Tribal Update Lummi Tribal Health Center

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Presentation transcript:

Tribal Update Lummi Tribal Health Center Northwest Portland Area Indian Health Board Quarterly Board Meeting January 18, 2017 Justin Iwasaki MD MPH Executive Medical Director

Dr. Dakotah Lane Lummi Tribal Member Bachelors in Engineering University of Washington Peace Corps in Malawi Doctor of Medicine Cornell Medical School Family Medicine Residency Daytona, Florida Board Certified in Family Medicine

Quality Improvement Activities Open Access Scheduling Hepatitis C Treatment Trauma Informed Primary Care

Open Access Scheduling

Open Access Scheduling Problem to be Solved The Walk-In Clinic Scheduling Model was a Problem Patients Long Wait Times. Difficult to Schedule Appointments or Hospital Discharge Providers Unpredictable. Difficult to Manage Chronic Disease. No Ability to Schedule Follow-Up Open Access Scheduling

WALK-IN CLINIC SCHEDULING OPEN ACCESS SCHEDULING 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM LUNCH 1:00 PM WALK-IN CLINIC 8:00 AM 8:20 AM 8:40 AM 9:00AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12-1 Lunch 1:00 PM 1:20 PM 1:40 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM HELD OPEN SAME DAY APPT WALK-IN CLINIC SCHEDULING OPEN ACCESS SCHEDULING “SAVE TIME CALL FIRST” HELD OPEN SAME DAY APPT

OPEN ACCESS SCHEDULING “SAVE TIME CALL FIRST” 8:00a 8:20a 8:40a 9:00a 12-1 Lunch 1:00p 1:20p 1:40p 2:00p 2:30p 3:00p 3:30p 4:00p* 8:00a 8:30a 9:00a 9:20a 9:40a 10:00a 10:30a 11:00a 11:30a 12-1 Lunch 1:00p 1:30p 2:00p 2:20p 2:40p 3:00p 3:30p 4:00p* 8:00a 8:30a 9:00a 9:30a 10:00a 10:20a 10:40 11:00a 11:30a 12-1 Lunch 1:00p 1:30p 2:00p 2:30p 3:00p 3:20p 3:40p 4:00p*

FALL 2014 SPRING 2016

FALL 2014 SPRING 2016

Open Access Scheduling Impact Third next available appointment decreased from 5-6 weeks to zero days Wait times decreased from 1-3 hours to less than 10 minutes Patient forecasting and planning Chronic disease care Open Access Scheduling

Hepatitis C Treatment

Problem to be Solved Hepatitis C Treatment High number of community members with chronic hepatitis c virus infection. n= 200-250 High number of persons who inject drugs can spread hepatitis C infection Treating hepatitis C infection has both individual and public health impact Hepatitis C Treatment

HEPATITIS C COORDINATOR FIRST PATIENT TREATED FALL 2016 PHARMACY CONTRACT PROVIDER TRAINING HEPATITIS C COORDINATOR NEW HEPATITIS C MEDICATIONS WASHINGTON MEDICAID COVERS NEW MEDICATIONS TELEMEDICINE PROJECT ECHO

Clinical Model vs Public Health Model Integrate treatment with opioid treatment program Hepatitis C Treatment

Trauma Informed Primary Care

Trauma Informed Primary Care 14 Clinics Around the Country Implement Trauma Screening, Assessment, and Referral to Treatment Trauma Informed Primary Care

Trauma Informed Primary Care Diabetic Cohort Initial 64 Patients A1C >9.0 Adverse Childhood Experience Screening Trauma Informed Primary Care

Referral to Behavioral Health ACE Screening Referral to Behavioral Health Referral to Behavioral Health and/or Support Group Decline Referral

Trauma Informed Primary Care 51 Patients Made Appointment 47 ACE Screening 4 Declined Avg Pre -A1C 10.8 Avg Post-A1c 9.0 *Statistically significant Trauma Informed Primary Care

Thank you.

IMPACT OF OPEN ACCESS SCHEDULING VISITS

FALL 2014 SPRING 2016