Increasing access to radiographic imaging for respiratory and musculoskeletal complaints in the medically underserved at four student nurse-run free clinics in southern California

Homelessness has a negative affect on the health of the homeless leading to frequent illness, use of emergency department care at considerably higher rates than people that are sheltered, and increased mortality rates compared to non-homeless persons. In 2010, 9% of hospital admissions in California were attributed to homeless patients that could have been treated in a primary care setting. The primary aim of this grant proposal is to increase access to radiographic serves for the medically underserved patients presenting with musculoskeletal and respiratory chief complaints at each of four student-nurse run free clinics in Southern California. It is hypothesized that increased access to diagnostic imaging and/or radiographic services for respiratory and musculoskeletal complaints, will increase the identification of abnormalities (diagnoses) in patients and will result in decreased emergency department visits and hospitalizations over time. A repeated measures design is proposed in order to evaluate differences between groups and the aggregate outcomes of interest will be measured. The sample group will consist of a consecutive sample size of 24 in each group every 3 months, both male and female with musculoskeletal and/or respiratory abnormalities, and will allow for an acceptable power study of 0.80 for an N-Way and Two-Way Repeated Measures Analysis of Variance, within and between subjects, with an effect size of 0.30 and an alpha level of 0.05. The proposed analysis of data will include an N-Way and Two-Way Analysis of Variance using the F-test as the test statistic to determine the interactions between clinics and time in the project and their relationship to the outcomes of interest.