RCHC Community Project Abstracts

Back to subject search page or search by preceptor site The Usage and Understanding of the POLST Form among Independently Living Senior Citizens in Veneta, Oregon Project Date: 6/29/2009 Oregon has been very successful in implementing portable orders for end-of-life care via the POLST, which is used in nursing homes, hospitals and hospice. For elderly people that aim to stay in their homes until their final days, their introduction to the POLST is usually from a primary care provider. This project was conducted in the Garcia Senior Center lunch program in Veneta, Oregon, where many of the participants live-independently. The aim was identify if the POLST was being used, identify barriers to its use and to create a presentation to break through some of the barriers. In a total of 6 hours spent at the Tony Garcia Center, data was collected that showed the POLST was not commonly used. Barriers included lack of exposure to the topic, confusing medical terminology and the lack of enthusiasm to talk about end-of-life care. Additionally, two presentations on the POLST were given to break through some of the barriers and forms were filled out on a one-on-one basis. The result was an increased awareness and interest in making choices regarding end-of-life care, and an increase in the number of participants that have POLST forms filled out. End-of-Life Care Decision Making in the Illinois Valley Project Date: 3/16/2009 The importance of end-of-life care can not be understated, it is the last thing we do for our patients. It has been an area of research and systemic improvement for 15 years, but we continue to see limitations in our care, namely short median stays in hospice (17 days in Oregon) and rural/urban discrepancies in percentages of resident deaths that are hospice enrolled (46% in Multnomah County vs. 36% in Josephine County). This project attempts to delineate patients' values in when considering end-of-life (EOL) care in order to examine some the upstream variables that determine how and when we provide EOL care. The design was a qualitative assessment of community members' values in EOL care decision-making through individual semi-structured interviews and anonymous voluntary surveys of community members and primary care providers (PCP). It was found that among patients that have discussed EOL with their doctor, PCP was the most influential person in their decision on EOL, though specialist and family members were also important inputs. Comparing Trends in Cardiac Disease between Multnomah and Klamath Counties Project Date: 2/9/2009 Background: Coronary heart disease (CHD) is the single leading cause of death in the United States. Mortality from CHD and overall incidence of CHD has been declining since the 1960’s. This trend has not been as significant in African Americans, Hispanic Americans, American Indians, individuals of lower socioeconomic status, and rural populations. Differing trends in heart disease have been observed within different sub-populations in Oregon. The purpose of this study was to compare trends in heart disease in the most urban area of Oregon, Multnomah County, to heart disease trends in a rural region, Klamath County. Methods and Results: Yearly, age adjusted heart disease death rate, coronary heart disease (CHD) death rate, myocardial infarction death rate, and risk factor data, including data on smoking, obesity, physical activity, diabetes, and cholesterol awareness data for Klamath and Multnomah counties was analyzed. Trends in heart disease mortality from 1995 to 2005 were compared. Heart disease death rates were found to be consistently been higher in Klamath County than in Multnomah County. Hispanics and Native Americans residing in Klamath County had significantly higher mortality rates from cardiac disease. There was a decreasing trend in heart disease mortality and myocardial infarction mortality in Multnomah County from 1995-2005 that was not apparent in Klamath County. Prevalence of major risk factors such as smoking and obesity was also found to be significantly higher in Klamath County. Conclusion: Klamath County exhibits several disparities related to recent trends in heart disease. Primary prevention programs with improved outreach that are more specifically targeted towards those living in rural areas need to be established. Better access to health care is necessary in rural Oregon. Physician shortages must be addressed to improve both preventive and specialized care. Investigating primary care provider perceptions and practices regarding smoking cessation in Florence, Oregon; and the development of a cost focused informational pamphlet Project Date: 12/29/2008 Rural areas have been shown to have higher rates of tobacco use than urban or suburban areas.(1) These higher rates have led to significant morbidity and mortality in rural populations.(3) Although state and national data has shown declining smoking rates over the past several years, these declines have not occurred as rapidly in rural areas.