OREGON OFFICE OF RURAL HEALTH: RURAL CLINIC GRANTS

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1 OREGON OFFICE OF RURAL HEALTH: RURAL CLINIC GRANTS In May of 2014, the Oregon Office of Rural Health (ORH) announced a onetime Rural Clinic Grant opportunity. All rural clinics were invited to apply for small grants of up to $10,000 for projects that would advance identified financial, operational, quality or community engagement priorities. Fifteen grant applications were received and 14 were funded for a total of $99,000. Applicants had one year (July 1, 2014 to June 30, 2015) to implement their projects. A summary of those projects and the project results follows. For more information on the grants, please contact Meredith Guardino at guardino@ohsu.edu.

2 ASHER COMMUNITY HEALTH CENTER Fossil Asher Community Health Center (ACHC) participates in the Wheeler County Local Community Advisory Council (LCAC). In 2013, the LCAC conducted an extensive community needs assessment, which identified access to specialists as a priority community health need. Wheeler County does not have any hospitals, pharmacies or independent practitioners. Two physician assistants employed at ACHC provide all primary care. All specialist referrals require travel outside of the county, usually 100 miles or more. This is difficult in the winter, especially for the elderly, who comprise 30% of Wheeler County s population. ACHC used the ORH Rural Clinic Grant to establish telehealth capacity in Fossil. The funds were used to purchase the equipment (pictured) to enable patients to connect by video to Psychiatrists at OHSU. While the video connect was available starting in October of 2014, it took a few months to work out the IT components and Psychiatrist assignments. Starting in early January ACHC reported that the video connect worked well, with OHSU psychiatrists providing psychiatry to the Fossil and Mitchell clinics 8 times to date, based on community needs.

3 BAKER COUNTY HEALTH DEPARTMENT Baker City In 2014 the Baker County Health Department and School Based Health Center entered into a collaborative agreement to implement an electronic health records (EHR) system. Funding for this project was received from Oregon Health Authority, the Office of Rural Health and the County s general fund. On May 12, 2015 both sites went live with the OCHIN Epic software system. The ORH Rural Clinic grant made it possible to purchase five workstations (pictured), two signature pads that clients will use for birth control consents and two scanners. Implementing EPIC has already helped to streamline our work flows, track data and provide better services to clients. The reproductive health program no longer has to do duplicate entry Site specialists are currently developing reports to reminder calls for those that haven t been seen in a long time. Labs are now sent and received electronically and uploaded to clients charts.

4 HARNEY DISTRICT FAMILY CARE CLINIC Burns During the past two years, Harney District Hospital (HDH) Family Care Clinic has been integrating mental and behavioral health services into the primary care setting. The clinic now has a Behaviorist for in-person services as well as a Telepsychiatrist for weekly online sessions and medication coordination. The integration of mental and behavioral health services, as well as growth in the patient population due to increased access, has created challenges with clinic s current layout and space. HDH Family Care Clinic used the ORH Rural Clinic Grant to help hire an architectural firm, Clark Kjos Architects, to do a feasibility study and design for increasing space and improving workflow. Work with Clark Kjos is currently ongoing.

5 MCKENZIE RIVER CLINIC Blue River Part of the McKenzie River Medical Clinic s 5-Year Strategic Plan includes increasing community knowledge about health and the clinic s services. To meet this goal, McKenzie River Clinic used the ORH Rural Clinic grant to put on a health fair at the McKenzie Chainsaw Art Festival. They offered free blood pressure and blood sugar checks, and had information available about heart disease, diabetes, exercise, healthy eating, and other health topics. They shared their space with the US Forest Service, which gave complimentary information about outdoor exercise options such as hiking and biking trails as well as with a local retired Registered Nurse who provided free foot care. The grant money paid for advertising banners, blood sugar test supplies, staff time for two Medical Assistants (all others were volunteer) and health-related giveaways such as pedometers and one ipod Nano as the prize for their free raffle. There were 140 raffle tickets turned in, 67 blood pressures were taken and 37 blood sugars were tested. We had enough [giveaways] left from 2014 to use again in Again we held our health fair in conjunction with the Chainsaw Art Festival. We added representatives from our local food pantry to provide information on how to access healthy free food It was great fun as well as being a benefit to the community. It allowed people become aware of clinic services and location and to become aware of changes they might make in their lives.

