Healthcare on wheels: Using mobile clinics to reach children all over Houston

Almost 12% of all children in Houston are uninsured or have never seen a healthcare provider, but a mobile healthcare program at Baylor and Texas Children’s Hospital aims to address the needs of the medically underserved.

One way we measure the social determinants of health for children is through the Childhood Opportunity Index (COI), which measures and maps the quality of resources and conditions for childhood development. COI 2.0 combines data from 29 neighborhood-level indicators into a single composite measure that is available for almost all U.S. neighborhoods (about 72,000 census tracts).  The COI’s 29 indicators cover education, health and environment, and social and economic factors. The score is assigned from 0-100, with 100 representing the child with the highest opportunity to succeed in health.

The COI ratings include very low, low, moderate, high, and very high. Houston’s overall COI is 40, which is 10 points lower than the average COI of the largest 100 cities in the U.S.

The Texas Children’s Mobile Clinic Program (TC-MCP) was created to provide comprehensive healthcare and preventive education to underserved children in the Houston area. We travel Monday through Saturday, all over the greater Houston area, caring for children from infancy to 18 years of age. Our free services include immunizations, well-child visits, sick visits, telehealth, on-site pharmacy and lab, social determinants of health screenings, a lifestyle modification program and a latent tuberculosis infection program.

The TC-MCP providers standing in front of the TCH fleet of mobile clinics. From L to R: Lynda Chima Aririguzo, MD, MPH, Cassandra Duran, DNP, RN, FNP-BC, Sanghamitra M. Misra, MD, MEd, Aditi Gupta, DO, and Norma I. Castillo, APRN, FNP-C

We recently analyzed all patients seen on our TC-MCP from January to December 2022 and found that among 5,440 patients, 50% were female, and 79% were Hispanic/Latino.

The overall COI, using census tract data and nationally normed values, showed that 75% of our patients come from very low or low COI; 14% had a moderate COI rating, and 11% measured high and very high on COI. We are now purposefully adjusting our clinic site locations to reach Houston areas with the lowest COI in hopes of reaching children who need our help the most.

So, what is the future of mobile healthcare? Mobile healthcare has proven to be a valuable resource and will continue to expand. Experts estimate that the number of mobile health clinics in the U.S. has increased well above 2,000 since 2019, in part due to the COVID-19 pandemic, which resulted in the rapid incorporation of mobile COVID vaccinations and testing units. In addition, organizations such as Doctors for America focused on reaching under-resourced communities with mobile units in urban and rural settings. The Mobile Healthcare Association is working diligently with the U.S. government to help mobile health programs across the country improve policies around mobile healthcare specifics such as billing.

Creating and supporting mobile programs is just the right thing to do. Return on investment (ROI) models like this one on pediatric mobile asthma treatment can prove that mobile programs are worth every dime spent to run them. By adapting the Harvard mobile health ROI model to our unique pediatrics program at Texas Children’s Hospital, we can demonstrate that annually, our direct cost saved is more than $1 million, and our societal cost saved is more than $6 million. It is clear that all medical systems should incorporate mobile clinics to improve access to care for all. The long-term success of mobile programs requires mission-oriented leadership, a diversified funding stream, community partnerships and outreach and focused clinic and impact statistics.

By Dr. Sanghamitra Misra, professor of pediatrics, Baylor College of Medicine, and medical director, Texas Children’s Hospital’s Mobile Clinic Program




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