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“We want the clinics to be places that are providing high-quality care across the life span.”
WITH THE NUMBER OF OLDER ADULTS IN THE U.S. expected to double by 2050, public health strategies to reduce premature death and disability from cancer, heart disease, flu, pneumonia and other conditions that disproportionately affect the older-adult population have taken on added urgency.
“In public health our goal is to keep people healthy longer, and we know that prevention and early detection through immunizations and screenings are critical strategies for doing that in the older population,” says Dr. Steven P. Wallace, professor and chair of the Fielding School’s Department of Community Health Sciences and associate director of the FSPH-based UCLA Center for Health Policy Research. “We also know, given current population trends, that unless we increase the use of preventive services the number of people with these conditions will rise sharply, which will be a huge burden on both the population and the health care system.”
Wallace notes that many older adults aren’t receiving the full set of recommended clinical preventive services (CPS). Utilization rates are particularly low among older African-Americans and Latinos, two groups that are aging even faster than the overall population. The number of African-American elders is projected to triple by 2050, and the population of Latino elders is projected to increase by a factor of six.
The Healthy Aging Partnerships in Prevention Initiative (HAPPI) aims to increase CPS use among low-income African-Americans and Latinos 50 and older in Los Angeles. An academic-community partnership that includes the UCLA Center for Health Policy Research, the Southside Coalition of Community Health Centers, the Los Angeles County Department of Public Health and the City of Los Angeles Department of Aging, HAPPI is one of 10 new and innovative community health programs funded by the U.S. Department of Health and Human Services’ National Prevention Partnership Awards Program. As the only program focusing on older adults, HAPPI is being closely watched as a potential model for improving older-adult health in low-income communities across the country.
HAPPI has set out to improve the ability of eight federally qualified health centers (FQHCs) in South Los Angeles to promote and deliver CPS to their predominantly African-American and Latino patients 50 and older. The initiative focuses on six CPS that the U.S. Centers for Disease Control and Prevention (CDC) has prioritized based on evidence of their public health impact in preventing disease and saving lives at a relatively low cost. These include screenings for colorectal, breast and cervical cancer; cholesterol screening; and immunizations for flu and pneumonia. Nationally, use of these services is well below goals set by the CDC’s Healthy People 2020 recommendations, particularly among African-Americans and Latinos.
Currently in its second year, HAPPI seeks to address these disparities through tailored strategies at the participating clinics that include education, training and technical assistance. To complement the work with FQHCs – federally funded community health centers that serve low-income patients – HAPPI is engaging community-based organizations in South Los Angeles to assist the clinics by increasing awareness and promoting the use of CPS among older adults.
“Historically, community health centers have done an excellent job providing care to children and their parents, but haven’t developed the expertise in caring for an older population,” says Nina Vaccaro, executive director of the Southside Coalition of Community Health Centers, a network of eight FQHCs representing more than 45 community- and school-based health clinics in South Los Angeles that are participating in HAPPI.
Vaccaro explains that 50-and-older adults have made up a small portion of the patient population at community clinics in the past, but the numbers are increasing; moreover, to receive government funding, FQHCs are held accountable for the quality of the care they provide, and are under greater pressure to meet the needs of the over-50 population. “We want the clinics to be places that are welcoming and providing high-quality care across the life span,” Vaccaro says. “HAPPI is an opportunity to address the needs of older low-income patients in a more targeted way.”
As the academic arm of the partnership, the UCLA Center for Health Policy Research team headed by Wallace is working with the community clinics to assess areas of need and identify strategies for increasing CPS use. Training sessions are being held with clinic staff to raise awareness and orientation to the services, and Wallace’s group has begun working with the community organizations to promote the services and forge partnerships with the clinics.
“Part of our goal in working with the clinics is to make sure we’re developing approaches that will be financially sustainable so that they will be able to institutionalize these projects after the pilot phase is over,” Wallace says. “Our role is to provide knowledge and resources. The clinics take that information and determine, based on their day-to-day realities, what will work best, and then we help them implement what they decide to do and assist with the evaluation.”
At South Central Family Health Center, an FQHC providing care to approximately 20,000 low-income patients at five sites in South Los Angeles, the HAPPI team has trained and offered continuing medical education presentations for providers, as well as working with the staff to identify and implement effective strategies to increase screening rates for colorectal and cervical cancer, which the center identified as top priorities. Wallace’s team has shared data on approaches that other clinics have implemented successfully; as a result, says Dr. Brendan Mull, South Central Family Health Center’s quality improvement director and disease management supervisor, the center’s providers have begun bundling services. “When a patient comes in for a flu shot, we will offer a colorectal cancer screening kit to take home,” he says. “When a woman comes in for a mammogram, we will offer her a Pap smear at the same appointment.”
Prior to HAPPI, Wallace’s team surveyed public health departments, aging-service providers, and community health centers to identify more than a dozen strategies that have proven to be effective in increasing uptake with multiple CPS and involving community partners, particularly with low-income populations. At each of the participating clinics HAPPI has also identified a champion – someone on the staff who is empowered by the medical director to conduct quality assurance activities designed to improve CPS rates. HAPPI is also working with community organizations to implement evidence-based strategies to increase awareness and use of the clinic services.
“Past efforts to increase clinical preventive services have focused on either clinics or community organizations, and we want to bring the two together,” says Peggy Toy, director of the UCLA Center for Health Policy Research’s Health DATA (Data, Advocacy, Training, Assistance) program, who is working closely with the community partners as HAPPI project director. “We believe this is a partnership that benefits both sides, and most importantly one that can improve the health of the older-adult population.”