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Reaching for the stars…. West Central Cluster Summit “Moving Ahead With Spread” November 8-10, 2004 Dallas, TX. CABUN Rural Health Services, Inc. Located in south/southwest rural Arkansas. We have clinics located in Hope, Lewisville, Hampton, Strong, Bearden, and Amity.
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Reaching for the stars… West Central Cluster Summit “Moving Ahead With Spread” November 8-10, 2004 Dallas, TX
CABUN Rural Health Services, Inc. • Located in south/southwest rural Arkansas. • We have clinics located in Hope, Lewisville, Hampton, Strong, Bearden, and Amity. • We have over 11 providers in these 6 clinics. • Each family practice clinic has their own special population ranging from migrants and homeless, to obstetrics and industrial workers.
Aim Statement CABUN Rural Health Services, Inc. will improve the quality of care and treatment for our diabetic and cardiovascular patients by redesigning our current system including laboratory studies, self-management, cardiac risk reduction, screening for complications, and preventive measures. Our average HgbA1C will be <8.0. Our blood pressure will be <140/90.
Team Members • The Hope, Lewisville, & Amity Clinics decided to involve all of their staff as members of the collaborative teams. This allowed each clinic as a whole to understand and help with the goals of the collaborative. • Team Leader Key Contact Info: • Hope: Lynn Terral, RN, Clinic Manager (870) 777-8420 lynnterral@hotmail.com • Lewisville: Sandra Miller, RN, Clinic Manager (870) 921-5781 LFPC1@magnolia-net.com • Amity: Janna Lock, RN, Clinic Manager (870) 342-5606 amitychc@alltel.net
How it all Started…. • The Hope Migrant/Community Health Center was the first to start in the Diabetes collaborative phase 2 in January 2000 with one MD & 72 diabetic patients. • We didn’t have a true population of focus because we wanted all our diabetic patients in the collaborative, including new ones.
Spreading the Collaborative Movement • The diabetes collaborative spread to the Lewisville Family Practice Center with 1 provider & 124 diabetic patients in January 2002. Then we continued to spread to the Amity clinic in July 2002 with 1 provider & 34 diabetic patients. • The Hope Migrant/Community Health Center added the Cardiovascular collaborative in March 2002 with 2 providers & 217 cardiovascular patients. • The Lewisville Family Practice Center decided to spread into the cardiovascular collaborative in May 2002 with 1 provider & 305 patients.
Best Practices • The clinic managers review the charts the day before for needed lab work or screening materials. • Development of the flow sheet has helped tremendously at the Hope Migrant/ Community Health Center. • The indigent patient medication program is invaluable for our patients. • Receiving literature and education material for our patients from pharmaceutical companies and other health care facilities. • Diabetic Track II program with the Migrant Clinicians Network is utilized at the Hope Migrant/Community Health Center.
Best Practices • Self-management goals reviewed on each visit with the diabetic patient. • The implementation of the self-management goal stamp. • The depression screening tool is very successful in all clinics. • Follow up with patients who are no shows, reschedules, or cancellations by all staff. • A checklist for lab test data at a glance is utilized at the Amity Clinic.
Best Practices • Standing orders are a must!! Better patient flow and monitoring. • Monthly collaborative team meetings at all clinic sites. • Foot sign in each exam room to remind the staff and patients of taking off their shows for LEAP exam. • Making relationships with local dentist and optometrist for assistance in patient care. • The AHEC residents received training each year to assure of understanding of the collaborative efforts.
Lessons Learned • Do not try to do everything by yourself. Rely on your team and your patient for help. • Do not give too much information to your patient. They need time to learn and understand their disease process. • Have education material in picture form as much as possible for those patients who are illiterate. • Develop relationships with your community leaders and health professionals. Your patients may need help in areas that the clinic cannot provide.
Biggest Challenges/Barriers • Cultural issues with patients. Hispanic and other nationalities have their own likes and dislikes. We learned to work with them, slowly changing their normal eating habits. • Money, staff, and time. Each clinic learned to make due without money, lots of home-made ideas. Some staff members became multi-tasked within capabilities. There are only so many hours in a day that we can work. We just do the best we can.
Next Steps • We plan to spread the diabetic collaborative to the Hampton clinic with 1 provider and 100 patients in November. • Before March 2005, we plan to spread to the two remaining clinics, Strong and Bearden, with the diabetes collaborative. • We are researching the Open Access Design. • We have discussed spreading to the Depression collaborative. Our biggest challenge will be mental health referrals.
