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. As Cool as ICE: A Community Health Initiative Supporting the Use of "In Case of Emergency" Contact Numbers in Cell Phones Project Date: 10/12/2009 Programming an ICE number, or In Case of Emergency contact number, into a cell phone can help emergency workers gain important medical information or contact a family member in the event that a patient is found unconscious or unable to communicate such vital information. Many community members have heard of the worldwide ICE number initiative, yet relatively few have one programmed into their cell phones. Based on previous research investigating methods for increasing the use of ICE numbers among patients already in Emergency Department waiting rooms, this project uses a preventative approach based on the paradigm of inoculation in the primary care setting using the training of “ICE Ambassadors” in the clinic and community. ICE numbers were directly entered into the cell phones of more than 30 community members. Additionally, medical clinic staff and over 80 volunteers with the local fire department were trained how to increase ICE prevalence by explaining WHY the program is important, by knowing HOW to program an ICE number, and by directly HELPing someone else enter one. The student produced and distributed to community members a “business card” with directions for programming an ICE number on one side and the principles of being an ICE Ambassador on the other. Thinking about Health Care in the USA: A Health Care Primer Project Date: 8/3/2009 Health care reform has been one of the big political and social topics of 2009. With a president committed to reform and an equally committed opposition the tenor of the debate has been flooded with misinformation and intentional misunderstanding. The physicians at Dunes Family Health Care felt that their voices needed to be heard on the subject and that it was in part their responsibility to educate their patients. To do this they wanted to develop a tool that they could use to talk to their patients about the basic traits of the US health care system and the key elements of proposed reforms. Patient literacy levels and sophistication are limiting factors in this discussion. A health care primer was developed in a tri-fold color pamphlet form in order to help the physicians with their discussion. A significant effort was made to simplify the presentation of this complex issue. But, ultimately the level of discussion in the finished pamphlet requires an amount of education or literacy that makes it inaccessible still to many of their patients. This seems unavoidable to a certain extent because the health care system is at some point irreducibly complex and can only be simplified so far before the discussion becomes dishonest or meaningless. Trauma Management at the Cottage Grove ED: Change in Process Project Date: 2/9/2009 Trauma preparedness in small community hospitals remains a Catch-22. On the one hand, these hospitals may not be designated formally as a trauma center – any organized emergency response units recognizing a serious trauma would bypass these hospitals and take the patient to a larger center. On the other hand, the community at large may at any moment arrive with serious trauma, unaware of the specific capabilities of their nearest hospital. Thus, these hospitals must be as prepared for trauma as possible despite often limited resources. Cottage Grove Community Hospital is one such hospital, located in a small town of 9,000 in Cottage Grove, OR. Last year a trauma event that was not handled optimally initiated a major revamping of the hospital’s trauma-preparedness on many levels. This project is aimed at outlining and understanding the process of change thus far, primarily via several discussions with the Emergency Department operations manager, Naomi Grace. Both the process of review of the event as well as the specific modifications made thus far were described in detail. Lastly, Ms. Grace indicated that her next step was to be a literature review of rural trauma. The final contribution of this project was the completion of a literature review and presentation of those findings to her. Assessment of Barriers To Hospice Referral In Baker City, Oregon Project Date: 2/9/2009 Hospice services have long been recognized as an important component in the spectrum of healthcare but certain barriers to referral still exist. This study attempted to assess potential barriers to referral in Baker City, Oregon by looking at perceptions, attitudes, and knowledge of hospice services by local primary care providers. Initial information was gathered through personal interviews with patients, hospice workers and physicians. The results of the interviews were that referral habits likely varied by age and experience of the physician, with older physicians being less likely to refer. Similarly, a lack of knowledge was thought to inhibit referral. An anonymous survey was then collected from 6 out of the 9 primary care physicians in town which assessed attitude, knowledge, perceived benefits and perceived barriers to referral. The results showed that every physician surveyed had a high level of knowledge about hospice services and requirements and that this did not likely affect referral rate. There was consistency between local opinion and what was found regarding age of physician with the one responding senior physician being less likely to refer. This was determined to be likely due to a poor interaction history between the physician and local hospice services. Additional responses from the other senior physicians in town could not be obtained, so no generalizations could not be made. However, it was evident that the greater factor that influences many aspects of small town life is determined by how well people work together. Patient Perceptions of Rural Surgery: Can John Day's Blue Mountain Hospital compete with larger outside hospitals? Project Date: 12/29/2008 CONTEXT: Rural residents frequently have decreased access to surgical services. Consequences of this situation include increased travel time and financial costs for patients. There are also economic implications for hospitals as they may lose revenue when patients leave the area in order to obtain surgical services. Rural communities vary in size and distance from more populated centers. Since rural hospitals are located in varying types of rural communities, they likely differ with regard to the provision of surgical care. PURPOSE: To describe the differences between hospitals located in smaller versus larger rural areas regarding the provision of surgical care. METHODS: A 12-item survey instrument based on one previously used in a pilot study was mailed to a national random sample of rural hospital administrators (n = 233). Rural location was determined using rural-urban commuting area codes. FINDINGS: One hundred and eleven surveys were received, yielding a 48% response rate. Hospitals in larger rural areas had an average of 9 surgeons compared to 1 at hospitals in smaller rural areas. More administrators at hospitals located in larger rural areas viewed the ability to provide surgical care as very important to the financial viability of their hospital. CONCLUSIONS: Among rural hospitals located in communities of varying sizes there are significant differences in how surgical services are delivered and the financial importance of providing surgical care. Administrators at hospitals located in larger rural areas, more than in smaller ones, report financial reliance on their ability to offer surgical care and have significantly more resources available to do so. 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. Recommended Techniques for Safe and Environmentally-conscious Disposal of Un-needed prescriptions in Madras, Oregon Project Date: 4/28/2008 The proper disposal of expired or unused prescription medications continues to be an ongoing problem in the United States with no standardized disposal technique in place at a federal level or, in Oregon, even a state level. This study was designed to examine the current disposal technique Madras residents utilize to dispose of unused or expired outpatient medications as well as to provide a comparison as to what happens in an inpatient setting at the pharmacy and home health/hospice associated with the MountainView Hospital. The design was an informal survey of patients in clinic regarding their disposal habits as well as querying the MountainView pharmacists and hospice nurses as to their current protocol for medication disposal. Further phone calls were made to the Oregon Board of Pharmacy and the DEQ in regards to their recommendations for proper disposal techniques. Previously, there was no information available to patients for proper techniques to purge unneeded medications; therefore the final product of this project was the development of a patient handout to inform Madras residents of the most appropriate and environmentally friendly mechanisms of pharmaceutical disposal. Furthermore, as there is no organized collection system for outdated or unused medications anywhere in Oregon, an additional component of the project was to create a proposal for the Madras Medical Group to use as a long term community solution for the problem of proper medication disposal Herbs and Natural Remedies in John Day, Oregon: A Historical Perspective Project Date: 4/28/2008 The Oregon Department of Parks and Recreation have discovered over 400 herbal and natural medicines at the Kam Wah Chung & Co. museum in John Day, Oregon. It has not previously been identified which of these herbs, if any, are used in modern medical practice, a question frequently asked by museum visitors. Therefore this study aims to answer the following two questions in the form of an educational brochure: 1) Of the remedies that Ing “Doc” Hay and his assistant Lung On used, which are some of the ones still in common use by alternative and western medical providers today? 2) What evidence exists for such use? The design involved interviewing persons directly involved in the museum’s herbal discovery work, researching the historical timeline of traditional Chinese medicine and checking out a scientific catalog of herbs identified at Kam Wah Chung & Co., researching modern-day usage of herbal supplements, and performing an evidence-based review of those in common use. Furthermore, this information was compiled into a visitor-friendly guidebook brochure to be used by the museum staff and handed out to visitors of the museum and interpretive center. In the nearby future, the museum plans to create a hands-on herbal exhibit for which they would offer this brochure to visitors. Finally, Dr. Holland’s clinic office will house copies for patients interested in learning more about the historical and present uses of herbs and the evidence base for such use. As an additional point, the brochure educates the public about the side effects and potential drug-herb interactions of a few traditional remedies. Barriers and Solutions to Receiving Adequate and Continuous Mental Health Services Among the Underserved Population in Lane County Project Date: 3/17/2008 Mental illnesses have a long history of being grossly underdiagnosed and undertreated. This is especially true for the medically underserved because they are not able to receive the health care needed to treat their mental illness. This problem stems from several major factors which were investigated during this five week clerkship. There were two main goals to this project. The first was to take a closer look at the barriers contributing to this problem, especially from the perspective of the provider. The design was to interview people in the community who treated members of the medically underserved and had a good understanding their social/mental problems. The second goal of this study was to identify what resources were available and what measures were being taken by the community to address this problem. Despite high levels of awareness in the community regarding the great need of mental health services for the indigent population, there exists many barriers preventing the progress of accessibility, availability, continuity of care, and general knowledge of services. Included is a handout summarizing mental health services in Lane County produced by the 100% Access Healthcare Initiative, a group geared towards providing services to all members of Lane County. Emergency Preparedness of Non-hospital Medical Offices in Astoria, OR Project Date: 12/31/2007 The problem studied is emergency preparedness of non-hospital medical offices in Astoria, OR. The population in question includes all the residents of Astoria. The methods used include in person interviews of physicians and office managers. The findings are that there were few offices that were prepared for a recent local disaster. This has