Taking the fight outside

Published 2:55 pm Saturday, July 3, 2010

Health care is leaving the walls of Austin Medical Center. At least that’s the hope of the center’s leading officials.

For months, health care — especially the costs of health care — has been a hotly debated topic across the nation and in Washington, D.C., but local officials are looking to translate that talk into action in Austin through the medical center’s Patient Centered Medical Home project, which started last year.

Joan Broers, AMC vice president of primary care, said the project poses a key question: “What do we need to think about transforming health for the future — not just from the medical center’s perspective — but from the whole community’s perspective?”

The project has set out a series of goals to change the way health care works in the community.

“It’s transformation,” Broers said. “It’s not about little tweaks to tweak a little part of the process, but it’s really about transformation. It’s going to take a lot of energy to work with these groups to think outside the box, to really look at things that are different than the way we’ve ever done them before.”

One of the project’s goals is to promote health outside the walls of the medical center. Adam Rees, AMC chief administrative officer, said there are many avenues to promote health in the community, but many of them are often underutilized.

The project is an opportunity to tie groups like the YMCA and Parenting Resource Center together. AMC CEO David Agerter said the idea is to connect the many agencies in the community that provide some level of health care.

“Austin and Mower County is rich in a lot of health care services, but they’re not connected, so people don’t know how to navigate, how to best use the health care system that we have in place,” Agerter said.

The answer to that puzzle is no easy task, but medical center officials are working to form a bridge between the many organizations. Since a meeting with community leaders on June 17, Agerter said they’ve been working to coordinate ideas.

Leaving AMC

According to Rees, statistics show medical centers only have about a 10 percent factor in a person’s overall health. However, a person’s behavior — exercise and eating habits — makes up about 40 percent of your overall health.

The question, Rees, said is how can the medical center have a profound impact on a person’s behavior?

“Is it the doctor preaching to the patient?” Rees said. “We sort of tried that. It sometimes works. It sometimes doesn’t. Or is it somehow engaging the community in really helping reinforce that. … We think the community will come together and create messages that will be used in many different venues.”

Work groups consisting of community leaders were formed at the June 17 meeting, and they’ll start working on steps for the project. The groups will look for the answers of how to move forward with this blended form of health care.

The work groups will likely start meeting in the fall, Rees said, because it’s difficult to start that up in the summer when people are more active.

That doesn’t mean the project won’t come without its challenges, as many of the community leaders involved are busy with many other things around town, but Rees said it’s positive that they’ll make time throughout the community.

Though there are many areas that could be addressed, Agerter said it will be important to prioritize their focus on a few areas to address to make a significant difference.

“We can’t do all of it,” he said. “But I think there’s a piece of it we can do, and we can do well. But we can do it.”

AMC is promoting a slogan for the program: Promote health, not health care.

Rees said AMC may also pick an area of health to promote at the medical center and at other areas around town, like the YMCA, churches and even schools.

Rees compared the project to the AARP/Blue Zones project of Albert Lea, a project that promoted health to help people live better, longer lives.

“This would be the Austin version of that,” Rees said.

Changing views of

health care

Another way health care is expanding beyond AMC’s walls is through technology.

One potential way to do that is the possibility of using electronic medical visits. Rather than coming into the medical center, patients could visit with a doctor or nurse over the phone or through web conferencing.

“Technology is really powerful in what we do,” said Carol Holtz chair of family medicine.

Broers said it may also soon be possible for patients to video conference with specialists at other hospitals rather than having to make the trip to places like Rochester.

A care coordination program has been set up to identify and assist patients with chronic health conditions, like diabetes, who need more help managing their care. A registered nurse serves as a care coordinator and works with a physician to help manage the patients care.

Patients with diabetes are one area that highlights this. Holtz said AMC staff uses records to track patients who have their diabetes in control and those that do not. That way, staff can be in communication with those who don’t have their diabetes in control.

For example, one patient utilizing the program is a diabetic man who works as a truck driver. He hadn’t been monitoring his condition. However, he was at risk of losing his license if his diabetes wasn’t in control.

In the past few months, he’s been communicating with his doctor and a nurse via the phone and is now in stable condition, and he’s even spreading information on the his CB radio to other drivers about where to find fresh fruits at stops.

“We’ve been able to meet him where he is to provide his medical care,” Holtz said

Future

Currently, hospitals are running such medical home projects on their own, but Borers said they may try to combine the different groups together to have a unified Mayo effort.

Some hope the lessons learned in the project could spread outside Austin to other hospitals.

Moving health care outside of the hospital is only one of the goals for the project, as it will also look to reduce health care costs. Another goal is to find measures to reduce stress and depression in the community. Much of the project is still in the early stages, and Rees said he’s excited to see how it will look.