• Health of women in Los Angeles County
  • Women living in poverty 3X more likely to have fair to poor health than women >200%FPL
  • Racial/ethnic disparities
• Barriers to accessing care among uninsured
  • 60% difficulty accessing services
  • 44% w/o regular source of care
  • 42% could not afford it
  • Transportation, child-care, long wait times
  • Language & culture
• Lack of preventive care among 'at risk' women

Source: Women's Health Status and Access to Health Care Services, L.A. Health Los Angeles County Department of Health Services

• Preventive screening provided via a mobile van to underserved women in Los Angeles County
• Services provided at no cost
• 1-3 times a week, usually weekends
• ~ 25 women served per event
• May 2002-September 2006
  • 3,436 women screened
  • 175 sites visited

(image: photo of mobile health clinic van)

• Improve the health of 'at risk' women in Los Angeles County
• Improve access to care
  • Overcome barriers of cost, transportation, childcare, language & culture
  • Establish a regular source of care for women requiring ongoing health care
• Provide preventive health screenings
  • To detect dormant disease at an earlier and preventable stage
• Increase awareness of the importance of prevention

'At risk' women in Los Angeles County

• Uninsured
• <200% FPL
• Live in underserved areas
• Recent immigrants
• Age 40-64 years
• Ethnic groups
  • African American, Armenian, Chinese, Korean, Latina and Vietnamese

(image: photo of two women hugging)

• Comprehensive preventive health assessment
  • Hypertension
  • Diabetes
  • Hyperlipidemia
  • Body Mass Index
  • Breast cancer screening – clinical breast exam
  • Cervical cancer screening
• Preventive health education
  • Chronic disease prevention
• Mobile mammography

• 300 Community Partners
  • Request clinic and provide site for event
  • Recruit women for screenings
  • Publicize event
• Venues
  • Health fairs
  • Community centers
  • Religious institutes
  • Consulates
  • Festivals
  • Adult schools

(image: drawing of flower)

• Patient Resource Workers
  • Community liaisons
  • Schedule appointments
  • Interview clients
    • Patient information
    • Medical history
  • Translate as needed at events
  • Make follow-up appointments after the event
• Clinician & Nurse/Educator
• Serving African American, Armenian, Chinese, Latina, Korean and Vietnamese communities

(image: drawing of five women)

• Conducted by nurse and physician at OWH
• Follow-up appointments scheduled for women with detected abnormalities
• Attempt to establish a medical home for women with any abnormal results
• Results sent to client
• In language satisfaction survey distributed within 1 week of mobile clinic visit

(image: photo of 3 women)

• Demonstrate target population was reached
• Evaluate prevalence of major preventable diseases in an underserved population
• Describe disparities in disease prevalence based on demographics and access to care

(image: an abstract drawing of a woman)

• Questionnaire Design
  • Demoimage: age, zip code, marital status, birthplace, ethnicity, preferred language, FPL
  • Access: insurance status, regular source of care, last physician visit, last preventive screenings
• Clinical outcomes
  • BP, HbA1c, direct LDL, BMI, Pap test, breast exam, GYN exam
• Analysis
  • Chi Square
  • Logistic regression

2,597 women seen at 130 events over 3 years

	MC (n=2,597)	LAC* (n=4,682)
Born outside of the US,%	82.4	43.2
Preferred language other than English,%	75.4	28.9
Ethnicity,%
Caucasian	3.2	35.1
Armenian	7.6	---
African American	12.3	10.3
Asian	35.1	14.9
Latina	41.3	39.7

*Source: 2002-03 Los Angeles County Health Survey

	MC (n=2,597)	LAC* (n=4,682)
Federal Poverty Level (FPL) < 200%	93.8%	49.6%
No health insurance	93.8%	20.8%
No regular source of care	76.9%	15.8%
Last physician visit > 2 yrs	34.0%	---
Last mammogram > 2 yrs (women > 40 yrs)	47.8%	27.2%
Last Pap smear > 3yrs	30.9%	10.7%

* Source: 2002-03 Los Angeles County Health Survey

	High Blood Pressure	Diabetes	High Cholesterol	Abnormal Pap Test	Abnormal Breast Exam
Overall, %	23.1	18.8	26.0	5.3	3.9
White
Caucasian, %	22.1	7.4	21.1	3.2	5.8
Armenian, %	26.7	12.8	45.0*	4.7	1.8
African American, %	28.0*	24.1*	27.6	6.8	2.3
Asian
Chinese, %	18.2	16.9	17.6	3.9	4.2
Korean, %	25.5	14.8	20.7	3.8	1.3
Latina
Mexican, %	20.1	18.6	23.9	4.1	5.1
Central American, %	22.5	28.6*	36.5*	10.6*	6.6

* p<0.05

	Adjusted OR	95% CI	p-value
High Cholesterol
Armenian	4.26	2.93,6.17	0.0001
All others	1.00
Central American	1.48	1.03,2.13	0.0358
All others	1.00
High Blood Pressure
African American	1.47	1.06,2.03	0.0221
All others	1.00
Diabetes
Central American	1.70	1.14,2.52	0.0088
All others	1.00
African American	1.55	1.03,2.31	0.0336
All others	1.00

	Overweight or Obese BMI
Overall, %	56.9
White
Caucasian, %	66.7
Armenian, %	67.0
African American, %	75.4
Asian
Chinese, %	22.7
Korean, %	24.4
Latina
Mexican, %	75.9
Central American, %	79.1

Note: Began calculating in year 2 (data not representative of entire sample; N=1,717 instead of 2,597)

• Reached target population
• Overall rates of disease was high is this population
• Specific ethnic groups were at higher risk for certain diseases
  • Central Americans – diabetes, high cholesterol, abnormal Pap test
  • Armenian – high cholesterol
  • African American – diabetes, high blood pressure

(image: photo of women holding hands in front of the mobile clinic van)

• Builds grassroots connections between the OWH and the women, community and CBOs
• Increases access to care for high-risk women
• Promotes early detection of disease
• Mobile clinic is the first step into ongoing care

• Mobile services are expensive
• Extensive administration and coordination required to work with community partners
• Detecting disease is not enough – getting women to change behaviors is much more difficult

• Shift focus from service delivery to maximizing client education
• Changed to Point-of-Service testing with on-site results
• Further build network of CBOs and partners
• Follow-up survey to determine whether women have established a medical home