What Haiti Can Teach the US about Providing Healthcare to the Uninsured Stan Shaffer, MD Founder, Healthy Mothers, Healthy Babies Kendra Wyatt Strategist, Community Access, Cerner
Session topics Delivering Care in Haiti Medical Pathology Social Pathology Community Focus Community Engagement Measuring Outcome Measuring Impact The Principles and Comparisons Medical Home Theory Kansas City, Missouri: Jackson Country Free Clinic Lasso the Power of Community and Information Technology Austin, Texas: Indigent Care Collaboration JaxCare, Jacksonville, Florida Health Banks- Privacy, Portability with Purpose Live from the WHO Standards Meeting, Kenya
Maternal Mortality Lifetime risk of death from pregnancy Sweden 1:30,000 United States of America 1:4000 World average 1:75 Haiti 1:16 Afghanistan 1:6
Percent of deliveries with skilled birth attendant
Child Mortality = 5,000 child deaths / year
Child Mortality - Haiti (< 5 years)
Neonatal Mortality - Haiti (< 28 days)
Potential for Basic Interventions Clean delivery, breast feeding, antibiotics Sepsis deaths 94% Prenatal tetanus vaccine Malaria prevention Neonatal resuscitation Tetanus deaths 81% Low birth weight deaths 59% asphyxia deaths 39% Jones, Child Survival II, 2003; Lancet 362:65-71
Community Survey Results Prenatal Care (percent of total) Births Attended by Skilled Health Staff (percent of total) Neonatal Mortality Rate (deaths per 1,000 live births) Haiti Country wide (WHO statistics) Baseline Community Survey 79 51 24 13 34 40
Community Survey Results Why didn t you go to the hospital? 1. Too far 2. Too expensive 3. Untrustworthy Underlying Medical pathology is Social pathology
The need Why didn t you go to the hospital? 1. Too far Community services 2. Too expensive Free care 3. Untrustworthy Quality Consistency Hospitality
Models of Maternity Care Hospital Comprehensive Expensive Remote Obstetricians Birthing Home Home Limited care Inexpensive Convenient Nurse Midwives Matrones
Continuity of Care Pregnancy planning Prenatal care and triage Prevention of infections Syphilis, HIV, Malaria Safe birth Clean delivery Skilled birth attendants Breast feeding support Vaccinations Nutrition and micro-nutrient supplementation Child development Road to Health
Health Information Technology Outcome monitoring Quality assurance Performance improvement Communication Resource sharing Health mapping Community health atlas
Community Health Atlas
Home visits Santé Communautaire Vit A Education HIV - DOT
Santé Communautaire Elimination of Intestinal Parasites
Maternal Transfers Number Vaginal bleeding 21* Postdates 19 Hypertension/Pre-eclampsia 17 Preterm labor 12 Repeat C-Section 9 Prolonged labor 8 Abnormal fetal position 2 Prolonged ROM 2 Eclampsia 2* Large uterine size 1 Fetal death 1
2005-2006 delivery data
Maison de Naissance Primary Outcome Measures Prenatal Care (percent of total) Births Attended by Skilled Health Staff (percent of total) Maternal Mortality Ratio (pregnancy related maternal deaths per 100,000 live births) Neonatal Mortality Rate (deaths per 1,000 live births) Haiti Country wide (WHO statistics) Baseline Community Survey MN Community 2005-2006 79 51 99 24 13 91 680 ---- 498 34 40 9
Community Engagement Employment Mothers clubs Community activism Vaccination campaigns Seeking water, housing, micro-loan programs
The value of a society is increased only as it cares for its most vulnerable. John Rawls Child survival a measure of civilization not just for the countries with high child mortality, but also for countries that could have changed the situation. William Foege
This isn t charity work, it s social justice. Paul Farmer
Childbirth in a Haitian Village Implications for the Un and Under-insured in the States
Partners In Health Healthcare as a Right vs Commodity Anywhere you have extreme poverty and no national health insurance, no promise of health care regardless of social standing, that's where you see the sharp limitations of market-based health care. Paul Farmer
Definition: Medical Home A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. A medical home addresses how a primary health care professional works in partnership with the family/patient to assure that all of the medical and non-medical needs of the patient are met. The physician should be known to the person/family and should be able to develop a partnership of mutual responsibility and trust with them.