6 RINEHART CLINIC Wheeler The Rinehart Clinic has had difficulty recruiting a new Medical Director to replace Dr. Harry Rinehart who is retiring. The CEO and Board of Directors used ORH Rural Clinic grant funds to offset the costs of recruiting firms and advertisements. The position remains open and Rinehart Clinic is now prioritizing hiring a Physician to supervise the clinic s two physician assistants.

7 ROGUE COMMUNITY HEALTH CENTER Butte Falls, Prospect and Union Creek The remote communities of Butte Falls, Prospect and Union Creek have a combined population of 2,634 persons. Rogue Community Health Center requested grant funding to conduct awareness and screening activities at local events in order to improve insurance enrollment and identify un-met medical needs. The ORH grant enabled Rogue Community Health Center to attend four local events at which they screened 204 people and had conversations with over 1,000 residents. Of the 204 screened for blood pressure, cholesterol and glucose 11% were found to have one or more abnormal values and were referred for follow up.

8 SACAGAWEA HEALTH CENTER St Helens Sacagawea Health Center (SHC) is a School-Based Health Center (SBHC) that offers primary and mental healthcare services to all students K-12 in the St. Helens school district and surrounding communities. In 2006, based on the results of a chart review in which it was determined that 27% of students had mental health issues; SHC established a mental health program in partnership with Columbia Community Mental Health. In order to better assist in identifying students who may be in need of mental health services, SHC requested funding to purchase a one-year trial of the Rapid Assessment for Adolescent Preventative Services (RAAPS). RAAPS is a cloud-based risk screening and counseling system that is used to identify the top behavioral risks of youth, ages I found the survey lengthy but useful for opening up a dialogue about risky behaviors and sensitive subjects such as depression, suicide, bullying, alcohol, drug use etc The questions and responses are entered on an ipad giving the responder some privacy and time to think about their responses At the end of the visit after reviewing the results a print out with information regarding risks, resources for help can be provided.

9 SOUTH GILLIAM COUNTY HEALTH DISTRICT Condon South Gilliam County Health District completed a new Wellness Center, an extension to the South Gilliam Health Center. Without a large enough population to enable hiring fitness instructor, the Health District found an alternative solution to offering fitness programming to improve community health. The ORH Rural Clinic Grant paid for the Fitness on Demand System, an audio/video exercise system (pictured) that allows people to choose from 100+ prerecorded videos at anytime the facility is open. The Fitness on Demand System was demonstrated at the Wellness Center opening on September 26 th.

10 SOUTH RIVER COMMUNITY HEALTH CENTER Winston ORH grant funding provided South River Community Health Center (SRCHC) the means to purchase health and wellness materials and supplies to host Be Well Winston, a Community Health Fair that was held outdoors on the health center s campus. In addition, the funds were used for a series of classroom presentations in the Winston-Dillard School District. SRCHC physician assistants, nurse practitioners and support staff engaged over 546 3rd graders in interactive presentations that focused on the importance of nutrition and physical activity. Presentations included trivia questions, Q&A sessions, hula-hoop contests, and goody bags with Frisbees and water bottles. Be Well Winston had 15 exhibitors, and 137 community attendees 57 of which were youth. An exit survey showed that 89% of respondents reported learning something new and 66% of respondents planned to make at least one healthy change based on information they learned at the event.

