RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Group Medical Appointments in Rural Oregon Project Date: 10/12/2009 Group Medical Appointments (GMA) provide one to one medical care in the presence of chronic disease peers. Group visits have shown to increase patient and physician satisfaction, deliver integrated care that enhances quality, improves access, and leverages physician time and productivity. The bulk of research on GMAs has focused on urban, chronic illness populations. Therefore, I was interested in developing a model for GMAs in the rural setting. My population of interest was defined as Walla Walla Clinic Milton-Freewater (WWCMF) chronic illness patients. The project served succeeded in not only educating the project leader in regards to alternatives to the traditional medical appointment, but also inspiring an urbanite to consider rural medicine as a career. Interpreter use in Klamath Falls, Oregon Project Date: 10/12/2009 United States Federal law requires that limited English proficient (LEP) patients be guaranteed effective communication in the course of a hospital or clinic visit. In order to assess the effectiveness of communication between providers and LEP patients in Klamath Falls, Oregon, Family Medicine and Pediatric clinics in this town were given a short survey on LEP patient population and interpreter use. All responding clinics have patients who are Limited English Proficient (LEP) and all utilize health care interpreters who are not certified (either bilingual staff or people to serve as interpreters brought in by the patient) as their primary method of interpretation. While these interpreters may have the skills required to be certified health care interpreters, this cannot be determined without undergoing the testing that leads to interpreter certification. This means that it is currently uncertain whether LEP patients are encountering accurate and effective communication in Family Medicine and Pediatric clinics in Klamath Falls, Oregon. Optimizing Care of Chronic Pain Patients in a Rural Primary Care Clinic Project Date: 8/3/2009 Treatment of chronic pain can present one of the most challenging scenarios in medicine – both for clinicians and patients alike. Managing constant prescription refill requests and sometimes frustrated patients can be taxing on clinic staff and providers, while communicating the subjective experience of pain can be emotional for patients whose pain may often go untreated or under-treated due to historical sensitivity about prescribing narcotic medications. Further complicating this delicate relationship between patient and clinic is the increasing prevalence of prescription drug diversion and abuse, particularly among American youth. This project investigated current trends in the management of chronic pain at the clinic and community level, gathering information from medical literature, local clinic staff, surveys of chronic pain patients, and interviews with key community role players. A summary of recommendations was developed to assist local providers in optimizing the care they provide to patients with chronic pain. Two Year Analysis of Total Joint Replacements at the Lower Umpqua Hospital Project Date: 3/16/2009 Hospital procedure volume has been shown to be inversely proportional to postoperative complications. The objective of this study was to determine if total knee and hip arthroplasties can be effectively and safely performed in a low procedure volume hospital such as the Lower Umpqua Hospital in Reedsport, Oregon. The medical records of patients undergoing elective, primary total knee and hip arthroplasties between January 2007 and December 2008 were reviewed for outcomes occurring three months after the procedure. Results were compared to a large Medicare cohort treated with similar procedures. At this hospital, the rates of complications were minimal to none. There was an acceptable rate of manipulation under anesthesia and no dislocations. One superficial infection was noted, but no deep infections. No deaths, DVT’s, PE’s, MI’s or pneumonias were experienced in this cohort. In conclusion, total knee and hip arthroplasties can be effectively and safely performed at the Lower Umpqua Hospital, a low procedure volume hospital. A Long Road Ahead: Barriers for the transition to a patient-centered medical home model of care in the rural setting Project Date: 2/9/2009 The “medical home” concept has emerged in recent years as a potential solution to make quality health care more affordable and accessible. It is defined as a patient-centered team effort to provide comprehensive and coordinated care over a sufficient duration of time to foster a strong level of patient-physician understanding and trust. The literature has demonstrated that this model has the ability to improve quality, reduce errors, and increase both patient and physician satisfaction. The team is a fluid network of health care professionals whose composition changes over time to meet the patient’s changing needs, with the primary care physician always operating as the team leader. The patient-centered medical home (PCMH) model also involves payment reform that compensates primary care physicians for productivity that has previously gone undercompensated, all while containing overall health costs. For small practices without pre-existing technologic or staffing infrastructure, the transition to a PCMH identity may by overwhelming or even seemingly insurmountable due to the potential for decreased productivity, financial strain, and personnel shortages. While working in the Tillamook, OR community, I investigated some of the barriers that a particular practice, Bay Ocean Medical, or others like it, might encounter should they opt to acquire that designation. 