Student-run clinic grades its own performance

A report card on a student-run free clinic in Fair Haven could be summarized thus: “Provides care comparable to national standards. Needs improvement.” But this report card stands out because it is a peer-reviewed paper authored by some of the clinic’s toughest critics: the Yale students themselves.

The paper, published in the February 2012 Journal of Health Care for the Poor and Underserved, found that the HAVEN clinic delivered preventive care to vulnerable populations at rates comparable to those of clinics nationwide—including professional ones—but fell short of some of its admittedly lofty goals.

“We’re screening at rates comparable to real primary care physicians,” said Lauren Graber, M.D. ’12, a student volunteer and co-author of the study. Graber, who served as a director of the clinic, is planning to pursue family medicine. “There certainly is room for improvement, but we show that students are able to provide a high level of care.”

Students enrolled in Yale’s health professional programs run HAVEN, which opened in 2005 and operates on Saturday mornings at the Fair Haven Community Health Center. It serves uninsured adults, mostly immigrants from Latin America. HAVEN is often their first exposure to the health care system in the United States, said Julia Lubsen, a medical student who is taking a fifth year to serve as co-director of the clinic.

The paper examined the clinic’s performance over a year, measuring its adherence to national screening guidelines for HIV, cholesterol, Pap smears, and blood glucose levels. Forty-two percent of patients were tested for HIV and 63.3 percent had their glucose tested, which didn’t differ from national rates. Among eligible patients, 59.6 percent had their cholesterol levels tested and 54.6 percent got a Pap smear, which were lower than rates nationwide but similar to rates among uninsured patients.

While HAVEN is on par with screening rates nationwide, these numbers fall short of recommendations outlined in Healthy People 2020, a plan launched by the federal government in 2010 to improve the nation’s health. In focusing on achieving the Healthy People 2020 goals, “we were aiming high,” said lead author and medical student Neel Butala. “Nationwide, very few clinics reach them.” Graber called the results “great,” given a patient population that is predominantly Spanish-speaking and has irregular or limited access to health care.

The students don’t plan to rest on their laurels, though, and have implemented a system to screen patients more thoroughly. “Part of what makes working at the clinic fun is just trying to improve it,” said Lubsen.