Reaching for the stars

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Reaching for the stars

• West Central Cluster Summit
• Moving Ahead With Spread
• November 8-10, 2004
• Dallas, TX

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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.

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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
  lt8.0. Our blood pressure will be lt140/90.

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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_at_hotmail.com
• Lewisville Sandra Miller, RN, Clinic Manager
  [phone] LFPC1_at_magnolia-net.com
• Amity Janna Lock, RN, Clinic Manager (870)
  342-5606 amitychc_at_alltel.net

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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 didnt have a true population of focus because
  we wanted all our diabetic patients in the
  collaborative, including new ones.

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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.

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Diabetes Measure Graphs
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Diabetes Measure Graphs
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Cardiovascular Measure Graphs
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Cardiovascular Measure Graphs
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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.

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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.

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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.

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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.

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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.

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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.