RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Recent Onset Cardio-pulmonary Disease in Three Fiberglass Plant Workers in Hines, Oregon Project Date: 3/17/2008 In 2007-2008 High Desert Medical Clinic in Burns, Oregon saw 3 patients who presented with acute-onset respiratory and cardiovascular illness after working with fiberglass at the Monaco Coach Corporation’s plant in neighboring Hines, Oregon. Purpose of the study: (1) identify what substances are used in fiberglass manufacturing that may cause cardio-pulmonary disease, (2) evaluate methods of protection used by the Monaco plant against occupational exposure to these substances, (3) consider ways in which the local medical community and plant management can improve public health regarding the occupational hazards associated with fiberglass manufacturing. Conclusions: (1) the Monaco plant has a thorough exposure protection policy that exceeds the requirements set by law or insurer, (2) although styrene is the principal toxin used in fiberglass manufacturing that is measured by regulatory bodies, there are other agents, such as fire retardant filler, phthylates, and fiberglass dust particles, that may be associated with respiratory and cardiovascular illness in plant workers. 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. The Impact of Methamphetamine on Community Health in Baker City Project Date: 4/30/2007 Methamphetamine (MA) is a stimulant drug with a high abuse potential and multiple adverse health consequences ranging from psychosis, intoxication-related trauma and self-mutilation to burns, abscesses and endocarditis. MA is unique among stimulant drugs of abuse in that it can be manufactured locally using simple and widely available starting materials. This drug may particularly impact rural areas as lower density population provides more privacy for clandestine MA labs. Small communities are less able to absorb the cost of MA-related visits to the emergency room, lost productivity and broken families. The methamphetamine epidemic has received much media attention, but how deep does the problem really go and what resources are needed? Traumatic injury in off-road vehicle use in rural Oregon Project Date: 4/30/2007 BACKGROUND: Rural MVA mortality is twice that of urban mortality. Pediatric ATV injuries are increasing, and new legislation is being presently debated. The study evaluated the risk of ATV injury in pediatric versus adult populations in the Blue Mountain Hospital service area over 33 months. METHODS: Emergency visits at BMH, selected by E-code E810-825. Outcomes were incidence and odds ratios. RESULTS: ATV’s accounted for 23.9% of the MVA patients. 9.4% of non-ATV injured patients and 22. 4% of ATV injured patients were pediatric. Risk factors for ATV injury include age < 16 (OR 2.85, p = 0.008), male gender (OR 3.18, p = 0.001), and white race (OR 3.408, p = 0.039). Risk of head or neck injury higher in ATV use (OR 2.637, p = 0.004). CONCLUSION: Age restriction as well as requirement of helmets, both currently proposed in the legislature, may decrease the burden of ATV-related injury on the rural pediatric population. Cattle Related Injuries in the Treasure Valley Project Date: 4/30/2007 The beef cattle industry is a $71 billion per year industry providing 28.0 billion pounds of beef to the U.S. public (USDA background statistics 2006). The beef cattle industry is also an important part of the economy of Ontario, Oregon. However, this industry is also subject to a wide variety of hazards and is considered one of the most dangerous industries in the United States and in the State of Oregon. This study attempts to identify the most common causes of agricultural injury by searching national databases, performing a local study and participating in local ranching activities. According to the national database, the most common fatal accidents were caused by tractor and machinery. The most common non-fatal accidents were related to livestock. These accidents were most commonly crush injuries followed by falls. In the local survey, there was a difference between the most common injury reported health professionals and local ranchers. This is likely due to differences in the rancher’s threshold for seeking medical attention based on the type of injury. Antenatal Depression in Klamath Falls, OR; development of a patient handout for use in patient education for at risk women Project Date: 3/19/2007 Depression during pregnancy and in the postpartum period is a major public health concern in the United States affecting approximately 20% of all pregnant women. This study attempted to assess the process of identifying women at risk and educating them on available options in the Klamath Falls Family Practice Residency Clinic. The design was observation of family physician's, obstetrician's, and psychiatrist's interaction with pregnant patients and patients with mental health problems during a five week rotation in a high-risk area. One faculty psychiatrist is the primary referral source for patients with medication questions. For counseling services patients are referred to Klamath County Mental Health. Patient openness to discuss the topic of depression and mental health concerns in general was observed. While the topic of depression was addressed when a patient initiated the discussion there appeared to be no standard method for screening pregnant patients for depression or discussing treatment options in the event of depression occurring. Also, although there were information handouts regarding depression, there was nothing specifically targeting pregnant or postpartum women. Thus the main goal and final product of this project was development of a patient handout for pregnant patients and those considering pregnancy with concern about depression and anti-depressant treatment. The perioperative evaluation of the diabetic patient in Grants Pass, OR: A patient guide for long-term disease management Project Date: 3/19/2007 Diabetic patients remain amongst the more vulnerable and complicated surgical candidates. Experts agree that the most effective measure taken to