(2) Previous studies have found that rural smokers tend to want specific smoking cessation counseling from their doctors, including medication costs, efficacies and a specific plan.(2) This study investigated the perceptions and practice patterns of primary care physicians in Florence, in order to assess which smoking cessation tools were being used and whether Florence providers give specific weight to issues like cost and efficacy. Questionnaires were given to Family Medicine and Internal Medicine physicians concerning smoking cessation. These questionnaires showed that providers find smoking cessation to be an important goal, but that they may be underestimating the number of smokers in their practices. All of the providers mentioned patient motivation and willpower as barriers to smoking cessation, while two mentioned the cost of the therapies. Half of the providers preferred Chantix to other pharmacotherapies. With the goal of providing specific information to patients on cost and effectiveness of the different smoking cessation options, a pamphlet was developed for provider and patient use during counseling. Dead-Man's Curves: Traffic Accident Prevention in Grant County, OR Project Date: 8/4/2008 Motor vehicle accidents (MVA's) are a significant cause of morbidity and mortality in Grant County, Oregon, and the associated expense costs individuals and the state thousands each year. This study attempted to identify the areas of recurrent traffic accidents in Grant County with the intention to advise the Oregon Department of Transportation (ODOT) to improve roadways as a means of trauma prevention. The student design included conversation with local as well as state police officials, local EMS responders and the Blue Mountain Hospital Trauma staff. In addition, systematic surveys of crash data was performed on the local police crash records, Oregon State Police Crash data, and the Blue Mountain Hospital Trauma database. Two stretches of road in Grant County were identified as being particularly dangerous - Picture Gorge and the OR 395 South of John Day. These two stretches of road have resulted in the activation of the Trauma Response System three times in the past two years, and comprise over 13% of all accidents in Grant County. The results from this study influenced the Blue Mountain Trauma staff to make recommendations to ODOT and to the Oregon Transportation Commission to investigate and improve these dangerous county roads. Pahe’yoo Meals of the Wadatika (Three Meals of the Burns Paiute Tribe) Project Date: 9/10/2007 Significant morbidity and mortality can be avoided in chronic disease states such as Hypertension, Diabetes, and health complications from obesity with simple lifestyle modifications such as a healthy diet and increased exercise. Many studies have emphasized this. By using surrogate markers such as blood pressure as a measure of cardiovascular disease and Hemoglobin A1C as a measure of diabetes control, doctors can monitor the progression of disease in a population. However, the doctors in Harney County often lament the poor health and poor treatment plan compliance among their Native American patient population, based on measurements of those surrogate markers. Barriers must clearly exist to patient compliance among the stated population. These can include mistrust of the medical community, inability to pay for services and medications, misunderstanding of treatment principles, and what types of foods constitute a healthy diet. How do you gain the trust of a patient population to help them to modify their current diet in a way that is beneficial in terms of health goals, but is also feasible, financially and culturally for them? What can be done to increase compliance and decrease the disease burden among Native Americans? While I cannot attempt to answer these huge questions in a lifetime of medicine, I can ask a smaller question which lead patient and provider in the right direction. What are the current dietary habits of the population in question, i.e., the Burns Paiute Tribe? Diabetes Education Handout Project Date: 8/6/2007 The number of people with Type 2 Diabetes is increasing in the United States. It is a major contributor to overall morbidity and mortality in the Untied States and in Astoria Oregon. There was an average of 41.8 deaths per year (17.5% of all deaths) caused by diabetes between 2000 and 2004 in the Astoria service area1. Following diabetes management guidelines can help decrease the associated morbidity and mortality of type 2 diabetes2.This study attempted to identify information that would be helpful in educating patients about newly diagnosed diabetes and compiling the information into a one page handout. A family doctor in Astoria was observed counseling newly diagnosed diabetics. Educational material for diabetics was reviewed. A handout for patients with diabetes was the end product. Death with Dignity - a rural community's perspective Project Date: 2/12/2007 Context: End of life care is a subject that has become more important over the last decade. “Death with dignity” is often a