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Comprehensive healthcare survey identifies gaps, priorities to improve public health in RI

New findings from an extensive survey initiative by the Rhode Island Department of Health (RIDOH) will inform a number of efforts to improve health outcomes and quality of care, while lowering costs in Rhode Island. These include the state's federally funded work to design and test innovative healthcare payment and service delivery reforms and Governor Gina M. Raimondo's initiatives to drive innovation across Rhode Island's entire healthcare system.

"Good data drives good decision-making, and the information we gathered will be invaluable to the state's ongoing work to build healthier communities and help more people make it in Rhode Island," said Nicole Alexander-Scott, MD, MPH, Director of Health. "A statewide inventory of health services and experiences of this scope and at this level of detail is almost unprecedented in the country. Its results will enhance our work to address the underlying social and environmental determinants of health, ensure access to quality healthcare for all Rhode Islanders, and eliminate the disparities in health outcomes that we see between different populations throughout our state."

"Understanding the current healthcare landscape in Rhode Island will be critical as we look to shift our entire healthcare industry towards a structure that rewards better outcomes and coordination, and healthier communities," said Health and Human Services Secretary Elizabeth Roberts. "There are many promising initiatives in Rhode Island that will benefit from such a robust data source, and I look forward to collaborating across state government as we use the data to inform our shared mission of keeping people healthier, at a lower cost."

Among the key findings of the statewide survey, called the RIDOH 2015 Statewide Health Inventory for its comprehensive outreach to Rhode Island healthcare practices and facilities and ability to serve as the basis for statewide health planning efforts, are data that show: The number of primary care physicians is 10 percent less than national standards for adequate access to care. Limited data exist at practices and facilities on the races, ethnicities, and language needs of patients. Nearly one-third (31 percent) of Rhode Islanders delayed or put off medical care because of cost, and almost half (47 percent) of these Rhode Islanders became sicker before receiving care. Roughly half (51 percent) of assisted living residences are not accepting new Medicaid patients. Only 32 percent of behavioral health clinics use community support teams or community health workers to help with patient navigation.

The inventory includes recommendations to address the key findings, such as focusing efforts on recruitment and retention of primary care physicians and standardizing data collection on race, ethnicity, and language to help facilities better address the needs of patients. The expansion of community health workers and community health teams would also help address the needs of patients, including the need to be able to confidently navigate the healthcare system in Rhode Island.

Many of the recommendations align with, and reinforce, the goals of Raimondo's initiatives to drive better outcomes and quality and lower costs across Rhode Island's entire healthcare system, including the publicly funded Medicaid program. These include identifying strategies to address cost barriers that prevent patients from receiving needed care in a timely fashion, and adopting strategies to improve access to community-based living arrangements for seniors, such as assisted living residences.

To collect data for the Inventory, RIDOH sent a series of surveys to healthcare facilities and practices in Rhode Island, ranging from primary care practices to long-term care facilities to hospitals. Additionally, community members were surveyed about their experiences with the healthcare system in Rhode Island.

The response rate for almost all of the surveys exceeded 90%. For the surveys sent to nursing facilities, hospitals, ambulatory surgery centers, dialysis centers, and MRI imaging centers, RIDOH collected responses from 100% of the facilities in the state.

The surveys that healthcare practices and facilities received included questions on the number of patients served, services and treatments provided, patient demographics, languages spoken by patients, hours of operation, insurance, and accessibility.

As part of Rhode Island's State Innovation Model initiative, survey findings and recommendations will be used to develop a statewide population health and behavioral health plan. The federally funded initiative charges states with using comprehensive data assessments to design and test innovative, multi-payer healthcare delivery and payment systems.

Inventory findings will also help RIDOH develop policies that best meet the health needs of Rhode Islanders and support the Certificate of Need process in Rhode Island. The Certificate of Need Process is a system in place to ensure that healthcare facility construction and expansion plans meet the actual needs of Rhode Island patients.

The inventory was the result of the 2014 Rhode Island Access to Medical Technology and Innovation Act, which required RIDOH to establish and maintain an inventory of healthcare facilities and services, with data on the location, distribution, and nature of the state's healthcare resources.

The results from the RIDOH 2015 Statewide Health Inventory are available online.

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