however, brought to light the importance of a disaster plan for non-hospital facilities. The final product of this project is a plan of action for the education and collaborative disaster planning by local physicians' offices and the emergency preparedness/safety coordinator of Columbia Memorial Hospital. The Unintended Model: Bringing Health Care Services to Rural Oregon Project Date: 10/15/2007 Santiam Memorial Hospital (SMH) in Stayton, Oregon is a unique small hospital with a rich history, influential present, and a hopeful future that strives to provide health care services to residents of the mid-Willamette valley in Marion and Linn counties. This qualitative study investigates how SMH administration, employees, and contracted providers have expanded their capacity for health care delivery in a challenging rural setting by cultivating successful staff and community relationships. The utility in exploring this unique situation includes elucidating strategies that may enable rural hospitals and providers to develop a greater capacity to meet the health care needs of other rural populations. The method of investigation primarily consisted of interviews and observation. I discovered that the ability of SMH and contracted providers to successfully deliver health care to their service population is tightly linked to local industry cooperation and successful community relations. Reminders to providers and parents as an intervention to address below-goal immunization rates Project Date: 9/10/2007 Rates of immunization at the Strawberry Wilderness Family Clinic were compared to those of other rural providers in Oregon and found to be lower than expected. The clinic staff was consulted to identify aspects of the immunization protocol which needed improvement. This lead to 1) creating a reminder to providers in the clinic EMR for children past due on immunizations and 2) assembling postcards to be sent to parents of past due children. These methods have been shown in the literature to improve immunization rates. Impact of these changes will be determined in future reviews of the clinic's rates. Additional interventions in clinic protocol, such as standing orders, and programs, such as Oregon AFIX, should be employed if rates continue to be below goal. Evaluation of Childhood Immunization Delivery in John Day, OR Project Date: 9/10/2007 Childhood immunizations are an important public health initiative in preventing what were once common causes of childhood morbidity and mortality. Rural children may face increased barriers to immunizations due to living in medically underserved areas. In John Day, OR, the Grant County Health Department provides and tracks the immunizations for all of the patients seen by Dr Holland. The objective of this study was to evaluate immunization delivery, compare records between the clinic and the health department, and suggest strategies by which immunization rates can be improved. An analysis of all of Dr Holland’s patients aged 19-35 months (22 children) was conducted using patient charts and health department immunization records to determine immunization status at 24 months, as well as percentages of late starts and missed opportunities. These results were compared with similar data from January 2006 for Dr. Holland’s clinic recently released from the Rural Oregon Immunization Initiative (ROII). The percentage of children up to date with the recommended series of 4 DTaP; 3 IPV; 1 MMR; 3 Hib; 3HepB; 1 Varicella was 72%, which is an improvement from the rate of 57% found by the ROII. The percentage of children up to date by 35 months was 77%, that of late starts was 18% and of missed opportunities 9%. While these rates are all improved from the ROII data from 2006, they are not yet reaching the Healthy People 2010 goal of 80% or better coverage. The rates could be improved by decreasing the percentages of late starts and missed opportunities, by improving communication between the health department and the clinic, and by addressing parents concerns and fears about immunizations. The clinic will begin using the ALERT immunization registry to better track immunizations and remind patients of due vaccines. All children found by this project to be behind on their vaccines were notified and encouraged to complete the series. Evaluation of the Potential for Expanded Use of the Cascade’s East Family Practice Residency Program Mobile Health Clinic Project Date: 7/2/2007 Southern Oregon includes much vast and scarcely populated territory. This is particularly true in the region served by the medical providers in Klamath Falls. Healthcare resources are intensely focused in Klamath Falls itself, with very minimal services available in the rest of the territory which encompasses almost 10,000 square miles. In addition to the geography, there are social and economic considerations which further pose barriers to effective healthcare access for the most rural residents. The Cascade’s East Family Practice Residency Program has initiated a mobile clinic in an effort to reach out to the vulnerable and underserved populations in the area. Currently the well equipped vehicle is targeting its service delivery to the homeless populations with monthly visits to the area shelters. Given the success of these initial efforts, there is great potential for successfully meeting further needs by expanding the services of the mobile clinic. A needs assessment was conducting to identify and prioritize potential uses of the mobile unit. The demographic and health data for the region was reviewed as well as the current health services. A list of needs and potential mobile clinic activities was then developed. Finally, the available resources and potential funding sources were evaluated and recommendations were developed for next steps. Gasps in the Night: Improving CPAP Compliance in the Primary Care Setting of Coos Bay, Oregon Project Date: 3/19/2007 Although continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea (OSA), it is sometimes intolerable to patients and compliance can be a major obstacle. Primary care providers may not be aware of the resources available to improve compliance and without early intervention the patient may ultimately fail the therapy. In addition, appropriate screening tools need to be integrated into the Electronic Medical Record (EMR) to diagnose sleep apnea, facilitate appropriate referrals for sleep studies, and to follow up after therapy has