RCHC Community Project Abstracts

Back to subject search page or search by preceptor site How effective is dyslipidemia screening in the Peace Harbor Family Medicine Clinic? Project Date: 9/7/2009 This study looks at the prevalence of dyslipidemias in a Family Medicine outpatient clinic in Florence, Oregon. The Peace Health electronic health record was used to identify adults 18 and older with at least one dyslipidemia; lower than recommended for HDL, or higher than recommendations for total cholesterol, LDL, or triglycerides. Medication lists were used to identify those receiving treatment, including omega-3 fatty acid supplements, statins, niacin, fibrates, etc versus those with no cholesterol treatment listed. 86.8% of patients in this population were found to have at least dyslipidemia, and 59.3% of these patients were receiving treatment. A patient handout on dyslipidemias, treatment, and the importance of screening was designed from this information. The Decision To Transition: Paper Charts vs. Electronic Medical Records (EMR) Project Date: 9/7/2009 Choosing to switch from paper charts to electronic medical records (EMR) is a major decision, philosophically and financially, for physicians and clinics. This study attempted to compare and contrast the advantages and disadvantages of paper charts vs. EMR and to identify the attitudes that physicians in Grants Pass, OR have towards these two systems. The methodology for this study was qualitative and an interview approach was utilized. Four physicians were interviewed based upon their time spent using paper charts/EMR and their intention of transitioning to EMR. Physician concerns for transition to EMR included quality of patient care, financial stability, time efficiency and impact on quality of life. Recommendations from physicians currently using EMR were included for health care providers considering the transition from paper charts to EMR. Rural Medicine in the Digital Era Project Date: 8/3/2009 Electronic medical records have been heralded as a cornerstone in the effort to eliminate waste and mistakes in medicine. Yet even today only a quarter of practitioners use EMR. The rates may be even lower in rural areas where practices are generally smaller and run on tighter budgets. This study will help to understand the key barriers to EMR adoption among rural primary care practitioners. Data was collected through formal and informal interviews with providers in Klamath Falls, OR. Through these conversations it became clear that while all of the providers were considering EMR, there were three types of barriers to adoption including financial, investigational and personal barriers. Given these barriers a low cost subscription EMR designed specifically for primary care practitioners would likely be the most beneficial design to encourage adoption of EMR among rural PCPs. Practice Innovation at Dunes Family Health Clinic: Are DFHC patients receptive to the idea of phone and email visits as alternatives to office visits? Project Date: 6/29/2009 Much of the excitement surrounding "Medical Home" style practice transformation involves streamlining patient-doctor interactions to make more appropriate use of time for all parties. One assumption called into question is whether doctor and patient need to physically see each other for a legitimate interaction to take place. If this is no longer the case, then the door is opened for new paradigms of patient visits, namely email and telephone visits. These services are currently scarce, primarily due to lack of reimbursement. But would providers and patients utilize these services even if they were reimbursed? This student sought to gauge patient sentiment at Dunes Family Health Clinic toward the idea of alternative doctor-patient encounters. A sample population of DFHC patients (n=189) completed a survey to answer these questions. The Use of Pre-Printed Order Sets for Inpatient Community Acquired Pneumonia Treatment to Increase Compliance with National Quality Measures in a Rural Hospital Project Date: 8/4/2008 Physician order sets for specific inpatient diagnoses are a potential method to decrease the incidence of medical errors. Computerized physician order entry (CPOE) is the gold standard of order sets and has been shown to decrease adverse events in larger hospitals. However, the cost of implementing CPOE is often financially infeasible for smaller, rural hospitals. An alternative is to CPOE is the use of pre-printed physician order sets for inpatient treatment. This study analyses the use of pre-printed order sets for meeting national quality measures for the treatment of community-acquired pneumonia in a 21 bed rural hospital located in Florence, Oregon. The data set collected was too small to draw any conclusion whether pre-printed order sets increased compliance with national standards. However, the pre-printed order set was used on only 22% (7/32) of pneumonia patients in the study. Increasing physician usage of the order set will be necessary to determine if pre-printed order sets are more effective in achieving national benchmarks. Primary Care in the Digital Age: Developing the next step of quality care delivery using computer resources in Lebanon, Oregon Project Date: 3/17/2008 Rural primary care in the United States faces a set of challenges in the upcoming years, chief among these is the lack of enough primary care providers to support a growing population, as it ages and manifests complications of chronic illnesses related to obesity. Rural areas face the added difficulty of