phrase that is used when discussing quality end of life care. However, this phrase is still not well defined. Furthermore, end of life care has been recognized as an ethical obligation of health care providers and caregivers, but this concept has not been examined from the perspectives of residents of rural communities. Objective: The objective of this project is to identify and describe elements of quality end of life care from the perspectives of residents living in the rural town of Scappoose, Oregon, as well as determining the level of awareness of advanced directives and POLST forms amongst those residents. Methods: This study is a qualitative study conducted using face-to-face interviews with open-ended questions. A total of 45 participants from 2 patient groups: clinic patients (n=28) and residents of a long-term care facility (n=17). Results: The participants identified eight domains of quality end of life care: avoiding inappropriate prolongation of dying, receiving adequate pain and symptom management, achieving a sense of control, having a peaceful and comfortable death, relieving burden, knowing that they are going to heaven, and not being alone. Overall, less than 50% of the participants in this project were aware of POLST forms. Conclusion: The conclusions drawn from this project are that the domains identified, which characterize a rural community’s perspective on end of life care, can serve as points for improving quality end of life care. Some of the values held by residents of Scappoose may also give insight as to how those residents have defined “death with dignity.” This project has also revealed the lack of awareness of POLST forms amongst the rural community of Scappoose, expressing a need for increased education regarding POLST forms and end of life care. When to transfer? Physician decision making while managing ST elevation MI patients in Coos Bay, OR; what to do when there is no interventional catheterization lab. Project Date: 1/1/2007 Current recommendations suggest that either a patient receiving thrombolytics should have a door to needle time in the hospital of 30 minutes or a primary percutaneous coronary intervention (PCI), door to balloon time, of 90 minutes. This project attempted to examine how local physicians in Coos Bay, OR made decisions regarding the management of patients with ST elevation MI, given the lack of a local catheterization lab and the necessity of transferring patients if they are to receive PCI. Debate about the best strategies to improve speed of reperfusion and has spawned discussions within the community about whether there is a necessity for a local interventional cath lab in Coos County, OR. Currently, Physicians in Coos County must decide how to treat these patients appropriately and when to transfer them to Eugene, OR for PCI. Interviews of 10 local physicians were performed to generate ideas and issues associated with management of STEMI patients. All of the physicians were from the same practice and managed patients at Bay Area Hospital in Coos County, OR and responses were compiled and compared to current literature. All physicians interviewed endorsed a combination of thrombolytics for patients when not contraindicated, followed by PCI, and primary PCI for patients not eligible for thrombolytics, due to the inability of transfer to reliably occur within 90 minutes. There was also a wide variety of timing for subsequent transfer reported. None of the interviewed physicians felt that an interventional cath lab was appropriate for the community at this time, citing a lack of economic viability, lack of patient volume, and the need for surgical back up as necessary to the process. Physician strategies in the management of STEMI, while guided by current literature, revealed necessary alterations and individualizations when working with limited resources. The final outcome yielded the result that when making complex decisions about transferring patients for cardiac cath, physicians in rural areas must make an assessment both of the various risks and benefits to their patient while also considering the resource limitations they face. When are Thrombolytics Indicated? Project Date: 1/1/2007 The issue of when and when not to use thrombolytics in rural community hospitals continues to exist. This issue is propagated by an increase in the use of percutaneous intervention in urban areas as well as the increasing frequency of immediate inter-hospital transfer to PCI capable institutions in the case of ST-Elevation Myocardial Infarction. This change in the standard of care in urban settings has caused a perceived lack of need for extensive education in the use of thrombolytics and a resulting deficiency in training at urban care centers. This alteration then disturbs health care administration at rural community sites due to consults from care centers where thrombolytics are rarely used. The use of protocols in community hospitals addressing the proper use of thrombolytic medications when indicated may prevent the under use of this live saving treatment. Charting