minimize peri-operative morbidity is maintaining long-term glycemic control. During a family medicine clerkship in Grants Pass, Oregon, it was noted that both patients and providers felt that improving patient awareness regarding diabetes management is key in achieving the optimal glycemic control. Given the complexity and scarcity of local diabetes educational resources, a summarized guideline was designed in the form of a patient hand-out to enhance peri-operative cooperation amongst patients and their various health care providers. Based on the request of local family doctors, a portion of this hand-out was dedicated to dietary instructions and risk factor modifications that can serve as a supplement to in-office discussions between the physician and the patient. West Nile Virus in Malheur County Project Date: 1/1/2007 Malheur County, Oregon recorded 52 cases of West Nile virus (WNV) infection during the 2006. This was a dramatic increase from 8 cases the previous year. Cases were investigated by the Malheur County Health Department (MCHD) and forwarded to the state Department of Human Services (DHS). No summary document was generated locally for the epidemic. This left providers without up-to-date information regarding risk for infection and treatment of lasting effects. My project was to generate a provider education pamphlet that included 1) a summary of the 2006 epidemic in Malheur County 2) a review of journal articles regarding the lasting effects of WNV 3) information on clinical trials currently enrolling cases, and 4) predictions for the 2007 season. This pamphlet will be printed and distributed to Malheur County providers by the MCHD Proper usage of child safety seats and booster seats in Baker County, OR: development of a brochure to educate patients for dispersal at the Baker County Health Department Project Date: 10/16/2006 Motor vehicle accidents are the leading cause of death and disability in children. This is often preventable with the proper use of child safety seats and booster seats. While these devices are often used by parents, in Oregon 85% of child safety seats and 51% of booster seats were installed incorrectly. Baker County has NHTSA certified child passenger safety technicians who can assist parents in inspecting and installing child safety seats and booster seats. The Baker County Health Department immunizes 97% of the children in the County and is an ideal location to reach parents and educate them regarding proper usage of child safety seats and booster seats and to direct them towards local resources for inspection and installation. A brochure was produced for dispersal at the health department which included information on local and internet resources, Oregon Law, and the proper usage of child safety seats and booster seats. 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 O & C: Unhealthy Drama in Rural Counties Project Date: 9/11/2006 Josephine County is one of many Oregon counties facing the permanent loss of multimillion-dollar "O&C" federal funding, with resulting deterioration of services in public health and safety. Funding is currently set to expire October 1, 2006, midway through my rotation in Josephine County. To examine the impending problem, I attempted to answer whether Josephine County would suffer a severe undermining of its public health because of its largely rural population, and to pursue promising courses of action. Methods: Research involved interviewing the public health departments of Josephine, Douglas, Curry, Jackson, Lane and Clackamas counties on the projected changes, as well as a literature review about the determination of support for health programs and the relevance and precedents of public polls. Findings: While there are unique challenges and few recourses associated with being a rural county, Josephine County appears particularly unprepared. Discussion: The ideal strategy involves a tripartite approach of (1) population education on the role of public health (2) assessment of support for additional tax levies (3) increased alternative funding, taxes, and innovation in organizational structure. The former calls for a controlled, randomized, and validated telephone survey throughout Josephine County to assess what, if any, type of tax levy citizens would support and the demographics involved. A 5-year retrospective analysis of all-terrain vehicle (ATV) injuries in children presenting to the Emergency Room in Reedsport, OR Project Date: 8/7/2006 Reedsport, Oregon is located three miles from the Oregon Dunes National Recreational Area which attracts all-terrain vehicle (ATV) riders from all over the country. The frequency of ATV trauma is increasing nationally and this retrospective review of ATV-related injuries presenting to the local ER over the past 5-year period revealed that ATV trauma is a significant problem in Reedsport, OR. Children under 16 account for 16% of the overall morbidity and appeared to be more vulnerable to head/neck injuries when compared with adults, despite demonstrating good helmet usage upon subsequent analysis. However, children were less likely to be hospitalized or transferred to another hospital than adults, which may indicate that their injuries were not as severe. Tandem riding (i.e., riding as a passenger) was a risk factor for ATV-related injury in children, which is consistent with the literature on pediatric ATV-related injury, and therefore provides a potential target for legislative intervention. Well-water use in Springfield, Oregon: Understanding Patient Knowledge and Practices and Developing a Patient Handout on Well Water Safety. Project Date: 7/3/2006 The safety of well water has important health implications for thousands of mostly rural Oregonians. While there is little data quantifying the amount of illness and disease caused each year by the contamination of well water, it is well known that certain contaminants both are present in well water and have the potential to cause short-and long-term health problems. This study attempted to assess the level of knowledge that patients at Springfield Family Physicians have of