RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Educating the Future Project Date: 2/9/2009 From a health care perspective, one of the most difficult tasks in a rural setting is recruiting new physicians to the area. Grants Pass has a population around 30,000 with a wide variety of specialists to serve the population. The problem: physicians are aging and there isn't anyone willing to replace them. It has gotten so bad that the general surgeons are threatening to cut weekend call all together. The greatest hope lies in the community's youth who are likely to return to their hometown upon completion of their training. I was invited to Grants Pass High School to teach the students in the advanced medical skills class how I became interested in medicine, what I did to get into medical school and what life in school is like. It was my goal to demonstrate how much fun medicine is, and how they can go about getting into medical school. To show how much fun it is, I used hypothetical trauma scenarios and asked them what to do. The next day, I brought in 12 pigs feet along with suture material and taught them how to suture using sterile techniques. Through this process, I learned how a physician is not solely a healer, but an educator as well. It is a physician's duty to educate the community. I used the classroom to educate students about medicine, and it was clear that more than a couple of interests were sparked. Utilization of the Emergency Medical Systems for Transfer of Patients to Portland Hospitals at the OHSU Family Medicine Clinic in Scappoose. Project Date: 9/10/2007 Rural health clinics serve a vital role in providing health care to areas where there are often few options; providers in these areas must often perform a greater variety of procedures with fewer resources than might be desirable. However, there are occasions when a patient must be transported to a hospital where additional resources required for his/her care are available. Scappoose, Oregon is located roughly 20 miles north of the nearest hospitals which are found in Portland. The Emergency Medical Systems and Fire Department of Scappoose are responsible for providing emergency response for a 100 square mile area as well as transferring patients from the OHSU family medicine clinic to Portland hospitals whenever the need arises. The Scappoose EMS consists of three ambulances, three career firemen, and any available volunteers. To better evaluate the utilization of the EMS for patient transfer of the Scappoose Family Medicine clinic, a thorough form for recording that data into a centralized record has been created. Proposal to the Paiute Indians of Burns, Oregon Project Date: 8/6/2007 While doing my clerkship in Burns, Oregon we encountered several cases of MRSA in patients, some of which required hospitalization to receive IV vancomycin. I did a chart review of all patients at HDMC that had been diagnosed with IC9 codes reflecting MRSA, cellulitis, and skin abscesses to determine the incidence of MRSA. We noted a 4.7% incidence from July 2007 to August 2007 of CA-MRSA in Paiute Tribal Members living on the reservation north of Burns. During the same period of time there was a 0.1% incidence of CA-MRSA among non Native American patients seen at the High Desert Medical Center (HDMC) in Burns. Previous annual incidences were between 0.23% and 0.33%. A literature search was then performed, and a proposal was written and submitted to the Paiute Indian Tribe to do nasal swabbing to determine the incidence of MRSA. An educational brochure was also created to be distributed to Tribal Members to help them decrease their chances of becoming infected and potentially hospitalized from MRSA. Proposal for the implementation of a vision screening protocol in the clinical practice of Dunes Family Health Care, Reedsport, OR Project Date: 10/16/2006 Vision problems impact patients of all age. Impaired vision affects 10 to 15 percent of preschoolers. It is also a common problem among older adults and has been identified as an independent risk factor associated with increased risks of falls and potential fractures in this population. Routine vision screening in the general population can lead to earlier detection of poor vision and appropriate referrals to prevent or reduce vision-related disabilities. A comprehensive literature review was conducted to summarize recommendations on vision screening in the general population. Sources include the USPSTF, AAFP, AAO, AAP, and the NIH. A protocol was then designed to implement, in time-efficient manner, the recommended vision screening tools and tests. The proposal was presented to the family practioners of Dunes Family Health Care in hopes of persuading the adoption of the protocol to improve the detection of vision impairments in the patient population. The Development of a Systematic Approach to Mental Health Evaluations at Treasure Valley Pediatric Clinic in Ontario, OR Project Date: 9/11/2006 Treasure Valley Pediatric Clinic (TVPC) in Ontario, Oregon has a significant number of patients that are seen for mental health care with ADHD accounting for the majority of these cases. The clinic has a total patient population of approximately 5600 patients and 204 (3.6%) patients have a diagnosis of ADHD. Other common mental health issues seen at the clinic include depression (129 patients), anxiety (51 patients), and autism (25 patients). With a staff that includes one pediatrician, two physician’s assistants, two counselors, and a registered nurse that acts as a care coordinator, TVPC is well-equipped to meet the mental health needs of its patients, but it lacks a unified approach to the initial evaluation of these patients. The goal of this project was to learn more about how initial mental health evaluations are performed at the TVPC and to work with the various healthcare providers at the clinic to develop a unified approach to these evaluations. The final product