been initiated. Therefore, it was undertaken to determine what kind of resources can be given to primary health care providers to improve CPAP compliance among their patients with OSA. Increasing High School Student Awareness of Health Careers in Union County Project Date: 3/19/2007 Although 20% of Americans live in rural areas, only 9% of the nation’s physicians practice there. Studies have shown that medical students raised in medically underserved areas tend to set up practice in such areas. Unfortunately, students from rural areas lack exposure to health care careers and practice opportunities. The purpose of this project was to develop and implement a rural outreach curriculum to help increase high school student awareness of health careers. The project goals were accomplished by visiting several high schools in Union County to give an interactive lecture designed to inspire students to enter the field of medicine. The project also included development of a student handout regarding age-specific OHSU and AHEC sponsored career exploration summer programs, available preceptorships, and available funding for high school students interested in a health career. The goal of the project is to reinforce the OHSU mission of attracting Oregonians to the School of Medicine and ultimately supplying all of Oregon with sufficient numbers of qualified health care professionals. Rural Healthcare Dialogue Project Project Date: 1/1/2007 Many private and public groups are currently involved in health care reform initiatives. The primary goal of this project is to decentralize and enrich the discussion of health care reform by engaging rural Oregonians in a conversation regarding their perceptions and expectations about healthcare, and to ensure that their opinions are relayed to the leaders of health care reform initiatives. Additionally, this project aims to foster leadership and activism among medical students and community members. Third year medical students will hold town-hall-style meetings in rural Oregon cities while on their required rural clerkships. These meetings will be open to the public, and provide education regarding the current state of health care in Oregon and the US, and discourse of several standardized discussion questions that focus on improved coverage and the finances of health care reform. Medical students serve as facilitators and document the general thoughts and sentiments for the group. Their results are communicated via a one-page summary document and one-page personal reflection document. At its conclusion, the findings will be shared with the Medicaid Advisory Committee, the Office of Private Health Partnerships, and the Oregon Health Policy Commission. So far, ten medical students have participated in the project, hosting meetings in eight cities. The findings to date are quite varied; however, several themes and lessons have emerged. First, many people lack understanding of the structure of our healthcare system, which creates a barrier to informed discussion. Second, the immigrant population is in favor of universal basic healthcare coverage while non-immigrants are generally opposed to coverage of non-citizens, and oppose tax increases to improve coverage. Third, students have responded positively to the experience, stating it has inspired them to continue participating in health care reform efforts. And last, rural health care providers believe that medical schools can influence future providers to practice in rural areas by recruiting students from rural cities, and by creating a rural medicine “fast track,” that specializes in training rural physicians. 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. Recruitment and Retainment of Rural Physicians: the difficulties found in the Frontier community of Grant County, Oregon. Project Date: 1/1/2007 Recruiting and retaining physicians in rural areas is an ongoing problem in the United States today. Physicians are trained in urban areas and often prefer to remain there to practice creating difficulty in recruiting to rural communities. If a physician does choose to practice in a rural setting they often feel isolated and overworked and usually remain for only a short time. This report analyzes the recruitment process of the Blue Mountain Hospital and a private clinic in Grant County, Oregon and identifies the difficulties in recruiting and retaining physicians in that area. Data were gathered from journal articles and interviews with local physicians and the hospital administrator. Grant County uses a variety of physician recruitment firms and word of mouth advertising, although in the last five years three of the new doctors have come through the Oregon Area Health Education Center. In the last eighteen years Grant County has had sixteen different physicians, each of them remaining only four years on average. In addition to lack of medical student exposure, local physicians identify various lifestyle and professional issues as barriers to recruiting and retaining physicians. I attempt to offer solutions to these issues including more selective recruiting and improved strategies to expose medical students to rural medicine Rural Healthcare Dialogue Project Project Date: 1/1/2007 Many private and public groups are currently involved in health care reform initiatives. The primary goal of this project is to decentralize and enrich the discussion of health care reform by engaging rural Oregonians in a conversation regarding their perceptions and expectations about healthcare, and to ensure that their opinions are relayed to the leaders of health care reform initiatives. Additionally, this project aims to foster leadership and activism among medical students and community members. Third year medical students will hold town-hall-style meetings in rural Oregon cities while on their required rural clerkships. These meetings will be open to the public, and provide education regarding the current state of health care in Oregon and the US, and discourse of several standardized discussion questions that focus on improved coverage and the finances of health care reform. Medical students serve as facilitators and document the general thoughts and sentiments for the group. Their results are communicated via a one-page summary document and one-page personal reflection document. At its conclusion, the findings will be shared with the Medicaid Advisory Committee, the Office of Private Health Partnerships, and the