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. An estimate of the cost and need of the provision of chemotherapy in Harney County. Project Date: 10/16/2006 Background: Each year approximately 150-250 people from Harney County (population about 7000) seek medical treatment for cancer. The long distance from home exposes patients to added risks during their treatment. Currently, Harney District Hospital (HDH) is researching the possibility of administering chemotherapy on site. This would result in saving cancer patients many hours on the road. Population: This project looked at a subset of Harney County cancer patients who are receiving treatment at Bend Medical Clinic (BMC), St. Charles Hospital. Type of study: Informational. Methods used: A cancer patient list was compiled by BMC, defined by cancer patients with Harney County address zip codes. This list was cross referenced with the EMR at the High Desert Medical Center (HDMC) in Burns to obtain patient's cancer diagnosis. A list of "safe" chemotherapy drugs were provided by BMC oncology staff. The cost of the drugs and administration were calculated. Results: The patient population is described. It appears that the administration of chemotherapy drugs at HDH would be fiscally feasible with chances for a net gain. The Bridge Assistance Program: Improving access to necessary health care in Florence, OR Project Date: 8/7/2006 Access to health care is a problem in rural communities no less than it is in cities. Indeed, rural communities often have fewer organizations and resources to assist people in accessing health care than do their urban counterparts. As the primary source of medical care in Florence, Oregon, the Peace Harbor Hospital and Health Associates utilize an innovative program to assist those members of the community who would otherwise fall through the cracks among private means, insurance and social programs. The Bridge Assistance Program provides medically necessary services to patients at reduced or no cost once it has been determined that payment for those services cannot be obtained from outside resources. The program focuses on providing preventive and early care in order to reduce costs related to acute care and collections processes. This project explores the criteria used to determine eligibility for the program and the types of health care the program helps patients to access. Patient feedback was analyzed to determine the circumstances that led patients to seek assistance from this program, the satisfaction patients have with the assistance they received and what patients believe the program could do to improve. Study results found that the Bridge Assistance Program serves a vital role for patients who cannot afford necessary health care and do not qualify for sufficient assistance from other aid programs to meet their medical needs. Patients were generally very satisfied with the assistance they received from this program, though lack of dental and vision services at Peace Harbor as well as the high cost of prescription medications continue to be factors that limit access to health care for these patients. Multiple Strategies Designed to limit Medication costs for the underserved at the West Salem Clinic Project Date: 4/25/2005 Medication cots in the United States continue to trouble the patients taking the medications and the physicians prescribing them. This study attempted to identify and explain the many strategies the Northwest Human Services West Salem Clinic is using to combat therapeutic costs. The design was collection of information and data from multiple sources regarding several current methods currently being used at the clinic. All staff involved with patient care as well as staff specifically dedicated toward cost reduction programs were observed, studied, and queried regarding the ins/outs of these programs. This project will allow for a wonderful synopsis for clinics to possibly emulate the medication reduction cost programs currently being implemented at the NHSWSC. Assessment of Fluoride Concentration in the Drinking Water in Ontario, Oregon and Surrounding Areas and Recommendations for Fluiride Supplementation for the Pediatric Population in this Community. Project Date: 3/21/2005 Tooth decay is one of the most common problems facing the population. Fluoride has been shown to be an effective means of helping slow or reverse the progression of disease. Excessive fluoride intake can lead to fluorosis, a poor cosmetic result. This risk necessitates optimization of fluoride intake. The average intake of fluoride in the community, based on its concentration in drinking water, was assessed by phoning various water treatment plants in the surrounding communities. Then, using extensive research data complied from multiple sources, a specific set of recommendations for fluoride supplementation in the pediatric population were made based on fluoride intake in the community in which the patient lives. Screening and Intervention for Psychosocial Risks: Analysis of Barriers to Appropriate Utilization of Social Services for Obstetric Patients in Astoria, Oregon Project Date: 2/7/2005 Most communities have social services available to, or directed towards the Obstetric population when they are identified as having specific needs. Unfortunately for the community of Astoria, Oregon, the obstetric patients in need may not be aware of the social services available to them. To further complicate the problem, there are no dedicated obstetric social workers in this community to identify high risk Obstetric patients and help them access and navigate the systems that administer these services. The individuals that are called upon to help obstetric patients connect with available resources are the health professionals caring for these patients such as the nurses, midwives and obstetricians, who are already overworked in their existing roles. This community project includes a survey of social services that are available to obstetric patients in the community of Astoria, Oregon: current methods used to identify patients with needs and facilitate connecting patients to these services; and based on this research, recommended changes to improve this process. A comprehensive list of the available social services was compiled to improve patient and provider awareness of available social services. Urgent Care Center in Lebanon – another example of serving the needs of the community Project Date: 2/7/2005 Developing a healthcare systems centered around the needs of a community has been an evolving and ever developing process spanning the past two decades in the small community of Lebanon, Oregon. Earliest efforts consolidated a group of primary care physicians – Family Practice physicians and Internists – employed under the umbrella of Samaritan Health Services. These efforts were directed toward providing