of this project was the development of a protocol for initial evaluation of patients with possible ADHD and other mental health concerns. Medical Management of Chest Pain in John Day, Oregon: Development of a Standing Order Form. Project Date: 9/11/2006 I was able to create a standard admission form that is clear in its wording, directs physicians and nurses towards up-to-date diagnostic testing and treatment strategies. Based on my interviews with the physicians, nurses, and ancillary healthcare professionals practicing at the Blue Mountain Hospital, this form will be useful and used by the physicians there. This has the potential to positively impact not only physicians and staff at Blue Mountain Hospital, but also its patients as studies have shown that effective standardized orders lead to more consistent and higher quality care. As chest pain is one of the most common diagnoses in hospitals across the nation, my form has the potential to make a sizable impact in the John Day and Grant County community. Streamlining and Clarification of Alcohol Withdrawal Standing Orders at Harney District Hospital Project Date: 7/3/2006 Harney District Hospital (HDH) administration and medical staff were interested in providing better care for their patients experiencing alcohol withdrawal by revising their current alcohol withdrawal orders and educating their staff. In the recent past they had some increased morbidity from unrecognized alcohol withdrawal that the staff and administration found unacceptable. A comparison of alcohol withdrawal orders from HDH and a larger Portland-area trauma one emergency department revealed some improvements that could be made to help minimize confusion and aid in earlier recognition of alcohol withdrawal syndrome (AWS). Some improvements were addressed in a revision of the current orders that is under submission for the next medical staff meeting at HDH. As a second area of improvement, an in-service was given for HDH nursing staff on alcohol withdrawal syndrome and the proposed revision of the alcohol withdrawal orders. The in-service consisted of a a 30-45 minute PowerPoint presentation about AWS and the proposed revisions of the alcohol withdrawal orders. The nursing staff was informally polled at the in-service about their concerns with the revised orders with an eye toward further clarification of the protocol. This approach was well received by both physicians and support staff at the hospital. Chronic Pain Group Classes in Scappoose: Value of the Program, Barriers to Participation, and Advice from Oregon’s Pain Management Leaders Project Date: 1/2/2006 Chronic pain management continues to be a challenging issue for patients and physicians. Multidisciplinary chronic pain management groups have become an important part of pain management for many patients in Oregon. A group of this nature was recently attempted in a Scappoose, Oregon family medicine clinic. The main obstacle to success was poor attendance. This study attempted to identify barriers to attendance and investigate solutions used by experts who have faced and overcome this obstacle within their own programs. The design was interviews with patients of the Scappoose family practice clinic as well as interviews with pain management leaders. Outcomes data was collected, where possible, to assess the potential value of continuing a multidisciplinary chronic pain management group at the clinic. Mental Health and Addiction services are vital component of our communities. Project Date: 4/25/2005 Mental health and addiction services are vital components of our communities. In my short time at the OHSU Scappoose Family Practice (SFP) Clinic, the tremendous amount of mental health and addiction issues within the patient population became readily apparent. This project focused on identifying the major mental health and addiction resources within Columbia County, the county which is home to the OHSU SFP Clinic. Additionally, this project attempted to strengthen the ties and communication between those mental health resources and the practitioners at the OHSU SFP Clinic. The data was obtained through interviews with Columbia Community Mental Health (CCMH) and OHSU SFP Clinic staff members. As a result of the interview with the Executive Director of CCMH, a listing of services provided by CCMH was created and distributed to OHSU SFP Clinic staff. In addition, the framework for efficient and effective long-term communication (about patients, resources, etc.) between the two entities was constructed. The birthing experience in Grant County, Oregon Project Date: 1/3/2005 John Day, like many other rural communities in Oregon, was recently faced with a dilemma: to continue obstetrical care by physicians despite rising malpractice insurance costs or as a community decide to no longer provide these services. While this debate directly influences the physicians and their patients, other allied health care workers in Grant County will also be affected. There are currently two options for obstetrical care in Grant County: the family practice clinic of Drs. Holland and Nichols or the local direct entry midwife, Sherry Lauer-Dress. The physicians provide standard medical care including routine lood work, ultrasounds and deliver at Blue Mountain Hospital. Sherry provides the same care by law, including access to order laboratories and ultrasounds at BMH, homeopathic medicine, and only does home deliveries. The question 1 addressed was threefold: 1. What percentage of women in Grant County are receiving first trimester prenatal care? 2. What form are they choosing- the traditional medical MD model or the alternative nurse-midwife model? 