the potential health risks of drinking well water, as well as patients' knowledge regarding steps that can be taken to assure the safety of well water. This was accomplished by designing a questionnaire about the sources of patients' drinking water and their attitudes and practices regarding water safety. Finally, a handout was developed to provide patients with information about well-water safety and resources to help test and maintain their wells. The Tillamook Safe Hunting Initiative: Assessment of the Hunter Education Program and Strategies for the Future Project Date: 3/20/2006 As hunting continues to be a popular recreational activity in Oregon’s Tillamook County, emphasis on safe hunting practices is necessary to ensure the safety of all persons who enter the wilderness each autumn. This study aimed to identify what safety awareness programs are available for Oregon residents in this region and to investigate the efficacy of such programs in preventing hunting-related accidents. In addition, an effort to recognize areas for improvement within hunter education was undertaken. Data on Oregon’s hunter education program was obtained through direct communication with the Oregon Department of Fish and Wildlife, personal interviews with hunters native to Tillamook County, and extensive web research. It was determined that emphasis on hunting safety (via formalized courses or independent learning) has led to a significant decrease in the number of hunting-related accidents over the past few decades in the state of Oregon. While firearm handling continues to be the mainstay of safety awareness, Tillamook County residents expressed an interest in basic life skills training and the importance of wearing hunter orange. Therefore, this project would not only provide an assessment of the Oregon hunter education program, but would also focus on the development of a small brochure providing tips on accident prevention and treatment. MRSA infections in rural areas Project Date: 2/13/2006 Community acquired MRSA is a growing problem in Grants Pass. I set out to get an idea what kind of problem this represented in the area. After looking at the disease from a variety of perspectives, I began to realize that the prevalence of the disease may outgrow the medical community’s ability to respond. I began this project in the hospital. I attended the quarterly infectious disease board meeting. Here I was introduced to a current assessment of the problem of both nosocomial MRSA and community-acquired MRSA in Josephine County. Dr. Daniel Selinger, the infectious disease specialist at the hospital, and Marjorie Underwood, the infection control nurse, were both helpful in answering my questions about hospital infection control policy. As it turned out, beginning in February, Three Rivers Hospital was changing some of their hospital protocol with regards to control of MRSA. This new policy was a divergence from the sister hospital, Rogue Valley Medical Center, in Medford and highlighted an ongoing national debate over proper infection control policy. I also spoke with Dr. Ruth Rabinovitch who is Dr. Selinger’s counterpart at Rogue Valley and is an adherent to the other policy approach. In the outpatient setting, I performed a chart review of any patient who during the last three years had a skin or soft tissue infection associated with MRSA. I examined twenty two charts, eleven of which contained a history of MRSA infection. Specifically I was looking for any of the risk factors associated with either a nosocomial MRSA infection or a community acquired MRSA infection. For the third component of my project, I visited both the county jails. At the Josephine County, I had a chance to interview the staff nurses who take care of the inmates. I wanted to get an idea of how they perceived the problem and what was their approach to treating infections that may be MRSA positive. I also had a chance to participate in a clinic for the inmates at the Jackson County jail. Here I had a chance to see some cases of skin and soft tissue infections and observe the Public Health Officer, Dr. Jim Shames, assess and treat these patients Although I did not come away from this experience with any solid answers about MRSA in a small community, it was heartening to see so many providers, in the hospital, in the clinic and in the community, that were working diligently to slow the growth of this inevitable phenomena. Assessing Occupational Asthma at Bright Wood Corp in Jefferson County. Project Date: 8/8/2005 Bright Wood Corporation is the largest employer in Jefferson County. Bright Wood, privately owned by the Stovall Family, is a group of secondary wood processing facilities that have many occupational hazards that contribute to the morbidity and mortality of the Central Oregon community. Bright Wood has done a respectable job lowering the acute injury rates, but many long-term morbidities have not been studied. Prior studies in occupational medicine highlight occupational asthma as a potentially unappreciated morbidity associated with wood dust. The objective of this study was to evaluate asthma rates within the community and comparing them to asthma rates within the Bright Wood employees seen at Madras Medical Group. Awareness of Diabetic Foot Complications in Baker City, OR Project Date: 8/8/2005 Diabetic foot complications are associated with significant morbidity and mortality. Patient education has been shown to decrease diabetic foot complications. Therefore, the purpose of this study was to assess patient education in a rural community. The level of education in Baker City diabetics was found to be low compared to other studies. Complications reported among diabetics were also low, suggesting that the lower level of education has not adversely affected this population. However, the complication rates could be reduced and education was shown to have a positive effect on reducing complications. Additionally, annual foot exams, podiatry referrals and medication management were lacking, and could be improved with education. Thus, a patient education brochure regarding diabetic