaven@utsouthwestern.edu
Project title: Determining the Ambulatory Care Needs of Low-Income Patients Attending a Community-Based Volunteer Clinic
Human subjects IRB approved project number (where applicable): N/A
Animal subjects IRB approved project number (where applicable): N/A
Project Type Patient-based research
Brief Description of Project:
Background: The North Dallas Shared Ministries (NDSM) clinic is one of several independent non-profit clinics located throughout Dallas, that provide free medical care to uninsured, low-income patients. Currently, the services delivered to the primarily Hispanic patient population using the clinic consist of providing immunizations and treating minor episodic illnesses. A study is planned to assess the level and type of unmet medical needs in the community in which NDSM is located, evaluate unmet needs among the adult patients currently using the clinic, and make recommendations to the NDSM staff on the best ways to address the unmet needs in the community and among clinic patients.
Problem: A descriptive community-based participatory research study is proposed to evaluate the adult health-care needs of the community served by NDSM. The primary activities involved in the project include:
1. Conduct an assessment of the primary medical needs and demographic characteristics of adult patients using the NDSM clinic. The student will use the existing NDSM clinic database of 3,500 patients who have accessed the clinic in the last 12 months to identify and document in a separate database: the primary zip codes and census tracks of patients being served by the clinic, the demographic characteristics of the patients being served, the primary diagnoses of the patients seen, the number of visits for each patient during the past year, and the presence of an chronic illnesses and other medical problems.
2. Conduct an assessment of the primary medical needs of adults living in the geographic area served by the clinic. The student will use existing databases to conduct an epidemiological study documenting and describing the type and extent of medical need that is known to exist in the zip codes and census tracks served by the NDSM. Existing reports are available through Dallas County Department of Health and Human Services, the annual Dallas Hospital District Community Health Checkup, and the Community Assessment of the Community Council of Greater Dallas. Secondary data will be used to identify ambulatory care sensitive conditions (those conditions that if treated early in the outpatient setting may avoid hospitalization), vital statistics and demographics, major health concerns of the population identified through the Behavioral Risk Factor Surveillance System, alternative sources of care, and major causes of morbidity and mortality.
3. A gap analysis will be conducted in the zip codes and census tracks served by the NDSM. Gaps refer to areas where health indicators vary from a standard, or from what might be expected. For all health conditions and concerns for which data are available, the level that the concern or condition is present in the NDSM adult clinic population will be compared to the level it exists in the community in which the patients live. "Gaps" (either positive or negative) will be identified for those concerns or conditions where the NDSM population and community differ from each other. The gap analysis will indicate areas where the NDSM seems to be meeting the expected health need in the community, where it is not meeting the perceived need in the community, and those areas where it may be providing an extraordinary amount of service relative to the expected level of need.
4. A cross-sectional survey of patients using the NDSM will be conducted to validate the findings of the gap analysis. During a two-week period the student will administer a survey to patients accessing the clinic asking them about the needs identified in the gap analysis. The survey will be conducted to determine if the needs identified reflect the patient's experience given what they know about their own health and the health needs of the their family and others living in the community. The survey will also inquire about the possible existence of other health needs not identified in the existing databases and gap analysis.
5. The student and the investigators will compile a comprehensive needs assessment report to be presented to the NDSM staff. The report will contain primarily descriptive statistics such as measures of dispersion and central tendency, with some elementary statistical analysis testing for differences in proportions identified in the gap analysis. The survey data will also be analyzed to test for statistically significant differences in responses based on relevant demographic factors. The purpose of the report will be to assist the staff in identifying areas of unmet health needs and for suggesting methods to develop culturally appropriate interventions. The analysis and report will be suitable for professional presentation , and it is expected that the student will present the results of the studies as part of the UT Southwestern Medical Center Student Research Forum. Additionally, the study results will be submitted for presentation at the Annual Meeting of the Society of Teachers of Family Medicine. The proposed study is expected to require medical student involvement for approximately 8 - 10 weeks to be completed.
Previous Research Activities or Publications with Medical Students:
Dr. DeHaven has participated as a sponsor for numerous medical student projects. Most of these have been funded through the Health Resources and Services Administration (HRSA) and Area Health Education Centers (AHEC). Projects resulted in numerous professional presentations including:
1997 Promoting Access to Community-Based Services Among the Elderly.
1998 Knowledge and Referral Patterns to Geriatric Community Agencies among Health Care Providers in a Family Practice Clinic.
1998 Assessment of Geriatric Depression and Functional Status in an Inner-city Primary Care Clinic.
Related publications with medical students include:
1999 Soltes BS, DeHaven, MJ, and O'Connor PE. Assessment of geriatric depression and functional status in an inner-city primary care clinic. Jacksonville Medicine 50: 306.
1998 Vasquez M, DeHaven MJ. Knowledge and referral patterns of geriatric community
agencies among family health care providers. Jacksonville Medicine 49: 307.
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