Oregon Health Policy Commission. So far, ten medical students have participated in the project, hosting meetings in eight cities. The findings to date are quite varied; however, several themes and lessons have emerged. First, many people lack understanding of the structure of our healthcare system, which creates a barrier to informed discussion. Second, the immigrant population is in favor of universal basic healthcare coverage while non-immigrants are generally opposed to coverage of non-citizens, and oppose tax increases to improve coverage. Third, students have responded positively to the experience, stating it has inspired them to continue participating in health care reform efforts. And last, rural health care providers believe that medical schools can influence future providers to practice in rural areas by recruiting students from rural cities, and by creating a rural medicine “fast track,” that specializes in training rural physicians. Utilization of the ER in Madras: Implications for health care availability and health care costs. Project Date: 9/11/2006 Between 1992 and 1999, the amount of ER utilization increased by 14% from 89.8 million to 102.8 million visits annually. This increase continues. US health care spending has also increased steadily, with rates of increase now in the double digits. Over-utilization of the ER has translated to increased health care spending, as well as inadequate long-term care for the patient. By analyzing the characteristics of patients admitted to Mountain View Hospital ER in Madras, we may gain some insights into the determining factors involved in patients' decisions to go to the ER instead of a primary care clinic. Madras is a rural community in central Oregon with unique health care issues related to its need for greater clinic accessibility, its shortage of primary care providers in the face of a growing population, and its housing of a larger subset of uninsured patients than Oregon as a whole. Mis-utilization of Mountain View Hospital's ER is a problem and solutions are discussed. Rural vs. University Medicine: A comparative review of data Project Date: 8/7/2006 Rural communities in Oregon face many obstacles to adequate health care relative to their urban counterparts, especially those with direct access to a teaching hospital. Among the more serious of these are: a lack of specialty care, a smaller selection of primary care, greater numbers of "working poor," and fewer clinical options for low income patients. Most medical students at OHSU are not exposed to non-university medicine until their third year of school, and even then, a miniscule percent of their overall education is dedicated to these pursuits. This project attempts to create a framework by which OHSU students can begin to understand the differences between rural and university health care settings before their clinical years. Nuclear Medicine in Reedsport, OR. Myth or Reality? Project Date: 1/2/2006 As the needs for nuclear studies are expanding in Reedsport, Oregon, the Lower Umpqua Hospital wants to introduce a gamma camera to be a part of their imaging facility. Being a small 22-bed critical access hospital for the area of 8,000 people puts certain financial restrictions on the scope of services the hospital can provide. Mainly a feasibility analysis for implementation of radionuclide studies into the hospital operations, this project attempts to evaluate the needs of the community and financial viability of the new imaging service. The potential barriers to entry, ways to mitigate them, and functional advantages of the hospital were explored. The analysis confirmed the immediate needs of the community for nuclear studies and supported the far-reaching plans to expand the scope of hospital services in the future. Pro-forma financial statements based on the realistic assumptions showed potential ability to break even on operations but inability to get any direct return on investment. The findings were shared with the hospital administration, staff of the radiology department, and physicians from the Dunes Family Health Care clinic. A pro-forma spreadsheet for profitability analysis was created for the hospital administration. Further research on how to make it profitable is suggested. Healthcare for the Underserved Population of Grant County. Project Date: 9/12/2005 Rural areas in Oregon tend to have large percentages of patients on Medicare or Medicaid than do larger more metropolitan areas. Grant County Oregon is served by four family doctors who not only see patients during clinic hours, but are on call 24 hours a day, seven days a week to staff the emergency room at Blue Mountain Hospital, the only hospital in the county. Grant County has a very vulnerable and needy population in terms of the ability to access and pay for medical care. 25% of people live at or below the poverty level, and 60% live at or below 200% of the poverty level. More than 60% of the patients who are treated at the Blue Mountain Hospital are on either Medicare or Medicaid. According to the US Census Bureau, about 18% of the population is living with some sort of disability. This situation is a reality in Grant County. Medicare and Medicaid programs only paid about two thirds of the charges that were billed to them from the Strawberry Clinic. This resulted in a loss of $30,000 last year. In March, 2005, the clinic became a Rural Health Clinic in an attempt to continue caring for the rural community. Methamphetamine use in Grant County: Development of a patient handout to increase methamphetamine treatment. Project Date: 8/8/2005 Methamphetamine use continues to be a growing and seriously problem in the United States, with rural areas being affected particularly heavily. This project was designed to increase the use of treatment options by methamphetamines users in Grant County, with the creation of a brochure that is available to patients in the Emergency Room at Blue Mountain Hospital and Grant County Center for Human Development. Before this project, there was a lack of ready information for people who use methamphetamines about their treatment options locally and regionally. The attention grabbing and succinct brochure highlights the reasons why methamphetamine use is harmful, increases insight into the person’s habit, and explains what options are available to help them quit. The handout can be easily altered to accommodate different regions of Oregon and the US, and it is