Chronic Pain in Grant County Project Date: 5/1/2006 In the primary care practice of Dr. Robert Holland and Dr. Russell Nichols in John Day, Oregon, chronic pain visits occupy an average of 4-5 visits per day and these patients see the doctor 2-3 times more frequently than other chronic pain patients. The age distribution of Grant County is becoming top-heavy, with those >65 years old comprising 17.1% of the population, nearly five percent greater than the national average. Additionally, the number of manual laborers and individuals participating in outdoor activities that are tough on their bodies is commonplace in this population. Hence, the development of a standardized form for charting frequent pain management visits for musculoskeletal, neuropathic, fibromyalgia, longstanding post-surgical pain, and chronic narcotic use can save both time and money for a busy primary care practice. The average cost savings per physician in the practice from using a form rather than dictating progress notes from chronic pain visits is approximately $772 per year. Efficacy of this form is likely to be seen more in a rural setting due to the fact that there is little turnover of the population and few doctors, so there is greater longitudinal data collection. Optimal use of the form will allow for concise, long-term data collection and more focused pain management strategies that improve both the patient and physician satisfaction. ASSET: Acute ST Segment Elevation Taskforce Awareness in Grants Pass, Oregon Project Date: 3/20/2006 Heart disease is the number one cause of mortality in Grants Pass, Oregon. Through recent studies, it is clear that Percutaneous Coronary Intervention is the best treatment option for a patient suffering from a myocardial infarction. The Acute ST Segment Elevation Taskforce, serving Grants Pass, was implemented in order to reduce infarct time between recognition of symptoms and therapy. Unfortunately, many patients are not aware of this program and are transporting themselves to the local hospital, one without treatment capabilities. With community education and awareness through direct patient contact, local newspaper articles, posters, and other media, patients were educated about the program. Such education resulted in an increased willingness to use the program and decrease morbidity and mortality. Length of patient enrollment on Blue Mountain Hospice, The Physicians who refer patients and suggeted strategies to reduce late referrals Project Date: 3/20/2006 Blue Mountain Hospice (BMH) opened in August 2005. As with most hospices, one of its main concerns is that a significant proportion of its patients are enrolled for only a matter of a few days. The concern is that as a result, many of these patients and their families may not have time to fully benefit from the services hospice has to offer. The goals of this project were to 1) further the degree of mutual understanding between the physicians of Grant County referring patients to BMH and the staff of BMH; and, 2) provide recommendations and resources to both the physicians and BMH on possible strategies which may help to reduce late referrals. To accomplish these goals, the seven Grant County physicians were surveyed on hospice referral history, training and attitudes towards hospice, barriers to timely referral and interest in hospice related continuing education. Files of patients referred to BMH were then reviewed to characterize the population referred. Results indicated that referring physicians generally believe they are well trained in hospice, express positive attitudes towards hospice and are moderately interested in continuing education. Of the 15 patients enrolled with BMH to-date who ultimately either died on hospice (12) or were discharged (3), the median length of enrollment was 6.5 days and two patients were enrolled for only one day. Recognizing that certainly not all of the late referrals could have reasonably been avoided, recommendations and associated resources are provided to both BMH and the referring physicians with the intent that the proportion of late referrals can, over time, be reduced and more of the patients and their families can fully benefit from the unique services offered by hospice. Chronic Disease Management in Grant County Project Date: 3/20/2006 Problem: Almost half of all Americans have a chronic disease which may lead to extensive morbidity and mortality. Traditionally, diseases such diabetes mellitus (DM), hypercholesterolemia, and asthma are managed on a reactive, acute need basis. Pro-active physician-patient management of these three diseases reduces disease morbidity and mortality. The Grant County Public Health Department is writing a grant for $60,000 to try to improve Grant County’s health care of these diseases. To write and effective grant proposal, the department needs to learn what PCPs in the community are currently doing to manage the diseases and to propose ideas for improvement. Methods: An interview survey was conducted with all of the eight PCPs in Grant County about their