PRACTICE IMPROVEMENT WORKBOOK



Practice Improvement Workbook

PHASE I – SITUATION ANALYSIS

Definition: The process that focuses on where the practice is today; this assessment obtains information which will

profile numerous aspects of the School-Based Health Center’s practice on a professional and individualized basis.

Internal Practice Environment Analysis

DEFINITION: A PROFILE OF THE SBHC’S PHYSICIANS, PROVIDERS, DEMOGRAPHICS, SERVICES, CUSTOMERS, AND REVENUE

SOURCES. THIS DATA BECOMES THE STARTING POINT FROM WHERE WE MEASURE THE PRACTICE’S IMPROVEMENT. (PLEASE (SEE DATA SOURCES IN APPENDIX FOR DETAILED DESCRIPTIONS OF EACH SECTION.)

1 A. PHYSICIAN/PROVIDER INFORMATION – “WHO ARE THE PROVIDERS AND AND WHAT ARE THEIR PROFESSIONAL, PRACTICE, AND PERSONAL BACKGROUNDS?”

|Key Factors |Summary |

| | |

|Names of staff members |Kay Fangerow |

| | |

|Positions held/ SBHC role(s) |SPHN, Director SBHC Program |

| | |

|Education and training |BSN, MS |

| | |

|Specialties/ subspecialties |PHN |

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|Credentials/ licensure |RN, PHN |

| | |

|Work experience |Public Health – 30 years |

| | |

|Age/ birth date |51 – 6/27/52 |

| | |

|Marital status/ partner’s name |Divorced |

| | |

|Children/ children’s names and ages |David 24, Sarah 22. |

| | |

|Hobbies/ special interests |Painting – reading. |

B. Physician/Provider Information – “Who are the providers and and what are their professional, practice, and personal backgrounds?”

|Key Factors |Summary |

| | |

|Names of staff members |Susan Strong |

| | |

|Positions held/ SBHC role(s) |N.P |

| | |

|Education and training |Cal State, Dominguez Hills 4 yrs BSN, UCLA MSN, FNP |

| | |

|Specialties/ subspecialties |ICU, RN |

| | |

|Credentials/ licensure |ANCC Family Nurse Practitioner Board Certified |

| | |

|Work experience |ICU – RN 11 yrs. Public Health 8 yrs. |

| | |

|Age/ birth date |52 – 8/11/51 |

| | |

|Marital status/ partner’s name |Married/Larry |

| | |

|Children/ children’s names and ages |Many, age 7 – 30 |

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|Hobbies/ special interests |Family |

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C. Physician/Provider Information – “Who are the providers and and what are their professional, practice, and personal backgrounds?”

|Key Factors |Summary |

| | |

|Names of staff members |Bridget Nagy |

| | |

|Positions held/ SBHC role(s) |Clinic Coordinator |

| |R.N., P.H. Nurse Cert., B.A. of Science in Nursing. Clinical Nurse Specialist and M.A. prog. |

|Education and training |completed, cert/degree pending. |

| | |

| |M/S, Oncology, neonatal Intensive Care Unit |

|Specialties/ subspecialties | |

| | |

|Credentials/ licensure | |

| |21 years nursing. |

|Work experience | |

| |46 – 9/23/57 |

|Age/ birth date | |

| |Married/Bruce |

|Marital status/ partner’s name | |

| |Jeremiah 20, Rosalie 19. |

|Children/ children’s names and ages | |

| |Traveling, reading, music |

|Hobbies/ special interests | |

| | |

| | |

D. PHYSICIAN/PROVIDER INFORMATION – “WHO ARE THE PROVIDERS AND AND WHAT ARE THEIR PROFESSIONAL, PRACTICE, AND PERSONAL BACKGROUNDS?”

|Key Factors |Summary |

| | |

|Names of staff members |Valerie Settje |

| | |

|Positions held/ SBHC role(s) |School Counselor |

| | |

|Education and training |BS- 2000, MS-2004. |

| | |

|Specialties/ subspecialties |Marriage, Family, Child Therapy – Substance abuse. |

| | |

|Credentials/ licensure |Pursuing Licensure |

| | |

|Work experience |10 years counseling |

| | |

|Age/ birth date |43, 9-11-60 |

| | |

|Marital status/ partner’s name |Seperated |

| | |

|Children/ children’s names and ages |None |

| | |

|Hobbies/ special interests |Camping, waterskiing, reading. |

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E. PHYSICIAN/PROVIDER INFORMATION – “WHO ARE THE PROVIDERS AND AND WHAT ARE THEIR PROFESSIONAL, PRACTICE, AND PERSONAL BACKGROUNDS?”

