Elizabeth Howey, of the Pagosa Springs Medical Center Wellness Center, presented to the Upper San Juan Health Services District board on Tuesday on the cardiovascular outreach program spearheaded in 2012.
In May of 2012, the district was awarded a three-year, $1.7 million Health Care Innovation award from the U.S. Department of Health and Human Services.
According to the PSMC website, the grant was designed, in conjunction with the Center for Medicaid and Medicare, to rapidly enhance programs focused on “improving health, health care quality, and reducing the costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) enrollees.”
The district began using their award to fund a program for a comprehensive approach to cardiovascular and stroke care in the community.
According to Howey, cardiovascular disease is the second leading cause of death in Archuleta County.
Most cardiovascular issues that lead to death can be prevented through proper health care and information, hence the program’s launch in 2012.
The program is designed to address all forms of care, from prevention to treatment to the handling of emergency situations to rehabilitation after a serious cardiac event occurs.
“All with the goal of better health, better care” for everyone, Howey stated.
As far as prevention goes, Howey said, “the Wellness Department has been tasked with 600 heart heath checks per year, along with lifestyle education for improved health.”
Departments within the district are working together to provide numerous community health services, among them critical care transports and follow-up paramedic visits, to patients.
“As you can see,” Howey told the board, “there are quite a few very dedicated, very passionate people behind this project.”
Another aspect of the project includes launching an aggressive marketing campaign to reach as far out into the community as possible.
The campaign includes fliers and banners highlighting the importance of de-stressing, smiling, dancing and taking care of your physical and mental health to benefit your heart.
The district has put out literature on symptom recognition and is launching a series of radio and television ads to inform community members about their health care options.
The ads, while designed to inform everyone in the community, are specifically targeted towards those individuals who do not seek care, are not aware of their need for care, or who are unfamiliar with the services offered by PSMC.
The campaign also offers tips on lifestyle changes and “driv[es] home that call to action,” informed Howey.
Howey told the board that the Wellness Center aims to inform and empower the community, reduce cardiovascular risk factors, facilitate health education and improve the overall health and quality of life in the community.
There are two main services offered by the project through the Wellness Center.
First, the center provides heart health checks, which inform patients on the state of their heart health and gives them tools to make beneficial changes in their lifestyle.
Second, the center offers wellness education classes that address physical activity, diet, stress management and other factors important for maintaining a healthy heart.
The goal of the program was to complete 500 heart checks in the first year; they exceeded their goal and were able to conduct over 630 screenings.
The Wellness Team has held health care events in schools, churches, the library, through civic organizations and through anyone else willing to let them.
Patients are walked through their screening results and given follow-up reminders for future visits, if appropriate.
Heart health screenings also create an opportunity for patient referrals to a primary health care provider.
So far, the district has been able to see measurable health improvements for patients having gone through the program, especially in regards to LDL and blood pressure numbers.
In the first year, 46 people out of the original 600 plus screenings came back for re-screenings. The 46 people who returned had abnormal LDL and blood pressure values during their initial heart check.
Seventy percent of those 46 people were brought into healthy ranges.
“A pretty impressive statistic,” Howey stated.
So far this year, Howey said the district has conducted 140 screenings, which is still above their goal for where they should be at as of right now. Staff has begun looking at screenings and examining the results for patients needing to be brought into healthy heart ranges.
Another positive impact the program has had is channeling new patients who do not already have a relationship with PSMC, or who have been avoiding or neglecting care, into the clinic for health care.
The program has also increased visibility for PSMC in the community.
The biggest challenge faced by the program, said Howey, “is commitment.”
“It can be very difficult to get someone to change their lifestyle, to change their habits, their hobbies, sometimes their social circle,” Howey said, especially if they have not had a scary cardiac event to motivate them to do so.
Another challenge is getting people to come into the wellness classes to learn about how to make such changes.
Initially, the project team tried hosting off-site classes; however, not enough people attended.
Since then, the Wellness Center has partnered with San Juan Basin Health to bring classes into the workplace. So far, those work-sites have included PAWSD, the library, Seeds of Learning and a few others.
“So far [the classes] look tremendously successful, and very well received,” Howey stated.
The Wellness Center has also started online programs in order to reach a wider audience.
of the program
The innovation grant is also being used to fund telemedicine, which offers “remote access for more robust care,” according to Howey.
This will soon include paramedic outreach visits to homes, which will provide in-home follow-up care after an acute event.
The paramedic outreach program will work closely with primary care physicians and other health care providers in the community to provide comprehensive care for an individual.
The program requires paramedics to go through an additional six to eight months of training, outside of their paramedic licenser. Training for the paramedics on how to conduct in-home visits is being conducted through Hennepin College in Minnesota. Currently, five paramedics are going through the program.
The district was able to get a vehicle donated for the project, which will give paramedics direct access, and primary care physicians remote access through teleconference, to recovering patients throughout the community.
While in-home, paramedics can assess other aspects of patients’ health, such as if there is food in the fridge or if there are safety concerns. They can then connect patients with the proper resources.
By allowing primary care physicians remote access to their patients, many unnecessary transports or emergency room visits may be avoided. Often times, when a patient calls a provider, the provider cannot make an accurate diagnosis over the phone, forcing the patient to come in. That will hopefully all change thanks to the outreach program.
The program is primarily designed to address the “serious gap between acute care and back to primary care and preventative care,” informed Howey.
The outreach program will offer care beginning 24 hours after patients are discharged, and will continue for 30 days thereafter.
A final element of the Wellness Center’s cardiovascular program is Patient Navigation.
Connie Cook currently works as the patient navigator for heart health.
Cook serves as a key communicator between several health care entities within the community and helps patients come up with an action plan to reduce any barriers they might have to health care.
Howey said Cook helps improve access to care by breaking down the common barriers patients have, such as financial, transportation, cultural (communication/language), distrust, family problems, lack of awareness of services, coordination of care between specialists and several others.
Cook also helps encourage patients to receive care sooner, rather than letting problems escalate until they demand emergency attention.
In addition, Cook assists patients with insurance needs, in some cases helping patients get their policies reinstated.
Dr. Malcom Rodger, board chairman, asked if the district has a person specializing in bilingual patient communication.
The board was informed that at this time, the district contracts out to a translation service over the phone. The patient, translator and health care provider have a conference call of sorts to figure out what the patient’s needs are.
According to Howey, patient navigation has had a positive impact on the district by reducing bad debt, often by helping patient’s insurance get reinstated. It is also credited with decreasing readmission through education and increasing patient satisfaction.