Maison de Naissance Providing a Physical Birth Home Virtual Consults Virtual Consults Data Center Outreach Via Football Clubs Drinking Water Waste Management Faith Partnerships Agriculture Productivity Home Cement Floor Tile Roof Community Health Workers MN Health Bank MN Baby,Mama, Family Haitian School of Midwifery Government Cell Phone Connectivity Power Midwives Les Cayes Hospital Education (BTI)Business Technology Institute Entrepreneurism
Medical Home Theory
So what do they do in Texas?
The Mother of them all. Indigent Care Collaboration, Austin Texas AUSTIN/TRAVIS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT AUSTIN TRAVIS COUNTY MENTAL HEALTH MENTAL RETARDATION CENTER (ATCMHMR) AUSTIN WOMEN'S HOSPITAL CENTRAL TEXAS MEDICAL CENTER CITY OF AUSTIN COMMUNITY CARE SERVICES DEPARTMENT JOHNS COMMUNITY HOSPITAL LONE STAR CIRCLE OF CARE PEOPLE'S COMMUNITY CLINIC PLANNED PARENTHOOD OF THE TEXAS CAPITAL REGION ROUND ROCK HEALTH CLINIC ST. DAVID'S HEALTH CARE SETON FAMILY OF HOSPITALS TRAVIS COUNTY HEALTHCARE DISTRICT TRAVIS COUNTY MEDICAL SOCIETY UT SCHOOL OF NURSING VOLUNTEER HEALTHCARE CLINIC WILLIAMSON COUNTY AND CITIES HEALTH DISTRICT All Members of the Safety Net Community Participate Community Health Record Community Health Workers
Virtual Medical Home Framework Community Foundation Philanthropy Health Plan Employer Faith Health Ministry Government Public Health Education Birth Center Hospice Environment Person Family Affordable Housing Appropriate Clothing Mobile Clinic Medical Home FQHC, Safety Net Specialist Nutrition Pharmacy Grandmothers Community Center Community Health Worker Hospital Health System Sports Clubs
Jacksonville Health Information Network Community Health Record A Virtual Medical Home Duval County Health Department Med Claims Shands Jacksonville Baptist Health System McKesson SMS Cerner JaxCare Claims Mayo Clinic Hospital Cerner.csv Files St. Vincent s Medical Center IDX Cerner Community Electronic Health Record HL7 Interfaces, Data Extracts Memorial Hospital University of Florida MediTech IDX AllScripts.M. Sulzbacher (FQHC) Med Mgr Brooks Rehabilitation Hospital MediTech Jacksonville Health Information Network Accessible via a secure internet site (SSL 128-bit encryption) Duval County Health Department HMS
Person Controlled Health Record Bank The Virtual Medical Home
A New Healthcare Transaction: Health Banks H.R.2991 Independent Health Record Trust Act of 2007 Dennis Moore U.S. Rep, D-Kan Saving money and lives using non-centric, consumer-driven independent health record banks Charter for not-for-profit, cooperative institutions with member-owned accounts Paul Ryan U.S. Rep, R-Wis IHRBs could save money and lives Sale of data with revenue considered tax-free income Gives providers access to data in emergencies Vision for a New Transaction "By offering member-owned accounts, independent health record banks have one focus the patient. - U.S. Sen. Sam Brownback, R-Kan.
Kansas City Employer Initiative
Live From Kenya & the WHO Speaker will update attendees on results of the WHO Health Information Standards Conference Held December 4-7, 2007
Finance Health & Medical Homes Not Sickcare Information Technology is like Clean Water Global Lessons
Resources Stan Shaffer, MD Maison de Nassaince www.maisondenaissance.com shaffers@umkc.edu Kendra Wyatt Cerner Corporation www.cerner.com kwyatt@cerner.com Partners In Health PIH.org Bridget McCandless, Medical Director, Jackson County Free Clinic bmmcca@comcast.net Ann Kitchen, Executive Director, Indigent Care Collaboration akitchen@icc-centex.org Rhonda Poirier, Executive Director, JAXCARE rpoirier@jaxcare.org