11 STRAWBERRY WILDERNESS COMMUNITY CLINIC John Day Many frontier clinics, such as Strawberry Wilderness Community Clinic (SWCC), are limited in their ability to locate and hire Certified Clinical Medical Assistants (CCMAs) due to the lack of nearby education opportunities. Newly hired Medical Assistants (MAs) at SWCC required intensive on-the-job training. When the demand for the delivery of more cost-effective quality healthcare increased, SWCC recognized that the resources utilized to train MAs could be used more effectively to advance patient care. SWCC decided, rather than look for CCMAs, they would promote a higher standard of care by advancing their MAs to become CCMAs. They used the ORH grant funding to pay for CCMA education, testing and credentialing. In April 2015, all 7 MAs passed the CCMA exam and became certified. In addition, their increased skills resulted in raises! SWCC hopes to sustain this program based on the commitment of Blue Mountain Hospital, by requiring (and assisting) MAs to obtain their CCMA within 2 years of hire.

12 TILLAMOOK REGIONAL MEDICAL CENTER Lincoln City In caring for his patient panel, Dr. Gregory Steinke wanted to address unhealthy lifestyle choices that were contributing to poor health outcomes. ORH Rural Clinic grant funds were used to pilot a clinic-based lifestyle medicine services pilot that included the following patient education sessions: Complete Health Improvement Program (CHIP), Depression-The Way Out, and Ditch Tobacco. To date, 78 patients have been enrolled in CHIP, 32 in the depression session and 13 in tobacco cessation. While the project is still working out how to best measure and evaluate the results, they provided the success story of Renee McKnight (pictured with Dr. Steinke), who quit smoking after 35 years. The Ditch Tobacco program consists of six weekly classes providing education, group support, and proven techniques. I followed all of the steps. They were effective. I think the thing that got to me the most was when we calculated how much we have spent on cigarettes in our lifetime. I smoked a house. I could have bought a house with the money I spent on cigarettes. And Dr. Steinke is awesome. He is intelligent and down to earth and he says it like it is. He hits all the marks. I trust him. I am forever grateful to him for the time he spent helping us.

13 VERNONIA HEALTH CENTER Vernonia Following a devastating flood in 2007 that destroyed the existing clinic, the Vernonia Health Center Board (VHCB) seized the opportunity to set a new path for healthcare in their rural area. In 2013, VHCB created the position of Facility Program Director (FPD) because they had identified the need for a full-time employee to drive the coordination and expansion of their facility and business model. The FPD serves as a liaison between partners and the community to identify community needs, identify new partners and resources and build a collaborative business model. Funds from the ORH Rural Clinic grant were used to offset the costs for this position for one year in order to focus general fund expenditures on community outreach and educational programming.

14 WARNER MOUNTAIN MEDICAL CLINIC Lakeview Warner Mountain Medical Clinic was selected to participate in a learning collaborative with the Patient Centered Primary Care Institute to meet the requirements of the Oregon Health Authority s Patient- Centered Primary Care Home (PCPCH) recognition program. In order to meet PCPCH requirements and improve the quality of care they provide, Warner Mountain Medical Clinic transitioned from paper medical records to Athena Health s Electronic Health Record (EHR) system. OHR Rural Clinic grant funding helped with this transition, funding 2 ipads and 4 computers for the clinic (Dr. Scott Graham pictured at a new computer in a consult room). Warner Mountain Medical Clinic is now about a year into the transition and while the transition had some hurdles, they report that patient care has improved. The patients have been surprisingly supportive of the changes in our practice including the patient portal. I believe this is directly a reflection of the attitude of the staff members, they have really rallied and made this a positive transition.

15 WATERFALL COMMUNITY HEALTH CENTER Powers Of the 815 people living in Powers, 127 are students and more than half are eligible for the free lunch program. By age 6, less than half of Powers children will have had a clinical or dental office visit. Difficulty recruiting and maintaining providers led to the establishment of a School-Based Health Center (SBHC), which currently serves not only the students, but the entire community. The SBHC was established in 2013 and is equipped with televideo conferencing, which enables real-time interaction with physicians at Waterfall Community Health Center s main location in Coos Bay. To better engage the Powers community in wellness activities and accessing services at the SBHC, Waterfall Community Health Center requested funding for six months of defined outreach activities. At the time of this report, Waterfall Community Health Center had not given information on the use of their received funds.