How AHCH Uses Data to Optimize Impact on Outreach

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Data Collection holds us accountable to our clients, our community, and to you. 

According to the 2023 Point in Time Count Report, homelessness in Albuquerque has grown by 83% in just one year. Due to several barriers to care, providing high-quality and continuous care to this population has historically been challenging.
More than ever, provider organizations need a systematic method to capture the needs of people experiencing homelessness, as well as evaluate the effectiveness and accessibility of services provided.

This is why AHCH is investing in evaluating the implementation and impact of its Integrated Health Outreach (IHO) model.

After spending much of 2023 refining our data collection strategy, we are excited about the possibilities that are coming to better demonstrate the effectiveness of our integrated health outreach model. 

Why do we collect data?

    Collecting and analyzing data on outreach is vital to making sure that AHCH continues to have an impact. It helps us be accountable to our community and our funders by ensuring that their support is not wasted on ineffective efforts. It also helps us be accountable to our clients and the communities we serve by ensuring that 1) we are providing services that match the stated need and 2) we are equitably servicing our designated service area. Data is also really important to help build evidence that the AHCH model works and continues to demonstrate a measurable and sustainable impact. 

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Heat Map of AHCH Integrated Health Outreach, July 2023 to May 2024

What kind of Data does AHCH Collect?

One of the ways we collect data is through client experience surveys. Incorporating client voices is central to AHCH’s Philosophies of Care. True to the Patient Centered Medical Home model, promoting client input to guide clinical practice helps reduce health inequities, encourage continued health seeking behaviors, increase self-efficacy, as well as improve client health outcomes. This also helps minimize waste and match the services provided to what client's needs are/what they ask for in the field. 

Also, as a Federally Qualified Health Center, we are required to report health impact and demographics through the Uniform Data System. We collect data on several metrics of the client population to report to the U.S. Health Resources and Services Administration (HRSA), such as ethnicity, gender, veteran status—as well as Cancer screenings, HIV, weight and tobacco counseling, depression screening, and homeless status. This helps us see in real time what the health needs are of this vulnerable community.

Finally, we collect data on where the need is. For example, the visual below is a heat map of areas where integrated health outreach was provided during the last 12 months. This data is key to helping us visualize where the need is and also evaluate if there are gaps in our outreach efforts. It's also really useful for our other outreach community partners as well. 

What do we do with the data afterwards?

Well, the key purpose of data is to evaluate and improve! We are constantly innovating and rising to meet the needs of people experiencing homelessness. 

    But also, as a leader in Integrated Health Outreach (IHO), AHCH can influence community decision-making. By refining data collection, evaluating for equity and accessibility, and sharing findings about the impact of outreach on health outcomes, we can amplify our evidence-based model of care to improve continuity and collaboration across the health care system. We do this through building community partnerships, engaging allies with strong public influence, and presenting findings at conferences, workshops, and trainings.

 One exciting new update is that we have partnered with the MolinaCares Accord to demonstrate the value of AHCH’s IHO and lay the groundwork for establishing a long-term, sustainable funding model for addressing the healthcare needs of people experiencing homelessness. Learnings from this MolinaCares grant project can play a critical role in the care for this population, helping individuals transition from living unsheltered in the streets to ending their homelessness and finding a primary care home.

Stay tuned, as we will release more information on this exciting partnership soon!

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