recruiting new doctors, with a net effect of leaving fewer PCPs to care for more patients in rural areas relative to urban areas. This project explores patient and physician perspectives on using the electronic health record and on-line resources to expand and streamline the care given to the Lebanon community within the Samaritan Health System. Using a 10 question online survey administered to patients over a two-week span and discussions with IT, administration, and physicians, I attempted to quantify patient desire and ability to engage more actively in their health maintenance. I also identified several possible future steps towards streamlining the delivery of care and engaged providers to learn the barriers and opportunities to test and integrate such measures. The overall conclusions drawn from these brief surveys were 1) the community may not yet be ready for or interested in deep online participation in their care; 2) several barrier exist both at the technical (software) and administrative levels to quick and agile trials of possible streamlining measures, and 3) despite these two facts, the opportunity exists at little to no initial cost to begin implementing future electronic functions that may likely ease the transition to future clinical advances. Effect Of Computer-Based Patient Record System On Patient Satisfaction In Eugene, Oregon. Project Date: 2/11/2008 Background and objectives: Computer-based patient record system is being increasingly implemented in physician offices. Implementation of electronic medical record changes the work process during the patient encounters. Studies have identified that physicians are concerned about electronic medical record utilization in the exam room negatively impacting physician-patient relations, leading to diminished patient satisfaction. The objective of this study was to determine the effect of computer-based patient record system in the examination room on patient satisfaction one year after implementation of the electronic medical record system when the physician is proficient at utilizing the EMR. The other objective was to determine patient satisfaction with web-based services, particularly secure messaging, lab result reporting, and medication refill requests, and confidentiality. Methods: A survey was given to 50 patients at the end of the visit at a family medicine physician’s clinic in Eugene, Oregon. The survey assessed the following factors: overall patient satisfaction, patient’s perception of the doctor’s proficiency, effect of computers in the exam room, patient satisfaction with patient web portal system, and patient’s concern about the confidentiality. Results: Majority (84% to 86%) of those surveyed rated computers in the exam room as very or somewhat positive in all five aspects of physician-patient communications. 83% to 100% of those who used the web-based services rated the four aspects as very satisfied. Discussion: This study showed that at 1 year after implementation of the electronic medical record system, CBPR in the exam room had a positive effect on all five aspects of physician-patient communications. Majority of the patients were very satisfied with the web services, which is consistent with other studies and adds to the existing data. Use of email in a rural family practice setting: a strategy to meet increasing demand on limited health care resources in John Day, Oregon. Project Date: 2/11/2008 The challenges created by physician shortages in rural communities require creative solutions that maximize available resources. Previous studies have demonstrated that Internet technology such as email, electronic medication refills, and web consults has the potential to improve efficiency and increase productivity among family practice clinics. It has also been shown that a majority of patients use the Internet and are interested in electronic communication with their physician. This study attempted to determine the number of patients in a family practice clinic in rural John Day, Oregon that have access to the Internet and are receptive to emailing with their doctor. Methods included a survey and informal interview of a convenience sample of patients at the clinic about their use of the Internet and attitude toward using this medium to interact with their doctor. Information about gender, age, and place of residence was also recorded. Fifty-nine percent of patients sampled did not use the Internet and were not interested in any form of Internet technology to communicate with their physician. This attitude was found entirely among elderly patients who cited their inability to navigate the web and lack of understanding of its potential benefits as reasons for not using the Internet. This survey showed that patients in John Day do not have enough interest and fluency in Internet technology to make this form of communication a viable option at this time. Quality Assurance at PeaceHealth: Medication Reconciliation as a Priority Patient Safety Goal Project Date: 12/31/2007 Despite the best intentions and hard work of healthcare providers, thousands of patients are harmed across the United States everyday. These instances of medical harm include adverse drug events (ADEs), which are many times the result of incomplete or inaccurate patient medication lists. ADEs can be reduced by implementing improved medication safety, so strategies to achieve this goal are a national patient safety priority. This study attempted to identify the process, successful implementation, and outcome of a medication reconciliation