California Health Care Improvement Projects (CHIPs)

Voting is Health: Increasing Civic Engagement Through Health Care Delivery Systems

If voting is a sign of a healthy democracy, we are in need of serious interventions. Voting is a health “thing”. It is the one power citizens have a right to holding democracy accountable. It ensures a right to a healthier life for people and their loved ones. The impact of voting and political decisions touch every part of our daily life, from safety to housing, education, and ultimately, our health. Voting sends a signal of support or dissent for policies that ultimately shape the social determinants of health. Social determinants subsequently influence who votes and who does not. As a physician, we see the bodily impact of inequities that bad policy and law shape everyday within our clinical and healthcare settings. The goal of this project is to operationalize voting program interventions to increase voter participation within and throughout healthcare organizations, especially those who are “othered” and disenfranchised in the voting process.

Building a System of Care Between Prison and Community Health Systems

People returning from incarceration face a myriad of health inequities, including increased emergency department utilization, hospitalization and death. In the first 2 weeks post release, people are 12 times more likely to die than their community counterparts from health conditions that could be treated in the primary care setting (including SUD, cardiovascular disease, mental illness and cancer).

Transitions Clinic Network has 21 affiliated FQHCs in 14 counties across California that have special programs to care for people returning from incarceration. However, no organized system of care coordination exists between state prisons and primary care systems. This CHIP project aimed to leverage the TCN network and existing relationships with the California Department of Corrections and Rehabilitation (CDCR) to create an organized system of continuity of care between state prison and community health systems.

By late spring 2020, COVID-19 was spreading like wildfire across state prisons due to congregate housing and cramped conditions. By fall of 2020, incarcerated people were 5 times more likely to contract COVID. Under community pressure, California state prison officials sought to release tens of thousands of people early to slow the spread of COVID-19 necessitating the immediate creation of care coordination systems.

Provider Accountability for Clinical Performance Metrics by Race

While it’s clear that racism and not race has been determined the driver for racial healthcare disparities, it can be frustrating and feel merely theoretical for providers to realize impactful mitigating efforts. My plan is to provide Provider Scorecards reflecting individualized performance metrics stratified by race as a reminder of provider onus regarding health disparities and alerting them to disparities they may unintentionally perpetuate. The goal would be to create a tangible monitor for unconscious bias.