hoped that it will increase the number of people who successfully quit their addiction to methamphetamines. Mental Health Resources in Clatsop County: A Summary of the Need For and Existing Mental Health Services Project Date: 3/21/2005 Mental health disorders and the need for mental health services are pervasive in all areas of Oregon, including rural communities like Clatsop County. Residents of Clatsop County have a greater proportion of alcohol and drug-related problems and have at least equal to or greater need for other mental health services. Despite the need for mental health services, resources are seemingly lacking, and furthermore, resources are not readily evident to local health care providers who must often align their patients with appropriate mental health services. The goal of this project was to examine the scope of the need for mental health services in Clatsop County, identify mental health resources in Clatsop County, formulate a pamphlet for use by local health care providers and community members which summarizes existing mental health resources, and approximate whether current resources adequately meet the needs of the population with mental illness. 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. Lessons Learned from a Pertussis Outbreak in Reedsport Project Date: 2/7/2005 Reedsport was hit by a pertussis outbreak in fall 2004. People were inexperienced and unprepared about management of outbreak. I interviewed the participants who were involved in the outbreak, including representatives from Douglas County Health Department (DCHD), Dunes Family Health Care clinic, Oregon State Health Department, schools, parents and local pharmacies. From their different perspectives I summarized the lessons learned from the outbreak and formulated some suggestions for them so that the community will be more prepared for future outbreaks. Philomath Pertussis Outbreak Project Date: 2/7/2005 The number of cases of pertussis has been steadily increasing during the last several years nationally and also in Oregon. Benton County has lead the state during the last year with the help of two outbreaks including a focus in Corvallis during spring and a recent outbreak centralized in Philomath during fall/winter of 2004. The incidence rate has reached 1250/100,000 in Philomath and has overwhelmed the County Health Department along with the rest of the health care system. To deal with the recent epidemic the health department has decided to change its policy concerning chemo prophylactic usage and to recommend antibiotics use only to asymptomatic contact in high risk-groups. This policy change will allow a more careful use of antibiotics and a stronger focus on groups that are more susceptible to complications such as infants, pregnant women and elderly. Through time spent collecting data at the health department, multiple interviews with various people who are involved at different level of the epidemic and my own experience assisting with taking care of patients with pertussis, I have developed a better understanding for how outbreaks are handled by a health system. During my investigation into the outbreak I realized that high school students had a high incidence rate and tended not to understand much about the disease. I made a video with several high school students that was played during school that gave basic information about pertussis, gave them reasons why the disease could be important to them and taught them some ways of decreasing its spread. I also made signs that are posted throughout the school which gave similar information. In addition, I made a handout for the family medicine clinic that I was rotating in that covered the most frequent questions that patients ask about pertussis in order to assist the staff and provide information to the patients in a quick, informative manner. Successful aging in the elderly population of Scappoose, Oregon: A report on the resources and facilities available to encourage successful aging. Project Date: 10/18/2004 The elderly population is the fastest growing group of individuals in the United States. It has been shown that avoiding disease and disability, sustaining high functioning, maintaining and establishing social networks, and actively engaging in life all lead to successful aging in the elderly. Many elderly rely on community services to accomplish successful aging, and it has been shown that rural areas tend to have deceased availability of these services and professionals. This research project identifies and reports the resources available to the elderly population of rural Scappoose, OR in order to age successfully. Visits to the local nursing home, assisted living community, and senior citizens’ center were made. Interviews with staff were conducted and tools to promote successful aging in the elderly population were discussed and recorded. The final report reveals that although Scappoose is a rural community, it contains the resources available to promote successful aging in the elderly population. Availability of Health Care in Warm Springs, With a Focus on the Elderly Project Date: 10/18/2004 Warm Springs is a small Native American community in central Oregon, located on the 640,000 acre reservation. The reservation is populated by The Confederated Tribes of Warm Springs, which consists of the Wasco, Warm Springs, and Paiute tribes. The tribe built a comprehensive Health and Wellness center that is utilized by the Indian Health Service for direct medical and dental care. Currently, the clinic serves an annual patient population of 5,750 through an array of specialty clinics, classes, and social services. One of the specialty clinics is a senior clinic that was recently implemented to accommodate specific health problems and concerns of the tribal elderly. Many of the native elderly population are chronically ill and mortality in the elderly is high, despite free and high quality health care. When HIS explored obstacles for seniors to receive health care, they revealed that seniors were consistently missing their appointments for reasons that could be remedied. The specialty clinic was designed to reduce total senior clinic appointments, aid in senior transportation, and coordinate the senior’s specific health care plan. Investigation into improvement in disease prevalence or improvement in health, since implementation of the senior clinic, has not yet been done. However, it is impressive to note that