program led by the Medication Oversight Safety Team of the Quality Committee (QC) at PeaceHealth ambulatory clinics in Eugene, Oregon. Because medication reconciliation is a PeaceHealth system-wide initiative, the population studied was all patients seen at PeaceHealth ambulatory clinics across several departments, including internal medicine, family medicine, and pediatrics. The methods included observation of and direct participation in the medication reconciliation process with patients. Formal interviews with the QC chairperson, PeaceHealth healthcare improvement coordinator, and internal medicine clinic front- and back-office staff were conducted. Weekly meetings with the QC chairperson and PeaceHealth quality department manager as well as participation in a QC retreat also contributed to the study. At PeaceHealth, the medication reconciliation process involves a defined series of interactions between patients, clinic staff, and physicians and monthly report of these events to the quality department for an audit. Over the last 9 months, PeaceHealth clinics have on average performed medication reconciliation with 88.5% of their patients, which is just under the set target of 90%. At this stage, the outcome, or actual reduction of ADEs correlated with medication reconciliation, is not being measured at PeaceHealth. Creating a health information library in a coastal community: the never-ending project. Project Date: 12/30/2002 Education continues to be a primary goal of population-based health care. This project begins to address the health education needs of a rural community through the establishment of a patient resource library. Informal interviews and observations, coupled with an internet-based search helped to formulate the two goals of this project: 1) laying the groundwork for a patient resource library with respect to location and physical construction, and 2) assembling examples of and guidelines for creating/selecting effective educational materials. Special attention was given to assessing the readability of existing patient information in light of the large segment of the population with low health literacy. Many well-used handouts were assessed as being written at reading levels exceeding those recommended by professional health educators. However, it may not be advisable to provide only low-literacy information, as this has been found to lead to decreased patient satisfaction. Getting Wired In Klamath Falls. Project Date: 1/2/2002 In the past 12-24 months, electronic communications have begun to be accepted into the world of health care. Currently, 62% of consumers seeking health care information are interested in getting it from their own physician. Over two-thirds of U.S. consumers rate communications with their physician as a primary reason for physician selection. 54% of consumers would switch their physician for the ability to interact online. The Klamath Pediatric Clinic web site was created in August of 2001 as a result of a survey that indicated similar consumer interest in a physician web page. An email system was also set up that allowed patients and their families to access their doctor via email. However, since it's establishment, the site has received few visitors and only one email has been sent through this system in the last 6 months. The intent of this project was to determine why there's a disparity between the initial survey results and actual utilization of the web site. A survey was created which addressed general Internet use, awareness of and interest in the Klamath Pediatric Clinic site, as well as features that would motivate consumers to use the web site. Project goals include determining if and why individuals are not utilizing this resource, determining what features would motivate consumers to use the web site, and utilizing the survey results to direct further action in order to increase overall use of the web site. Survey Results: The majority of responders utilize the Internet at least three times per week. 69% of those surveyed were not aware of the Klamath Pediatric Clinic web site. 62% of desired features are currently offered on the site. 86% of those surveyed are interested in visiting this site. These findings suggest that the reason consumers are not utilizing the Klamath Pediatric Clinic web site is because of lack of awareness. Thus, advertising was increased with the hopes of increasing consumer awareness of the site. Business cards and pamphlets with the web site address were made available in the clinic. A link to the web site was created through the search engine, www.google.com. Surfing Lessons in Klamath Falls? Project Date: 5/6/2002 One third of the US population uses the Internet regularly. One half of these people have used the Internet to look up medical information in the last year. Half of these admit that what they read influenced their decision regarding treatment. There are 26,000 health-related websites as of March 2001. The public needs help in finding quality web pages, evaluating sites for reliability, and discovering the resources that are available. Klamath Falls is a diverse rural population with significant Internet use and poor statistical information regarding individual use and Internet access. In the future, a study to further investigate needs and use would be a great student project, and there are numerous local grants available. For the sake of this project, however, a brochure was created instructing the public where to look for medical information, and how to evaluate what they find. The Use Of Handheld Computers In Clinical Practice: A Comparison Between Urban And Rural Settings. Project Date: 8/13/2001 This study attempted to elucidate the prevalence of handheld computers in primary care practices as well as physician perceptions surrounding the utility of these increasingly common devices. The design is a cross-sectional study conducted with surveys completed by telephone and personal interview. 