primary health care focused on community need. By placing primary care office visits under the larger Samaritan Health Systems organizational umbrella, primary care physicians could better spread the responsibility of caring for all in the community -- those with insurance, those without insurance, as well as recipients of Medicare, Medicaid, and Oregon Health Plan. In 2000 when outside independent Urgent Care organizations were seriously looking at Lebanon as a new location of a “doc in a box” center, Samaritan Health Services rallied again in their “community needs” approach. From these efforts were born the remodeling efforts of the Samaritan Lebanon Emergency Room, designed to provide adjoining Urgent Care / Emergency Room services at the local Lebanon hospital. Since its opening in 2001, the Samaritan Lebanon Urgent Care has been well received by the community as well as area PCP’s, and has become a successful and profitable addition to the Samaritan Network of HealthCare Services. Providing adjunct services to those provided by a patient’s PCP, acute health care issues can be handled in the same day, without an appointment, at a cost equal to or within 5% of a standard PCP office visit. Minor acute illness and injuries can be funneled to the urgent care center for treatment. There, patient care does not incur the high costs of Emergency Room handling, and ER volume strain is reduced. The Samaritan Lebanon Urgent Care center is open 7 days a week, handles between 50 to 75 patient cases daily, and provides acute healthcare to patients with private insurance, Oregon Health Plan, Medicare, Medicaid, as well as self paying patients. Patient Participation in the Legislative Process in Klamath Falls, OR: Identifying Patterns and Perceived Obstacles Project Date: 7/5/2004 Patient initiated discussions concerning dissatisfaction with various health and health care policies are common in the rural primary care setting. Anecdotally, however, patients report not sharing these opinions with their legislators, while lawmakers describe a situation in which they feel uninformed about the ideas of the citizens in the communities they represent. A disconnect exists, whereby opportunities for constructive sharing of opinions and factual knowledge are missed. In order to describe the patterns of participation in the legislative process amongst the patients of a primarily adult Family Practice clinic, a patient survey was administered that inquired about both past experience if contacting legislators, perceived barriers to making such contact, and interest in obtaining information designed to facilitate this contact in the future. 33% of survey respondents had contacted their legislators in the past, an average of 2.6 times. 30% of those contacts were in regards to a health or health care issue. For those respondents who wanted to contact legislators but did not do so, common reasons cited included “I don’t know how to contact them”, “I’m not confident about how to present my ideas”, and “I don’t think it will make a difference”. 57% of all respondents said it would be helpful to have information about legislators and how to contact them, while 63% said having this information would make it more likely that they would contact their legislators in the future. In response to the survey answers, a patient information guide was designed in order to provide both accurate contact information for the appropriate Representatives and Senators, as well as suggestions for effective ways to communicate with legislators, and additional resources for more information. Is The Grass Really Greener On The Other Side? A Descriptive Analysis Of The Perception Of Health Care In Newport, OR. Project Date: 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. Implementation of the Client Self Assessment (CSA) into Lutheran Community Services NW Treatment Center in Klamath Falls Project Date: 11/4/2002 Substance abuse treatment success is highly correlated with client motivation. While there is no guaranteed method of increasing client motivation, one could assume that engaging clients in their own treatment would be one method for doing so. The Client Self Assessment (CSA) is a client-centered instrument that may help engage clients in monitoring their own progress in treatment. It is a weekly self-assessment tool that measures the emotional state, substance use, difficulty in reducing use, and treatment satisfaction of clients. Clients and therapists can then monitor over time how treatment is going and provide “real-time” feedback to the therapists. Benefits include: improvement of record-keeping, ability to show trends over time, allows time for clients to reflect on previous week’s activities, and allows therapists to intervene more quickly with “real-time” feedback. The CSA was implemented into Lutheran Community Services NW in Klamath Falls for a trial bases. Therapists were interviewed after 3 weeks of using the instrument. Overall, there was a favorable response to using the CSA. It engaged clients in discussion and in monitoring their own treatment as well as provided weekly record-keeping for the therapists. The center plans on continuing to use the self-assessment form. 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. How Residents Of Baker City Choose Their Primary Care Physicians. Project Date: 1/2/2002 The purpose of this project was to evaluate how people in Baker City choose their primary care physicians. It was thought that information about how people choose their doctors could be beneficial to rural physicians seeking to increase their patient loads. Selected patients in Baker City were asked to complete a questionnaire about how they chose their doctor. Results of the study revealed that residents of Baker City rely on recommendations from trusted sources about as much as those in previous studies did. In addition, Baker City residents rely more on personal knowledge of their physicians and whether insurance will cover the doctor visits, than did patients in previous studies. This is thought to be due to the higher percentage of Medicaid patients in rural areas and to the nature of a smaller community where patient might be more likely to know their physician outside of their medical role. Back to subject search page or search by preceptor site