current management of DM, hypercholesterolemia, and asthma. They were also asked what challenges they had managing each of these diseases, and what suggestions they had to improve the management of these diseases. Findings: Most PCPs actively monitored DM, many monitored hypercholesterolemia, and only one actively monitored asthma. Poor patient motivation and understanding as well as computer and time limitations were viewed as the largest challenges. Group education classes, such as the group diabetic dietitian class, were viewed as the most helpful resource. In addition, the majority of PCPs think a tickler file would be helpful. Conclusion: Grant County PCPs are currently using a variety of methods to manage DM, hypercholesterolemia, and asthma. All of expressed a desire for improve disease management, mentioning several clinical and community suggestions. Asthma in Northeast Portland: Examining the increased prevalence in the underserved Project Date: 10/17/2005 Asthma is a chronic inflammatory disorder of the airways that can be controlled with proper medications. Seventeen million people, 5% of the population, are asthmatics in the United States. The prevalence of asthma amongst children and adults is higher in Oregon than the rest of the nation. Morbidity and mortality is highest in patients who live in the inner-city or who come from low income homes. There are many social, economic, environmental, and pharmacological factors that lead to increased asthma rates among this population. The purpose of this project is to assess the factors that lead to increased asthma rates in Northeast Portland, assess the most effective asthma prevention and treatment programs, and to assess the availability of interventions that are currently in place in the Portland area. Warm Springs Health and Wellness Center Mortality Review of 2002-2003 Project Date: 9/12/2005 Mortality studies are an important and valid tool for evaluating the healthcare issues that affect a community. This project is a mortality review, recording the causes of death of patients of Warm Springs Health and Wellness Center in 2002 and 2003. Patient information was recorded by age at death, sex, immediate cause of death, manner of death, and associated co-morbidities such as alcohol, smoking, and seat belt use. Results from this study were compared to US mortality statistics in 2002 and 2003, and to previous Warm Springs mortality data for 1991-2000. The current study included the deceased from a population of 6464 active patients who received their care at Warm Springs Health and Wellness Center. The average age of death in Warm Springs over the two-year period (Jan. 2002 - Dec. 2003) was 45.5 years. This is lower than the average age of death during 1991-2000 of 46.7 years, and the average US life expectancy of 77.5 years in 2002 and 2003. This mortality review found that an average of 72% of deaths in Warm Springs were from natural causes, 20.5% from accidents, 4.3% from suicides, and 2.6% were from homicides. ASSET: An Effort to Improve Outcomes for Acute MI Patients in Rural Southwestern Oregon and Northern California Project Date: 4/25/2005 With the increasing numbers of patients with coronary artery disease in this country spanning from metropolitan cities to rural communities, there is a growing population of patients at risk for acute myocardial infarction. Successful treatment of acute myocardial infarctions requires adequate and prompt identification and transfer to a facility for definitive treatment. The most effective treatment for ST elevated myocardial infarctions (STEMI) is percutaneous coronary intervention (PCI). Rapid PCI is the treatment of choice to minimize morbidity and mortality from STEMI. Unfortunately, time is heart muscle in the event of a heart attack. In rural communities, local hospital evaluation, transport to the nearest cath lab many miles away, and activation of the cardiac care team leads to a delay of 2 hours or more. The ASSET program developed by Dr. Brian Gross in Medford, Or has attempted to minimize the time delays and get cardiac patients in rural communities to definitive catheter treatment in a timely fashion. The program involves local rural community hospitals and their ambulance services as well as a group of on call interventional cardiologists in Medford to serve a nearly 50 mile radius around the Medford area. The protocol allows for first responders to identify STEMI patients in the field and bypass the nearest local hospital to transport the patient to a pre-alerted cardiac intervention team in Medford. The outcome was a decrease in the morbidity and mortality associated with time delays accrued in the rural setting and to make rural Oregon the “safest place to have a heart attack”. Diabetes Education in Scappoose, OR: Assessing diabetic education through the development of a patient questionnaire and educational handout Project Date: 3/21/2005 Diabetes is a very common disease in the U.S. and is growing in prevalence by the day. It is a major cause of morbidity and mortality and one of every