While an accurate understanding of available resources is crucial to public health planning efforts, the size and complexity of the health care system in the U.S. makes estimating service capacity difficult. Due to time and cost restraints, capacity estimations often rely solely on licensure databases or an extrapolation from a sampling of practices and do not aim to aggregate information collected from all health practices and providers in a given area. Fortunately, meaningful estimates of health system capacity have recently become a top priority for state officials in Rhode Island. In 2014, the Rhode Island State Legislature mandated that a rigorous statewide healthcare utilization and capacity study take place every two years (§ 23-93-5).
On November 1st 2015, the Rhode Island Department of Health completed a year-long effort to fulfill this mandate and collect utilization and capacity information from every health clinic, practice, and center in the state of Rhode Island. Using detailed surveys, they asked clinical sites across twelve categories (e.g. Primary Care, Behavioral Health, Hospitals, and Nursing Homes) to report on a wide variety program characteristics. The surveys included questions on hours of operation, number of patients seen in a year, patient demographics, accepted insurance types, use of technology, types of procedures performed, types of providers employed, number of full-time-equivalents (FTEs) for each provider type, and many others. Incredibly, the response rate for most of the 12 surveys was above 90%.
JSI assisted in cleaning, analyzing, and interpreting this large dataset in September and October of 2015, providing tables, graphs, maps, and text to be included in the department’s final report. The tables, graphs, and text summarized the survey results and the maps showed the location of each clinical site alongside demographic information (e.g. race, income, age, education) of Rhode Island cities, towns, and select neighborhoods. JSI is also in the process of creating a dynamic online mapping tool that would make this information easily accessible and customizable for different audiences.
From this analysis, the Department of Health highlighted a number of key findings:
- The “number of full-time equivalents of primary care physicians is up to 40% lower than previous estimates and is about 10% less than national standards for adequate access to care.”
- “Limited data exists across practices and facilities regarding race, ethnicity and primary languages of patients, as well as a lack of appropriate interpreter services at many healthcare facilities and practices.”
- As the state’s “reinventing Medicaid initiative seeks to expand access to community-based settings for long-term care, 51% of assisted living residences reported they are not accepting new Medicaid patients.”
- “Financial barriers, such as high co-pays and deductibles, may be preventing Rhode Islanders from receiving the care they need when they get sick.”
(Rhode Island Department of Health 2015 Statewide Health Inventory: Utilization and Capacity Study, Executive Summary).
Already, these findings have informed a series of recommendations to advance the system of care in Rhode Island. You can read about these recommendations, along with the study’s other findings, in the publically-available full report. We look forward to seeing this study used to improve the health and wellbeing of Rhode Islanders across the state.