now more than 90% of seniors attend their Senior Clinic appointments. As the senior clinic continues to be used, it will be interesting to note possible changes in the health of the seniors as well as in the attitudes of elderly, ideally taking accountability and control over their health. Mental Health: Breaking Down Barriers to Mental Healthcare in the Philomath Area Project Date: 10/18/2004 Mental illness is common across America and this may be most apparent in primary care clinics. Primary care physicians have become a significant focal point to mental healthcare delivery everywhere, but especially in rural communities where community mental health resources are lacking. This report assesses the prevalence and disease burden of mental illness in the U.S. overall, in our rural communities, and in Benton County. Secondly, it discusses the barriers to mental healthcare and the role of the primary care physician for mental healthcare delivery. Thirdly, it evaluates the community mental health resources available in the Philomath-Corvallis area, as well as how the physicians of Philomath Family Medicine are utilizing these resources. Finally, from the information gathered by survey of the community, and physician and therapist interviews, a consolidated list of community mental health resources was produced, including contact information, description of services, eligibility and cost. The ultimate goal is that these lists will promote more effective utilization of community mental health resources in the Philomath area. Addressing A Possible Solution for Specialty Outreach Clinics. Project Date: 9/13/2004 OHSU Scappoose Family Practice was recently designated a Rural Health Center. While this designation provides adequate primary care reimbursement for Medicaid and Medicare patients, these patients still experience delays establishing tertiary care. To address a possible solution to this problem we researched the plausibility of specialty outreach clinics. We reviewed 1,000 referrals from the OHSU Scappoose Rural Health Center in 1999 to identify potential specialties with enough patient demand to warrant regular scheduled visits to Scappoose Family Practice Clinic. We also identified which specialties are limited to location by technology, and finally we asked the question if specialties did come to the Scappoose clinic on a regular schedule, would this expedite Medicaid and Medicare patient access to tertiary care. Our findings identified five tertiary specialties that have met these preliminary criteria; Orthopedics, Cardiology, Otolaryngology, Rheumatology, and Dermatology. Warm Springs Use of Native Healers Project Date: 8/9/2004 Even though the Indian Health Service at Warm Springs provides extensive care for the Native population through its Clinic, no information is known as to the extent of Native Healer presence on the Reservation. Native Healers are otherwise known as Medicine Men, or Women. Thus this study was conducted with the goals of assessing the presence of native medical practices within the population at the IHS clinic. There have been one study done on this topic, but there a couple of case reports and focused articles in the literature available. The one published study is by C. Kim and Y.S. Kwok looking at the Navajo population in the early 90s. They have concluded that 62% of Navajo Native Americans have used native healers in their lifetime, and that 39% have used one the past year. They found that the concerns that were brought to native healers were mostly arthritis, pain, depression and anxiety and chest pain. Majority of the study focused on epidemiology of native healer use in the realm of socioeconomic status within the reservation. Very few differences were found between the users and non-users. Assessment of services available to seniors in Baker City, Oregon Project Date: 7/5/2004 The population of those over 65 in the United States is rapidly expanding, a trend that has profound implications for health care practitioners and organizations serving seniors. Rural communities in particular are seeing a surge in this population. Observation of physicians in Baker City, Oregon and their interactions with elderly patients demonstrated that primary care practitioners are often called upon to connect seniors with appropriate resources, both medical and social. Navigating the numerous agencies and trying to determine which services are provided can be frustrating for physicians, seniors and their families. A survey of services available to seniors was conducted, as well as interviews with organizations providing resources. It was concluded that while there are a multitude of opportunities for seniors in Baker City, a large portion of seniors were not making use of se services. Although there are a number of reasons for this, it is hypothesized that utilization of services may increase if health care providers are able to more easily access contact information. In order to aid practitioners in this endeavor, a comprehensive list of services for seniors in the Baker City area was produced. Facing the loss of obstetrical care in Grant County: Is the community prepared? Project Date: 5/10/2004 Multiple studies have shown that many rural Oregon clinicians performing obstetrical deliveries have already stopped or plan to stop providing this service in the near future. Despite malpractice subsidization efforts such as the Rural Medical Liability Financial Reinsurance, these rates continue to soar, forcing many physicians out of obstetrical practice. The number of physicians who routinely perform obstetrical care in Grant County has dwindled in recent years, such that only one family physician performing OB remains in this isolated county of 8,000 people and 5,000 square miles. If no viable alterative is identified, he, too, will likely stop providing OB care in one month and women will be left to drive long distances for prenatal care and their delivery. In the advent of this potential crisis, this project was designed to assess the community’s preparedness for this transition, as well as childbearing women’s intentions for obtaining prenatal care. These goals were obtained through two methods: 1) a 12-question survey of 33 pregnant and postpartum women that sought information on demographics, risk factors, barriers to receiving care elsewhere, and anticipated plans at the onset of labor, and 2) interviews with community health partners to identify