White River Rural Health Center

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White River Rural Health Center

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

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White River Rural Health Center, Inc.

• Participant in DM1 CVD1 Collaboratives
• 15 Clinic sites in rural east Arkansas
• - Established in 1986 with 3 sites
• - Co-located with mental health and local
  county health unit
• - Provide perinatal,, pharmacy and dental
  services in addition
  to primary care
• Over 97,000 encounters in 2002
• POPULATION SERVED
• 864 DM patients 1572 CVD patients in the 9
  current clinic sites
• 124 DM patients at Des Arc recently added for
  Finance/Redesign collaborative
• gt 51 of patients live below 200 of poverty
  level
• gt 30 of patients have less than HS education

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Chronic Dz. Aim Measures
AIM To redesign the system of care to provide
improved care to our patients with diabetes or
cardiovascular disease. We will accomplish this
by making changes in the following areas patient
self-management, decision support, delivery
systems, information systems, community
relationships, and leadership.

• Key Measures
• 90 of pts will have influenza vaccinations
• 90 of pts will have pneumococcal vaccinations
• 90 of pts will have annual lipid profiles
• 90 of pts with 2 or more Blood Pressures
  annually
• 70 of pts with Self-Management Goal
• 65 of pts have BP lt140/90 (CVD) or BPlt130/80
  (DM)
• 90 of DM pts with 2 HbA1c tests annually
• of DM pts with HbA1c lt 7

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Team Members

• Dr. Steve Collier, CEO
• Dr. Nick Pasalidis, MD
• Terry Hill, CCO
• Joey Miller, CAO
• Brenda Kennedy, RN
• Monica Lindley, RN
• Greg Wolverton, IS Specialist

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Teams
January 1999 (DM1) - Cotton Plant Medical Clinic
Parkin Medical Clinic McCrory Health
Center June 2000 (Patient Visit Redesign)
Carlisle Medical Clinic April 2001(CVD1) - Cotton
Plant Medical Clinic Wynne Medical Clinic,
McCrory Health Center December 2001 (DM/CVD)
Swifton Medical Clinic, (Parkin added CVD) June
2002 (DM/CVD) Kensett Medical Clinic, Newport
Medical Clinic, Brinkley Health Center July 2003
(Financial Redesign) Des Arc Health
Center August 2004 (CVD) - Augusta
Team Leader Contact Info Brenda Kennedy, RN
E-mail brenda.kennedy_at_wrrhc-ar.org
Phone [phone]
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How it all Started.

• White River in the first stage of change
• January 1999
• DM1 Cotton Plant Medical Clinic, Parkin Medical
  Clinic McCrory Health Center

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White River on the Move

• April 2001
• CVD 1 Cotton Plant Medical Center, Wynne
  Medical Clinic, McCrory Health Center
• December 2001
• DM/CVD Swifton Medical Clinic (Parkin added
  CVD)

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And on.

• June 2002
• DM/CVD Kensett Medical Clinic, Newport Medical
  Clinic, Brinkley Health Clinic

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Continue Spreading in Arkansas

• June 2003
• Financial Redesign Des Arc Medical Clinic

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Spreading

• August 2004
• CVD Augusta Medical Center

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Core DM Measures
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Core CVD Measures
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Core Measure Graphs
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Core Measures
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Optional Measures - DM
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Core Measures - CVD
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Core Measures - CVD
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Optional Measures - CVD
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Optional Measures - CVD
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Lessons Learned

• Accountability
• Follow up
• Training program is essential
• Leadership must be aware of process and directly
  involved

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Anticipating Barriers Issues
Those that the team can resolve
Those that leadership needs to address

• Clinical decision making
• Staff responsibilities
• Education for additional staff
• Local resources for patients

• Information systems
• Scheduling systems
• Resources for time and equipment
• Additional staff requirements
• Provider buy-in
• Integration of data collection system

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Next Steps

• Continue spreading to complete all 15 sites
  involved in Collaborative
• Employees will be evaluated annually on
  collaborative participation
• Spread to other chronic diseases Cancer is
  next..

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A Story to Share....Our Organization

• Recognized in Rural Healthy People 2010 as a
  Model Practice for DM Care in 2003
• University of Chicago study in 2001-2003
• Eli Lilly/Medicaid DM Project 2002-2003
• Arkansas Delta Regional Development Network for
  DM Center in Brinkley 2002-2004
• ADA Recognition for DM Self Management Education
  Program 2003
• Recognized as a Model for Relationships between
  CHCs and Hospitals by the Natl Rural Health
  Assoc.