|Key Factors |Summary |

| | |

|Names of staff members |Elvia Gomez |

| | |

|Positions held/ SBHC role(s) |Student Support Service Clerk |

| |Graduated in Mexico, Bilingual Secretary/Account, Interpretor/Translator course, Cal State San |

|Education and training |Bernardino |

| | |

|Specialties/ subspecialties |Multi task worker |

| | |

|Credentials/ licensure |none |

| | |

|Work experience |21 years clerical private/public school system. |

| | |

|Age/ birth date |48, 4/1/56 |

| | |

|Marital status/ partner’s name |Married/Alberto |

| | |

|Children/ children’s names and ages |Oscar 30, Christian 29, Rebecca 15, Vanessa 14 |

| | |

|Hobbies/ special interests |Movies, reading. Love spending time with my husband and children. |

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| | |

F. Physician/Provider Information – “Who are the providers and and what are their professional, practice, and personal backgrounds?”

|Key Factors |Summary |

| | |

|Names of staff members |Mary Grace Gonzalez |

| | |

|Positions held/ SBHC role(s) |Community Liaison |

| | |

|Education and training |AA- Ongoing training |

| | |

|Specialties/ subspecialties |High risk/crisis intervention |

| | |

| |none |

|Credentials/ licensure | |

| |14 years |

|Work experience | |

| | |

|Age/ birth date |56, 5/5/48 |

| | |

|Marital status/ partner’s name |Widow (24 years) |

| | |

|Children/ children’s names and ages |Maria 33, Catherine 28, Cris, 24, Sean 17 |

| | |

| | |

|Hobbies/ special interests | |

Practice Improvement Workbook

INTERNAL PRACTICE ENVIRONMENT ANALYSIS -- (CONTINUED)

1. SBHC PRACTICE/CATCHMENT DEMOGRAPHICS – “WHO ARE THE PROVIDERS AND WHAT ARE THEIR PROFESSIONAL, PRACTICE, AND PERSONAL BACKGROUNDS?”

|Key Factors |Summary |

| | |

|Medical sponsoring organization |San Bernardino County Department of Public Health |

| | |

|Collaborating partners |Adelanto School district |

| |Bilingual Family Counseling Services |

| |Methodist Women’s group |

| |Adelanto Community Resource Center |

| |St. Mary’s Medical Center |

| |Adelanto Community Tool Box |

| |Children’s Network |

| |High Desert Community Collaboration |

| |SBC Department of Behavioral Health |

| | |

| | |

|Parental consent process |SBHC consents are part of the school’s enrollment package. There are signed by parent at |

| |beginning of school year or as children enter school. New consents are not signed each |

| |year. |

| |Immunization consents are provided at time of first appointment. If a child will need |

| |additional immunizations, the parent has the option of signing them all and parent does not |

| |need to be present at next immunization appointment. |

| | |

| | |

| | |

| |The district nurse is on site at WSP 0 - 4 hours per week. She has a total of 12 schools. |

| |There are (3) school district counselors that are shared by the other 11 schools, but do not|

| |come to WSP as we provide MH services. |

|Other school-based health related services (school nurse) |School Psychologist is available for IEP’s only |

| |WSP health aide on site 10:45 – 2:45 each day in the front office |

| | |

| | |

| |Principal – Mr. Sadler will be reassigned August 2004. will have New principal 8-2004. |

| |-Teachers – 26, Educational aides, and instructional aides |

| | |

| | |

| |SST consists of teachers, principal, parent, others |

| | |

|School principal teachers/ other personnel | |

| | |

| |No advisory board |

| | |

| |SBHC board has 9 members. Board meets once a month Sept – June each year. |

|Student support team | |

| |Geographic boundaries of WSP are Highway 395, and lots of desert. School catchment area is |

| |Highway 395 on the East, Mt Shadow – 10 miles north, Rancho Rd – 2 mile south, Chamberlaine |

| |– 15 miles west into the desert |

|SBHC advisory board | |

| | |

|School board support |Primarily poverty level area at WSP – 84% users are 100% and below poverty level. |

| |Population trends of WSP are increasing Hispanic and Black. Neighborhoods are primarily |

| |multi-family apartment dwellings, very poor, unkempt single family homes and trailer parks. |

|Geographic boundaries |In Adelanto city 8.2 % of population are in institutions – as in prison. 62.3% of |

| |households have individuals under age 18. |

| |Data source – 2000 Census, AESD, SBCo demographic reports, SBGC database |

| | |

| | |

| |36% of students are uninsured. 47% are on Medicaid, and most of them are on welfare. Major|

