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Taihung Duong, PhD Robin Danek , MPH Priya Abhyankar

Meeting Rural Community Needs: The Community Health Project in Rural Medical Education and The Value of Public Health in the PreMedical Education of Future Rural Physicians. Taihung Duong, PhD Robin Danek , MPH Priya Abhyankar Indiana University School of Medicine – Terre Haute

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Taihung Duong, PhD Robin Danek , MPH Priya Abhyankar

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  1. Meeting Rural Community Needs:The Community Health Project in Rural Medical EducationandThe Value of Public Health in the PreMedical Education of Future Rural Physicians Taihung Duong, PhD Robin Danek, MPH PriyaAbhyankar Indiana University School of Medicine – Terre Haute Indiana State University

  2. Active Physicians per 100,000 Population • Active Patient Care Physicians: 194.5/100,000 (34th/50 states) National Median: 215.1 Massachussetts: 314.8/100,000 (1st/50) • Active Patient Care Primary Care Physicians: 71.2/100,000 (36th/50 states) National Median: 80.4 Vermont: 111.5/100,000 (1st/50) • Active Physicians By Selected Age Groups Under Age 40: 16.5% Age 60 or older: 23.4% Active Primary Care Physicians per 100,000 Population Physician Workforce in Indiana (2010)

  3. The darkest shading indicates the best access and the lightest colors indicate poor access. Physician Accessin Indiana

  4. Established in 1997 • Recruit high school students from rural areas of Indiana • High school GPA 3.5 minimum • SAT 1200 minimum or ACT 27 minimum • Entering class of 10 admitted to Indiana State University Undergraduate College with full-tuition waiver. • Conditionally accepted to IU School of Medicine • Undergraduate college GPA 3.5 minimum • MCAT score equal to the mean of the entering class from the previous year Indiana State University/ Indiana University School of Medicine – Terre HauteRural Health Initiative B/MD program

  5. Total Number of Physicians 34 • Primary Care 20 (59%) • Family Medicine 13 • Internal Medicine / Pediatrics 1 • Pediatrics 5 • Obstetrics/Gynecology 1 • General Surgery 3 (8%) • Specialties 11 (32%) • Anesthesiology 6 • Diagnostic Radiology 1 • Emergency Medicine 2 • Neurology 1 • Orthopedic Surgery 1 • In Residency Programs 11 • Practicing in Indiana: 19 (83%) • Practicing in Rural Indiana: 6 (3%) • Practicing Out-Of-State: 4 (17%) Graduates from ISU/IUSM B/MD Program

  6. Established 2008 • Recruit medical school applicants from rural areas of Indiana • College graduates apply to IUSM and then to IUSM-Terre Haute RMEP program. • 2 separate admissions interviews • RMEP Interview Committee include rural community members. • Medical students are based for all 4 years of medical school in Terre Haute. Indiana University School of Medicine – Terre HauteRural Medical Education Program

  7. Total Number of Physicians 31 • Primary Care 23 (74%) • Family Medicine: 15 • Internal Medicine /Pediatrics: 1 • Internal Medicine: 3 • Obstetrics/Gynecology: 1 • Pediatrics: 3 • Specialties 8 (26%) • Anesthesiology: 3 • Emergency Medicine/Pediatrics: 1 • Emergency Medicine: 2 • Neurology: 1 • Physical Medicine and Rehabilitation: 1 Graduates from the IUSM-Terre Haute Rural Medical Education Program

  8. Physicians need training in: • Community Engagement • Leadership • Population Health to prepare them to work with partners within the community and to adapt medical care to address population health needs. Sheline et al. Academic Medicine 2014 May 13 [Epub ahead of print] Primary Care Physicians as Change Agents

  9. Manage chronic disease • Redesign clinical care delivery systems • Collaborate with interdisciplinary teams in the community to develop and implement health initiatives Improving Population Health

  10. Year 1: Rural Medicine through the Eyes of a Rural Patient and a Rural Practice • Year 2: Understanding the Community Context of Rural Medicine • Year 3: Problem-Solving in the Rural Community: Research and Planning to Meet Community Needs • Year 4: Leadership in Rural Medicine: Implementing Change Action Items of the Rural Medical Education Program (RMEP)

  11. Research in Community Health (RiCOH) • Designed for undergraduate sophomore college students in the B/MD program. • Immersion population health research experience in hometown rural community. • Partnership with local health departments, community hospitals or regional Area Health Education Center (AHEC). Community Health Project (CHP) • Designed for fourth-year medical students in the IUSM-Terre Haute Rural Medical Education Program. • Research project on health assessment and intervention. RiCOH and CHP

  12. “The overuse of U.S. emergency departments is responsible for $38 billion in wasteful spending each year.” • New England Health Institute (2010)

  13. Identify and analyze the characteristics of frequent users of the emergency department. • Identify potential solutions to this issue. Purpose

  14. Define frequent user • Identify frequent users from May 2012 to May 2013 • Collect patient information from ER records using HPF Webstation • Analyze the data in Microsoft Excel Materials and Methods

  15. Age Distribution of Frequent Users

  16. Frequent User Gender Ratio

  17. 43% of frequent users claim having a history of mental health issues. Of these: • 67% claim anxiety • 56% claim depression • 23% claim substance abuse • 17% claim bipolar disorder • 8% claim they have had suicide ideations Mental Health History

  18. Top 5 Principal Diagnoses of Frequent Users

  19. How to think independently • How to write and read research papers • Research requires patience • The mechanics of an ER visit • The behind-the-scenes details of hospital work • The difficulties of emergency health care treatment • The value of primary care physicians What I have learned

  20. RiCOH provides students with initial exposure to research and public health CHP extends experience: • Longitudinal • Spring of 3rd year-Spring of 4th year • Encouraged to return to hometown/community RiCOH and CHP

  21. Objectives: • Demonstrate how to select study design • Evaluate available health ed materials • Write literature review • Recruit clinic staff and participants • Design or choose appropriate survey • Design appropriate intervention tool (if applicable) • Complete CITI training and IRB protocol • Collect and analyze data • Write final report CHP details

  22. Topics included: • Nutrition related(6) • Sexual Health (2) • Smoking Cessation (2) • Emergency Department Usage (2) • Resources for Autistic Families • Alcohol Abuse among College Students • Coronary Artery Disease • Fall Prevention in the Elderly Previous Community Health Projects

  23. Emergency Room Study • 2 studies spanning two different years • Terre Haute • Clinton Tele-Health Education and Coronary Artery Disease • Effectiveness of using tele-health in educating patients on the risk factors of CAD Highlights

  24. Insight into Public Health • Population health versus medicine Interprofessional Education (IPE) component Sustainable projects • “Big picture” of particular topic in Indiana Research experience required for most residencies • Increases competitiveness Benefits

  25. Robin Danek, MPH, Robin.Danek@indstate.edu • Taihung Duong, Ph.D. tduong@iupui.edu • Priya Abhyankar pabhyankar@sycamores.indstate.edu Contact Information

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