RCHC Community Project Abstracts

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Hospitalization of Hospice Patients
Date of project: 3/21/2005

OBJECTIVES: To identify reasons why hospice patients are admitted to the hospital, evaluate what treatments they receive, and identify any violations of hospice philosophy. DESIGN: Retrospective analysis of hospital charts and hospice nursing case notes from 2000 to 2005. SETTING: Newport, OR PARTICIPANTS: Hospitalized patients enrolled in Pacific Communities Hospice prior to hospital admission from 2000 to 2005. MEASUREMENTS: Specific information was gathered on each patient including: hospice admit date, hospice diagnosis, primary insurance, hospital admit date, reason for admission, route of hospital entry, length of hospital stay, treatments and procedures received in the hospital, discharge destination, date of death and place of death. RESULTS: Seven hospice patients were hospitalized between 2000 and 2005. The average age of hospice enrollment was 62 years old. Lung cancer was the most frequent terminal diagnosis. The average length of time from hospice enrollment to hospital admission was 62 days. Out of the 7 patients admitted to the hospital, 3 were admitted for pain control and 2 for seizure control. The average length of stay was 2.5 days. Three of seven patients died during their hospital stay. Various treatments were provided to these patients although one patient received the same care that had been provided at home. Two patients received peripheral IV’s. One patient received a blood transfusion. Two patients had a central line placed and a head CT. CONCLUSION: From reviewing charts of hospitalized hospice patients it appears that each admission was due to symptom management issues. Non-invasive studies performed, including head CT and EKG on 2 patients, were done to aid in symptom relief management. The invasive procedures done, which included blood transfusion and central line placement, were done to provide symptomatic relief in accordance with hospice philosophy.

The Road To Recovery: transportation for radiation oncology patients in Lincoln County
Date of project: 8/9/2004

Traveling daily to radiation oncology centers for therapy is a roadblock in the treatment of some cancer patients from Lincoln County. A group of providers is in the process of making reliable and inexpensive transportation available to these patients. In this attempt, current information on radiation patients and where and how they receive treatment was needed in order to secure funding and garner support for this program. For this project, the necessary state and county cancer data was obtained from the Oregon State Cancer Registry and statistics and information were obtained from the Samaritan Regional Cancer Center (SRCC) regarding Lincoln County radiation patients as well as physician referral data. This information reveals the number of patients and the likely demand for transportation. It also shows that some patients referred for therapy are not receiving the treatment they need at SRCC. It is hoped that providing this information will aid in the process of securing reliable transportation for future radiation oncology patients from Lincoln County.

Trends in Hospital Transfer Rates of AMI Patients at PCH in Newport, OR
Date of project: 8/18/2003

It had been suspected by the medical staff that over the recent few years, more and more Acute Myocardial Infarction (AMI) patients (at Pacific Health Community Hospital in Newport, OR) are being transferred out to care facilities that offer a catheterization/angioplasty lab and tertiary cardiac care, as such is not available in the rural city of Newport. This study shows that there has indeed been a progressive increase in transfer rates of AMI patients out of PCH (32% in 1995 versus 60% in 2002). However, unlike hypothesized, patients presenting to PCH still cannot be offered angioplasty as primary treatment for AMI; additionally, thrombolytics are still readily administered in patients who meet the criteria for thrombolysis. The increase in patient transfer rate is better attributed to the fact that there now exists a tertiary cardiac care facility (Good Samaritan Hospital, Corvallis) in much closer proximity to Newport than ever before. Results from this study suggest that, for those AMI patients seeking initial treatment at PCH in Newport, these two hospitals have been seeking to improve efficiency of optimizing cardiac care in a more sophisticated facility if needed.