| |employers in the are: state correctional facilities, various small manufacturing plants. |

|Socio-economic boundaries |Data source – 2000 Census, AESD, SBCo demographic reports, SBGC database |

| | |

| | |

| | |

| |School bussing available for children in outlying areas |

| |Public transportation – buses only. |

| | |

| | |

| |Collaborative relationship with St Mary’s. They are our after hours provider, but there is |

| |no fiscal link between us |

| | |

|Economic boundaries | |

| |Dr. Nwagwgu is only MD provider in Adelanto. She is a pediatrician who requires payment at |

| |time of service. She is only provider – at all – in Adelanto |

| | |

| |Demographics for WSP are quite different than Adelanto as a whole. WSP population 650 – |

| |15% White, 20% Black, 60% Hispanic |

| |Adelanto city population 18,100– 50.5% white, 13.1 % Black, 45.8% Hispanic |

| |Data Source: UDS, 2000 Census |

| | |

|Transportation availability before and after school, weekends, summer | |

| | |

| |Only 47.2% of individuals 16 years and over in Adelanto arw in the labor force. 2000 census|

|Hospital affiliations | |

| | |

| |Number of families in Adelanto below poverty level – 21.4 %. With children under age 18 – |

| |25.7%. Families below poverty level with female head of household – 46.2%. 2000 Census |

|Affiliations with primary care and mental health outpatient facilities | |

| | |

| |Most prevalent housing structure in Adelanto are - One unit structures – 67.7%, 20 or more |

| |units – 6.9%, mobile homes – 8.9%.. 2000 Census There has been a lot of new housing |

|Demographics |developments in past couple of years in south Adelanto, but none in the area of WSP. |

| | |

| | |

| | |

| |Adelanto was incorporated in 1969. It used to have its own police force, but recently |

| |started contracting with the SBC sheriffs department for services. In the last nice years |

| |the chief of police and two officers were indicted for various crimes against the city – |

| |separate incidents. They have a very nice Civic Center for which the city manager went to |

| |prison over the graft involved in it’s construction. Data source: newspapers and rumor |

|Labor Market |mill |

| | |

| | |

| |In Adelanto 11,828 individuals are considered work force age. 47.2% are in the work force. |

|Economy |Major occupations are: transportation/moving occupations – 28%, sales – 24.4%, 19.8% |

| |manufacturing, 2000 Census |

| | |

| | |

| |Education of population over 25 years of age: less that 9th grade – 11.5%, 9th to 11th – |

| |21.4%, HS – 29.9%, some college – 26.8%, AA – 5.0%, Bachelor’s – 3.9%, graduate school – |

|Housing |2.0%.. 2000Census |

| | |

| | |

| |Community college 15 miles away in Victorville, State College 40 miles away in San |

| |Bernardino, nearest private University 50+ miles away in Redlands. |

| | |

| | |

| | |

|Government |Most homes have utilities including indoor plumbing, however a few in WSP catchment have |

| |none. |

| | |

| | |

| |In Adelanto 70% of workers drive alone ina car, truck, or van, 21% carpool, .7% use public |

| |transportation, 1.7% walk, 3% have other means (I have no clue what that could be – bike |

| |maybe), 2.7 % work at home. Public Transportation services have greatly improved in past |

| |couple of years – used to have a partime mini-van and now have 4 bus routes that serve |

| |Adelanto and WSP area. 2000 census, bus route flyers |

| | |

| | |

|Employment |There used to be George Air Force Base , but it is closed now. Nearest real air service is |

| |in Ontario airport – 50+ miles from Adelanto. |

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|Education | |

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|Colleges and Universities | |

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|Utilities | |

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|Transportation | |

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|Air Service | |

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Practice Improvement Workbook

INTERNAL PRACTICE ENVIRONMENT ANALYSIS -- (CONTINUED)

2. SERVICE PROFILE – WHAT ARE THE CURRENT SERVICES THAT THE SBHC PROVIDES AND WHAT IS THE UTILIZATION OF THESE SERVICES BY THE PATIENT POPULATION?”