ten healthcare dollars are spent on diabetes and its related complications.1 Since diabetics themselves are the one’s responsible for the prevention of long-term complications, they must be properly educated on the basic etiology of their disease and it’s management. This study attempts to assess the overall education on pertinent facts about diabetes in both the diabetic and non-diabetic population in Scappoose, OR, and then to educate patients on important concepts and common misperceptions of diabetes management. Overall, this study found that diabetics in general were not more knowledgeable about their disease than the non-diabetic population. In fact, the general population seemed to be more knowledgeable about the etiology, prevention and treatment of diabetes and the diabetic population sampled. Suicide in Harney County: Is it higher than metropolitan Portland? Project Date: 3/21/2005 Suicide is a significant medical issue in the rural United States. This study compared the suicide rate in rural Oregon with more urban areas of Oregon from 1998-2004. It also attempted to answer the question of why the rural suicide rate is higher than urban areas. The design was retrospective review of Oregon vital statistics grouped by counties. Counties were separated into groups according to population. Mean yearly suicide rates for each group were calculated as well as overall suicide rate per group during the time period from 1998-2004. Statistics for variables thought to be associated with suicide rate were also obtained and compared to the group suicide rate in an attempt to determine if any relationship exists. Calculated suicide rates were generally higher in Oregon's rural counties than in urban counties. There was also a difference between the most rural and most urban counties in each variable obtained, however there did not appear to be a trend when looking at all groups by increasing urbanization. Therefore, there does appear to be an increased suicide rate in rural Oregon counties which is consistent with other rural areas worldwide, however no definite risk factors were identified. Evaluation of Cervical Cytology Screening in Madras, Oregon: clinical considerations in the context of changing standards of care Project Date: 3/21/2005 The incidence of cervical cancer worldwide has declined sharply since the advent of cervical cancer screening. Current focus on decreasing morbidity and mortality related to cervical cancer rests on improvement of screening methods, development of screening guidelines, and establishment of effective follow-up systems. In the context of continually evolving screening methods and guidelines, clinicians are faced with the task of complying with current standards of care. This is made more difficult by subtle lack of consensus between the leading organizations on when and how to screen. The intent of this project was to evaluate Madras Medical Group’s current screening program and to identify areas for future improvement. By examining Pap data from March 2004- March 2005, creating a spread sheet, and reviewing charts, several trends were identified. Madras Medical Group appears to be over-screening women with history of hysterectomy and women who are older than 70. The intervals between Paps may also be more frequent than necessary, especially in patient who are getting ThinPrep exams. By developing a system to identify women who do not need yearly cervical cytology screening, Madras Medical Group may be able to improve their compliance with current standards of care. Hospitalization of Hospice Patients Project Date: 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. Neonatal Mortality in Josephine County: Current and Historical Perspectives Project Date: 2/7/2005 The problem of neonatal mortality and its associated risk factors in Josephine County, Oregon was examined in 1997 by OHSU Masters student and Public Health Nurse Virginia Adams. Her work demonstrated a community whose newborn babies suffered a 33% increased relative risk of neonatal mortality (death within the first 28 days of postnatal life) compared to babies born elsewhere in the state. The objective of this investigation is to compare the most current statistics regarding neonatal mortality to this historical data to identify areas of improvement and continued struggle within the community of Josephine County. Methods employed in this investigation include critical examination of health statistics and a series of interviews conducted by myself with care providers in Josephine County. To the credit of the community, this investigation found many admirable gains made by dedicated providers. Since the publication of Adams' study, neonatal mortality rates have in Josephine County have decreased significantly (from 8.6 to 5.0/1,000 live births), rates of inadequate prenatal care have dropped from 10.1% to 3.6% (well below OR state averages), and numerous other risk factors for poor neonatal outcomes have been decreased. However, despite these gains, several substantial problems exist in Josephine County which pose