In November 2023 I wrote an article on how the Los Angeles Network for Improved Services (LAES), a qualified and non -profit health information organization (QHIO), provided data in support of several street medicine programs. That work has become even more important during the current relief of forest fires. During a recent web seminar, the leaders of the Callejera Medico program and Callejera Healthcare In Action spokes on their collaboration.
Lanese medical director Ali Zadeh, MD, said the organization has been working with the Los Angeles County Public Health Department, in efforts to help people who have been affected by forest fires. «Lanes has been very involved with the support of the evacuation center,» he said. “We provide public health nurses access to patient information to help them order and refill the recipes for people who have been affected and who have lost their livelihoods, their medications and other things as part of the fires forestry. We have also been part of an analysis that is being carried out in DPH, which currently evaluates the impacts on the health of forest fires. «
Lanes is supporting the effort to provide data on hospital visits and outpatient patients of the emergency department that are related to asthma and cardiovascular conditions that would be affected by this type of forest fire activity, he explained.
Zadeh then presented Sonali Saluja, MD, MPH, vice president of Medical Director of Health and Medical of the population in Action, where it supervises clinical teams and directs research and evaluation efforts. He previously served as directly from the Family Center for Science and Innovation of Gehr’s health systems at the Keck School of Medicine of the USC, where she was an assistant professor of Clinical Medicine and Hospitalist at the LAC+USC Medical Center.
In his presentation, he emphasized that medical care in action is an almost completely mobile organization that takes care of homeless patients and institably hosted. Its mission is to improve the lives of people who experience the lack of housing through holistic and high quality care. Saluja said the organization complies with its patients, where both are literally and figuratively to provide medical and social services. “When I say that we literally know our patients where they are, we will go to them, whether they are in tents, recreational vehicles, under the underground steps, whatever. When I say that we know them figuratively, what I am really talking about is to need them to achieve shared objectives about housing and health. That has really been such a positive experience for me as a doctor who works with patients. It has really been a gratifying dynamic of patient and supplier. «
Medical care in action has 19 teams in six counties in California. From each truck, they can do medical attention, home care and navigation coordination. From the side of medical care, they generally have an advanced practice provider, such as an AP or an NP, as well as a medical assistant, RN or LVN. The care offered ranges, from primary care and management of chronic diseases to OB/Gyn, addiction/mental health care, even acute care for patients who wish to avoid going to the emergency or urgent service.
“It is important to say that we really provide attention based on the team. We are all in close communication between us, and I think it really works well because we are part of the same organization, ”he said.
«From an care coordination perspective, we have between three and five browsers in pairs per team, and this is really the muscle of our team,» Saluja said. “Many of them have lived the experience themselves, either homeless or have fought with addiction in the past. They do everything from organizing transport, going to appointments with patients, getting food and clothing from our patients and hooking them with all kinds of different services. And they really help generate trust with our patients. They do motivational interviews to change health behaviors. Then they are incredibly invaluable, and I would say that the muscle and the heart of our team. «
The organization also has housing browsers, which can navigate the homeless people management information system so that patients connect to the correct resources. They obtain funds through Cal-A and for housing and rental deposits. In 2024 they improved the housing status of 949 patients and 279 of them, they could help support permanent homes.
Highlighting some results, Saluja said that medical care in action diagnosed 715 patients with hypertension in the last six months, and 84% receive treatment, compared to a national average of only 63% in regards to mental illnesses, They have diagnosed more than 1,100 patients with mental illness and 61% are in a prescribed treatment, compared to 47% of adults with mental illnesses they receive national treatment.
«Our data does not include therapy, so it is probably an underestimation, and we hope to incorporate it into the future,» Saluja said. «And we have 106 patients who are taking injectable and injectable antipsychotic medications, which we find that they are really a stabilizing force for many of our patients with serious mental illnesses.»
Saluja added that patients do not take into account, they have much more access to care, and the attention they receive is highly fragmented. «That is why having a tool like lanes is so critical and important for our ability to take care of our patients.» The Medical Registry based in Cedars-Sinai they use, called CS-Link, is integrated with lanes.
For a recent patient contest, Saluja described to quickly get the medications from this patient and see that a lot of medications were recently prescribed, “which, for me, tells me that this patient has probably heart failure and/or liver disease . They are also in advance. I am very worried about the fact that they have many comorbid conditions. I can get your summary discharged and very well, at the end of your high summary, it tells us about the problems to address in the outpatient environment of this patient.
“Without lanes, we would be starting from the square one. We would probably have had to double many of the exams and diagnoses that I already had, which would be expensive, would lead to care for care, ”said Saluja.
“Another thing that the lanes offer, especially with the integration into our EMR, are the alerts about the income of our patients. This allows us to reach hospitals and EDS to verify our patients. We can actually call the hospital and say: ‘Hey, before he leaves the patient, let us know. We can help prepare. We can talk to our patients while they are in the hospital, even visit them there, what we do quite frequently. Now we can also prepare for the discharge of our patients with medications, wound care, follow -up visits. It has really led many much more soft care transitions. ”
Saluja ended up sharing part of medical care in the challenges of action and the possible solutions he is exploring. “We have difficulty finding patients. We are exploring new types of monitoring devices that patients are often very excited about acceptance, but they don’t always work. »
They also have challenges with low adhesion rates to medicines. “But we are working with pharmacies that now deliver directly to patients. We have limited access to technology in the field. Lanes has a mobile and friendly version that we have been using, and we are very excited by the next lanate patient passport, ”he said. “We have challenges with the continuity of care, but we are associating with organizations throughout patient care and other street medicine organizations. And finally, we are looking for more sustainability and exploring things like the payment rates of street medicine to help us do it. ”
