June 20, 2018
Transforming Douglas County, one clinic at a time
Of the 8,760 hours in a year, even a patient with a chronic disease might only spend a few of those hours directly with a doctor or nurse. The rest of the time they are on their own — following doctor’s orders and motivating themselves to exercise, eat healthy foods and consistently take their medication.
With such limited time spent directly with patients, it’s especially important for healthcare providers to work together and consider their patients’ lives, communities and homes beyond the brick and mortar walls of a clinic.
Thanks to a grant funded out of the Prevention and Public Health Fund, Douglas County Health Department (DCHD) has partnered with local clinics over the last four years to help them do just that.
It Takes a Team
Celeste Ehrenberg, DCHD’s community health planner, says that in an ideal world, healthcare providers themselves should be spending 75 percent of their time examining, diagnosing, treating, educating and making medical decisions for patients.
However, if a provider is overburdened, that’s often not the case — and they’re pulled away from those critical responsibilities.
“When you see your healthcare provider, generally the clinical staff takes your vitals, and updates your meds and your recent health history,” Ehrenberg said. “But in a lot of clinics, especially smaller ones, they sometimes don’t know how to delegate or how to start doing things a nurse or pharmacist or front end staff can do.”
By working with clinics to practice team-based care, DCHD is helping healthcare providers understand how to distribute the workload as an integrated team and remove any unnecessary tasks from the provider’s burden.
As a result, the providers have more time to customize patient care, and provide support for individuals and families to better manage their own health.
For example, a clinic modeling team-based care may have all of its healthcare providers choose five diabetic patients in need of the most care. Then, once a month, the team, which includes at least two healthcare professionals — such as a physician, nurse, community health worker, pharmacist, behavioral health specialist or diabetic educator — all meet to discuss the patients, how to bring the disease under control, how to provide the patients extra care and how to follow up with them. Once a patient is showing improvement, they’re removed from the list and monitored over time.
“That’s team-based care. They have a huddle, and they discuss who’s responsible for what,” Ehrenberg said. “That way, the provider can focus on the actual examination, diagnosis, education and treatment.”
DCHD also works to develop written policies and procedures for each clinic based on medical standards and recommendations, resulting in more consistent care for all patients.
South Omaha Medical Associates
South Omaha Medical Associates (SOMA) has seen great results over the years since DCHD’s involvement.
“The key for us has always been that while other grantees took on 11 to 12 clinics, we didn’t. We just took on one or two,” Ehrenberg said.
By tailoring the same strategies to individual clinics — such as encouraging staff to go paper-free with Electronic Health Records (EHRs) and teaching them how to run quarterly reports — DCHD has helped the clinics overcome obstacles they used to face.
For example, SOMA started out only 50 percent paper-free, and now they’re up to 99 percent. With more easily accessible, electronic patient data, the clinic can now prevent needy patients from falling through the cracks.
With updated written policies and procedures to guide their practice, SOMA is seeing more positive health outcomes for all its patients who have or may be developing diabetes and cardiovascular disease.
On top of it all, Blue Cross Blue Shield has recognized SOMA twice with an award for transformation of their clinic.
Methodist Community Health Clinic
Similarly, Methodist Community Health Clinic now has access to its patients’ EHRs, is learning to run reports and can track its patients over time. Its once broad policies are now tailored and specific.
“They’ve really embraced team-based care,” Ehrenberg said. “It’s allowed them to justify why they should hire more staff, and they’ve been able to integrate the mission of their clinic — to help those who need it the most.”
With a food pantry and Lutheran Family Services in same building, along with partnering with Methodist College’s Mobile Diabetes Center, the Methodist clinic can connect its patients with the resources and care that no single healthcare professional could provide alone.
At the end of the day, DCHD wants to meet the clinics where they’re at so the work transitions seamlessly over time.
By creating individualized sustainability plans, DCHD provides recommendations to each clinic with flexible strategies for continual improvement.
“Our goal with the grant is that everything we’ve touched, we’ve left better than we found it,” Ehrenberg said. “Ideally, the clinics will still be able to sustain the efforts that have worked best for them and continue that care with their patients.”