potential threats to newborns. Perhaps most notably is the problem of illicit drug use during pregnancy, for which Josephine County maintains the highest rate of all counties in Oregon. Other persistent risk factors for neonatal mortality identified by care providers include recent reductions in public funds which have forced clinic closures and ended subsidized housing programs for pregnant women. Reported Stroke Mortality in Harney County: the perceived need for additional stroke education Project Date: 2/7/2005 Cerebrovascular accident "Stroke" is one of the leading causes of Morbidity and mortality in the US. Unfortunately, Oregon stands out as a state with a disproportionate stroke-related burden of morbidity and mortality. As Harney County is one of the most rural counties in the state, the goal of this project was to use rough analysis of mortality data for the county and state to make assessments of relative stroke burden compared to stroke. What was revealed from the analysis was a significantly decreased level of stroke-related deaths reported for the county, than the state. Assuming that Harney County is not significantly healthier than the state at large, the disparity in reporting is hypothesized to be due to a relative lower level of stroke awareness and education, which may lead to lower frequency of presentation to available health system. Therefore, a newspaper article/public service announcement was written and information cards posted in the clinic in an effort to further educate the community to the signs, symptoms and risk factors associated with stroke. Thus, the intended long term outcome from this project developed into further education of the Harney County community regarding recognizing stroke and minimizing risk factors. Working toward a Community based education approach for Diabetes management and prevention of complications in John Day, Oregon Project Date: 2/7/2005 Diabetes is a disease that is approaching epidemic proportions in the US. It is a disease with high morbidity and mortality due in large part to its complications. Intensive therapy has been shown to be important in the prevention and control of diabetes. Community - based education is one modality of treatment that has been shown to work to prevent development of, and reduce complications of diabetes. In this study I surveyed 68 diabetes treatment and management where patients had questions. The results of this survey show a high interest in small group-based education for diabetes. Issues that many diabetics had questions about included nutrition, medications, need for specialist exams, and blood testing. These topics could be covered in group-based education and supplemented with a brochure/handout. The results of this survey and production of this handout may be useful building blocks to establish community-based or small-group education in John Day, Oregon. Warm Springs Health and Wellness Center Preliminary Mortality Review 2001 Project Date: 3/24/2003 Mortality studies are an important tool to understand healthcare issues pertinent to a community. The present project is a mortality review of patients at the Warm Springs Health and Wellness Center, in Oregon, who died in 2001. Information recorded included: immediate cause of death, age of death, sex, if restrained in MVA and associated co-morbidities including alcohol, smoking, Hepatitis C and HIV. Results were compared with US, IHS, Oregon and previous Warm Springs’ mortality data. The average age of death, 52.3 years, was comparable to Warm Springs’ 1991-2000 data, 46.7 (40.6-53.2), and was predictably lower than the US life expectancy in 2000, 76.9. The top 4 categories of death were 1) cancer, 2) chronic liver disease, 3) diseases of the heart and 4) accidents. While dramatic shifts can be seen in yearly mortality reviews, the data suggests that the local healthcare system is making an impact on certain diseases, such as diabetes. Mortality Trends In Grant County, Oregon: 1995-1999 Project Date: 1/2/2002 This project sought to study the leading causes of mortality in Grant County, and to determine if they differ from the rest of the state. The study design was a retrospective analysis of mortality data from 1995-1999. Overall mortality rates, deaths from major cardiovascular disease, malignant neoplasms, chronic respiratory diseases, diabetes, accidents and suicides in Grant County were compared to the state rates. It was found that major cardiovascular disease, malignancy, and chronic respiratory disease were the leading ceases of death in Grant County. Additionally, the overall mortality rate, death rate from malignancy (specifically colon cancer), and death rate from chronic respiratory diseases were found to be significantly (P<.05) higher than the state rate during the period studied. The causes of these increased rates are uncertain, but further investigation is recommended to determine if changes in community education and/or preventative medicine would help decrease these mortality rates. Back to subject search page or search by preceptor site