|Key Factors |Summary |

| | |

|Evaluation and management services |Case management – 22 cases per SBHC data base – but know this is inaccurate |

| | |

| |Medical encounters 2003 – 2,325 |

|Well care/ preventive services | |

| |Vision and hearing are part of well child visits |

|Vision and hearing screening | |

| |Mental health encounters 2003 – 1,047 |

|Mental health /behavioral health | |

| |Kids can cook – 25 kids |

|Counseling/ education |Asthma – Open Airways – 7 kids |

| |Hygiene – 100 kids |

| |CPR – 11 kids, 11 adults |

| |Car seat safety - 36 |

| | |

| |None |

|Reproductive health | |

| |Screen only - all kids – 650 |

|Oral health | |

| |Cooking classes – but no dietary services |

|Nutrition/ dietary | |

| |None |

|Procedures/in office surgical services | |

| |None |

|Ancillaries – diagnostic (lab) | |

| |None |

|Ancillaries – non-diagnostic | |

| |None |

|Non-traditional ancillaries | |

| |Department has standard practice procedures that govern practice. |

|Other – Physicians Extenders | |

| | |

Practice Improvement Workbook

INTERNAL PRACTICE ENVIRONMENT ANALYSIS -- (CONTINUED)

3. Customers/Patients Information – “What is the profile of the patient who receives the SBHC’s services, i.e. profile by geography, personal information, and health status?”

|Key Factors |Summary |

| | |

|Number of active/ registered students |797 – 2003 UDS |

| | |

|Patient age analysis |mostly age 5 – 11 |

| | |

|Patient grade analysis |K – 5 |

| | |

|Diagnosis analysis |Per UDS report – 6 asthma, 20 contact derm, 15 otitis, 123 mental disorders 95 immunizations – |

| |see print out for details. 1229 NP visits, 1096 RN visits, 1047 mental health, 871 enabling. – |

| |2003 UDS |

| | |

| |Only one zip for all of Adelanto – 92301 |

|Zip code survey | |

| |See demographics |

|Race | |

| |Male – 49% , female – 51% |

|Sex | |

| |Do not track this |

|Parent/guardian status | |

| |Unable to determine from chart or database |

|Primary care provider status | |

| |Only know if seeing WSP therapist |

|Mental health provider status | |

| |none |

|Status by other key factors | |

| | |

Practice Improvement Workbook

INTERNAL PRACTICE ENVIRONMENT ANALYSIS -- (CONTINUED)

4. CUSTOMERS/PAYORS INFORMATION – “WHAT ARE THE DISTINGUISHING CHARACTERISTICS OF PAYOR GROUPS WHO FINANCE THE DELIVERY OF HEALTH CARE SERVICES TO THE SBHC POPULATIONS?“

|KEY FACTORS (BY PAYOR) |SUMMARY |

| | |

|Payor mix |We don’t really get paid – about $2,000 per year from CHDP or Medi-Cal |

| |None |

|Commercial, number of lives by carrier | |

| |None |

|HMO contracts, number of lives by carrier | |

| |5 – 10 per year |

|Medicaid lives | |

| |None – not a provider |

|CHIP lives | |

| |None |

|Self-Pay lives | |

| |None |

|Medicare lives | |

| |None |

|CHAMPUS lives | |

| |99% of visits |

|Grants | |

| |None |

|Foundations | |

| |None |

|Other funding sources | |

Practice Improvement Workbook

INTERNAL PRACTICE ENVIRONMENT ANALYSIS -- (CONTINUED)

5. SUPPLIERS/REFERRAL INFORMATION – “DESCRIPTION OF THE SBHC’S REFERRAL SYSTEM (INCOMING AND OUTGOING). WHAT DOES THE SBHC’S REFERRAL SYSTEM LOOK LIKE AND HOW DOES IT OPERATE?

|Key Factors |Summary |

| | |

|Incoming | |

|By whom, for what, and how are students referred to the SBHC for services? |Do not track – but most are referred by office |

| | |

|Self | |

|Parents | |

|School nurse | |

|Teachers | |

|Counselors | |

|Principal | |

|Police/ juvenile justice | |

|Other providers or agencies | |

| | |

|Outgoing | |

|To whom, for what services/procedures, what diagnoses, how paid? | |

| |Mental health - for those conditions that cannot be handled at school |

|PCPs |dental disease – class III caries are paid for by state plan for uninsured low income kids. |

|Specialists |Screening are done at school free to all |

|Dentists |Medi-Cal or PMD provider for illnesses that cannot be treated at SBHC. NP’s ”dispense” meds as |

|Mental health counselors |needed for non insured kids. |

|Substance abuse treatment programs | |

|Nutritionists | |

|Laboratories | |

|Health department | |

|Community health center | |

|Hospitals | |

|Other | |

Practice Improvement Workbook

INTERNAL PRACTICE ENVIRONMENT ANALYSIS -- (CONTINUED)

6. REVENUE PROFILE – “WHAT TYPE OF PAYMENT SOURCES CREATE THE SBHC’S REVENUE?”

|Key Factors (By Payor) |Summary |

| | |

|Fee for service or productivity (by number of visits, user) |Do not usually bill – are starting to track as became FQHC and are not required to. Billed |

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