21 physicians in Ontario, OR and the surrounding area were surveyed, including primary care specialties such as family practice, internal medicine, pediatrics, emergency medicine, and OB/GYN. 29% of physicians used handheld computers in their practice and the average number of years in practice was 9.33. Physicians from both urban and rural settings ranked the importance of handheld computer features very similarly, and the results provide guidelines for furture handheld software and hardware development. Coos Bay Medical Informatics: Physician and Administration Perspectives, Expectations and Assessment of Implementing an Electronic Medical Record. Project Date: 8/13/2001 The exponential expansion of costs in the U.S. health care system are driving the U.S. health care system towards a state of bankruptcy: 15% of the Gross Domestic Product is now being spent on health care. Despite the incredible availability of computers and electronic media, the American Health Care industry still relies mainly on paper to record and transmit information at many key points. The storage, maintenance, and access costs consume more than 40% health care institution budgets and 25% of the health care provider's time. At Indiana University Medical Center, an Electronic Medical Record has been created that contains most patient data (numeric coded test results, drug use, diagnosis, clinic activity, textual reports, and itemized charges) for an urban tax supported teaching hospital, a VA medical center, and their outpatient facilities. This Electronic Medical Record is well connected with the surrounding clinics that feed into the hospital forming a streamlined medical record that is well protected and efficient. Although, the interventions of technology are expensive, a series of carefully controlled clinical trials has shown consistently that by using the EMR, they were able to lower costs by 8-13%. In addition length of hospital stays were shortened by almost a full day, and delays in initiating drug therapy and concurrent drug interaction errors were lowered by one third. In the end of the 16 month randomized controlled clinical trial, involving more than 5000 inpatients, physicians using the workstations in their clinics, generated hospital bills $887, per patient, less than those who used paper charts to write all orders. Given the major advantages, there are still many hidden pitfalls that must be considered before implementing such a system. Some of those that come up, are data security, and data integrity, data safety and data ability. Although all of these concerns are quite valid, proper implementation of data encryption tactics can be used to fulfill the guidelines elucidated by the Health Insurance Portability and Accountability Act (HIPAA). These goals and guidelines are quite similar to those of The Data Protection Act of 1984 seen in the UK. Keeping the aforementioned research in mind, the question of "why" implementation of an electronic data record has been successfully shown time and again. The task of this project, seeks to clearly delineate the Bay Area Hospital and its surrounding clinics' expectations in regard to the incoming computer information system that they wish to implement. In addition and more importantly it strives to elucidate the varying goals between the physician, nurse, and administrative perspective of how such as system can be successfully implemented without breaking a budget of $3.5 million dollars earmarked over the next five years aimed to serve the Coos County patient population. In clear terms this project aims to answer the following questions: 1. What do physicians seek f Increasing Information Accessibility Using Physician Webpages: The Development of the Klamath Pediatric Clinic Webpage Project Date: 7/2/2001 This project sought to address the need for increased access to community and health resources by creating a physician webpage. A webpage was developed for the Klamath Pediatric Clinic after researching available site options and content material. Patients and patients' parents were given an informal questionnaire that asked about Internet use and health topics they would like more information on. Results: 73% of respondents stated that either they or someone in their family used the Internet on a regular basis (defined as usage >1x/month). 70% stated they had at some point used the Internet to look up medical/health information, and 92% said they would use the Internet to look up medical information if they thought it were easily accessible. When asked what community resources they would like more information on, the following results were seen: 20% said mental health; 19% said social services, 17% said family planning; 9% said a specific medical condition; 6% said substance abuse. These results were used to tailor the site's resources and links. Goals the website hopes to accomplish include increasing overall resource accessibility and health information, and more efficient communication between Clinic personnel and patients. The website address is: http://doctor.medscape.com/klamathpediatrics Back to subject search page or search by preceptor site