This month HRSA’s Health Information Technology (IT) website highlights the work of the Association of Asian Pacific Community Health Organization’s (AAPCHO) Enabling Services Accountability Project (ESAP). Health centers often provide a range of non-clinical services, such as financial counseling, housing and food assistance programs, language services, case management and health education. The participating health centers refer to these services as “enabling services” and emphasize their critical importance to support the care received by many low-income and minority patients. Enabling services are key components of the patient-centered medical home and ensure that underserved patients obtain responsive, affordable, and culturally and linguistically appropriate health care. However, the lack of data collected on enabling services makes it challenging for health centers to demonstrate to payers and policymakers the value these services bring. AAPCHO’s utilizes EHR data to evaluate the impact of these enabling services on health care access and outcomes; and uses this information to address health disparities within Asian American, Native Hawaiian, and other Pacific Islander (AA & NHOPI) communities.
Figure 1. A dashboard for the use of enabling services for January 1, 2010 to December 31, 2010. The Dashboard shows the number of services used by month based on enabling service code.
AAPCHO was formed in 1987 by community health centers primarily serving medically underserved Asian Americans, Native Hawaiians, and other Pacific Islanders (AA & NHOPIs), and the community-based health organizations that provide health care and social services to these populations. AAPCHO recently celebrated its 25th anniversary as a national organization advocating on behalf of medically underserved Asian Americans, Native Hawaiians, & other Pacific Islanders and the community health centers that serve them. The organization offers technical assistance and training to promote the establishment and expansion of services for medically underserved AA & NHOPI communities. AAPCHO currently supports twenty-nine health centers and organizations.
AA & NHOPI communities experience disparities in access to care and health status as compared to non-Hispanic Whites. According to the U.S. Census Bureau, over 17% of single-race Asians in the U.S. did not have health insurance coverage in 2009.[i] Additionally, AA & NHOPIs suffer disproportionately from diseases such as tuberculosis, diabetes, hepatitis B, and cancer.[ii] Enabling services seek to increase access to and the effectiveness of care delivered to patients.
AA & NHPOI communities rely heavily on enabling services provided by local community health centers to allow them to access health care services. The health centers participating in AAPCHO’s ESAP use their electronic health record (EHR) data to target and measure the use of these services in clinics that serve AA & NHOPI communities. Capturing this information in the EHR allows health centers to increase their ability to accurately and efficiently track and document the enabling and health care services provided within AA & NHOPI communities. In addition, health centers participating in AAPCHO’s ESAP can use this information to effectively communicate the impact of these programs with policymakers and funders.
Although, the health centers in AAPCHO’s ESAP utilize different EHR systems to document and track enabling services, AAPCHO works with each health center to develop standardized data and customized EHR templates. The standardized data and use of customized EHR templates is important in allowing caseworkers and other staff to document the specific type of enabling services provided and amount of time spent in each encounter. The clinics can use this information to run reports to track service use and the impact of these services on patient care, access and health outcomes.
Figure 2. A quality report for diabetes patients within a subpopulation from January 1, 2007 to February 28,2007. Quality Reports displays HbA1c levels for patients based on ethnicity, birth date, lab date of test, and health center.
Communities can conduct their own customized analyses of their EHR data to evaluate how their services have impacted the populations served. For example, the Pacific Innovation Collaborative Enabling Services project utilizes electronically collected patient health information to determine if the enabling services they provide improve health outcomes for patients living with diabetes. Through an electronic patient monitoring system and decision support tool, clinic and enabling service support staff can readily access a patient’s medical record, as well as review the overall steps and processes required in helping the patient The enabling services and patient data can also provide valuable information, such as the cost and level of resources required to provide services, which can be used to help justify funding of these critical services. Overall, the documentation and examination of enabling services will help improve health outcomes and reduce health disparities for underserved populations at large.
For more information on AAPCHO’s ESAP program please contact Hui Song, MPH at or (510) 272-9536 x119.
[i] U.S. Census Bureau press release. “Income, Poverty, and Health Insurance Coverage in the United States: 2009.” Available at http://www.census.gov/newsroom/releases/archives/income_wealth/cb10-144.html
[ii] AAPCHO mission as cited on website: http://www.aapcho.org/site/aapcho/