Is The Grass Really Greener On The Other Side? A Descriptive Analysis Of The Perception Of Health Care In Newport, OR.
Date of project: 2/10/2003

Rural environments are historically thought of as engendering a strong sense of belonging where the residents support each other both social and financially. However, the residents of Newport do not get all their services from within their community. They frequently venture to the larger cities to buy goods where selection is greater. The present study sought to answer the question whether people in rural communities also seek care locally or go to larger communities, and what their views are regarding the quality of care offered. Methods: Residents within the community were randomly selected to answer a 12 item forced-choice questionnaire to access their overall satisfaction with healthcare in Newport, use of local community resources, and attitude towards access to care in the rural setting. Likewise, a retrospective analysis of the hospital database across all surgical procedures between 1/1/02 - 12/31/02 was performed to evaluate the complication rate at Samaritan Pacific Community Hospital. Results: Interestingly, patient satisfaction was overall very positive. Furthermore, outcomes from the local hospital are comparative to nationally published data. Conclusion: Most residents seek care locally and are very satisfied, yet a prevailing belief that they are at a disadvantage living rurally may continue to undermine rural health in Newport despite the efforts of the healthcare community.

Increasing Access And Affordability Of Prescription Drugs For Medicare Patients In A Rural Health Setting
Date of project: 2/10/2003

Affordable access to prescription medications is a problem for many elderly patients in the United States. For elderly persons living in rural communities the problem seems to be even greater - there seems to be a certain negative synergy between being elderly and living in a rural setting when it comes to drug access. To top it off, rural health clinics lack the typical interdisciplinary teams seen in some urban clinics. By not having a social worker or volunteer who might help patients decipher drug discount programs, health care workers are called to wear many hats, all in a nine-to-five workday. This project aimed to identify what characteristics about elderly rural patients make them vulnerable to decreased access to affordable drugs. The next step attempted to identify what one rural health clinic was doing to increase access. Extensive research was conducted on the available programs for cost savings on prescription drugs. Finally, a revised program was designed to increase access and affordability for patients and hopefully increase efficiency for the health care worker.

Water Fluoridation--Surveying Attitudes of Parents in a Community Water Fluoridated Town Towards Water Fluoridation
Date of project: 9/23/2002

Tooth decay is the most chronic disease of childhood (1). Early studies have shown that water fluoridation (the adjustment of the natural fluoride concentration of fluoride deficient water to the level recommended for optimal dental health) is responsible for a 50-70% reduction in dental caries in children who live in areas with community water fluoridation (2). Despite its effectiveness and ubiquity (over 60% of all public water sources in the US are fluoridated), many people are unaware of the benefits of fluoride and are resistant to its use. This study attempted to determine the attitudes of parents towards fluoride supplementation in a pediatric practice in Newport, Oregon (one of the only cities in Oregon to fluoridate the municipal water supply). Eighty patients were surveyed. Ninety-four percent of patients surveyed supported the use of fluoride to prevent tooth decay, but only 78% wanted it in their water. Almost half of patients living in Newport were unsure whether or not their water source was fluoridated. Almost half of patients living in non-fluoridated surrounding towns were also unsure. Because almost half of the patients surveyed were unsure of the fluoridation status of their hometown, a handout was developed and given to patients in order to provide simple facts about fluoride, including identification of the towns in the area that fluoridate the water supply.

Paying for Prescription Drugs in Newport, Oregon. An analysis of prescription drug expenses and the methods of payment for patients at Pacific Internal Medicine
Date of project: 9/23/2002

Prescription drug costs create a financial burden for many patients nationwide. This study attempts to assess this burden for patients at Samaritan Pacific Internal Medicine (SPIM) of Newport, Oregon. A survey of patients was conducted to examine how they pay for pharmacotherapy (i.e. insurance, out-of-pocket payment, government assistance), the monthly expense of prescription drugs, and what percentage of the patient population believes that prescription drug costs are a barrier to treating their medical conditions. This study also evaluated the methods employed by SPIM to assist their patients in obtaining drugs at discounted rates; this analysis was performed through observation and informal interviews of members of the medical staff. The results of the survey indicate that many do consider the cost of prescription drugs a barrier to healthcare, particularly patients with net monthly incomes below $1500, those paying over $50 per month for prescriptions, and the uninsured. Analysis of office practices to assist patients in managing prescription costs demonstrates that SPIM works diligently to educate patients about opportunities to receive discounted drugs and to assist them with the application process required to receive them.

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