3. What does the lay midwife model entail? The methods include obtaining the breakdown of all birth certificates issued in 2004 from Grant County Health Department, conduction a chart-review of all the Blue Mountain Hospital deliveries, and interviewing Sherry Lauer-Dress and several postpartum patients. The results showed that Grant County issued fifty-seven birth certificates in 2004. Forty-eight of those were delivered at Blue Mountain Hospital (BMH), five were delivered by Sherry and four were delivered in hospitals in other counties. Ninety-five percent of BMH delivered patients had documented 1st or 2nd trimester prenatal care. The midwife patients had an average of 100% 1st trimester care. A summary of the interviews with Sherry and the postpartum patietns are presented in the results section. Perceived Availability of Physicians To Patients in the Clinical Setting Project Date: 10/18/2004 Access to medical care is often the main barrier to health in a rural community. While access can take on many different meanings for a community, I chose to focus on the perceived availability of physicians to patients in the clinical setting. I observed an independent Internal Medicine practice of 4 physicians and 2 nurse practitioners serving roughly 12,000 patients in a rural area. Over a five-week period, I observed office staff and physician perceptions that patients have many unrealistic expectations for the logistic aspects of their health care. I listened to patients’ questions and expectations regarding their care by the facility. Unnecessary phone calls and incomplete follow-up were two main complaints by office staff, while not being able to talk to a person on the phone and high cost of medications were consistent problems noted by patients. This informal research resulted in the formation of an educational handout to patients to improve their expectations of the logistics of their medical care. By improving patient knowledge of appropriate interactions with the office staff, it is hoped that there will be a decrease in unnecessary phone call volume, to ultimately improve access to the clinic for urgent concerns. Lessons Learned from Initial Clerkship- Experience in a New Community Project Date: 7/5/2004 As the first 3rd year clerk in Grants Pass, OR, I set out to assess the expectations of the medical community regarding the rural training of OHSU medical students as well as to inform the preceptors, the hospital administration and additional medical staff regarding the goals and objectives of the rural clerkship. To achieve these goals, I conducted a focus group study that had the following specific objectives: To determine the relevance of the OHSU Rural Community Health Clerkship goals and objectives in relation to the expectations of the rural clerkship preceptors. To assess the opportunities available for clerks throughout the medical community. To assess the level of interest in increasing OHSU's footprint in Grants Pass. Mental Health: Coordination of Care in Josephine County Project Date: 5/10/2004 Access to and delivery of mental healthcare in rural America is a significant problem. According to the primary care providers (PCP) in Josephine County, OR, this is one of the most frustrating aspects of their practices. The family practice physicians felt that Josephine County Mental Health Department (JCMHD) was not adequately taking care of the mental health needs of their patients. JCMHD felt that they were doing a reasonable job of this and that their policies and procedures were well thought out and implemented with the blessing of the directors of the local independent physician associations (IPA). This project attempted to improve communication and understanding between the JCMHD and local PCPs in the area in order to help bridge the impasse that had festered. Multiple interviews were held with administrators at JCMHD and local PCPs as well as the director of one of the two local independent physician associations. Through these discussions, a proposal was made to the local IPA and JCMHD. The proposal includes four parts: 1. Same-day call back to the local PCPs from the psychiatrist. 2. Prompt feedback from the therapists after the patient’s initial visit either through a phone call or a fax. 3. Urgent slots with the psychiatrist will be made available for acute patient care. 4. A meeting to be held every four months with representatives from JCMHD as well as the directors of the two local IPAs. The local IPA is on board with the proposal and JCMHD is still reviewing the proposal, but seems willing to agree to it as well. Anticipating Longitudinal Growth Project Date: 2/11/2002 This paper encompasses 3 related projects: first, to assess patient satisfaction with the process of establishing care with a PCP at Peace Harbor's Health Associates clinic in Florence, OR; second, to assess local FNP's perceptions of their professional relationships with their Physician colleagues & to describe some current literature on the topic; third, to assess the attitudes of employees of Health Associates about the quality of care delivered by Mid-levels as compared to Physicians. Such data could prove useful in planning for Peace Harbor's expansion. Three distinct surveys facilitated these goals. On average, new patients consider a (5) day wait "reasonable," but a 23-24 day wait "expected." In light of this, 44% of incoming patients had to wait "longer than expected." 83% of new patients feel the most important quality in selecting a specific PCP is his/her special interest in their disease, about 67% were assigned to their first-choice PCP, & 94% of incoming patients feel provider continuity is more important than not. The current FNP's feel their practice is an admixture of "collaborative" & "parallel" models. Finally, staff & nursing cohorts have overwhelming confidence in Physicians to provide superior primary care over Mid-levels (contrary to results of a randomized trial used as the survey's "answer key"), the Mid-level cohort holds false beliefs about their ability to provide better care than Physicians, & Physicians demonstrate uncertainty about the matter. Back to subject search page or search by preceptor site