problems, concerns, and potential solutions that might prevent or minimize the impact of the crisis. Survey results revealed a population of many Medicaid patients and first-time mothers. Although most women reported a willingness to travel for prenatal care, 82% stated they would go to the local hospital in Grant County at the onset of early labor signs, suggesting the need for continued emergency OB services. Results of the interviews with health leaders are summarized in a problem/solution format. The results were shared with the same community health partners to assist in their preparedness planning. Who becomes a rural physician? Characterizing the Physicians of Oregon’s South Coast Project Date: 9/29/2003 There have been efforts to characterize rural physicians in hopes of correcting the shortage of health care in rural areas, and several generally accepted assumptions have emerged. This project aims to determine if these “basic truths” apply to rural Oregon, particularly the South Coast area surrounding the community of Coos Bay. A survey addressing these questions was sent to 99 physicians with a 46% response rate. To further investigate the belief that rural experiences increase interest in rural practice, an analysis of OHSU graduates before and after the implementation of the rural clerkship was undertaken. The data presented indicates that many of the accepted truths do not in fact hold up for the populations investigated. How does a county hospital in a town of 4,000 people afford a full-time MRI? A case of rural hospital success. Project Date: 11/10/2003 MRI is an powerful and important diagnostic tool but is a luxury that many rural hospitals cannot afford. This project focused on one such rural hospital, Tillamook County General Hospital (TCGH), that is currently completing installation of a full time MRI scanner. This rural hospital serves a population of just over 24000 people, yet it has managed to foresee economic viability for this expensive imaging modality. Interviews were conducted to MRI technicians at each of the 11 Oregon hospitals serving the Oregon Coast to establish the type of MRI services available, the number of patients scanned per week and per month. MRI cost analysis and comparison among the Oregon Coast hospitals was done via Health Care Financing Administration and American Hospital Association data made available on the world wide web. TCGH shows a slightly higher rate of MRI utilization than the average of the 11 Oregon Coast Hospitals, but Tillamook does have a higher proportion of it's residents as over the age of 65, based on Census 2000 data. Tillamook has the third lowest average cost per MRI ($451) of the seven Oregon Coast Hospitals with available MRI cost data. Only Gold Beach ($350) and Coos Bay ($128) have lower average costs per MRI, while the other reporting hospitals show charges of up to $600 and even $800 dollars. Budget data obtained by interviews with the TCGH administrators demonstrate confidence in the projected financial viability of the MRI scanner; further confirming that the timing is right for TCGH to implement a full time MRI scanner of its own. This will certainly increase access to this valuable diagnostic imaging modality while concurrently providing a revenue boost to ensure overall hospital viability at TCGH. Getting It Out There:Developing a Health Care Resource Guide in a rural Community Project Date: 5/5/2003 The Community Health Improvement Partnership (CHIP) has been undertaking a large-scale health needs assessment in Reedsport, OR over the last two years. This has been done by written survey and town hall meetings. These efforts have yielded a set of health issues that the community finds important. The CHIP committee is now at a stage to start implementing solutions to these findings. As my project, I participated in the CHIP committee on health information and referral. The community had indicated that it was difficult to find the appropriate health resources. To that end, the committee has begun compiling a list of healthcare resources and organizing them in a searchable database to be linked to the Lower Umpqua Hospital website and printed for use in establishments that provide resources for a large number of people. The resource directory is expected to be a comprehensive document outlining services, points of contact, hours, etc. It is expected that it will take about 6 months to complete, therefore; an interim guide will be used that simply provides resource names and phone numbers. Adult Foster Homes in Philomath, Oregon. A survey of services offered, population served, and the licensing requirements of these institutions. Project Date: 9/23/2002 With the aging of our population comes an increasing need for more long-term care facilities. Adult foster homes (AFH) were spawned from the need for facilities that could provide quality care in a less institutionalized setting at a reasonable cost (about two-thirds the cost of nursing home care). Philomath is a small town of approximately 4,000 inhabitants, which is located in Benton County. Benton County has a population of 77, 929, 10.3 % (8026 individuals) of this population is 65 or older. There are two adult foster homes in Philomath, His House and Heaven's Half Acre. The goals of this project were to first identify what role these adult foster homes play in Philomath and the surrounding communities, to understand the services offered and to finally identify licensing and requirements for licensure. These goals were met via interviews with the Benton/Linn County AFH licensor and with the providers at the homes in Philomath. The findings of this study illustrate that AFHs provide long-term care to those with Activities of Daily Living (ADL) impairment. The homes in Philomath serve primarily the elderly (65 and older) and, occasionally, younger disabled individuals from Philomath and its surrounding cities. There are three levels of AFH, which provide progressively higher acuity of care. His House is a level III AFH and Heaven's Half Acre is a level II AFH. Adult foster homes must comply with regulations formulated by the state legislature, which are enforced through the local Senior Services Division in Albany by the AFH licensor Colleen Susac. Through the interviews conducted some gaps were identified in the services offered by adult foster homes, these are discussed throughout the paper. Back to subject search page or search by preceptor site