foot care would be appropriate. Improving patient awareness of stroke disease Project Date: 7/4/2005 According to the American Health Assocation (AHA), stroke is the leading cause of long term disability in the United States today. Four million Americans currently live with the chronic effects of strokes, with another 700,000 strokes occurring each year. In addition, studies show that for all strokes, 50-70% of patients are able to recover functional independence, with another 15-30% remaining permanently disabled. Due to the long-term medical care and disability that is so often needed, the annual cost of stroke treatment has soared to $57 billion annually in the United States alone. Thus, the need to recognize stroke risk factors and educate those at risk has become increasingly important to healthcare practitioners. The AHA, American Stroke Association and National Stroke Association all agree that studies have proven the existence of a variety of stroke risk factors, which are all classified as controllable or uncontrollable. Examples of controllable factors include smoking, obesity and alcohol consumption while uncontrollable problems include family history and age. By virtually any outcome measures defined, study questionnaire results show that baseline knowledge of strokes among West Salem Clinic patients is sufficient at best. In addition, comparison of questionnaires with corresponding patient chart info provide evidence that stroke knowledge actually declines linearly with stroke risk, exactly the opposite preferred trend. After completing the study questionnaire, all subjects were furnished with materials containing basic information regarding stroke disease background, risk factors and symptoms. In addition, other methods to improve patient awareness of stroke disease are considered. Assessing the Resources Available to At-Risk Pediatric Patients Project Date: 8/9/2004 Individuals under the age of eighteen comprise approximately one fourth of the population of Baker County, Oregon. Nearly one fifth of these individuals live below the poverty line, which produces significant ramifications on this society as a whole. Physicians serving this population may offer not only medical services, but also refer other resources to these patients. Through interviews with representatives of community organizations and literature review, services available to pediatric patients who are of low-income families in Baker County were researched. In order to facilitate the awareness and utilization of these resources, patient education material highlighting medical, educational, social, spiritual, and recreational resources available to low-income Baker County pediatric patients was developed and distributed to various agencies in Baker City. Screening for depression in the elderly Project Date: 5/10/2004 Objective: To evaluate depression among individuals over the age of 65 presenting the primary care setting. Methods: The 15 Geriatric Depression Scale (GDS) was distributed to both Spanish and English speaking patients in the primary care setting. The question also included demographic information to identify possible risk factors for depression in the community being evaluated. School Vending Machines and Obesity in Ontario, Oregon Project Date: 3/29/2004 Obesity is an epidemic among adolescents in America. Overweight children are at risk for many diseases as children and later as adults. There are myriad factors that have contributed to the current epidemic. These factors have been termed a “toxic environment.” I evaluated the food environment at Ontario High School to address what factors at school contribute to a toxic environment. My study found that 40.9% of students at Ontario High School were overweight or at risk to become overweight. This is well above the national rate of 30.4%. A survey assessed reasons for meal termination and the number of snacks purchased from school vending machines. Overweight adolescents were more likely to stop eating because of external cues than healthy weight adolescents. Overweight students drank nearly 2.5 times more soda pop than those of healthy weight. Using this data, a letter was sent to Ontario High School’s principal and school board members strongly encouraging the elimination of soft drink vending machines from school. 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. Examination of risk factors for the development of osteoporosis in adolescent girls at the Woodburn Pediatric Clinic. Project Date: 7/1/2002 Osteoporosis is a major health issue in America, affecting 30% to 40% of adults older than 60. Although osteoporosis is most prevalent in the older population, it is now understood that its roots lie with the pediatric population. The failure to achieve an adequate peak bone mass is a significant risk factor for future development of osteoporosis, and this process is almost complete by the onset of adulthood. This study attempts to identify the prevalence of risk factors in 9 to 13 year old girls that may predispose them to the development of osteoporosis. Data was collected by surveying girls regarding their dietary habits, exercise routine, medication use, and family history of osteoporosis. A chart review of well child exams for children of the same age was completed to assess how the Woodburn Pediatric Clinic addresses the issue of bone health. The findings of this study estimate that 60% of female patients in this age range were not consuming the recommended 1300 mg of calcium daily, 50% were not participating in regular weight-bearing exercises, and 33% already had a known family history of osteoporosis. The chart review demonstrated that the Woodburn Pediatric healthcare team is addressing nutrition and exercise in a broad sense, but fail to specifically evaluate and educate patients about the risk of developing osteoporosis. It is recommended that clinicians begin screening girls for inadequate calcium intake and exercise and providing counseling regarding preventing osteoporosis beginning at the 5-year-old well child exam. Back to subject search page or search by preceptor site